HB 632 (BR 2055) - R. Damron
AN ACT relating to health insurance.
Create a new section of KRS 304.17A-500 to 304.17A-590 to establish standards to determine if a managed care plan has a dominant market share; require every insurer and every insurer holding company to report to the commissioner sufficient information to calculate market share; require a dominant insurer to allow covered persons in an accessing managed care plan access to participating providers in the dominant managed care plan; require the accessing managed care plan to give 120 days notice prior to date of access; provide that the participating provider in a dominant managed care plan does not have to provide goods or services to a covered person under an accessing managed care plan if the provider would not accept the person as a patient under normal business practices; allow the participating provider in a dominant managed care plan to apply to the commissioner to be excused from providing services to a covered person in an accessing managed care plan; prohibit a dominant managed care plan from providing any incentive for a participating health care provider to request to be excused; require an accessing insurer to reimburse a dominant insurer its administrative expenses in facilitating access to the dominant managed care plan up to five dollars per certificate holder per month; provide that a accessing insurer, who is improperly denied access or is injured by failure of a dominant insurer to comply with this Act, has a civil cause of action; amend KRS 304.17A-500, and 304.17A-515 to conform; amend 304.17A-250 to require the contract between insurer and health care provider to include a provision that the insurer and provider will comply with this Act; amend KRS 304.17A-300 to require a provider-sponsored integrated health delivery network to acknowledge that it is a managed care plan subject to the provisions of this Act; amend KRS 304.17A-525 to require insurers to include in provider contracts provisions that require the providers to accept the provisions of this Act; amend KRS 304.17A-565 and 304.17A-570 to conform.
Feb 9-introduced in House
Feb 10-to Banking and Insurance (H)
Feb 24-posted in committee