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Managed Care State Laws

Managed Care State Laws and Regulations, Including Consumer and Provider Protections

Updated: May 2010; material added September 2011

Archive Report:  This summary compilation of state laws and polices was originally compiled and published 2000, with regular updates and additions through 2005.  Because states enacted far fewer changes in this area since 2005, this report is no longer maintained on a regular basis.  It remains an accurate historical "panaramic" view of the range of state-specific initiatives in an era where there was relatively little federal law.

The Affordable Care Act - the 2010 federal law substantially adds to the regutory requirements in some of the areas covered in this report.  See NCSL's latest (2010-2011) reports and descriptions online at the NCSL Health Reform website, http://www.ncsl.org/Default.aspx?TabID=160&tabs=831,139,1156#1156

 

 

More than 170 million Americans receive health care coverage or benefits through some type of "managed care" setting.1  By 2007 about 20 percent of these services are directly provided by a health maintenance organization (HMO), while the majority are served through other managed arrangements, 60 percent in Preferred Provider Organizations (PPO) and 13 percent in Point of Service (POS) plans.

Nearly all states have passed "patient protection" or consumer-oriented laws and/or regulations.  State legislation and resulting enacted laws were an intense focus from 1992 through 2002, with dozens of measures enacted yearly, amidst major media attention, anecdotal stories of patients denied treatment, and several major lawsuits. The U.S. Congress has not enacted comparable managed care consumer legislation, although different plans passed the Senate and/or House between 1999-2002.   This activity has dropped off dramatically since 2002, in part because so many states already had laws in place.  The Health Policy Tracking Service summarized this change as "state legislatures and regulatory agencies, consumers and managed care entities have reached a reasonable operational balance." 2  Since 2001 HMO enrollment has declined in many areas, but the enacted laws generally remain in place and in force. 

The details and the extent of these state laws vary considerably, but they remain in force as a mechanism for regulating HMOs and other forms of managed care organizations. The actual extent of these laws vary and is not detailed in this report.

STATE ROLES LIMITED BY ERISA:

State health insurance laws only apply to about 45% of health policies - those "fully insured plans" in which mostly individuals and small and medium sized businesses and organizations pay premiums. Only federal ERISA law applies to the 55% "self-insured health insurance policies."  The U.S. Department of Labor oversees and enforces ERISA requirements, which are generally less extensive than the state requirements noted below.  Many insurers offer and administer both types of plans.  Medicaid managed care plans are administered through state law but consumer and provider protections may be regulated separately from the statutes cited in this report.  See statute language for details.
    (Source: EBRI, September 2007)

Access to Services - Table 1

Access to Services - Table 2

Appeals and Remedies - Table 3

Provider Flexibility and Report Cards - Table 4

Mandate Examples - Table 5

Comprehensive Consumer Rights Statutes with citations - Table 6

2005-07 Managed Care Laws - Table 7

 

   .


Also see Managed Care Overview, an NCSL compendium of reports and documents, updated 2006.

Table I ~ Access to Services

    • Comprehensive Consumer Rights Laws
    • Any Willing Provider -
    • Continuity of Care -
    • Direct Access to OB/GYN -
    • Direct Access to other health professionals.
    • Specialist as Primary Care Provider -
    - These multi-purpose laws, often 20 to 50 pages in length, generally are designed to define and protect the rights of health care consumers enrolled in managed care. Often they are termed "patient protection" or "consumer rights" laws. Statute citations and links to full text are listed below, in Table #6 Numerous states require that managed care organizations contract with any provider (from physicians and hospitals to pharmacists and chiropractors) that is willing to meet the terms of the contract.
    Update: An April 2003 U.S. Supreme Court decision affirmed the Kentucky law, and the validity of such state regulation more generally. A number of states require managed care plans to provide current and new enrollees the opportunity to continue to receive care and services for a period of time with a provider that has been terminated or dis-enrolled from the plan. Many states now allow women to see an obstetrician or gynecologist without first getting permission or a referral from a primary care provider. Some states also afford women the ability to designate their OB/GYN as their primary care provider. For people with a single chronic health problem, the usual HMO procedure of calling a primary care provider first for a referral can be frustrating and unproductive. A number of states now allow an enrollee to select a specialist (such as a neurologist, a mental health provider or a cancer specialist) to be their main provider.

