§ 27-41-49 - Third party reimbursement for services of certain health care workers. - Rhode Island Statutes

SECTION 27-41-49

   § 27-41-49  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, health maintenance organization,nonprofit or for profit health service corporation which provides benefits toindividual subscribers and members within the state, or to all group membershaving a principal place of employment within the state, shall provide benefitsfor services rendered by a certified registered nurse anesthetist designated asa certified registered nurse anesthetist by the board of nurse registration andnursing 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 healthmaintenance organization has an alternative contractual relationship to fundthe services of a certified registered nurse anesthetist.

   (b) It shall remain within the sole discretion of the healthmaintenance organization as to which certified registered nurse anesthetists itshall contract with. Reimbursement shall be provided according to therespective principles and policies of the health maintenance organization;provided, that no health maintenance organization may be required to pay forduplicative services actually rendered by a certified registered nurseanesthetist and any other health care provider. Nothing contained in thissection shall preclude the health maintenance organization from conductingmanaged care, medical necessity or utilization review.