Rhode Island § 27-41-39 - Health Maintenance Organizations

§ 27-41-39. Certified registered nurse practitioners and psychiatric and mental health nurse clinical specialists.

(a) Every individual or group policy or contract delivered, issued for delivery, or renewed by a health maintenance organization in this state shall provide coverage for the services of certified registered nurse practitioners, practicing collaboratively, and psychiatric and mental health nurse clinical specialists to subscribers, if those services are within the certified registered nurse practitioner’s or psychiatric and mental health nurse clinical specialist’s area of professional competence as established by education and certification, and are currently reimbursed when rendered by any other healthcare provider. No health maintenance organization may be required to pay for duplicative services actually rendered by a certified nurse practitioner and any other healthcare provider.

(b) Nothing in this chapter shall preclude the conducting of managed care reviews and medical necessity reviews by an insurer or hospital or medical service corporation or health maintenance organization.

(c) Every individual or group policy or contract delivered, issued for delivery, or renewed by a health maintenance organization in this state shall provide coverage for certified registered nurse practitioners to provide primary care, intermediate, home, long-term, and inpatient care as primary care providers, when the certified registered nurse practitioner is a participating provider, consistent with, and practicing within, the scope of his or her professional license.

(d) Notwithstanding any law to the contrary, all insurers, nonprofit medical service corporations, nonprofit hospital service corporations, and health maintenance organizations shall provide subscribers with an opportunity to select a certified registered nurse practitioner, who is a participating provider, as a primary care provider.

(e) Notwithstanding any law to the contrary, all insurers, nonprofit medical service corporations, nonprofit hospital service corporations, and health maintenance organizations shall insure that all participating primary care provider certified registered nurse practitioners are included on any publicly accessible list of participating providers for the respective organization.