By Ms. Resor, a petition (accompanied by bill, Senate,
No. 632) of Pamela P. Resor for legislation relative to
fair and equitable managed care contracting standards.
Financial Services. |
By Ms. Resor, a petition (accompanied by bill, Senate,
No. 632) of Pamela P. Resor for legislation relative to
fair and equitable managed care contracting standards.
Financial Services. |
Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:
SECTION
1. Chapter 1760 of the General Laws is hereby amended by inserting after
section 10 (b) (3) the following:
(4) a requirement that physician group budgets be based on an accepted per
member per month cost determined by actuarial input from a collaboration of
representatives including physicians, business groups, employers, carriers and
the Division of Insurance.
(5) a requirement that reinsurance amounts be determined according to an
actuarial standard estimate of catastrophic events in a provider unit.
(6) a requirement that carriers provide the physician or physician group with
detailed expense descriptions, including but not limited to member name, dates
of service, primary care and referring physician information, the physician
and/or facility performing the services, amount paid, and, where applicable,
amount withheld. Physicians should also receive specific information on the
company's provider units and/or contracted physicians reconciliation process so
that the provider can review the information at least three months prior to the
corporation's declaring the provider unit above, under, or at budget."
(7) a provision permitting the provider to refuse participation in one or more
such other plans at the time the contract is executed without affecting the
provider's status as a member of or for eligibility in the plan which is the
subject of such contract or other plans."
(8) a prohibition against modification of the contract without the express,
written consent of all parties.
(9) a requirement that claims which may involve other carriers or future
settlements, including but not limited to auto accidents involving legal cases,
be extracted from year end budget and settlement information
