An Act relating to liability for providing managed care services, to regulation of managed care insurance plans, and to patient rights and prohibited practices under health insurance; and providing for an effective date.

Updated: March 21, 2000

Patients need assurance that the quality of their health care will not be compromised as managed care expands. Labor and Commerce Committee Substitute House Bill 211 requires managed care entities to provide a reasonable standard of health care, and holds them civilly liable if they do not. It also establishes requirements for contracts between managed care entities and their health care providers, patients and their group managed care plans, and health care insurers and their insureds, providing patients with the following:

• access to emergency room services
• availability of medical services or adequate referral options
• full disclosure of treatment options
• choice of health care providers, including specialists
• clear descriptions of covered items and services, benefits, procedures, compensation methods, availability (and exclusions) of prescription medications and the availability of translation or interpreter services
• a point-of-service plan option
• follow-through of preapproved payment
• quick utilization review decisions
• opportunity for appeals of utilization review decisions
• added protection from denial, reduction, or termination of payment for health care services

In addition, this legislation gives health care providers the freedom to share all testing and treatment options with their patients, and lets them advocate for their patients without the risk of being penalized or terminated by the managed care entity they contract with. It also prohibits contracts between managed care entities and health care providers from including "hold harmless" clauses for the managed care entity or financial incentives for providers to withhold medically necessary services.

While it streamlines the health care system, managed care may also increase the vulnerability of patients and doctors, resulting in a lower quality of care. HB211 is necessary to ensure continued quality health care in the face of a growing managed care industry.I urge you to support this legislation.