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Engrossed Senate Bill (S)

DIGEST

Health insurance transparency. Specifies that the compliance of a practitioner and a provider facility with federal law meets the good faith estimate requirements concerning health service costs. Allows the commissioner of the department of insurance to issue an order to discontinue a violation of a law (current law specifies orders or rules). Requires a domestic stock insurer to file specified information with the department of insurance. Prohibits a health plan from requiring a health care provider to submit a prior authorization request to a third party and requires the health plan to transmit the request to the third party through Health insurance transparency. Specifies that the compliance of a practitioner and a provider facility with federal law meets the good faith estimate requirements concerning health service costs. Allows the commissioner of the department of insurance to issue an order to discontinue a violation of a law (current law specifies orders or rules). Requires a domestic stock insurer to file specified information with the department of insurance. Prohibits a health plan from requiring a health care provider to submit a prior authorization request to a third party and requires the health plan to transmit the request to the third party through secure electronic transmission. Amends the deadline by which a health plan must respond to a nonurgent care prior authorization request. Requires a health plan to offer a health care provider that submitted a prior authorization and received an adverse determination the option to request a peer to peer review by a clinical peer concerning the adverse determination. Requires a health plan to post notice of a technical issue with its claims submission system on the health plan's Internet web site. Requires a health plan to post on its Internet web site not later than February 1 of each year: (1) the 30 most frequently submitted CPT codes in the previous calendar year; and (2) the percentage of the 30 most frequently submitted CPT codes that were approved in the previous calendar year. Establishes an approval process for a health plan's proposed premium rate increase of 5% or greater as compared to the previous calendar year. Prohibits an insurer and a health maintenance organization from altering a CPT code for a claim unless the medical record of the claim has been reviewed by an employee who is a licensed physician. Requires an insurer and a health maintenance organization to provide a contracted provider with a current reimbursement rate schedule: (1) every two years; and (2) when three or more CPT code rates change in a 12 month period. Urges the study by an interim committee of prior authorization exemptions for certain health care providers. ... View more