SB 0853 Regulation of HMOs With Regard to Emergency Services
LR Number:L2194.02I Fiscal Note:2194-02
Committee:Corrections and General Laws
Last Action:02/27/96 - Voted Do Pass S Corrections & General Laws Committee
Effective Date:August 28, 1996
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Current Bill Summary

SB 853 - This act regulates the actions of health maintenance organizations (HMOs) with regard to access to emergency services. Emergency services are defined as a medical condition with symptoms of sufficient severity that a lay person would believe a visit to an emergency facility is warranted. HMOs must provide 24 hour access to emergency services.

HMO plans must reimburse emergency service providers even if they do not have a contractual arrangement with those providers. HMOs assume full legal and financial responsibility for a patient if the HMO acts against the recommendations of the attending physician of an individual following emergency services. According to the provisions of this act, HMOs may not retrospectively deny the authorization for an evaluation or treatment.