History of Actions | Background | Title |
Description: Managed health care plans; grievance procedures for.
| 1 | 01/18/99 | (H) | Referred To Insurance | |
| 2 | 02/02/99 | (H) | Died In Committee |
| Effective date | NO EFFECTIVE DATE | |
| Disposition | Dead | |
| Deadline | General Bill/Constitutional Amendment | |
| Revenue | No | |
| 3/5ths vote required | No |
House Committee:
Principal Author: Moak
Title: AN ACT TO AMEND SECTION 83-41-409, MISSISSIPPI CODE OF 1972, TO REQUIRE MANAGED HEALTH CARE PLANS TO MAINTAIN AND ADMINISTER A GRIEVANCE PROCEDURE FOR ENROLLEES AND PARTICIPATING PROVIDERS AND TO REPORT TO THE MISSISSIPPI DEPARTMENT OF INSURANCE THE NUMBER OF COMPLAINTS RECEIVED; TO REQUIRE MANAGED HEALTH CARE PLANS TO PROVIDE FOR A DUE PROCESS HEARING AND REVIEW PROCESS FOR A PROVIDER WHO IS INVOLUNTARILY DELETED FROM A PROVIDER NETWORK OR DENIED PARTICIPATION IN THE NETWORK; TO PROHIBIT MANAGED HEALTH CARE PLANS FROM OFFERING PROVIDERS A FINANCIAL INCENTIVE BASED SOLELY ON THE NUMBER OF SERVICES OR REFERRALS DENIED BY THE PROVIDER; TO REQUIRE MANAGED HEALTH CARE PLANS TO ANNUALLY REPORT THE PERCENTAGE OF REVENUES EXPENDED ON HEALTH CARE SERVICES AND ADMINISTRATION; TO REQUIRE ADVANCE DISCLOSURE OF PREAUTHORIZATION REQUIREMENTS BY MANAGED HEALTH CARE PLANS FOR MEDICAL SERVICES OR SUPPLIES; TO PROHIBIT THE EXCLUSION OF A PHYSICIAN FROM A MANAGED HEALTH CARE PLAN'S PROVIDER NETWORK BASED SOLELY ON THE PHYSICIAN'S ECONOMIC PROFILE; TO REQUIRE MANAGED HEALTH CARE PLANS TO COVER EMERGENCY ROOM VISITS BASED UPON THE "PRUDENT LAY PERSON" STANDARD; TO REQUIRE MANAGED HEALTH CARE PLANS CONTRACTING WITH THE DIVISION OF MEDICAID TO SPEND A MINIMUM PERCENTAGE OF REVENUE ON DIRECT PATIENT CARE, AND TO PROVIDE FOR A MANAGED HEALTH CARE PLAN "POINT-OF-SERVICE" OPTION; TO CODIFY SECTION 83-41-410, MISSISSIPPI CODE OF 1972, TO PROHIBIT ANY MANAGED CARE ENTITY FROM RESTRICTING OR RETALIATING AGAINST ANY PARTICIPATING MEDICAL PROVIDER FOR DISCLOSING TO ANY MEMBER IN THE MANAGED CARE PLAN APPROPRIATE MEDICAL INFORMATION REGARDING TREATMENT OR SERVICES UNDER THE PLAN; TO REPEAL SECTION 83-41- 415, MISSISSIPPI CODE OF 1972, WHICH PROVIDES THAT THE PROVISIONS OF THE PATIENT PROTECTION ACT OF 1995 AND THE HEALTH MAINTENANCE ORGANIZATION-PREFERRED PROVIDER ORGANIZATION-PREPAID HEALTH BENEFIT PLAN PROTECTION ACT DO NOT APPLY TO THE MISSISSIPPI MEDICAID PROGRAM; AND FOR RELATED PURPOSES.
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