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1997 SESSION

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HB 2789 Health maintenance organizations; accountability for quality care.

Introduced by: James M. Shuler | all patrons    ...    notes | add to my profiles

SUMMARY:

Health maintenance organizations; accountability for quality care. Requires every health maintenance organization (HMO) to supply with its evidence of coverage statement a description of the HMO's method for resolving complaints and the enrollee's appeal rights. The State Corporation Commission (SCC), the State Health Commissioner, and the Department of Health Professions are directed to monitor and examine the complaint system. This bill requires the Commission by regulation to establish a minimum required complaint system for HMOs which permits all interested persons to complain regarding access and quality matters and violations of law and which (i) allows appeals from the HMO to be directed to the State Health Commissioner, the Department of Health Professions, or the SCC when a complaint is not resolved, (ii) permits complaints to be filed directly with the SCC in case of serious or imminent danger to the health of the patient or violation of law, and (iii) requires the SCC, expeditiously and fairly, to investigate, adjudicate and resolve complaints and appeals. Each HMO must submit an annual complaint report to the Commission, the State Health Commissioner, and the Department of Health Professions. This bill also increases the frequency of required examinations of HMOs by the SCC and the State Health Commissioner from once every five years to once every four years.


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