SB 249 IN

0likes☆Favorite🔕SubscribeShare

Passed One Chamber

Specifies that the compliance of a practitioner and a provider facility with federal law meets the good faith estimate requirements concerning health service costs. Allows the commissioner of the department of insurance to issue an order to discontinue a violation of a law (current law specifies orders or rules). Requires a domestic stock insurer to file specified information with the department of insurance. Prohibits a health plan from requiring a health care provider to submit a prior authorization request to a third party and requires the health plan to transmit the request to the third party through secure electronic transmission. Amends the deadline by which a health plan must respond to a nonurgent care prior authorization request. Requires a health plan to offer a health care provider that submitted a prior authorization and received an adverse determination the option to request a peer to peer review by a clinical peer concerning the adverse determination. Requires a health plan to post notice of a technical issue with its claims submission system on the health plan's Internet web site. Requires a health plan to post on its Internet web site not later than February 1 of each year: (1) the 30 most frequently submitted CPT codes in the previous calendar year; and (2) the percentage of the 30 most frequently submitted CPT codes that were approved in the previous calendar year. Establishes an approval process for a health plan's proposed premium rate increase of 5% or greater as compared to the previous calendar year. Prohibits an insurer and a health maintenance organization from altering a CPT code for a claim unless the medical record of the claim has been reviewed by an employee who is a licensed physician. Requires an insurer and a health maintenance organization to provide a contracted provider with a current reimbursement rate schedule: (1) every two years; and (2) when three or more CPT code rates change in a 12 month period. Urges the study by an interim committee of prior authorization exemptions for certain health care providers.

• Liz Brown Republican · author
• Ed Charbonneau Republican · author
• Michael Crider Republican · author
• Dave Heine Republican · sponsor

1. Jan 10, 2022 Authored by Senator Brown L · upper
2. Jan 10, 2022 First reading: referred to Committee on Health and Provider Services · upper
3. Jan 20, 2022 Senator Charbonneau added as second author · upper
4. Jan 27, 2022 Committee report: amend do pass, adopted · upper
5. Jan 31, 2022 Amendment #1 (Brown L) prevailed; voice vote · upper
6. Jan 31, 2022 Second reading: amended, ordered engrossed · upper
7. Jan 31, 2022 Senator Crider added as third author · upper
8. Jan 31, 2022 Senators Becker and Melton added as coauthors · upper
9. Jan 31, 2022 Senator Randolph added as coauthor · upper
10. Feb 1, 2022 Third reading: passed; Roll Call 163: yeas 49, nays 0 · upper
11. Feb 1, 2022 House sponsor: Representative Heine · upper
12. Feb 1, 2022 Cosponsors: Representatives Lehman, Carbaugh, Schaibley · upper
13. Feb 2, 2022 Referred to the House · upper
14. Feb 7, 2022 First reading: referred to Committee on Financial Institutions and Insurance · lower

The published texts of this bill as it moves through the legislature. Each links to the official document on the state legislature site. Data from OpenStates.

• Engrossed Senate Bill (S) · Jan 31, 2022 · PDF
• Introduced Senate Bill (S) · Jan 6, 2022 · PDF
• Senate Bill (S) · Jan 27, 2022 · PDF