PETITION OF:

Chapter 176 of the general laws, as appearing in the 2002 official edition, is hereby amended by inserting the following new chapter:— 176Q Consumer Choice of Nurse Practitioner Services.

Section 1. As used in this chapter, the following words shall have the following meanings:

"Carrier", an insurer licensed or otherwise authorized to transact accident or health insurance under chapter 175; a nonprofit hospital service corporation organized under chapter 176A; a nonprofit medical service corporation organized under chapter 176B; a health maintenance organization organized under chapter 176G; an organization entering into a preferred provider arrangement under chapter 176I; a contributory group general or blanket insurance for persons in the service of the Commonwealth under chapter 32A; a contributory group general or blanket insurance for persons in the service of counties, cities, towns and districts, and their dependents under chapter 32B; the medical assistance program administered by the division of medical assistance pursuant to chapter one hundred and eighteen E and in accordance with Title XIX of the Federal Social Security Act or any successor statute; and any other medical assistance program operated via a governmental unit for persons categorically eligible for such program.

"Commissioner", the commissioner of insurance.

"Insured", an enrollee, covered person, insured, member, policyholder or subscriber of a carrier.

"Non-discriminatory basis", a carrier shall be deemed to be providing coverage on a non-discriminatory basis if said plan does not contain any annual or lifetime dollar or unit of service limitation imposed on coverage for the care provided by a nurse practitioner which is less than any annual or lifetime dollar or unit of service limitation imposed on coverage for diagnosis and treatment by other participating providers.

"Nurse Practitioner", a registered nurse who holds authorization in advanced nursing practice as a nurse practitioner under the provisions of chapter 112, Section 80B.

"Participating Provider", a provider who under a contract with the carrier or with its contractor or subcontractor, has agreed to provide health care services to insureds with an expectation of receiving payment, other than coinsurance, co-payments or deductibles, directly or indirectly from the carrier.

"Primary Care Provider", a nurse practitioner or other health care professional qualified to provide general medical care for common health care problems. The provider supervises, coordinates, prescribes, or otherwise provides or proposes health care services, initiates referrals for specialist care, and maintains continuity of care, within their scope of practice. Providers will often follow patients over long periods of time.

Section 2. The commissioner and the group insurance commission shall require that all carriers, on a nondiscriminatory basis, shall include coverage to their insured for care provided by nurse practitioners as participating providers for the purposes of health maintenance, diagnosis and treatment. Such coverage shall include, but not be limited to, benefits for primary care, intermediate care and inpatient care, including care provided in a hospital, clinic, professional office, home care setting, long term care setting, mental health or substance abuse programs, or other settings when rendered by a nurse practitioner practicing within the scope of her professional license.

Section 3. A nurse practitioner practicing within the scope of her licensure under the provisions of chapter 112 section 80B shall be considered fully qualified as a primary care provider to an insured.

Section 4. Notwithstanding any special or general law to the contrary, all carriers shall provide their insured with an opportunity to select a nurse practitioner as a primary care provider or to change their primary care provider to a nurse practitioner at any time during their coverage period.

Section 5. Notwithstanding any special or general law to the contrary, all carriers shall ensure that all nurse practitioners in the carrier's health plans are included on any publicly accessible list of participating providers for the carrier.

Section 6. Complaints of noncompliance against carriers shall be filed with and investigated by the commissioner or the group insurance commission whichever shall have regulatory authority over the carrier. The commissioner and the group insurance commission shall promulgate regulations to enforce sections 2, 3, 4 and 5 above.