MISSISSIPPI LEGISLATURE

1997 Regular Session

To: Public Health and Welfare

By: Senator(s) Gollott

AN ACT TO PROVIDE FOR THE DIRECT ACCESS OF PATIENTS TO DERMATOLOGICAL SERVICES UNDER HEALTH INSURANCE CONTRACTS AND MANAGED HEALTH CARE PLANS; TO PROHIBIT CERTAIN REQUIREMENTS OF REFERRAL FROM A PRIMARY CARE PHYSICIAN AS A CONDITION OF COVERAGE UNDER HEALTH INSURANCE CONTRACTS AND MANAGED HEALTH PLANS; AND FOR RELATED PURPOSES. 

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

SECTION 1. (1) It is the intent of the Legislature to encourage health care cost containment while preserving the quality of care offered to citizens of this state. The Legislature finds that there is an increasing number of health insurance benefit and managed care providers which require a referral from a primary care physician to a dermatologist as a condition of the payment of benefits to an insured patient. The Legislature finds that such a requirement blocks unfairly a patient's choice of direct access to providers of health care services and may not be in the public interest.

(2) As used in this section the term:

(a) "Dermatological services" means services ordinarily and customarily rendered by a physician specializing in the practice of dermatology.

(b) "Health benefit policy" means any individual or group plan, policy or contract for health care services issued, delivered, issued for delivery or renewed in this state by a health care corporation, health maintenance organization, accident and sickness insurer fraternal benefit society, nonprofit hospital service corporation, nonprofit medical service corporation or similar entity.

(c) "Primary care physician" means a physician who is board certified or board eligible and practices in general internal medicine, pediatrics, obstetrics, gynecology or family practice.

(d) "Health maintenance organization" means any entity which is required to be licensed under Section 83-41-301 et seq., Mississippi Code of 1972.

(e) "Managed care entity" means a health maintenance organization, an insurer, a hospital or medical service plan certified under Section 83-41-401 et seq., Mississippi Code of 1972, an employer or employee organization or plan, and any other entity, including a preferred provider organization, which establishes, operates or maintains a network of providers, conducts or arranges for utilization review activities, and contracts with a health maintenance organization, an insurer, a hospital or medical service plan, an employer, an employer organization or with any other entity providing coverage for health care services.

(f) "Member" means an enrollee, an insured and any other person entitled to receive health care coverage for health care services from a managed care entity.

(3) No health benefit policy which is issued, delivered, issued for delivery, or renewed in this state on or after July 1, 1997, shall require as a condition to the coverage of dermatological services that an enrollee, subscriber, or insured first obtain a referral from a primary care physician.

(4) Managed care entities shall not deny or limit reimbursement for services provided to a member, or deny the provision of dermatological services to a member, on the grounds that the member was not referred to the provider by a provider or other person acting on behalf of, pursuant to an agreement with, or under the direction of, whether direct or indirect, the managed care entity. As frequently as reasonably necessary to facilitate such direct access to providers, but no less frequently than once per year, each managed care entity shall deliver to members a complete listing of all dermatological providers in any provider network selected by the managed care entity.

SECTION 2. This act shall take effect and be in force from and after July 1, 1997.