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SF 491 Senate Long Description

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)