1998 Regular Session
To: Public Health and Welfare
By: Representative Moody
House Bill 1194
(As Passed the House)
AN ACT TO AMEND SECTION 41-83-31, MISSISSIPPI CODE OF 1972, TO PROVIDE THAT A HEALTH CARE SERVICES UTILIZATION REVIEW DETERMINATION THAT IS ADVERSE TO A PATIENT OR PROVIDER MUST BE EVALUATED AND CONCURRED IN BY A PHYSICIAN LICENSED TO PRACTICE IN MISSISSIPPI EXCEPT FOR THE COMPREHENSIVE HEALTH INSURANCE RISK POOL ASSOCIATION; AND FOR RELATED PURPOSES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:
SECTION 1. Section 41-83-31, Mississippi Code of 1972, is amended as follows:
41-83-31. Any program of utilization review with regard to hospital, medical or other health care services provided in this state shall comply with the following:
(a) No determination adverse to a patient or to any affected health care provider shall be made on any question relating to the necessity or justification for any form of hospital, medical or other health care services without prior evaluation and concurrence in the adverse determination by a physician licensed to practice in Mississippi. The reasons for any adverse determination shall be discussed by the physician with the affected health care provider, if the provider so requests.
(b) Any determination regarding hospital, medical or other health care services rendered or to be rendered to a patient which may result in a denial of third party reimbursement or a denial of precertification for that service shall include the evaluation, findings and concurrence of a physician licensed to practice in Mississippi and trained in the relevant specialty or subspecialty, if requested by the patient's physician, to make a final determination that care rendered or to be rendered was, is, or may be medically inappropriate.
(c) The requirement in this section that the physician who makes the evaluation and concurrence in the adverse determination must be licensed to practice in Mississippi shall not apply to the Comprehensive Health Insurance Risk Pool Association or its policyholders.
SECTION 2. This act shall take effect and be in force from and after July 1, 1998.