Relating to the termination or suspension by an insurer of a contract with a preferred provider.
Impact
The enactment of HB 2397 is expected to have a significant impact on state insurance regulations, specifically within the realm of provider contracts. By requiring insurers to furnish justification for contract terminations and to provide a mechanism for review, the bill is likely to foster a more equitable environment for healthcare providers. This legislative change may lead to increased accountability from insurers and create a more predictable framework for providers who find themselves at risk of losing their contracts.
Summary
House Bill 2397 addresses improvements to the process related to the termination or suspension of contracts between insurers and preferred providers. The bill mandates that before terminating a contract, insurers must provide written reasons and offer a reasonable review process for the affected provider, with certain exceptions for situations involving imminent harm or actions taken by medical licensing authorities. The intention behind this bill is to enhance transparency and ensure that providers have a fair opportunity to contest decisions made by insurers regarding their contract status.
Sentiment
Overall sentiment regarding HB 2397 appears to be cautiously optimistic among healthcare providers and advocates for patients' rights. Supporters of the bill have welcomed the greater oversight of insurance practices, highlighting its potential to protect providers and ensure fair treatment. However, there are concerns that insurers might find ways to circumvent these provisions, and some stakeholders emphasize the need to monitor the bill's implementation closely to ensure it achieves its intended goals.
Contention
While HB 2397 aims to improve contract termination processes, there are notable points of contention surrounding its scope and effectiveness. Critics have expressed apprehension that the exceptions outlined in the bill — particularly those involving imminent harm — could be broadly interpreted by insurers to justify terminations without adequate review. Additionally, the enforcement of the review process and the timelines provided for decision-making are areas that some legislators suggest require further refinement to ensure fairness and timeliness in resolving disputes.
Relating to preferred provider benefit plan out-of-pocket expense credits for payments made by an insured directly to a physician or health care provider.
Relating to health maintenance organization and preferred provider benefit plan minimum access standards for nonemergency ambulance transport services delivered by emergency medical services providers; providing administrative penalties.
Relating to the transfer and statutory novation of insurance policies from a transferring insurer to an assuming insurer through an insurance business transfer plan; authorizing fees.