Rhode Island General Laws 27-41-57. Acupuncture services
(a) Every group health insurance contract, plan, or group policy delivered, issued for delivery, or renewed in this state that provides medical coverage, and every group policy that provides for treatment of persons for the prevention, cure, or correction of any illness or physical or mental condition shall provide, as an optional rider, coverage for the services of a doctor of acupuncture as a provider of acupuncture services.
Terms Used In Rhode Island General Laws 27-41-57
- Contract: A legal written agreement that becomes binding when signed.
- 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
- provider: means a healthcare professional or a healthcare facility. See Rhode Island General Laws 27-41-2
(b) For the purposes of this section:
(1) “Coverage for the services of a doctor of acupuncture as a provider of acupuncture services” means coverage for acupuncture as defined in § 5-37.2-2(1).
(2) “Doctor of acupuncture” means a practitioner licensed under chapter 37.2 of Title 5.
(c) It remains within the sole discretion of the health maintenance organization as to which doctor of acupuncture it contracts with. Reimbursement shall be provided according to the respective principles and policies of the health maintenance organization; provided, that no health maintenance organization is required to pay for duplicative services actually rendered by a doctor of acupuncture and any other healthcare provider. Nothing contained in this section precludes the health maintenance organization from conducting managed care, medical necessity, or utilization review.
History of Section.
P.L. 1999, ch. 288, § 4.