Bill Text: MS HB1222 | 2018 | Regular Session | Introduced

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Bill Title: Patient Protection Act of 1995; bring forward sections from.

Spectrum: Partisan Bill (Republican 1-0)

Status: (Failed) 2018-01-30 - Died In Committee [HB1222 Detail]

Download: Mississippi-2018-HB1222-Introduced.html

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MISSISSIPPI LEGISLATURE

2018 Regular Session

To: Public Health and Human Services; Appropriations

By: Representative Chism

House Bill 1222

AN ACT TO BRING FORWARD SECTIONS 83-41-403 AND 83-41-409, MISSISSIPPI CODE OF 1972, WHICH ARE PART OF THE PATIENT PROTECTION ACT OF 1995, FOR PURPOSES OF POSSIBLE AMENDMENT; AND FOR RELATED PURPOSES.

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

     SECTION 1.  Section 83-41-403, Mississippi Code of 1972, is brought forward as follows:

     83-41-403.  As used in this article:

          (a)  "Department" means the Mississippi Department of Insurance.

          (b)  "Managed care plan" means a plan operated by a managed care entity as described in subparagraph (c) that provides for the financing and delivery of health care services to persons enrolled in such plan through:

              (i)  Arrangements with selected providers to furnish health care services;

              (ii)  Explicit standards for the selection of participating providers;

              (iii)  Organizational arrangements for ongoing quality assurance, utilization review programs and dispute resolution; and

              (iv)  Financial incentives for persons enrolled in the plan to use the participating providers, products and procedures provided for by the plan.

          (c)  "Managed care entity" includes a licensed insurance company, hospital or medical service plan, health maintenance organization (HMO), an employer or employee organization, or a managed care contractor as described in subparagraph (d) that operates a managed care plan.

          (d)  "Managed care contractor" means a person or corporation that:

              (i)  Establishes, operates or maintains a network of participating providers;

              (ii)  Conducts or arranges for utilization review activities; and

              (iii)  Contracts with an insurance company, a hospital or medical service plan, an employer or employee organization, or any other entity providing coverage for health care services to operate a managed care plan.

          (e)  "Participating provider" means a physician, hospital, pharmacy, pharmacist, dentist, nurse, chiropractor, optometrist, or other provider of health care services licensed or certified by the state, that has entered into an agreement with a managed care entity to provide services, products or supplies to a patient enrolled in a managed care plan.

     SECTION 2.  Section 83-41-409, Mississippi Code of 1972, is brought forward as follows:

     83-41-409.  In order to be certified and recertified under this article, a managed care plan shall:

          (a)  Provide enrollees or other applicants with written information on the terms and conditions of coverage in easily understandable language including, but not limited to, information on the following:

              (i)  Coverage provisions, benefits, limitations, exclusions and restrictions on the use of any providers of care;

              (ii)  Summary of utilization review and quality assurance policies; and

              (iii)  Enrollee financial responsibility for copayments, deductibles and payments for out-of-plan services or supplies;

          (b)  Demonstrate that its provider network has providers of sufficient number throughout the service area to assure reasonable access to care with minimum inconvenience by plan enrollees;

          (c)  File a summary of the plan credentialing criteria and process and policies with the State Department of Insurance to be available upon request;

          (d)  Provide a participating provider with a copy of his/her individual profile if economic or practice profiles, or both, are used in the credentialing process upon request;

          (e)  When any provider application for participation is denied or contract is terminated, the reasons for denial or termination shall be reviewed by the managed care plan upon the request of the provider; and

          (f)  Establish procedures to ensure that all applicable state and federal laws designed to protect the confidentiality of medical records are followed.

     SECTION 3.  This act shall take effect and be in force from and after July 1, 2018.

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