27 R.I. Gen. Laws § 27-20-6.1 Uniform explanation of benefits and coverage: Nonprofit Medical Service Corporations – Rhode Island
Status: Enacted Year Enacted: 2012
A nonprofit medical service corporation shall provide a summary of benefits and coverage explanation and definitions to policyholders and others. The forms required by this section shall be made available to the commissioner on request.
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27 R.I. Gen. Laws § 27-20-62. Emergency services: Nonprofit Medical Service Corporations – Rhode Island
Status: Enacted Year Enacted: 2012
If a nonprofit medical service corporation offering health insurance coverage provides any benefits with respect to services in an emergency department of a hospital, it must cover emergency services consistent with the rules of this …
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27 R.I. Gen. Laws § 27-29-17.3. Notice of premium or coverage changes: Insurance – Unfair Competition and Practices – Rhode Island
Status: Enacted Year Enacted: 2003
An insurer shall provide to the first-named insured at the mailing address shown on the policy, and to the insurance producer of record, written notice of any premium increase in excess of ten percent (10%) …
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27 R.I. Gen. Laws § 27-41-10. Information to enrollees: Health Maintenance Organization Act – Rhode Island
Status: Enacted Year Enacted: 1983
Every health maintenance organization shall promptly provide to its enrollees notice of any material change in the operation of the organization that will affect them directly.
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27 R.I. Gen. Laws § 27-41-14.1. Prohibition against restraint on provider-patient communications: Health Maintenance Organization Act – Rhode Island
Status: Enacted Year Enacted: 1997
No health maintenance organization shall refuse to contract with or compensate for covered services an otherwise eligible health care provider solely because the provider has in good faith communicated with one or more of his …
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27 R.I. Gen. Laws § 27-41-16. Examination: Health Maintenance Organization Act – Rhode Island
Status: Enacted Year Enacted: 1983
The director of health may make an examination concerning the quality of health care services of any health maintenance organization and the providers with whom the organization has contracts, agreements, or other arrangements as often …
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27 R.I. Gen. Laws § 27-41-2. Definitions: Health Maintenance Organization Act – Rhode Island
Status: Enacted Year Enacted: 1983
Provides defintions for Chapter 41 Health Maintenance Organizations.
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27 R.I. Gen. Laws § 27-41-79. Emergency services: Health Maintenance Organization Act – Rhode Island
Status: Enacted Year Enacted: 2012
If a nonprofit medical service corporation offering health insurance coverage provides any benefits with respect to services in an emergency department of a hospital, it must cover emergency services consistent with the rules of this …
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27 R.I. Gen. Laws § 27-41-8. Evidence of coverage and charges for health care services: Health Maintenance Organization Act – Rhode Island
Status: Enacted Year Enacted: 1983
Every enrollee is entitled to evidence of coverage for the payment and for the provision of health care services under a health maintenance organization. No schedule of charges, rates, or rating formulae for enrollee coverage …
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27 R.I. Gen. Laws § 27-41-9. Required reports: Health Maintenance Organization Act – Rhode Island
Status: Enacted Year Enacted: 1983
Every health maintenance organization shall also file quarterly statements with the insurance commissioner, due on or before forty-five (45) days after the quarter ending in accordance with the National Association of Insurance Commissioners’ guidelines and …
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27 R.I. Gen. Laws §§ 27-36-1 & 27-36-2: Consumer Representation at Rate Hearings – Rhode Island
Status: Enacted Year Enacted: 1977
If the hearings are related to a rate increase request by a health insurer, then the hearings shall be open to the public.
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28 Pa. Code §§ 9.601, 9.602, 9.651, 9.671, 9.672: Managed Care Organizations – Pennsylvania
Status: Enacted Year Enacted: 2001
Sections relate to billing practices for emergency services for managed care organizations.
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305 Ill. Comp. Stat. § 5/5-2.01. Medicaid accountability through transparency program: Medical Assistance – Illinois
Status: Enacted Year Enacted: 2010
There is a Medicaid accountability though transparency program through which the department shall publish de-identified information about claims.
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305 Ill. Comp. Stat. § 5/5-30. Care coordination: Medical Assistance – Illinois
Status: Enacted Year Enacted: 2011
At least 50% of eligible patients shall be enrolled in the coordinated care program. Payments can be based on the coordination of care. There is a specific program for patients with chronic illnesses, and the …
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305 Ill. Comp. Stat. § 5/5-30.1. Managed care protections: Medical Assistance – Illinois
Status: Enacted Year Enacted: 2014
An MCO shall pay any provider of emergency services that does not have in effect a contract with the contracted Medicaid MCO. The default rate of reimbursement shall be the rate paid under Illinois Medicaid …
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305 Ill. Comp. Stat. § 5/5-30.2. Monthly reports; managed care enrollment: Medical Assistance – Illinois
Status: Enacted Year Enacted: 2015
The department must publish monthly enrollment reports on the website. The Department must annually publish on its website each Medicaid Managed Care Entity’s quality metrics outcomes and must make public an independent annual quality review …
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