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1999 SESSION

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SB 1185 Managed care health insurance plans.

Introduced by: Stanley C. Walker | all patrons    ...    notes | add to my profiles

SUMMARY AS INTRODUCED:

Managed care health insurance plans. Implements comprehensive reforms in managed health care by providing for (i) external independent review of adverse utilization review decisions, (ii) an ombudsman to intervene in health care coverage disputes, (iii) civil liability for adverse health treatment decisions made by managed care entities, (iv) mandated coverage for the treatment of diabetes, (v) mandated coverage for participation in clinical trials, (vi) parity in benefits for the treatment of mental illnesses, (vii) required patient notification of changes in benefits, (viii) required and extended continuation of care for a covered person by a provider who is no longer a participating provider, (ix) standing referrals to specialists, (x) specialists to serve as primary care physicians in certain situations, (xi) prohibitions in provider contracts that allow incentives for refusing health care, (xii) accessibility to nonformulary prescription drugs, (xiii) the ability to use out-of-network providers, and (xiv) 24-hour availability of personnel to authorize medical treatments.


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