SB 0082 Creates procedures for physicians to engage in negotiations with HMOs and certain other insurance companies
LR Number:0052S.02I Fiscal Note:0052-02
Committee:Insurance and Housing
Last Action:01/24/01 - Hearing Conducted S Insurance & Housing Committee Journal page:
Effective Date:August 28, 2001
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Current Bill Summary

SB 82 - This act creates procedures for physicians to engage in negotiations with health maintenance organizations (HMO) and certain other insurance companies. This act will be known as the Patient-Physician Advocacy Act.

Physicians may negotiate their contracts with HMOs and certain other large insurance entities as a group or through a third party representative, which may be a member of the physicians' group or another person designated by the group to be the negotiator.

Physicians within a service area of a health insurance policy may meet and discuss, for the purpose of negotiating practices and procedures that include, but are not limited to: contract negotiations; the delivery of care and cost-efficient health management; promoting patient education; identifying fraud; administrative needs; dispute resolution; patient referral; physician reimbursement; quality assurance; utilization review; and physician selection and termination criteria. The Department of Insurance may collect annual information on the impact of this provision on state physician fees.

Any person authorized as a physician representative must comply with specific requirements and provide specific information to the Attorney General as outlined in subsection 9 of Section 354.526 of this act. After the parties have negotiated, the representative must provide a copy of the proposed contract to the Department for review and response within certain time limits.

Physicians may not jointly coordinate the cessation or limitation of health care services. They may not negotiate with the insurance company to restrict non-physician health care providers from participation in the policy simply because they are non-physicians. Finally, the physician representative will be required to pay a fee to the Department in order to act as a representative.

This act is substantially similar to SB 829 (2000).