Bills › 88th General Assembly
Relating to health benefit plan network access and adequacy, and including applicability provisions
Topics:Business & economy
Where it is now
- Done: IntroducedJune 9, 2020
- Stopped: SubcommitteeDied when the General Assembly ended
- Next: House committee
- Next: Passes the House
- Next: Senate committee
- Next: Passes the Senate
- Next: To the Governor
- Next: Signed into law
Died when the session ended The 2020 session adjourned on June 14, 2020, the General Assembly’s last regular session. Bills that didn’t pass both chambers died. What’s a funnel?
What’s in it
This bill relates to health benefit plan network access and adequacy, and substantially conforms to the national association of insurance commissioners’ health benefit plan network access and adequacy model act. The bill establishes standards for health carriers’ networks, and for the adequacy, accessibility, transparency, and quality of health care services offered under a network plan. “Health carrier” is defined in the bill as an entity subject to the insurance laws and regulations of this state, or subject to the jurisdiction of the commissioner, that contracts or offers to contract, or enters into an agreement to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services, including a health insurance company, a health maintenance organization, a hospital and health service corporation, or any other entity providing a plan of health insurance, health benefits, or health care services.
Read the full explanation
The bill establishes requirements for written agreements between health carriers offering network plans, intermediaries, and participating providers, and requires a health carrier to obtain the insurance commissioner’s approval for the health carrier’s access plan. “Intermediary” is defined in the bill as a person authorized to negotiate and execute a provider contract with a health carrier on behalf of a health care provider or on behalf of a network. The bill defines a “participating provider” as a provider that, under a contract with a health carrier, or with a health carrier’s contractor or subcontractor, has agreed to provide health care services to covered persons with an expectation of receiving payment directly or indirectly from the health carrier, in addition to a covered person’s cost-sharing. A health carrier’s access plan must ensure the ongoing sufficiency of the provider network consistent with the requirements detailed in the bill. The bill prohibits balance billing except in certain circumstances as detailed in the bill. “Balance billing” is defined in the bill as the practice of a provider billing for the difference between the provider’s charge for provision of a health care service and a health carrier’s allowed amount for the health care service. The bill applies to all health carriers’ health benefit plans delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2021.