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PAG LIN
1 1 Section 1. NEW SECTION. 514I.1 SHORT TITLE.
1 2 This chapter shall be known and may be cited as the
1 3 "Patient Right To Know Act".
1 4 Sec. 2. NEW SECTION. 514I.2 DEFINITIONS.
1 5 As used in this section, unless the context otherwise
1 6 requires:
1 7 1. "Health care provider" means a person licensed under
1 8 Title IV, subtitle 3, of the Code, to provide health care
1 9 services.
1 10 2. "Health plan" means any public or private health plan
1 11 or arrangement offered by an insurance company, health
1 12 maintenance organization, or organized delivery system that
1 13 provides or pays the cost of health benefits, and includes an
1 14 organization or network of health care providers who furnish
1 15 health services for such plan under contract with the entity
1 16 offering the plan.
1 17 3. "Medical communication" means any communication, other
1 18 than a knowing and willful misrepresentation, regarding the
1 19 mental or physical health care needs or treatment of a patient
1 20 and the provisions, terms, or requirements of the health plan
1 21 or another health plan relating to such needs or treatment
1 22 made by a health care provider to any of the following: a
1 23 current, former, or prospective patient or the patient's
1 24 guardian or legal representative; an employee or
1 25 representative of the entity offering the health plan; or an
1 26 employee or representative of any state or federal authority
1 27 with responsibility for the licensing or oversight of such
1 28 entity or health plan. Medical communications include, but
1 29 are not limited to, communications concerning any tests,
1 30 consultations, or treatment options; any risks or benefits
1 31 associated with such tests, consultations, or options;
1 32 variation among health care providers and institutions
1 33 providing such services in experience, quality, or outcomes;
1 34 the basis or standard for the decision of an entity offering a
1 35 health plan to authorize or deny health care services or
2 1 benefits; the process used by such an entity to determine
2 2 whether to authorize or deny health care services or benefits;
2 3 and any financial incentives or disincentives provided by such
2 4 an entity to a health care provider that are based on service
2 5 utilization.
2 6 Sec. 3. NEW SECTION. 514I.3 PROHIBITION OF INTERFERENCE
2 7 WITH MEDICAL COMMUNICATIONS – LIMITATIONS.
2 8 1. An entity delivering, amending, or renewing a contract
2 9 to offer a health plan on or after July 1, 1997, shall not
2 10 provide, as part of a contract with a health care provider,
2 11 any restriction on or interference with a medical
2 12 communication. A contract delivered, amended, or renewed
2 13 prior to July 1, 1997, shall comply with this prohibition
2 14 within thirty days.
2 15 2. a. An entity offering a health plan shall not take any
2 16 of the following actions against a health care provider on the
2 17 basis of a medical communication:
2 18 (1) Refusal to contract with the health care provider.
2 19 (2) Termination of or refusal to renew a contract with the
2 20 health care provider.
2 21 (3) Refusal to refer patients to or allow others to refer
2 22 patients to the health care provider.
2 23 (4) Refusal to compensate the health care provider for
2 24 covered services.
2 25 (5) Any other retaliatory action against the health care
2 26 provider.
2 27 b. The prohibition against retaliatory actions applies to
2 28 actions taken on or after July 1, 1997, notwithstanding the
2 29 date of the occurrence of the medical communication upon which
2 30 the retaliatory action is based.
2 31 3. A provision in a health plan contract that is
2 32 prohibited under subsection 1 is deemed null and void.
2 33 4. This chapter shall not be construed as preventing an
2 34 entity offering a health plan from acting on information
2 35 relating to treatment actually provided to a patient or the
3 1 failure of a health care provider to comply with legal
3 2 standards relating to the provision of care.
3 3 EXPLANATION
3 4 This bill prohibits insurance companies, health maintenance
3 5 organizations, and organized delivery systems from restricting
3 6 or interfering with the medical communications between a
3 7 health care provider and the health care provider's patients
3 8 or employees of the entity offering the health plan or of a
3 9 state or federal licensing or oversight authority. The bill
3 10 also prohibits an entity which provides a health plan from
3 11 taking retaliatory action against a health care provider based
3 12 on medical communications. Any agreements or arrangements
3 13 prohibited by the bill immediately are deemed null and void.
3 14 However, health plans are given 30 days from enactment of the
3 15 bill to comply with the provisions of the bill.
3 16 LSB 1844XS 77
3 17 pf/sc/14
Text: SF00107 Text: SF00109 Text: SF00100 - SF00199 Text: SF Index Bills and Amendments: General Index Bill History: General Index
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