Key

: Numbers indicate year of law enactment |  blue = web link |  reg [italics] = regulation only

 Index by First Letter of State A C D F G H I K L M N O P R S T U V W

State Comp. Consumer Rights Any Willing Provider Continuity of Care Direct Access, OB/GYN Direct Access, other Specialist as PCP
Alabama 99 <97  . 96 01  .
Alaska 98, 00   00   98  
Am. Samoa . . . . . .
Arizona <97, 00 . 00 . 00 .
Arkansas 97 05 97 97 <97 .
California 94, 95, 99 . 98 <97, 98 . .
Colorado 97 . 97 97, 98 . .
Connecticut 97 <97 . 97 95, 00 .
Delaware 98 <97 98 97 . .
Dist. of Columbia 98 . 98 98 98 .
Florida 97, 00 repeal 00 97, 99 97 97  
Georgia 96, 99, 99 <97   96 95  
Hawaii 98          
Idaho 97 94   96    
Illinois 99, 99 <97, 99 99 96    
Indiana 98 <97 98 97, 98 98 98
Iowa 99   99      
Kansas 97   96 01 98  
Kentucky 98, 00 94, 98, 00, 02 00 00    
Louisiana 97   95 97    
Maine 96, 00   00 95, 97 95?  
Maryland 95   96 94 99 99
Massachusetts 00 94, 99 00 00 00  
Michigan     01   99?  
Minnesota <97, 97 94 97 97    
Mississippi 95 94   95    
Missouri 97   97 97 01?  
Montana 97     97 97?  
Nebraska 98     97    
Nevada 97     97    
New Hampshire 97 <97 97 97, 98 00?  
New Jersey 97 93 97 97   97
New Mexico 98     97   98
New York 96   <97 97 <97 97
North Carolina 01 <97, 01 01 97   01
North Dakota 99 <97        
Ohio 97, 99     99    
Oklahoma 97, 99   99   99  
Oregon 95, 97, 01   01, 05 97    
Pennsylvania 98   98 98   98
Puerto Rico            
Rhode Island 96   97 97    
South Carolina 98 <97 98 98    
South Dakota 99, 03 90 Rx 84, 00, 01      
Tennessee 98, 00 <97, 98 98 97, 98   98
Texas 96, 97, 97 95 <97, 97 97 <97 97
U.S. Virgin Is.            
Utah       97, 98    
Vermont 96 . 97 97 . .
Virginia 95, 98, 99, 99   96, 99 96 97,99,00 99-00
Washington 96, 00 . 00 95 00 .
West Virginia 01 . 01 98, 01 . .
Wisconsin 98 <97 98 99 . .
Wyoming . <97 . . . .

 

Table II ~ Access to Services, Part 2

    • Standing Referrals to Specialist -
    • Emergency Care Coverage -
    • Emergency Prudent Lay Person -
    • Emergency Room coverage.
    • Freedom of Choice -
    • Ombudsman/Consumer Assistance -
    Many states call for health plans to institute procedures that provide an enrollee that requires specialized medical care over a prolonged period of time to receive a standing referral to a specialist. This is generally for people with a chronic, degenerative, disabling or life-threatening disease. Numerous states require reimbursement for emergency care services. This includes screening and stabilization. Many state laws specify automatic coverage for emergency medical conditions "of sufficient severity, including severe pain, that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of medical attention to result in placing the person’s health in jeopardy." Managed care organizations can not discount the price for their enrollees by reducing the selection of providers. These programs are state-funded, independent offices that act directly on behalf of a patient unable to get needed medical care or other services.

First Letter of State A C D F G H I K L M N O P R S T U V W

State  Standing Ref. To Specialist Emergency Care Coverage Emergency Prudent Lay Person Emergency Room Freedom of Choice Ombdsm./
Consumer Asst.
Alabama  99 99 99    <97  
Alaska          98  
American
Samoa
           
