MISSISSIPPI LEGISLATURE

1999 Regular Session

To: Insurance

By: Representatives Howell, Barnett (92nd)

AN ACT TO CREATE A NEW SECTION TO BE CODIFIED AS SECTION 83-41-419, 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 AMEND SECTION 83-41-415, MISSISSIPPI CODE OF 1972, IN CONFORMITY TO THE PRECEDING PROVISION; AND FOR RELATED PURPOSES.

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

SECTION 1. The following shall be codified as Section 83-41-419, Mississippi Code of 1972:

83-41-419. (1) No managed care plan, health maintenance organization, independent practice association, other entity contracting for the provision of health care services, or any other entity, shall prohibit or restrict any participating provider from disclosing to any subscriber, enrollee or member any medically appropriate health care information that the participating provider deems appropriate regarding (a) the nature of treatment, risks or alternatives thereto; (b) the availability of alternate therapies, consultations or tests; (c) the decision of any plan to authorize or deny services; or (d) the process the plan or any person contracting with the plan uses, or proposes to use, to authorize or deny health care services or benefits. Any such prohibition or restriction contained in a contract with a participating provider shall be void and unenforceable.

(2) (a) Upon the application and rendering by any managed care entity of a decision to terminate an employment or other contractual relationship with or otherwise penalize a participating physician, surgeon or medical provider, that entity shall be prohibited from denying such an application or terminating that relationship principally for advocating medically appropriate health care that is consistent with that degree of learning and skill ordinarily possessed by reputable physicians, surgeons and medical providers practicing according to the applicable legal standard of care.

(b) For the purpose of this subsection, "to advocate medically appropriate health care" means to appeal a payor's decision to deny payment for a service pursuant to the reasonable grievance or appeal procedure established by a medical group, independent practice association, preferred provider organization, foundation, hospital medical staff and governing body, or payor, as required by Section 41-83-1 et seq., or to protest a decision policy, or practice that the physician, consistent with that degree of learning and skill ordinarily possessed by reputable physicians practicing according to the applicable legal standard of care, reasonably believes impairs the physician's ability to provide medically appropriate health care to his or her patients.

(3) This section shall not be construed to prohibit a managed care plan from making a determination not to pay for a particular medical treatment or service, or to prohibit a medical group, independent practice association, preferred provider organization, foundation, hospital medical staff, hospital governing body, or payor from enforcing reasonable peer review or utilization review protocols or determining whether a physician, surgeon or medical provider has complied with those protocols.

SECTION 2. Section 83-41-415, Mississippi Code of 1972, is amended as follows:

83-41-415. Articles 7 and 9 do not apply to the Division of Medicaid in the Office of the Governor, with the exception of Section 83-41-419, relating to the prohibition against certain participating provider contract restrictions.

SECTION 3. This act shall take effect and be in force from and after July 1, 1999.