§ 27-41-49.1 - Third party reimbursement for services of registered nurse first assistants. - Rhode Island Statutes

SECTION 27-41-49.1

   § 27-41-49.1  Third party reimbursement forservices of registered nurse first assistants. – (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 registered nurse first assistant designed as such;provided, 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 of Perioperative Nursing (minimum of two yearsperioperative experience);

   (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 health maintenanceorganization has an alternative contractual relationship to fund the servicesof a registered nurse first assistant.

   (b) It remains within the sole discretion of the healthmaintenance organization as to which registered nurse first assistant itcontracts with. Reimbursement provided according to the respective principlesand policies of the health maintenance organization; provided, that no healthmaintenance organization is required to provide direct reimbursement, or payfor duplicative services actually rendered by a registered nurse firstassistant and any other health care provider. Nothing contained in this sectionprecludes the health maintenance organization from conducting managed care,medical necessity or utilization review.