§ 27-20-35 - Third party reimbursement for services of certain health care workers. - Rhode Island Statutes

SECTION 27-20-35

   § 27-20-35  Third party reimbursement forservices of certain health care workers. – (a) Every individual or group health insurance contract, plan or policydelivered, issued or renewed by an insurer or nonprofit or for profit healthservice corporation which provides benefits to individual subscribers andmembers within the state, or to all group members having a principal place ofemployment within the state, shall provide benefits for services rendered by acertified registered nurse anesthetist designated as a certified registerednurse anesthetist by the board of nurse registration and nursing education;provided, that the following conditions are met:

   (1) The certified registered nurse anesthetist providescertain health care services under the supervision of anesthesiologists,licensed physicians or licensed dentists in accordance with § 5-34.2-2(c),which requires substantial specialized knowledge, judgment and skill related tothe administration of anesthesia, including pre-operative and post-operativeassessment of patients; administering anesthetics; monitoring patients duringanesthesia; management of fluids in intravenous therapy and management ofrespiratory care;

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

   (3) The certified registered nurse anesthetist is not asalaried employee of the licensed hospital or facility for which the nonprofitmedical service corporation has an alternative contractual relationship to fundthe services of a certified registered nurse anesthetist.

   (b) It shall remain within the sole discretion of thenonprofit medical service corporation as to which certified registered nurseanesthetists it shall contract with. Reimbursement shall be provided accordingto the respective principles and policies of the nonprofit medical servicecorporation; provided, that no nonprofit medical service corporation may berequired to pay for duplicative services actually rendered by a certifiedregistered nurse anesthetist and any other health care provider. Nothingcontained in this section shall preclude the nonprofit medical servicecorporation from conducting managed care, medical necessity or utilizationreview.