HB 420 -- Managed Care

Sponsor:  Hagan-Harrell

This bill modifies provisions relating to managed care entities
and requirements for open referrals, legal actions against the
entity, and preventative services.  In its provisions relating
to open referrals, the bill requires managed care entities to
offer open referrals in all health plans so that a referral from
a primary care physician is not required to obtain medical
treatment.  Relating to legal actions against managed care
entities, the bill specifies that the managed care entity is
liable to an enrollee for damages caused by a failure to
exercise ordinary care in making treatment decisions.  The
entity is not liable for damages if it did not participate in
the treatment and if payment for treatment was not denied or
delayed by the entity.  Managed care entities are prohibited
from contracting with physicians, hospitals, and other health
care providers if the contract includes a provision that the
managed care entity will be held harmless from damages caused by
its treatment decisions.

The bill also includes exceptions to the utilization review
requirements of Chapter 376 and requires managed care entities
to offer coverage for preventative services such as annual
physical examinations, immunizations, and cancer screening.