E Relating to health; establishing a uniform complaint resolution process for health plan companies, excluding companies licensed to sell accident and sickness insurance and nonprofit health service plan corporations providing only dental or vision coverage; defining complaint and complainant; requiring health plan companies to establish and maintain an internal complaint resolution process meeting certain requirements; specifying the procedures for filing a complaint and certain notice requirements of health plan companies relating to decisions; requiring health plan companies to establish an internal appeal process for reviewing decisions relating to filed complaints and specifying the procedures for filing an appeal; requiring health plan companies to inform enrollees of the complaint resolution procedure and the procedure for utilization review in member handbooks, subscriber contracts or certificates of coverage, specifying certain notice requirements; requiring health plan companies to maintain records of enrollee complaints and resolutions, specifying a minimum retention period requirement, requiring reports of unresolved complaints to the commissioners of commerce or health; granting enrollees receiving adverse determinations the right to external review, defining adverse determination and imposing a request filing fee, cost of the external review in excess of the filing fee to be borne by the health plan company, authorizing human services program recipient requests for expert medical opinions under the external review process during the course of appeal of medical determinations to the commissioner of human services, costs to be paid by the commissioner; requiring the commissioner of administration in consultation with the commissioners of health and commerce to contract with an organization or business entity to provide independent external reviews of adverse determinations, specifying certain request for proposal criteria and prescribing the external review process and certain standards of review, decision to be nonbinding on the enrollee and binding on the health plan company, authorizing the health plan company to seek judicial review on certain grounds; granting immunity from civil liability to persons participating in good faith in external reviews; requiring the commissioners to make available to the public upon request summary data on rendered decisions; including health maintenance organizations under the requirements; specifying certain geographic accessibility requirements for certain HMO services, providing for certain exceptions; modifying certain provisions under the utilization review act, conforming certain provisions to the complaint resolution and appeal processes; expanding jurisdiction to community integrated service networks (CISN) and accountable provider networks and modifying the scope; modifying certain definitions and defining health plan company; requiring communication of initial determination on requests for utilization review to the provider and enrollee within a certain number of days of the request and modifying the procedure for notice of determination not to certify; requiring use of an expedited initial determination under certain conditions; modifying the appeal process and notice requirements and certain requirements relating to prior authorization of services; repealing the HMO complaint system and the health plan company complaint procedure and dispute resolution processes and certain rules ( ja)