Relating to health; requiring the health data institute to collect certain utilization and enrollee data; expanding the prohibition on agreements or directives between health plan companies and health care providers and clarifying the financial incentives disclosure requirement; prohibiting health plan companies from interfering with decisions of treating physicians, authorizing certain service and coverage limits; expanding the prohibition on health plan company or health care provider retaliation or discrimination for complaints; modifying the utilization review and notice process; requiring organization procedures for independent external appeals of certain determinations and prohibiting certain health care professional utilization review conflicts; requiring and providing for the adequacy of preferred provider networks, for enrollee choice of providers and for a written process for selection of participating providers, specifying certain discrimination prohibitions; requiring health plan companies to consult with participating physicians on medical policy, quality and medical management procedures; modifying and expanding certain health plan company complaint resolution process requirements, requiring and providing for the establishment of internal and external appeals processes, including health maintenance organizations under the external appeals process requirement, specifying certain rulemaking requirements of the commissioners of commerce and health and providing for certification of external appeal entities by the commissioner of commerce; prohibiting health plan companies from discriminating against enrollees in the delivery of health care services; specifying certain minimum hospital stay requirements for breast cancer treatment and specifying certain prohibited discriminatory practices; requiring health plan companies providing coverage for mastectomies to provide coverage for resulting reconstructive breast surgery; requiring coverage for certain investigation uses of prescription drugs; modifying certain requirements for the coverage of emergency services; expanding continuity of care requirements; requiring and providing for enrollee access to specialty care and for coverage for approved clinical trials; requiring and providing for health plan companies to establish and maintain ongoing internal quality assurance and continuous quality improvement and drug utilization programs; specifying certain disclosure requirements of health plan companies and including HMOs under the requirements; requiring and providing for the confidentiality of medical records; reducing the time limit for preauthorization of nonemergency services or benefits; specifying certain reference substitution requirements of the revisor of statutes; repealing the dispute resolution procedure and the point of service option exemption for certain smaller health plan companies (mk)