Arizona  00 96 00      
Arkansas   <97 <97      
California  98 94        <97, 99
Colorado  99   <97  <97    98
Connecticut   97 <97     98  99
Delaware  01 98 98    <97  
District of Columbia  98 98 98      
Florida  97 96      <97  96, 98, 00
Georgia   96 <97  <97  <97  99
Guam            
Hawaii  99 98, 99 97      
Idaho   97 <97    <97  
Illinois  99   99      99
Indiana   <97, 98 98      
Iowa     99    <97  
Kansas  <97 97 <97      
Kentucky  00 98, 00 98, 00    96  98
Louisiana   <97, 99 <97, 99    <97  
Maine  00 00 <97, 00      98
Maryland  99, 00 96, 98, <97    <97  99
Massachusetts  00   00      98, 00
Michigan     <97      <97
Minnesota  <97 97 <97  <97    <97, 98
Mississippi     99    <97  
Missouri  <97   <97  <97    
Montana   97      <97; 01  
Nebraska   98 <97      
Nevada   97, 99 <97      
New Hampshire   97        
New Jersey   97      93  00
New Mexico  <97; 97 97, 98 <97  <97    
New York  96 96 <97      
North Carolina  99, 01 97 <97    <97  01
North Dakota     99    <97  
Ohio  <97 97 <97  <97    
Oklahoma  99 97 00    <97  
Oregon  01 01 <97      <97
Pennsylvania  98 96, 98 98  98    
Puerto Rico            
Rhode Island            99
South Carolina  98   98    98  
South Dakota   99 99  99, 03 90 Rx  
Tennessee  98 97 <97    <97, 98  <97
Texas   97 <97    <97  99
U.S. Virgin Islands            
Utah  00   00      99
Vermont <97    <97      98
Virginia  99, 00 <97, 97 <97, 00  <97  <97  99
Washington  00   <97      
West Virginia  01 96 98, 00    01  
Wisconsin  98   <97, 98      <97
Wyoming            

 


Table 3 ~ Appeals and Remedies

    • Independent/External Review of denials
    •  Many states now require an independent or "external appeal" panel to evaluate the validity of denied care. Once opposed as too costly by the managed care industry, this idea now is embraced as a "reasonable" alternative to court suits. 

    • An Update on State External Review Programs, 2006 This report by AHIP provides an analysis of publicly available data from state external review programs operating in 2006. Published 7/9/2008.

    • Insurer Liability -

      These state provisions held health maintenance organizations liable for health treatment decisions. NOTE: A landmark U.S. Supreme Court decision in July 2004 ruled unanimously that patients cannot sue their HMO under state laws for failing to pay for doctor recommended care.  Experts describe the decision as ruling that federal ERISA law "completely pre-empted such lawsuits brought in state court."  The listings below are retained for legislative history, but portions of the statutes may not be in effect. Offers people the ability to receive services from an out-of-plan provider given that they are willing to pay higher out-of-pocket costs. Managed care organizations might offer this type of plan to eliminate the use of closed-panel HMOs.

    • Liability: Ban on "hold harmless" clauses in Provider Contracts
    • Liability, Financial: Enrollee
    • Point of Service -
    • Right to a second medical or surgical opinion - 9 states formally mandate the option to obtain a second opinion, with costs covered by insurance.   These states are CA, MD, MN, MO, NJ, NY, RI, WV & WI. (not listed in the Table below) 

First Letter of State A C D F G H I K L M N O P R S T U V W

State Ind./External
Review of Denials
 Insurer Liability  Liability: Provider Contracts Liability, Financial: Enrollee  Point of Service
Alabama          
Alaska  00        98, 00
American
Samoa
         
Arizona  <97, 00  00      
Arkansas 97, 05     97, 01  99
California  96, 99  99  99    
Colorado  <97, 99, 05     97  
Connecticut  97, 05    97 97  
Delaware  98, 01     98  
District of Columbia  98        
Florida  <97, 00        
Georgia  99  99  99    96
Guam          
Hawaii  98, 00        
Idaho          97
Illinois  99    99    00
Indiana  99, 01    97 98  98
Iowa  99, 01        97
Kansas  99     97  
Kentucky  00        
Louisiana  99  99  97 97  
Maine  00  00  97, 00    
Maryland  98, 01    <97    <97
Massachusetts  00    00    00
Michigan  <97, 00        
Minnesota  99        <97
Mississippi          
Missouri  <97  97  97    
Montana  99    99    97
Nebraska       98  
Nevada  01        
New Hampshire  00, 05    93, 97    
New Jersey  <97, 01  01      97
New Mexico  <97  98      
New York  98    96    95
North Carolina  97, 01, 05  01      
North Dakota  05    97 99  
Ohio  <97, 99     97  
Oklahoma  99  00  00 97  97
Oregon  01  01  <97    95
Pennsylvania  98        
Puerto Rico          
Rhode Island  <97    96, 99    
South Carolina  00    98    98
South Dakota  9903    99 99  
Tennessee  97, 98, 99    97 98  98
Texas  97  97  97, 99 99  97, 99
U.S. Virgin Islands          
Utah  00        
Vermont  <97, 98    97    
Virginia 99    98, 97  98
Washington  00, 01  00  00    00
West Virginia  01  01      
Wisconsin  00        99?
Wyoming          
State Ind./Ext. Review of Denials  Insurer Liability  Liability: Provider Contracts Liability, Financial: Enrollee  Point of Service

