Chapter 06-218

2006 -- H 7572 SUBSTITUTE B

Enacted 07/03/06

A N A C T

RELATING TO HEALTH CARE SERVICES -- UTILIZATION REVIEW ACT

Introduced By: Representative Norman L. Landroche

Date Introduced: February 16, 2006

It is enacted by the General Assembly as follows:

     SECTION 1. Chapter 23-17.12 of the General Laws entitled "Health Care Services -

Utilization Review Act" is hereby amended by adding thereto the following section:

23-17.12-8.1. Variance of statutory requirements. – (a) The department is authorized

to issue a statutory variance from one or more of the specific requirements of this chapter to a

review agent where it determines that such variance is necessary to permit the review agent to

evaluate and address practitioner billing and practice patterns when the review agent believes in

good faith that such patterns evidence the existence of fraud or abuse. Any variance issued by the

department pursuant to this section shall be limited in application to those services billed directly

by the practitioner. Prior to issuing a statutory variance the department shall provide notice and a

public hearing to ensure necessary patient and health care provider protections in the process.

Statutory variances shall be issued for a period not to exceed one year and may be subject to such

terms and conditions deemed necessary by the department.

(b) On or before January 15, 2008, the department shall issue a report to the general

assembly summarizing any review agent activity as a result of a waiver granted under the

provisions of this section.

     SECTION 2. This act shall take effect upon passage and shall sunset and be repealed on

July 1, 2008.

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LC02345/SUB B/2

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