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2022 SESSION

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HB 146 Insurance; provider complaints, etc.

Introduced by: Christopher T. Head | all patrons    ...    notes | add to my profiles | history

SUMMARY AS PASSED HOUSE:

Insurance; examinations; provider complaints. Provides that any person may submit a complaint of noncompliance by an insurer with any insurance law, regulation, or order of the State Corporation Commission on behalf of a health care provider. The bill provides that the Commission shall investigate such complaints and notify the complainants of the outcomes, but that the Commission shall not have jurisdiction to adjudicate individual controversies or matters of contractual dispute.

SUMMARY AS INTRODUCED:

Insurance; examinations; health care provider panels. Requires the State Corporation Commission to conduct an examination of the business and affairs of an insurer upon (i) request by a statewide association representing health care professionals affirming no less than 10 complaints alleging insurer misconduct in a six-month period from providers participating in such insurer's network or (ii) verifiable information that such insurer has violated any law, regulation, or prior order of the Commission. The bill requires the Commission to publish a reasonably detailed summary of each violation and any corrective action plan on the Commission website within 60 days of the completion of an examination. The bill requires a health insurer that uses a provider panel to establish procedures for (a) notifying a provider at least 90 days prior to the implementation of a policy that restricts enrollee access to the provider's services, (b) providing reasonable notice to primary care providers in the insurer's provider panel prior to the implementation of a policy that restricts enrollee access to the specialty referral services provider, and (c) notifying the purchaser of the health benefit plan of any change in policy that restricts enrollee access to a contracted provider. Finally the bill requires a health insurer to provide with a renewal coverage proposal written notice of intent to increase by more than 15 percent the annual premium charged for coverage.