 

Table 4 ~ Provider Flexibility and Report Cards

    • Bans on Financial Incentives -
    • Ban on Gag Clauses -
    • Report Cards -
    • Medical Director Requirements -
    • Hospital Stay after Childbirth -
    • Ban on "All Products" Clauses - Some contracts between providers and managed care companies require the provider to contract for all products that are offered by the managed care entity.  Several states have banned the use of such requirements as an unfair trade practice. (updated 2006)
    Many states prohibit a managed care plan from rewarding doctors for performing a less costly procedure or prescribing a less costly drug. Most states have laws prohibiting any agreement that limits doctors’ ability to inform patients of treatment options, especially if some choices may cost the insurer more. A 1997 federal law now bans gag clauses for Medicaid and Medicare managed care. In an effort to assist consumers in choosing a plan, several states now require publication of an evaluation booklet or, "report card" to report on the performance of a managed care organization. Also see NCSL Report. Some managed care organizations’ chief officers have business degrees rather than medical credentials. During the past few years, several states have established specific qualifications and responsibilities for HMO medical directors; most require a current in-state medical license. Many states require reimbursement for (typically) at least a 48-hour maternity stay. A federal law requiring coverage for a 48-hour stay took effect in January 1998.

First Letter of State A C D F G H I K L M N O P R S T U V W

State Ban on Financial Incentives Ban on Gag Clauses Report Cards Medical Director Requirements Hospital Stay after Childbirth Ban All Products Clauses
Alabama       99 reg 96  
Alaska  98, 00  98, 00     96 01
Am. Samoa            
Arizona  00  97   00 97  
Arkansas    97   X reg 97  
California  96  96  99 99 97  
Colorado    96  99 Reg 98  
Connecticut    97  95    96 ['07]  
Delaware  98  96   99 97  
Dist. of Columbia    98        
Florida  96  97  97 97 96  
Georgia  97, 99  96, 99     01  
Guam            
Hawaii    98   99    
Idaho  97  97     96  
Illinois  97  99   99 96  
Indiana    96   98, 00 96  
Iowa    97, 99  99   96  
Kansas  97  97  99   96  
Kentucky    98   X 98  01
Louisiana  97, 99  97  99 99 97  
Maine  00 96     95, 95  
Maryland  96 96  98 98 X  00 H, S
Massachusetts  00  <97, 00  00 00 X  
Michigan    96, 97  00      
Minnesota  97  97, 00  74 01 96  00
Mississippi            
Missouri  97  97  99 00 96  
Montana  97  97   01 97  
Nebraska  97, 98  97        
Nevada  97, 99  97   97 97  98
New Hampshire  00  96   00 96  
New Jersey  97  97, 97  98 97 95  
New Mexico  97, 98  97, 98  94, 99   96  
New York    96  98 X 96  
North Carolina  01     99 97  
North Dakota  99  97   99? X  
Ohio  97  97     96  
Oklahoma    97  98 X 96  
Oregon    97  <97, 99   95  
Pennsylvania  98  96     96  
Puerto Rico            
Rhode Island  96  96, 97  <97, 99 X 96  
South Carolina    98   99 76  
South Dakota  99  99   99 96  
Tennessee    96  99   96  
Texas  97, 99  97  95 X 97  
U.S. Virgin Islands            
Utah    97  98, 99   01  
Vermont  97  96  99 00    
Virginia    96  99 00 96, 01 00
Washington    96, 00  99 00 96  
West Virginia  97, 01  97     97  
Wisconsin    75, 98  99 97    
Wyoming    97        
State Ban on Financial Incentives  Ban on Gag Clauses Report Cards Medical Director Requirements Hospital Stay after Childbirth Ban All Products Clauses

Table 5 ~ Mandates for Insurance Coverage (Examples)

These mandates are just four coverage examples of the 40+ types of mandated requirements enacted across all 50 states. A more detailed list, published by the Council for Affordable Health Insurance is available here: 50- state mandate information, 2009 update.  (a pdf format document).

