Proyectos de ley › 88.ª Asamblea General
Relating to health benefit plan network access and adequacy, and including applicability provisions
Dónde está ahora
- Hecho: Presentado9 de junio de 2020
- Se detuvo: SubcomitéMurió al terminar la Asamblea General
- Sigue: Comité de la Cámara
- Sigue: Lo aprueba la Cámara
- Sigue: Comité del Senado
- Sigue: Lo aprueba el Senado
- Sigue: A gobernador(a)
- Sigue: Firmado como ley
Murió al terminar la sesión La sesión de 2020 terminó el 14 de junio de 2020, la última sesión ordinaria de la Asamblea General. Los proyectos que no pasaron por ambas cámaras murieron. ¿Qué es el embudo (funnel)?
Qué contiene
La explicación oficial está en inglés; todavía no hay resumen en palabras sencillas.
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.
Lea la explicación completa
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.