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ACROSS SESSIONS
- Subject Index: Since 1995
- Bills & Resolutions: Since 1994
- Summaries: Since 1994
Developed and maintained by the Division of Legislative Automated Systems.
1995 SESSION
HB 1973 Accident and sickness insurance; utilization review.
Introduced by: John Watkins | all patrons ... notes | add to my profiles
SUMMARY:
Accident and sickness insurance; utilization review. Establishes standards for utilization review and for appeals from adverse utilization review decisions. The bill requires each entity performing utilization review to develop standards and criteria that are objective, clinically valid and compatible with established principles of health care. Additionally, such entities are required to develop utilization review plans conforming to certain criteria. Utilization review entities are required to be accessible to both patients and providers at least 40 hours per week during normal business hours. Treating providers are to be notified of any adverse utilization review decision within two working days of the decision. Additionally, the bill requires utilization review entities to make good faith efforts to obtain information from providers before rendering adverse decisions.
The bill also establishes methods for (i) reconsideration of any adverse decision and (ii) appeals from such decisions. Decisions on appeals are to be rendered by a peer of the treating health care provider who (i) did not participate in the adverse decision or any prior reconsideration thereof, (ii) is not employed by or a director of the utilization review entity and (iii) is licensed to practice in Virginia or under a comparable licensing law of another state as a peer of the treating health care provider. The bill prohibits penalizing any health care provider who invokes the appeals process or advocates on behalf of his patients to the utilization review entity. Utilization review records must be maintained by the review entity for five years. The Department of Medical Assistance Services' internal utilization review procedures are exempted from most of the bill's requirements.
FULL TEXT
- 01/20/95 House: Presented & ordered printed LD2083484 pdf
- 02/02/95 House: Committee substitute printed LD1584484-H1 pdf
- 02/24/95 House: Bill text as passed House and Senate (HB1973ER) pdf
- 04/10/95 House: Reenrolled bill text (HB1973ER) pdf
- 04/17/95 Governor: Acts of Assembly Chapter text (CHAP0745) pdf
AMENDMENTS
HISTORY
- 01/20/95 House: Presented & ordered printed LD2083484
- 01/20/95 House: Referred to Committee on Corporations, Insurance and Banking
- 02/02/95 House: Reported from C. I. B. w/sub. (21-Y 0-N)
- 02/02/95 House: Committee substitute printed LD1584484-H1
- 02/03/95 House: Read first time
- 02/04/95 House: Read second time
- 02/04/95 House: Committee substitute agreed to LD1584484-H1
- 02/04/95 House: Engrossed by House - com. sub. LD1584484-H1
- 02/05/95 House: Read third time and passed House (98-Y 1-N)
- 02/05/95 House: VOTE: PASSAGE (98-Y 1-N)
- 02/05/95 House: Communicated to Senate
- 02/06/95 Senate: Read first time
- 02/06/95 Senate: Referred to Committee on Commerce and Labor
- 02/13/95 Senate: Reported from C. & L. with amendments (14-Y 0-N)
- 02/14/95 Senate: Constitutional reading dispensed (39-Y 0-N)
- 02/14/95 Senate: VOTE: CONST. READING DISPENSED (39-Y 0-N)
- 02/15/95 Senate: Passed by for the day
- 02/16/95 Senate: Read third time
- 02/16/95 Senate: Reading of amendments waived
- 02/16/95 Senate: Committee amendments agreed to
- 02/16/95 Senate: Reading of amendment waived
- 02/16/95 Senate: Floor amendment rejected (Holland, E.M.)
- 02/16/95 Senate: Engrossed by Senate as amended
- 02/16/95 Senate: Passed Senate with amendments (40-Y 0-N)
- 02/16/95 Senate: VOTE: PASSAGE (40-Y 0-N)
- 02/17/95 House: Placed on Calendar
- 02/20/95 House: Senate amendments agreed to by House (97-Y 1-N)
- 02/20/95 House: VOTE: ADOPTION (97-Y 1-N)
- 02/24/95 House: Bill text as passed House and Senate (HB1973ER)
- 02/28/95 House: Enrolled
- 03/01/95 Senate: Signed by President
- 03/02/95 House: Signed by Speaker
- 03/27/95 House: Governor's recommendation received by House
- 04/06/95 House: House concurred in Gov's recommendation (97-Y 0-N)
- 04/06/95 House: VOTE: ADOPTION (97-Y 0-N)
- 04/06/95 Senate: Senate concurred in Gov's recommendation (40-Y 0-N)
- 04/06/95 Senate: VOTE: ADOPT GOV. RECOMMEND. (40-Y 0-N)
- 04/06/95 Governor: Governor's recommendation adopted
- 04/06/95 House: Reenrolled
- 04/06/95 House: Signed by Speaker as reenrolled
- 04/06/95 Senate: Signed by President as reenrolled
- 04/06/95 House: Enacted, Chapter 745 (effective 7/1/95)
- 04/10/95 House: Reenrolled bill text (HB1973ER)
- 04/17/95 Governor: Acts of Assembly Chapter text (CHAP0745)