    • Diabetes -
    • Inpatient Care after Mastectomy -
    • Post-Mastectomy Breast Reconstruction - Coverage for reconstructive surgery of cancerous breast and/or unaffected breast in order to achieve symetry.  "Yes" indicates that the reconstruction is covered IF mastectomy is also covered.
    • Off-label Prescription Drug Use -
    require coverage of pharmaceuticals, equipment, supplies and sometimes education for at-home treatment. Additional details at Diabetes mandates web page. Coverage for a minimum number of hours in an inpatient hospital is mandated after a mastectomy or lymph node dissection. For specific uses, like treating cancer or other life-threatening diseases, all prescription drugs are to be covered. This includes drugs that are not FDA approved.

First Letter of State A C D F G H I K L M N O P R S T U V W

State  Diabetes Supplies Inpatient Care after Mastectomy Post-Mastectomy Breast Reconstruction Off-label Prescription Drug Use
Alabama        <97
Alaska  00    00  
Am. Samoa        
Arizona  98, 00    <97, 99  00
Arkansas  97  97  <97  <97
California  <97, 99  98  98  <97
Colorado  98      
Connecticut  97  97  <97  <97
Delaware  00    yes  yes
Dist. of Columbia  00    yes  
Florida  95  97  <97  <97
Georgia  98  99  yes  <97
Guam        
Hawaii  00      
Idaho      00  
Illinois  98  97  <97  <97
Indiana  97    <97  <97
Iowa  84, 99    yes  
Kansas  98    <97  99
Kentucky  98  98  98  98
Louisiana  97    <97, 99  97
Maine  96  97  <97  98
Maryland  97  99  <97  <97
Massachusetts <97, 00      <97
Michigan 00    <97  <97
Minnesota 94, 97    <97  98
Mississippi 98    yes  97
Missouri 97    <97  97
Montana  01  97  <97  
Nebraska  99    00  yes
Nevada 97     <97  99
New Hampshire  97    <97  99
New Jersey  96  97  <97  <97
New Mexico  97  97  yes  97
New York 93  97  <97  <97
North Carolina  97  97  <97  <97, 01
North Dakota      yes  97
Ohio    01  yes  <97
Oklahoma 96  97  <97  <97
Oregon 87, 01    yes  97
Pennsylvania  98  97  <97  yes
Puerto Rico        
Rhode Island  96  97  <97  <97
South Carolina  99  98  <97  <97
South Dakota  99, 00    yes  00
Tennessee  97    <97  97
Texas  97, 99  97  <97, 99  99
U.S. Virgin Islands        
Utah  00    00  
Vermont  97      yes
Virginia  98, 99, 00  98, 98  98  <97, 97
Washington  97    <97  <97
West Virginia  96

 

