MISSISSIPPI LEGISLATURE

2000 Regular Session

To: Public Health and Welfare

By: Representative Moody

AN ACT TO AMEND SECTION 41-83-31, MISSISSIPPI CODE OF 1972, TO DELETE REVERTER OR ROLLBACK PROVISIONS THAT WOULD REQUIRE THAT A HEALTH CARE SERVICES UTILIZATION REVIEW DETERMINATION WHICH IS ADVERSE TO A PATIENT OR PROVIDER MUST BE EVALUATED AND CONCURRED IN BY A PHYSICIAN LICENSED TO PRACTICE IN MISSISSIPPI, EXCEPT IN CASES INVOLVING 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. 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 precertification for that service shall include the evaluation, findings and concurrence of a physician 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, 2000.