An Act to reduce inequities in access to medical procedures
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Progress
Where this bill stands in the legislative process.
- Introduced
- Passed House
- Passed Senate
- To Governor
- Became Law
Overview
This bill aims to address inequities in healthcare access by preventing insurance companies from reducing payments to providers solely because they also provide other services, such as minor surgery, on the same day. It focuses on ensuring fair reimbursement for evaluation and management services and procedural services. The bill establishes guidelines for administrative services provided by carriers or utilization review organizations.
Key provisions
- Carriers cannot reduce payments to providers for evaluation and management or procedural services if those services are furnished by a participating provider and are otherwise covered.
- Provisions in provider agreements that allow for reduced reimbursement based on bundled services are void.
- Carriers or utilization review organizations must recommend coverage authorization to the third-party payor.
- The bill addresses payment inequities related to bundled services.
- It clarifies the responsibilities of carriers and utilization review organizations regarding payment recommendations.
- It focuses on evaluation and management and procedural services.
- It prohibits payment reductions based on bundled services.
- It establishes guidelines for administrative services.
Who is affected
- Healthcare providers
- Insurance companies
- Patients
- Health benefit plan enrollees
Bill text
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Sponsors
Official sponsors from legislative records.
2 on record
Primary sponsor
Joint Committee on Financial Services
Cosponsor
William C. Galvin
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