§ 27-20-5. Contracts with subscribers.
Each nonprofit medical service corporation may contract with its subscribers for any
medical service as may be provided under any nonprofit medical service plan adopted
by the corporation; provided, that:
(1) If any medical service as may be provided for shall include service that may be lawfully
performed or rendered by a podiatrist, the contract shall provide for the payment
for the service so performed or rendered by a podiatrist;
(2) If any medical service as may be provided for shall include service that may be lawfully
performed or rendered by a certified registered nurse practitioner or psychiatric
and mental health nurse clinical specialist, the contract will provide for the payment
for the service performed or rendered by a certified registered nurse practitioner
or psychiatric and mental health nurse clinical specialist to subscribers. No nonprofit
medical service corporation may require supervision, signature, or referral by any
other healthcare provider as a condition of reimbursement to a certified registered
nurse practitioner; provided, that no nonprofit medical service corporation may be
required to pay for duplicative services actually rendered by both a certified registered
nurse practitioner and any other healthcare provider;
(3) If any medical service as may be provided for shall include service that may be lawfully
performed or rendered by a licensed midwife, the contract delivered, issued for delivery,
or renewed in this state shall provide for the payment for the service performed or
rendered by a licensed midwife in accordance with each health insurer's respective
principles and mechanisms of reimbursement, credentialing, and contracting if those
services are within the licensed midwife's area of professional competence as defined
by regulations promulgated pursuant to § 23-13-9, and are currently reimbursed when rendered by any other licensed healthcare provider.
No nonprofit medical service corporation may require supervision, signature, or referral
by any other healthcare provider as a condition of reimbursement except when the requirements
are also applicable to other categories of healthcare providers; provided, no insurer
or hospital or medical service corporation or patient may be required to pay for duplicate
services actually rendered by both a licensed midwife and any other healthcare provider.
Direct payment for licensed midwives will be contingent upon services rendered in
a licensed healthcare facility and for services rendered in accordance with rules
and regulations promulgated by the department of health; provided, that this provision
shall not prohibit payment for services pursuant to § 42-62-26 or for other services reimbursed by third-party payors;
(4) If any medical service that may be provided for shall include service that may be
rendered by a counselor in mental health or a therapist in marriage and family practice,
excluding marital and family therapy unless there is an individual diagnosed with
a mental disorder, the contract shall provide for payment for the service performed
or rendered when deemed medically necessary by the nonprofit medical service corporation
in accordance with its standard medical management protocols and within the nonprofit
medical service corporation's subscriber contractual limits. In the case of a limited
provider network, it shall remain within the sole discretion of the nonprofit medical
service corporation as to which certified counselors in mental health and certified
therapists in marriage and family practice with which it shall contract. Nothing contained
in this subdivision shall require the nonprofit medical service corporation to provide
coverage other than in conjunction with a related medical illness; and
(5) No contract between a nonprofit medical service corporation and a dentist for the
provisions of services to patients may require that the dentist indemnify or hold
harmless the nonprofit medical service corporation for any expenses and liabilities,
including without limitation, judgments, settlements, attorneys' fees, court costs,
and any associated charges, incurred in connection with any claim or action brought
against the nonprofit medical service corporation based on the nonprofit medical service
corporation's management decisions, or utilization review provisions for any patient.