This bill amends the Managed Care Law to establish new standards for health carrier provider contracts, particularly focusing on the termination of such contracts that affect a significant number of patients. It allows the insurance commissioner to hold an informational public hearing within 15 business days of receiving notice of a contract termination that impacts 1,000 or more covered persons. The purpose of the hearing is to gather information on how the termination may affect access to care in the community, but it does not grant the commissioner the authority to approve or disapprove the termination. Additionally, the bill mandates that health carriers provide written notice to affected patients within 5 business days of the contract termination, detailing their rights to continued access to the provider for 60 days post-termination.

The bill also repeals and reenacts a section of the Managed Care Law regarding provider contract standards. It requires that all contracts entered into after July 1, 2003, include a provision for continued access to the provider for 60 days following termination, except in cases of unprofessional conduct. The continued access must be reimbursed according to the terms of the health benefit plan and the prior contract. Furthermore, the commissioner is authorized to adopt rules to specify the notice content and process for consumers when a contract is terminated. The effective date of the act is set for 60 days after its passage.

Statutes affected:
Introduced: 420-J:8
As Amended by the Senate: 420-J:8
SB548 text: 420-J:8