§ 27-20-5 - Contracts with subscribers. - Rhode Island Statutes

SECTION 27-20-5

   § 27-20-5  Contracts with subscribers.– Each nonprofit medical service corporation may contract with its subscribersfor any medical service as may be provided under any nonprofit medical serviceplan adopted by the corporation; provided, that:

   (1) If any medical service as may be provided for shallinclude service which may be lawfully performed or rendered by a podiatrist,the contract shall provide for the payment for the service so performed orrendered by a podiatrist;

   (2) If any medical service as may be provided for shallinclude service which may be lawfully performed or rendered by a certifiedregistered nurse practitioner or psychiatric and mental health nurse clinicalspecialist, the contract will provide for the payment for the service performedor rendered by a certified registered nurse practitioner or psychiatric andmental health nurse clinical specialist to subscribers. No nonprofit medicalservice corporation may require supervision, signature, or referral by anyother health care provider as a condition of reimbursement to a certifiedregistered nurse practitioner; provided, that no nonprofit medical servicecorporation may be required to pay for duplicative services actually renderedby both a certified registered nurse practitioner and any other health careprovider;

   (3) If any medical service as may be provided for shallinclude service which may be lawfully performed or rendered by a licensedmidwife, the contract delivered, issued for delivery, or renewed in this stateshall provide for the payment for the service performed or rendered by alicensed midwife in accordance with each health insurers' respective principlesand mechanisms of reimbursement credentialing and contracting if those servicesare within the licensed midwives' area of professional competence as defined byregulations promulgated pursuant to § 23-13-9, and are currentlyreimbursed when rendered by any other licensed health care provider. Nononprofit medical service corporation may require supervision, signature, orreferral by any other health care provider as a condition of reimbursementexcept when the requirements are also applicable to other categories of healthcare providers; provided, no insurer or hospital or medical service corporationor patient may be required to pay for duplicate services actually rendered byboth a licensed midwife and any other health care provider. Direct payment forlicensed midwives will be contingent upon services rendered in a licensedhealth care facility and for services rendered in accordance with rules andregulations promulgated by the department of health; provided, that thisprovision shall not prohibit payment for services pursuant to § 42-62-26or for other services reimbursed by third party payors; and

   (4) If any medical service which may be provided for shallinclude service which may be rendered by a counselor in mental health or atherapist in marriage and family practice, excluding marital and family therapyunless there is an individual diagnosed with a mental disorder, the contractshall provide for payment for the service performed or rendered when deemedmedically necessary by the nonprofit medical service corporation in accordancewith its standard medical management protocols and within the nonprofit medicalservice corporation's subscriber contractual limits. In the case of a limitedprovider network, it shall remain within the sole discretion of the nonprofitmedical service corporation as to which certified counselors in mental healthand certified therapists in marriage and family practice with which it shallcontract. Nothing contained in this subdivision shall require the nonprofitmedical service corporation to provide coverage other than in conjunction witha related medical illness.

   (5) No contract between a nonprofit medical servicecorporation and a dentist for the provisions of services to patients mayrequire that the dentist indemnify or hold harmless the nonprofit medicalservice corporation for any expenses and liabilities, including withoutlimitation, judgments, settlements, attorneys' fees, court costs, and anyassociated charges, incurred in connection with any claim or action broughtagainst the nonprofit medical service corporation based on the nonprofitmedical service corporation's management decisions, or utilization reviewprovisions for any patient.