Relating to mediation of out-of-network health benefit claim disputes concerning enrollees, facility-based physicians, and certain health benefit plans; imposing an administrative penalty.
Impact
The implementation of HB 2256 is expected to have significant implications for state laws around health insurance and the operation of medical facilities. The bill specifically stipulates requirements regarding network adequacy, which implies hospitals would need to ensure that there is a sufficient number of providers available for each medical specialty. Moreover, it prohibits exclusive contracts between hospitals and specific physician groups or health benefit plans, thereby fostering a competitive environment for medical services. These changes suggest an effort to improve access for enrollees and enhance the overall quality of care provided within the state.
Summary
House Bill 2256 aims to establish a framework for the mediation of disputes arising from out-of-network health benefit claims involving enrollees and facility-based physicians. By regulating the relationships between physicians, hospitals, and health benefit plans, the bill intends to ensure that certain standards are maintained in the provision of health care services. This legislation would apply to all health benefit plans that provide coverage for medical expenses and would enforce specific contractual requirements designed to better facilitate resolution of payment issues that can occur when services are delivered outside of a network. Notably, the introduction of mediation could imply a more central role for state authorities in resolving disputes that previously depended on individual negotiation between these parties.
Contention
While support for HB 2256 is grounded in the belief that it will lead to fairer practices in the mediation of health benefit disputes, some stakeholders have raised concerns regarding potential administrative burdens and enforcement issues. Critics assert that the mediation process could complicate and delay the resolution of claims, creating obstacles for patients seeking prompt reimbursement for out-of-network services. The balancing act between providing adequate healthcare access and enforcing regulatory measures presents a point of contention that will likely continue to be debated during the bill's consideration.
Relating to claims submitted and requests for verification made by a physician or health care provider to certain health benefit plan issuers and administrators.
Pharmacists authorized to prescribe, dispense, and administer drugs to prevent acquisition of human immunodeficiency virus; pharmacists authorized to order, conduct, and interpret laboratory tests necessary for therapy that uses drugs to prevent acquisition of human immunodeficiency virus.
Licensed pharmacist authority expanded to initiate, order, and administer vaccines and medical and laboratory tests; and medical assistance coverage required.