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1996 SESSION

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HB 1393 Health insurance; health care provider panels.

Introduced by: Kenneth R. Plum | all patrons    ...    notes | add to my profiles

SUMMARY:

Accident and sickness insurance; health care provider panels. Establishes procedures for establishing and using health care provider panels. The bill requires sponsors of such panels (defined by the bill as "carriers") to publicize their intentions to develop panels and to provide applications and the relevant terms and conditions for participation on provider panels to health care providers seeking admission to them. Additional provisions require notice to (i) covered individuals regarding provider panel status changes and (ii) purchasers of health benefit plans providing a description of all types of payment arrangements that a carrier uses to compensate providers, including withholds, bonus payments, capitation and fee-for-service discounts. The bill also prohibits contracts between a carrier and a provider from requiring that the provider (i) as a condition of participation on the panel, waive any right to seek legal redress against the carrier and (ii) indemnify the carrier for the carrier's negligence, willful misconduct or breach of contract (if any). The bill further provides that such contracts (i) may not prohibit, impede or interfere in the discussion of medical treatment options between a patient and provider and (ii) must permit and require the provider to discuss medical treatment options with the patient. Finally, the bill requests the Joint Commission on Health Care to study the need to require a point-of-service option in managed care plans and other issues relating to the impact of provider panels.


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