MISSISSIPPI LEGISLATURE

1998 Regular Session

To: Public Health and Welfare

By: Senator(s) Bean

AN ACT TO AMEND SECTION 41-83-31, MISSISSIPPI CODE OF 1972, TO PROVIDE THAT NO ADVERSE DETERMINATION OR DENIAL OF THIRD PARTY REIMBURSEMENT UNDER ANY PROGRAM OF HEALTH CARE UTILIZATION REVIEW SHALL BE MADE WITHOUT PRIOR EVALUATION AND CONCURRENCE BY A PHYSICIAN LICENSED TO PRACTICE MEDICINE IN MISSISSIPPI; AND FOR RELATED PURPOSES. 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:

SECTION 1. Section 1-83-31, 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 medicine in Mississippi. The reasons for any adverse determination shall be discussed by said 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 pre-certification for that service shall include the evaluation, findings and concurrence of a physician licensed to practice medicine 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.

SECTION 2. This act shall take effect and be in force from and after July 1, 1998.