SB 1245 Allows physicians to jointly negotiate with certain health carriers
LR Number:4455S.01I Fiscal Note:4455-01
Committee:Small Business, Insurance & Industrial Relations
Last Action:02/16/04 - Second Read and Referred S Small Business, Insurance Journal page:S320
and Industrial Relations Committee
Effective Date:August 28, 2004
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Current Bill Summary

SB 1245 - This act allows two or more physicians to jointly negotiate with a carrier to engage in certain activities involving non-fee-related matters. These activities shall include: defining medical necessity; utilization management procedures; clinical practice guidelines; preventive care policies; patient referrals; drug formularies; liability of physicians; method and timing of payments; procedures for selecting and terminating participating physicians; and terms of contracts.

If the Attorney General finds that a carrier has a substantial amount of market power in a particular area and that this is a threat to the quality of patient care, then two or more physicians may negotiate with the carrier regarding fees and fee- related matters.

Before entering into negotiations, a joint negotiation representative must submit certain information, including a fee, to the Attorney General for his approval. Physicians are permitted to communicate with each other and the representative regarding contractual terms. The representative shall have the sole authority to negotiate with the carrier on behalf of the physicians as a group.

After an agreement has been reached between the representative and the carrier, a copy of the proposed contract must be submitted to the Attorney General for his written approval or disapproval. If negotiations end, then the representative must report such information to the Attorney General within 14 days. All information disclosed to the Attorney General shall be confidential.

The Attorney General shall report to the Governor and the General Assembly by August 28, 2008 on the implementation of this bill. The Attorney General shall have rule-making authority.