Legislative Session number- 82

Bill Name: SF0491

E Providing for certain patient protections; requiring the commissioner of
commerce to divide a certain percentage of civil or administrative penalties
imposed on health carriers or health maintenance organizations among policy or
certificate holders affected by the violation, exception; authorizing HMOs to
establish flat fee copayments for prescription drugs, limiting the copayment for
brand name prescription drugs with generic equivalents and providing a certain
brand name prescription drug exception; requiring health maintenance contracts
to cover drugs, devices, treatment or procedures associated with clinical trials
under certain conditions, requiring HMO notice to enrollee participants of the
coverage upon enrollee inquiry; expanding expenditure data requirements for
health care cost containment purposes; excluding clinics or health care systems
acting under delegation agreements with regulated utilization review
organizations from the definition of utilization review organization, regulated
utilization review organizations to be accountable for the activities of the
clinic or health care system; requiring the licensing as physicians of persons
employed by health plan companies as medical directors, defining medical
director and providing an exception, requiring health plan company name and
licensure information reports to the commissioner of commerce; modifying certain
health plan company continuity of care requirements, specifying certain covered
services termination limits and certain notice, services authorization,
continuity of care plan preparation and disclosure requirements; modifying
certain requirements for access to specialty care, requiring mandatory standing
referrals under certain conditions and eliminating certain services and
secondary referral restrictions on specialists providing primary care services
to enrollees, authorizing certain health plan company limits; requiring the
commissioners of health and commerce in consultation with the commissioner of
employee relations (DOER) to convene a work group to study health plan coverage
of clinical trials, specifying certain membership representation requirements
and duties and requiring a report of findings and recommendations to the
legislature by a certain date; requiring the commissioner of health to by a
certain date evaluate the feasibility of collecting data on the quality of
patient care provided in hospitals, outpatient surgical centers and other health
care facilities, specifying certain examination and consideration requirements,
requiring preparation and distribution of a written report by a certain date
(mk, ja) (Ch. 196, 2001 VETO)