Rhode Island General Laws 27-41-65. Mandatory coverage for certain lyme disease treatments
Subscribers to any health maintenance organization plan shall be afforded coverage under that plan on or after January 1, 2004, for diagnostic testing and long-term antibiotic treatment of chronic lyme disease when determined to be medically necessary and ordered by a physician acting in accordance with chapter 37.5 of Title 5 entitled “Lyme Disease Diagnosis and Treatment” after making a thorough evaluation of the patient’s symptoms, diagnostic test results, and response to treatment. Treatment otherwise eligible for benefits pursuant to this section shall not be denied solely because the treatment may be characterized as unproven, experimental, or investigational in nature.
History of Section.
P.L. 2003, ch. 113, § 6; P.L. 2003, ch. 114, § 6; P.L. 2004, ch. 34, § 5; P.L. 2004, ch. 35, § 5.
Terms Used In Rhode Island General Laws 27-41-65
- Health maintenance organization: means a single public or private organization that:
(i) Provides or makes available to enrolled participants healthcare services, including at least the following basic healthcare services: usual physician services, hospitalization, laboratory, x-ray, emergency, and preventive services, and out-of-area coverage, and the services of licensed midwives;
(ii) Is compensated, except for copayments, for the provision of the basic healthcare services listed in subsection (20)(i) of this section to enrolled participants on a predetermined periodic rate basis;
(iii)(A) Provides physicians' services primarily:
(I) Directly through physicians who are either employees or partners of the organization; or
(II) Through arrangements with individual physicians or one or more groups of physicians organized on a group practice or individual practice basis;
(B) "Health maintenance organization" does not include prepaid plans offered by entities regulated under chapter 1, 2, 19, or 20 of this title that do not meet the criteria above and do not purport to be health maintenance organizations; and
(iv) Provides the services of licensed midwives primarily:
(A) Directly through licensed midwives who are either employees or partners of the organization; or
(B) Through arrangements with individual licensed midwives or one or more groups of licensed midwives organized on a group practice or individual practice basis. See Rhode Island General Laws 27-41-2
- Physician: includes a podiatrist as defined in chapter 29 of Title 5. See Rhode Island General Laws 27-41-2