Title 45, Chapter 18, Section 15
( 45-18-15)
(a) The board shall promulgate such rules and regulations as may be
required for the effective administration of this article. Such
rules and regulations shall include, but not be limited to, rules
and regulations establishing the conditions under which employees
who originally rejected coverage may acquire coverage at a later
date. The commissioner of community health, as executive officer of
the board, shall employ such personnel as may be needed to carry out
this article and such employees shall be employees of the Department
of Community Health. The pro rata share of the costs of operating
the Department of Community Health in the manner prescribed by law
shall be a part of the administrative costs of the employees' health
insurance plan. (b) The board shall investigate fees of hospitals, pharmacists, and
practitioners of the healing arts and present recommendations to the
General Assembly by not later than January 15, 1991, for a schedule
of maximum fees for hospitals and practitioners of the healing arts.
The recommended fees for hospitals shall be determined based upon a
statistical analysis of the peer groups adjusted for the intensity
of the case mix for hospitals of same licensure classification or
subclassification (e.g., general, pediatric, psychiatric,
rehabilitation, etc.) and of similar services in the same geographic
area. The recommended fee schedule shall not be at the average of
the usual and customary charges if the board determines that the
average represents an unreasonably high or low charge. (c) The recommended fees for practitioners of the healing arts and
pharmacists shall be determined based upon a statistical analysis of
the peer groups for such practitioners and pharmacists of the same
licensure classification (e.g., internists, family practitioners,
cardiologists, neurosurgeons, etc.) and of similar services in the
same geographic area. The recommended fee schedule shall not be at
the average of the usual and customary charges if the board
determines that the average represents an unreasonably high or low
charge. (d) The recommendations shall include an analysis of all hospitals,
pharmacists, and practitioners accepting assignment of benefits for
such services not to exceed the amount authorized by the fee
schedule. The board shall publish a list of practitioners that
accept assignment of benefits under the plan. (e) The recommendations shall include an analysis of the impact of
practitioners agreeing to provide medical or surgical services at a
reduced rate for members of the health insurance plan and of
pharmacists and hospitals agreeing to provide hospital services,
medical equipment, or pharmaceuticals at a reduced rate for members
of the health insurance plan. The board shall publish a list of
practitioners of the healing arts, pharmacists, and hospitals that
offer a reduced rate for members and the rate at which those
services, equipment, or pharmaceuticals have been offered. |