§ 27-18-48 - Third party reimbursement for services of certain health care workers.
SECTION 27-18-48
§ 27-18-48 Third party reimbursement forservices of certain health care workers. – (a) Every individual or group hospital or medical services plan contractdelivered, issued or renewed by an insurer or nonprofit or for profit healthservice corporation which provides benefits to individual subscribers andmembers within the state, or to all group members having a principal place ofemployment within the state, shall provide benefits for services rendered by acertified registered nurse anesthetist designated as a certified registerednurse anesthetist by the board of nurse registration and nursing 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 accidentand sickness insurer has an alternative contractual relationship to fund theservices 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.