 <97  
Wisconsin  87    yes  
Wyoming  01      

Table 6 ~ Comprehensive Consumer Rights Statute Citations

First Letter of State A C D F G H I K L M N O P R S T U V W

STATUTES

Alabama 1999-2000 Regulations
Alaska 1998 law: SB 197
2000 law: HB 211
Arizona <1997 law
2000 law: HB 2600
Arkansas 1995, 1997 law: AR Code §23-99-201 ; AR Code §23-99-401 et seq.
2005 law: SB 191
California 1994 law: SB 1832
1995 law: AB 1152
1995 law: AB 1266
Colorado 1997 law: HB 1122; Colo. Rev. Stat. §10-16-702 et seq.
Connecticut 1997 Conn. Acts, P.A.97-99 HB6883    [link 07]
2003: Conn Acts P.A. 03-169 [effective 2004]
Delaware Del. Code Ann. tit. 16, § 9110 (1998)  [repealed]
Del. Code Ann tit. 18 Insurance  § 6401 et seq.
District of Columbia 1998 law
Florida 1997 law: HB 297
2000 law: HB 2339
Georgia 1996 law: HB 1338
1999 law: SB 210
1999 law: HB 732
Hawaii 1998 law: SB 2297
Idaho 1997 law: SB 1150
Illinois 1999 law: SB 251
1999 law: (dental only) SB 721
Indiana 1998 law: SB 364
Iowa 1999 law: SF 276
Kansas 1997 law: SB 204
Kentucky 1998 law: HB 315
2000 law: HB 390
Louisiana 1997 law: HB 2228
Maine 1996 law: S 769
2000 law: Chapter 742 of 2000 LD 543
Maryland 1995 law: HB 724 and SB 499
Massachusetts Mass. Gen. Laws Ann. ch. 141, § 16D (2000) H 4525            [link 07]
Michigan n/a
Minnesota <1997 
Minn. Stat. Ann. Sections 62J.695 to 62J.76, cited as the "Patient Protection Act."  (1997) SF 960
Mississippi 1995 law: SB2669 Certification standards only
Missouri 1997 law:  MO Stat. 354.400 et. seq.   HB 335
Montana 1997 law: SB 365
Nebraska 1998 law: LB 1162
Nevada 1997 law: AB 156
New Hampshire 1997 law: SB 178
New Jersey 1997 law: SB 269
New Mexico 1998 law: HB 361
New York 1996 law: SB 7553 (NY Ins. Sec. 48)
North Carolina 1997 Regulations;
2001 law: S 199 (Session Law 2001-446; effective March 1 & July 1, 2002)     [link '08]
North Dakota 1999 law: SB 2400
Ohio 1997 law: SB 67 HB 361
Oklahoma 1997 law: HB 1416 [link '08]
1999 law: HB 1681 [link '08]
Oregon 1995 law: SB 979 
1997 law: SB 21
2001 law: HB 3040
Pennsylvania 1998 law: SB 91
Rhode Island 1996 law: RI Gen. Laws § 23-17.13-1 et seq.
South Carolina 1998 law: SB 310
South Dakota 1999, 2000, 2003 laws: SD Chapter 58-17C                   [link '07]
Tennessee 1998 law: HB 2949
Texas 1996 Regulation
Tex. Insurance Code Ann. § 3.70-3C (1997) SB383
Tex. Insurance Code Ann. § 1.35A (1997) SB385
Utah n/a
Vermont 1996 law: S.345
Rule 10.000 Quality Assurance Standards and Consumer Protections for Managed Care Plans
Virginia 1995 law: HB 1973 (Chapter 745)
1996 law: HB 1393 (Chapter 776)
1998 law: SB 712 (Chapter 891) § 32.1-137.1.
1999 law: HB 871 (Chapter 649)
1999 law: SB1235
Washington 1996 law: SB 6392
2000 law: SB 6199
West Virginia  2001 law: HB 2216
Wisconsin  1998 law: AB 768
Wyoming n/a


2005-07 Managed Care Laws

Although more than 98 percent of state Managed Care Laws were enacted prior to 2003, several states did passed laws in 2005, mostly amending or expanding earlier laws.  A 2007 CT law passed in May.   These are 10 of the more substantive state measures.

STATE 2005-07 MANAGED CARE LAWS 2
AR SB 190, SB 191  Patient Protection Act. Includes broad "any willing provider" (AWP) provisions, and a right to sue for violations, including of AWP sections.
CO SB 37 expands external review by requiring second-level internals appeals of denied benefits, by a 3-member panel, with 2 independent experts.
CT HB 7000 provides that the Managed Care Ombudsman will work to "foster communication between mental health professionals and providers."
SB 1002 expands independent review by requiring that adverse rulings must include the "principal reasons for the the determination" and terms for further appeal to the state commissioner of insurance.
SB 1297 creates a fine for failure to provide notice of the resolution of a complaint.
H 7055 of 2007: establishes a statutory definition of medical necessity or medically necessary for health insurance coverage to ensure consistency throughout health insurance policies; creates a presumption that a treatment is medically necessary.
IN SB 254 allows HMOs to provide selected documents in electronic or paper form.
NH HB 737 clarifies that a covered beneficiary who uses a voluntary internal appeal or review may also request an external review.
SB 77 provides that providers are entitled to a complete copy of any proposed contract and 60-day notice for any material change in fee schedules.
NC SB 74 expands existing managed care laws to clarify that they apply to individual insurance plans as well as group plans.  Restricts external review to normal business hours.
OR HB 3465 expanded "continuity of care" provisions.
RI SB 774 change the total minimum net worth required for an HMO Certificate of Authority.
TX SB 1284 provides that mergers between two HMOs make them subject to preexisting insurance law.
WV SB 425 provides for grievance procedures and permits health status as an underwriting condition; also includes HMOs to risk-based capital requirements and incorporation standards.

Notes:

Italics = Regulations, not statute
1 - America's Health Insurance Plans, 2005 Report
2 - "Managed Care" Issue Brief by Thomson West/Health Policy Tracking Service, 12/31/2005

Compiled by Richard Cauchi, NCSL Health Program, Denver, Colorado.   This is a preliminary edition of NCSL research, subject to additional edit and design work prior to final publication.

 

 

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