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2011 SESSION
HB 1928 Health insurance; independent external reviews.
Introduced by: Daniel W. Marshall, III | all patrons ... notes | add to my profiles
SUMMARY AS PASSED HOUSE: (all summaries)
Health insurance; independent external reviews. Revises the process for independent external reviews of a health carrier's adverse decision regarding covered health care benefits. The measure (i) eliminates the minimum eligibility threshold, (ii) eliminates the $50 filing fee, and (iii) expands situations for which an independent external review may be requested to include covered persons of all licensed health carriers. Currently, only persons covered by managed care health insurance programs may request an independent external review. Under this measure, insurers are required to incur the full cost of every review; currently, the Commonwealth incurs the cost of any review that does not result in denied services being covered. The measure tracks the Uniform Health Carrier External Review Model Act prepared by the National Association of Insurance Commissioners. The federal Patient Protection and Affordable Care Act requires states to adopt such an external review program by July 1, 2011. The measure also requires health carriers to establish an internal appeals process. The utilization review standards are revised to apply to adverse determinations, which are defined as determinations by a managed care health insurance plan that a request for benefit does not meet the plan's requirements or is determined to be experimental or investigational, thereby resulting in a denial, reduction, or termination of the requested benefit. The length of time the utilization review entity is required to maintain records is increased from five to six years. The measure expires July 1, 2014.
FULL TEXT
- 01/11/11 House: Prefiled and ordered printed; offered 01/12/11 11101708D pdf | impact statement
- 02/01/11 House: Committee substitute printed 11104563D-H1 pdf | impact statement
- 02/23/11 House: Bill text as passed House and Senate (HB1928ER) pdf | impact statement
- 04/06/11 House: Reenrolled bill text (HB1928ER2) pdf
- 04/06/11 Governor: Acts of Assembly Chapter text (CHAP0788) pdf
AMENDMENTS
HISTORY
- 01/11/11 House: Prefiled and ordered printed; offered 01/12/11 11101708D
- 01/11/11 House: Referred to Committee on Health, Welfare and Institutions
- 01/27/11 House: Referred from Health, Welfare and Institutions by voice vote
- 01/27/11 House: Referred to Committee on Commerce and Labor
- 02/01/11 House: Reported from Commerce and Labor with substitute (17-Y 1-N)
- 02/01/11 House: Committee substitute printed 11104563D-H1
- 02/03/11 House: Read first time
- 02/04/11 House: Read second time
- 02/04/11 House: Committee substitute agreed to 11104563D-H1
- 02/04/11 House: Engrossed by House - committee substitute HB1928H1
- 02/06/11 House: Passed by for the day
- 02/07/11 House: Read third time and passed House (95-Y 4-N)
- 02/07/11 House: VOTE: PASSAGE (95-Y 4-N)
- 02/08/11 Senate: Constitutional reading dispensed
- 02/08/11 Senate: Referred to Committee on Commerce and Labor
- 02/14/11 Senate: Reported from Commerce and Labor (15-Y 0-N)
- 02/16/11 Senate: Constitutional reading dispensed (40-Y 0-N)
- 02/17/11 Senate: Read third time
- 02/17/11 Senate: Passed Senate (39-Y 0-N)
- 02/23/11 House: Enrolled
- 02/23/11 House: Bill text as passed House and Senate (HB1928ER)
- 02/23/11 House: Signed by Speaker
- 02/23/11 Senate: Signed by President
- 03/26/11 House: Governor's recommendation received by House
- 04/05/11 House: Placed on Calendar
- 04/06/11 House: House concurred in Governor's recommendation (97-Y 0-N)
- 04/06/11 House: VOTE: ADOPTION (97-Y 0-N)
- 04/06/11 Senate: Senate concurred in Governor's recommendation (40-Y 0-N)
- 04/06/11 Governor: Governor's recommendation adopted
- 04/06/11 House: Reenrolled
- 04/06/11 House: Reenrolled bill text (HB1928ER2)
- 04/06/11 House: Signed by Speaker as reenrolled
- 04/06/11 Senate: Signed by President as reenrolled
- 04/06/11 House: Enacted, Chapter 788 (effective 7/1/11)
- 04/06/11 Governor: Acts of Assembly Chapter text (CHAP0788)