§ 27-18-48.1 - Third party reimbursement for services of registered nurse first assistants. - Rhode Island Statutes

SECTION 27-18-48.1

   § 27-18-48.1  Third party reimbursement forservices of registered nurse first assistants. – (a) Every individual or group hospital or medical services plan contractdelivered, issued or renewed by an insurer or nonprofit health servicecorporation which provides benefits to individual subscribers and memberswithin the state, or to all group members having a principal place ofemployment within the state, shall provide benefits for services rendered by aregistered nurse first assistant designated as a registered nurse firstassistant provided, however, that the following conditions are met:

   (1) The registered nurse first assistant provides certainhealth care services under the supervision of a licensed physician; iscurrently licensed as a registered nurse in Rhode Island; has successfullycompleted a course in preparing the registered nurse as a first assistant inaccordance with the Association of Operating Room Nurses core curriculum guidefor the registered nurse first assistant and includes a minimum of one academicyear in a college or university with didactic instruction and clinicalinternship programs; and is certified in perioperative nursing by theCertification Board Perioperative Nursing (minimum of two years perioperativeexperience);

   (2) The policy or contract currently provides benefits foridentical services rendered by a provider of health care licensed by the state;and

   (3) The registered nurse first assistant is not a salariedemployee of the licensed hospital or facility for which the accident andsickness insurer has an alternative contractual relationship to fund theservices of a registered nurse first assistant.

   (b) It shall remain within the sole discretion of theaccident and sicknesses insurer as to which registered nurse first assistant itshall contract with. Reimbursement shall be provided according to therespective principles and policies of the health maintenance organization;provided, however, that no accident and sicknesses insurer may be required toprovide direct reimbursement, or pay for duplicative services actually renderedby a registered nurse first assistant and any other health care provider.Nothing contained in this section shall preclude the health maintenanceorganization from conducting managed care, medical necessity or utilizationreview.

   (c) This section shall not apply to insurance coverageproviding benefits for: (1) hospital confinement indemnity; (2) disabilityincome; (3) accident only; (4) long term care; (5) Medicare supplement; (6)limited benefit health; (7) specified disease indemnity; (8) sickness or bodilyinjury or death by accident or both; and (9) other limited benefit policies.