H 7618 SUBSTITUTE A ======== LC004755/SUB A ======== S T A T E O F R H O D E I S L A N D

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1 0 -- H SUBSTITUTE A LC00/SUB A S T A T E O F R H O D E I S L A N D IN GENERAL ASSEMBLY JANUARY SESSION, A.D. 0 A N A C T RELATING TO INSURANCE - HEALTH INSURANCE Introduced By: Representatives Bennett, Solomon, Naughton, Azzinaro, and McNamara Date Introduced: February 1, 0 Referred To: House Corporations It is enacted by the General Assembly as follows: SECTION 1. Section -- of the General Laws in Chapter - entitled "Accident and Sickness Insurance Policies" is hereby amended to read as follows: --. Acupuncture services. -- Acupuncture and Oriental medicine services. -- (a) Every group health insurance contract, plan, or group policy delivered, issued for delivery or renewed in this state which provides medical coverage, and every group policy which 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, within the scope of practice, of a doctor of acupuncture and Oriental medicine licensed under chapter. of title as a provider of acupuncture services; provided, that this section shall not apply to insurance coverage providing benefits for: (1) hospital confinement indemnity; () disability income; () accident only; () long term care; () Medicare supplement; () limited benefit health; () specified disease indemnity; () sickness or bodily injury or death by accident or both; and () other limited benefit policies. (1) "Doctor of acupuncture" means a practitioner licensed under chapter. of title. () "Coverage for the services of a doctor of acupuncture as a provider of acupuncture services" means coverage for acupuncture as defined in -.-(1). (c)(b) It shall remain within the sole discretion of the accident and sickness insurer as to which doctor of acupuncture and Oriental medicine it shall contract with. Reimbursement shall be

2 provided according to the respective principles and policies of the accident and sickness insurer; provided, that no accident and sickness insurer may be required to pay for duplicative services actually rendered by a doctor of acupuncture and Oriental medicine and any other health care provider. Nothing contained in this section shall preclude the accident and sickness insurer from conducting managed care, medical necessity or utilization review. SECTION. Section -1- of the General Laws in Chapter -1 entitled "Nonprofit Hospital Service Corporations" is hereby amended to read as follows: -1-. Acupuncture services. -- Acupuncture and Oriental medicine services. -- (a) Every group health insurance contract, plan, or group policy delivered, issued for delivery or renewed in this state which provides medical coverage, and every group policy which 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, within the scope of practice, of a doctor of acupuncture and Oriental medicine licensed under chapter. of title as a provider of acupuncture services. (1) "Doctor of acupuncture" means a practitioner licensed under chapter. of title. () "Coverage for the services of a doctor of acupuncture as a provider of acupuncture services" means coverage for acupuncture as defined in -.-(1). (c)(b) It remains within the sole discretion of the non-profit hospital service corporation as to which doctor of acupuncture and Oriental medicine it shall contract with. Reimbursement is provided according to the respective principles and policies of the non-profit hospital service corporation; provided, that no non-profit hospital service corporation is required to pay for duplicative services actually rendered by a doctor of acupuncture and Oriental medicine and any other health care provider. Nothing contained in this section precludes the non-profit hospital service corporations from conducting managed care, medical necessity or utilization review. LC00/SUB A - Page of

3 SECTION. Section -0- of the General Laws in Chapter -0 entitled "Nonprofit Medical Service Corporations" is hereby amended to read as follows: -0-. Acupuncture services. -- Acupuncture and Oriental medicine services. -- (a) Every individual or group health insurance contract, plan, or group policy delivered, issued for delivery or renewed in this state which provides medical coverage, and every group policy which 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, within the scope of practice, of a doctor of acupuncture and Oriental medicine licensed under chapter. of title as a provider of acupuncture services. (1) "Doctor of acupuncture" means a practitioner licensed under chapter. of title. () "Coverage for the services of a doctor of acupuncture as a provider of acupuncture services" means coverage for acupuncture as defined in -.-(1). (c)(b) It remains within the sole discretion of the non-profit medical service corporation as to which doctor of acupuncture and Oriental medicine it contracts with. Reimbursement is provided according to the respective principles and policies of the non-profit medical service corporation; provided, that no non-profit medical service corporation may be required to pay for duplicative services actually rendered by a doctor of acupuncture and Oriental medicine and any other health care provider. Nothing contained in this section precludes non-profit medical service corporations from conducting managed care, medical necessity or utilization review. LC00/SUB A - Page of

4 SECTION. Section -1- of the General Laws in Chapter -1 entitled "Health Maintenance Organizations" is hereby amended to read as follows: -1-. Acupuncture services. -- Acupuncture sand Oriental medicine services. -- (a) Every individual or group health insurance contract, plan, or group policy delivered, issued for delivery or renewed in this state which provides medical coverage, and every group policy which 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, within the scope of practice, of a doctor of acupuncture and Oriental medicine licensed under chapter. of title as a provider of acupuncture services. (1) "Doctor of acupuncture" means a practitioner licensed under chapter. of title. () "Coverage for the services of a doctor of acupuncture as a provider of acupuncture services" means coverage for acupuncture as defined in section -.-(1). (c)(b) It remains within the sole discretion of the health maintenance organization as to which doctor of acupuncture and Oriental medicine it contracts with. Reimbursement is 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 Oriental medicine and any other health care provider. Nothing contained in this section precludes the health maintenance organization from conducting managed care, medical necessity or utilization review. SECTION. This act shall take effect on January 1, 0. LC00/SUB A LC00/SUB A - Page of

5 EXPLANATION BY THE LEGISLATIVE COUNCIL OF A N A C T RELATING TO INSURANCE - HEALTH INSURANCE *** 1 This act would prohibit health insurance insurers from discriminating against any health care provider, who is acting within the scope of their license or certification, concerning participation and coverage in their plan. This act would take effect on January 1, 0. LC00/SUB A LC00/SUB A - Page of