§ 27-41-5 - Powers of health maintenance organizations. - Rhode Island Statutes

SECTION 27-41-5

   § 27-41-5  Powers of health maintenanceorganizations. – (a) The powers of a health maintenance organization include, but are notlimited to, the following:

   (1) The purchase, lease, construction, renovation, operation,or maintenance of hospitals, medical facilities, or both, and their ancillaryequipment, and any property that may reasonably be required for its principaloffice or for any other purposes that may be necessary in the transaction ofthe business of the health maintenance organization as defined in §27-41-2(h);

   (2) The making of loans to a medical group under contractwith it in furtherance of its program or the making of loans to a corporationor corporations under its control for the purpose of acquiring or constructingmedical facilities and hospitals or in furtherance of a program providinghealth care services to enrollees;

   (3) The furnishing of health care services through providersthat are under contract with or employed by the health maintenance organization;

   (4) The contracting with any person for the performance onits behalf of certain functions such as marketing, enrollment, andadministration;

   (5) The contracting with an insurance company or a hospitalor medical service corporation licensed in this state for the provision ofinsurance, indemnity, or reimbursement against the cost of health care servicesprovided by the health maintenance organization;

   (6) The offering, in addition to basic health care services,of:

   (i) Additional health care services;

   (ii) Indemnity benefits covering out of area or emergencyservices; and

   (iii) Indemnity benefits, in addition to those relating toout of area and emergency services, provided through insurance companies orhospital or medical service corporations.

   (b) A health maintenance organization shall file notice, withadequate supporting information, with the director of business regulation priorto the exercise of any power granted in subdivision (a)(1), (a)(2), or (a)(4)of this section. The director of business regulation shall disapprove anyexercise of power only if in the director's opinion it would substantially andadversely affect the financial soundness of the health maintenance organizationand endanger its ability to meet is obligations. The director of businessregulation shall approve or disapprove any exercise of power within areasonable time, subject to certification of approval from the director ofhealth and to the requirements of chapter 15 of title 23, the Health CareCertificate of Need Act of Rhode Island.

   (c) Investment in real estate may be made only for thepurposes set forth in subdivision (a)(1) of this section, except that thehealth maintenance organization shall not be required to fully comply with theuses described in subdivision (a)(1) of this section until December 31 of theyear following the year of purchase. Upon submission to the director ofevidence demonstrating that the health maintenance organization is makingsatisfactory progress toward compliance with this subsection, the director maygrant an extension of no more than one year beyond the time provided.

   (d) The director of business regulation may promulgate rulesand regulations exempting from the filing requirement of subsection (b) of thissection those activities having a de minimis effect.