Rhode Island General Laws 27-18.9-1. Purpose of chapter
(a) The purpose of this chapter is to:
(1) Promote the delivery of quality health care in a cost-effective manner;
(2) Foster greater coordination between healthcare providers, patients, healthcare entities, health benefit plans and utilization-review entities to ensure public health well-being;
(3) Protect beneficiaries, businesses, and providers by ensuring that review agents are qualified to perform review activities and to make informed decisions on the medical necessity and appropriateness of medical care;
(4) Ensure that review agents maintain the confidentiality of medical records in accordance with applicable state and federal laws; and
(5) Interface and maintain compliance with federal benefit determination and adverse benefit determination requirements.
Terms Used In Rhode Island General Laws 27-18.9-1
- Adverse benefit determination: means a decision not to authorize a healthcare service, including a denial, reduction, or termination of, or a failure to provide or make a payment, in whole or in part, for a benefit. See Rhode Island General Laws 27-18.9-2
- Benefit determination: means a decision to approve or deny a request to provide or make payment for a healthcare service or treatment. See Rhode Island General Laws 27-18.9-2
- Commissioner: means the health insurance commissioner. See Rhode Island General Laws 27-18.9-2
(b) Nothing in this chapter is intended to prohibit or discourage the health insurance commissioner from consulting or collaborating with the department of health, or any other state or federal agency, to the extent the commissioner in his or her discretion determines such consultation and/or collaboration is necessary and/or appropriate for the administration and enforcement of this chapter.
History of Section.
P.L. 2017, ch. 302, art. 5, § 5.