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SB17-151

Consumer Access To Health Care

Concerning changes in the requirements for the coverage of health care benefits to allow for increased consumer access to health care services.
Session:
2017 Regular Session

The bill requires a health insurance carrier or an intermediary that conducts credentialing, utilization management, or utilization review to:

  • Base health care coverage authorizations and medical necessity determinations on generally accepted and evidence-based standards and criteria of clinical practice;
  • Disclose to a carrier's policyholders and providers the evidence-based standards and criteria of clinical practice and processes that the carrier uses for coverage authorizations and medical necessity determinations of health care services;
  • Ensure that coverage authorizations and medical necessity determinations are performed by a health care provider;
  • Categorize a condition as a new episode of care if the same provider has not treated the policyholder for the condition within the previous 30 days; and
  • Ensure that tiered prior authorization criteria are based on generally accepted and evidence-based standards and criteria of clinical practice.

The bill prohibits:

  • An intermediary from requiring coverage authorization or a medical necessity determination prior to the evaluation and management services provided by a health care provider to a policyholder during an initial health care visit; and
  • A carrier from creating incentives to reduce or deny coverage authorizations or medical necessity determinations.
    (Note: This summary applies to this bill as introduced.)

Status

Introduced
Lost

Bill Text

Sponsors

Sponsor Type Legislators
Prime Sponsor

Sen. L. Crowder,
Rep. J. Ginal,

Sponsor

Sen. J. Kefalas,

Co-sponsor