An Act Concerning Conferences Between Health Carriers' Clinical Peers And Health Care Professionals.
The passage of SB00417 is expected to affect the ongoing relationship between health carriers, health care professionals, and covered individuals by ensuring that health care professionals are involved early in the decision-making process concerning medical necessity. By establishing a formal mechanism for discussion following adverse determinations, the bill promotes transparency and allows for potentially quicker resolutions to disputes regarding medical necessity. The effective date for this change is October 1, 2015, at which point health carriers must comply with the new provisions.
Senate Bill No. 417, also known as Public Act No. 15-139, addresses the procedural requirements for health carriers when notifying covered individuals about initial adverse determinations based on medical necessity. The bill specifically mandates that health carriers inform a covered person's health care provider of the opportunity for a conference with a clinical peer following such adverse decisions. This requirement aims to foster communication between health carriers and health care professionals and may lead to better outcomes for patients undergoing treatment.
The sentiment surrounding SB00417 appears to be generally positive, especially among health care professionals and advocates who view the enhanced communication channels as beneficial for patient care. Supporters argue that creating a formal opportunity for health care providers to confer with clinical peers can lead to more informed decisions that take into account the nuances of individual patient cases. However, some skepticism exists concerning the practical implementation of these provisions and whether health carriers might still employ delays in communication that could affect patient care outcomes.
Notable points of contention include concerns about how effectively health carriers will implement the new requirements and the potential for ongoing barriers to timely communication between clinical peers and health care professionals. While the bill establishes a clear policy requiring notification and opportunity for discussion, the actual impact will depend heavily on how tightly health carriers adhere to these regulations and whether they allocate sufficient resources to facilitate these required consultations. Potential loopholes or compliance challenges could undermine the bill's intent.