Bill Text: MS SB2142 | 2016 | Regular Session | Introduced
Bill Title: Health insurers; prohibit discrimination against independent clinical laboratories.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Failed) 2016-02-23 - Died In Committee [SB2142 Detail]
Download: Mississippi-2016-SB2142-Introduced.html
MISSISSIPPI LEGISLATURE
2016 Regular Session
To: Insurance
By: Senator(s) Carmichael
Senate Bill 2142
AN ACT TO PROHIBIT A HEALTH INSURER FROM DISCRIMINATING AGAINST ANY INDEPENDENT CLINICAL LABORATORY THAT IS LOCATED WITHIN THE STATE OF MISSISSIPPI AND IS WILLING TO MEET THE TERMS AND CONDITIONS FOR PARTICIPATION ESTABLISHED BY THE HEALTH INSURER; TO PROHIBIT A HEALTH INSURER FROM IMPOSING A MONETARY ADVANTAGE OR PENALTY THAT WOULD AFFECT A BENEFICIARY'S CHOICE AMONG THOSE INDEPENDENT CLINICAL LABORATORIES; TO PROVIDE INJUNCTIVE RELIEF FOR VIOLATIONS OF THE ACT; TO REQUIRE THE DEPARTMENT OF INSURANCE TO ADOPT REGULATIONS TO IMPLEMENT THE PROVISIONS OF THE ACT; TO AMEND SECTION 83-41-409, MISSISSIPPI CODE OF 1972, IN CONFORMITY THERETO; AND FOR RELATED PURPOSES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:
SECTION 1. As used in this act:
(a) "Department" means the Mississippi Department of Insurance.
(b) "ERISA" means the federal Employee Retirement Income Security Act of 1974, as amended, 29 USCS, Section 1001 et seq.
(c) "Health benefit plan" means (i) any health insurance policy or certificate, health maintenance organization contract, hospital and medical service corporation contract or certificate, self-insured plan or plan provided by a multiple employer welfare arrangement, to the extent permitted by ERISA; or (ii) any health benefit plan that affects the rights of a Mississippi insured and bears a reasonable relation to the State of Mississippi, whether delivered or issued for delivery in the state; or (iii) the Mississippi State and School Employees Health Insurance Plan; or (iv) the Mississippi Medicaid Program established in Section 43-13-101 et seq. Health benefit plan shall not include insurance arising out of a worker's compensation claim.
(d) "Health insurer" or "health care insurer" means any entity that is authorized by the State of Mississippi to offer or provide health benefit plans, policies, subscriber contracts or any other contracts of similar nature that indemnify or compensate health care providers for the provision of health care services.
(e) "Independent clinical laboratory" means a laboratory that is independent both of the attending or consulting physician's office and of a hospital, where microbiological, serological, chemical, hematological, biophysical, radiobioassay, cytological, immunohematological, immunological, pathological or other examinations are performed on materials derived from the human body, to provide information for the diagnosis, prevention, or treatment of a disease or assessment of a medical condition.
(f) "Noninsurer" means an entity that is not required to obtain authorization from the department to do business as a health insurer but that does have a provider network.
SECTION 2. A health insurer shall not discriminate against any independent clinical laboratory that is located within the State of Mississippi and is willing to meet the terms and conditions for participation established by the health insurer.
SECTION 3. (1) A health care insurer shall not, directly or indirectly:
(a) Impose a monetary advantage or penalty under a health benefit plan that would affect a beneficiary's choice among independent clinical laboratories that participate in the health benefit plan according to the terms offered. "Monetary advantage or penalty" includes:
(i) A higher copayment;
(ii) A reduction in reimbursement for services; or
(iii) Promotion of one independent clinical laboratory over another by these methods;
(b) Impose upon a beneficiary of health care services under a health benefit plan any copayment, fee or condition that is not equally imposed upon all beneficiaries in the same benefit category, class or copayment level under that health benefit plan when the beneficiary is receiving services from a participating independent clinical laboratory pursuant to that health benefit plan; or
(c) Prohibit or limit an independent clinical laboratory that is qualified under this act and is willing to accept the health benefit plan's operating terms and conditions, schedule of fees, covered expenses and utilization regulations and quality standards, from the opportunity to participate in that plan.
(2) Nothing in this act shall prevent a health benefit plan from instituting measures designed to maintain quality and to control costs.
(3) Insurers shall establish relevant, objective standards for initial consideration of an independent clinical laboratory and for an independent clinical laboratory to continue as a participating provider in the plan. Standards shall be reasonably related to service provided but not based solely on the volume of procedures performed by the provider.
SECTION 4. Any person adversely affected by a violation of this act may sue in a court of competent jurisdiction for injunctive relief against the health insurer.
SECTION 5. The Commissioner of Insurance, acting through the department, shall:
(a) Enforce this act using powers granted to the commissioner in the Mississippi Insurance Code; and
(b) Be entitled to seek an injunction against a health insurer in a court of competent jurisdiction.
SECTION 6. (1) This act shall apply to:
(a) All health insurers, regardless of whether they are providing insurance, including pre-paid coverage, or administering or contracting to provide provider networks; and
(b) All multiple employer welfare arrangements and multiple employer trusts.
(2) Nothing in this act shall be construed to cover or regulate health care provider networks offered by noninsurers.
SECTION 7. The department shall adopt regulations to implement the provisions of this act and may obtain any information from health benefit plans that is necessary to determine if such plan should be certified or enjoined.
SECTION 8. Section 83-41-409, Mississippi Code of 1972, is amended 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 * * *; and
(g) Comply with all requirements in Sections 1 through 7 of this act.
SECTION 9. This act shall take effect and be in force from and after July 1, 2016.
