Synopsis As Introduced Creates the Network Adequacy and Transparency Act. Provides that administrators and insurers, prior to going to market, must file with the Department of Insurance for review and approval a description of the services to be offered through a network plan, with certain criteria included in the description. Provides that the network plan shall demonstrate to the Department, prior to approval, a minimum ratio of full-time equivalent providers to plan beneficiaries and maximum travel and distance standards for plan beneficiaries, which shall be established annually by the Department based upon specified sources. Provides that the Department shall conduct quarterly audits of network plans to verify compliance with network adequacy standards. Establishes certain notice requirements. Provides that a network plan shall provide for continuity of care for its beneficiaries under certain circumstances and according to certain requirements. Provides that a network plan shall post electronically a current and accurate provider directory and make available in print, upon request, a provider directory subject to certain specifications. Provides that the Department is granted specific authority to issue a cease and desist order against, fine, or otherwise penalize any insurer or administrator for violations of any provision of the Act. Makes other changes. Effective January 1, 2018.
House Committee Amendment No. 1 Replaces everything after the enacting clause. Reinserts the introduced bill with the following changes: Removes the definition of "administrator". Includes in the definition of "insurer" workers compensation insurance and pharmacy benefit managers. Defines "telehealth" and "telemedicine". Removes references to "administrators" throughout the Act. Removes provisions requiring an insurer providing a network plan to file the following information with the Director of Insurance: the method of the marketing plan and certain written policies and procedures. Provides that insurers shall provide the Director a description of how the use of telemedicine, telehealth, or mobile care services may be used to partially meet the network adequacy standards (rather than a description of each network hospital of the percentage of physicians in certain specialties who practice in the hospital are in the insurer's network). Provides that the Department shall consider establishing ratios for certain physicians or other providers (rather than requiring ratios at a minimum to include certain physicians or other providers). Provides that maximum travel and distance standards for network plan beneficiaries established annually by the Department shall be done in consultation with the Department of Public Health. Removes the requirement that the network plan must demonstrate, prior to approval, that it has contracted with physicians who specialize in certain areas in sufficient numbers at any in-network facility or in-network hospital so patients have reasonable access to the in-network physicians. Provides that the network plan shall demonstrate sufficient inpatient services. Provides that the network plan may consider use of other health care service delivery options. Provides that the Director may (rather than shall) conduct periodic (rather than semi-annual) audits of the accuracy of provider directories. Removes language granting the Director specific authority to issue a cease and desist order against, fine, or otherwise penalize any insurer for violations of any provision of the Act. Makes other changes.
House Floor Amendment No. 2 Provides that the Act applies to an individual or group policy of accident and health insurance with a network plan amended, delivered, issued, or renewed in this State on or after January 1, 2019. Defines "authoritative representative". Removes references to "exchange plans or Medicare Advantage Plans". Removes language that requires insurers to file a description of services for review prior to going to market. In provisions concerning notice of renewal or termination, includes language that primary care providers must notify active affected patients of nonrenewal or termination of the provider from the network plan, except in the case of incapacitation. Adds provisions concerning facility nonparticipating provider transparency. Makes other changes. Provides that the bill takes effect upon becoming law (rather than on January 1, 2018).
Senate Committee Amendment No. 1 In provisions concerning network adequacy, removes language providing that the network plan shall demonstrate sufficient inpatient services, including services by preferred providers who specialize in emergency medicine, anesthesiology, pathology, and radiology. Removes provisions concerning facility nonparticipating provider transparency.