§ 26.1-47-10 — Preferred provider arrangements - Requirements for accessing air ambulance providers

North Dakota § 26.1-47-10

• Jurisdiction: North Dakota
• Title 26.1: Insurance
• Ch. 26.1-47: Preferred Provider Organizations

Text

ambulance providers.
1. In addition to the other preferred provider arrangement requirements under this
chapter, a preferred provider arrangement must require the health care insurer and
health care provider comply with this section.
2. Except as otherwise provided under this section, before a health care provider
arranges for air ambulance services for an individual the health care provider knows to
be a covered person, the health care provider shall request a prior authorization from
the covered person's health care insurer for the air ambulance services to be provided
to the covered person. If the health care provider is unable to request or obtain prior
authorization from the covered person's health care insurer:
a. The health care provider shall provide the covered person or the covered
person's authorized representative an out-of-network services written disclosure
stating the following:
(1) Certain air ambulance providers may be called upon to render care to the
covered person during the course of treatment;
(2) These air ambulance providers might not have contracts with the covered
person's health care insurer and are, therefore, considered to be out of
network;
(3) If these air ambulance providers do not have contracts with the covered
person's health care insurer, the air ambulance services will be provided on
an out-of-network basis;
(4) A description of the range of the charges for the out-of-network air
ambulance services for which the covered person may be responsible;
(5) A notification the covered person or the covered person's authorized
representative may agree to accept and pay the charges for the
out-of-network air ambulance services, contact the covered person's health
care insurer for additional assistance, or rely on other rights and remedies
that may be available under state or federal law; and
(6) A statement indicating the covered person or the covered person's
authorized representative may obtain a list of air ambulance providers from
the covered person's health care insurer which are preferred providers and
the covered person or the covered person's representative may request
those participating air ambulance providers be accessed by the health care
provider.

b. Before air ambulance services are accessed for the covered person, the health
care provider shall provide the covered person or the covered person's
authorized representative the written disclosure, as outlined by subdivision a and
obtain the covered person's or the covered person's authorized representative's
signature on the disclosure document acknowledging the covered person or the
covered person's authorized representative received the disclosure document
before the air ambulance services were accessed. If the health care provider is
unable to provide the written disclosure or obtain the signature required under
this subdivision, the health care provider shall document the reason, which may
include the health and safety of the patient. The health care provider
documentation satisfies the requirement under this subdivision.
3. The rights and remedies provided under this section to covered persons are in addition
to and may not preempt any other rights and remedies available to covered persons
under state or federal law.
4. The department shall enforce this section and shall report a violation of this section by
a facility to the department of health and human services.
5. This section does not apply to a policy or certificate of insurance, whether written on a
group or individual basis, which provides coverage limited to:
a. A specified disease, a specified accident, or accident-only coverage;
b. Credit;
c. Dental;
d. Disability;
e. Hospital;
f. Long-term care insurance as defined by chapter 26.1-45;
g. Vision care or any other limited supplemental benefit;
h. A Medicare supplement policy of insurance, as defined by the commissioner by
rule or coverage under a plan through Medicare;
i. Medicaid;
j. The federal employees health benefits program and any coverage issued as a
supplement to that coverage;
k. Coverage issued as supplemental to liability insurance, workers' compensation,
or similar insurance; or
l. Automobile medical payment insurance.
6. A health care provider is exempt from complying with this section if the health care
provider determines and documents that due to emergency circumstances,
compliance might jeopardize the health or safety of the patient.
7. The commissioner may adopt rules to implement this section.