07-R408
2007 -- H 6502
Enacted 07/07/07
J O I N T
R E S O L U T I O N
CREATING A SPECIAL
LEGISLATIVE COMMISSION TO STUDY THE FEASIBILITY OF
ENACTING LEGISLATION
TO EMPOWER PRIMARY CARE PROVIDERS TO JOINTLY
NEGOTIATE WITH HEALTH
INSURERS
Introduced By:
Representatives Murphy, and Mumford
Date Introduced: June 06,
2007
WHEREAS,
A substantial amount of health care services in this state are purchased for
the
benefit of patients by health care insurers engaged in the provision of health
care financing
services
or it otherwise delivered subject to the terms and agreements between health
care
insurers
and providers of the services; and
WHEREAS,
Health care insurers also manage the health care services rendered to
patients
through utilization review programs and other managed care tools and associated
coverage
and payment policies; and
WHEREAS,
Health care insurers are often able to dictate the terms of the provider
contracts
that they offer primary care physicians and other health care providers, and
will
commonly
offer provider contracts on a take-it-or-leave-it basis; and
WHEREAS,
Current federal anti-trust enforcement policy restricts health care providers'
ability
to collectively negotiate fee-for-service arrangements with payers. The large
majority of
primary
care physicians and other health care providers do not have sufficient market
power to
negotiate
or reject provider contract terms; and
WHEREAS,
Health care insurers have significant influence by virtue of their market
power,
economic resources and control over payments. In response, health care
providers seek a
method
to assert their appropriate balancing influence on health care issues; and
WHEREAS,
It is the intention of the general assembly to determine the public benefit or
consequences
associated with authorizing primary care providers to jointly discuss with
health
care
insurers topics of concern regarding the provision of quality health care, or
to jointly
negotiate
with health care insurers and to qualify such joint negotiations and related
joint
activities
for the state-action exemption to the federal and state anti-trust laws through
the
articulated
state policy and active supervision of the state attorney general; now,
therefore be it
RESOLVED,
That a special legislative commission be and the same is hereby created
consisting
of five (5) members: one of whom shall be the Health Care Advocate of the
Department
of Attorney General, or designee; one of whom shall be the Director of the
Department
of Health, or designee; one of whom shall be the Commissioner of the Office of
the
Health
Insurance Commissioner, or designee, who shall be the chair; and two (2) of
whom shall
be
primary care practitioners or their representatives, of whom one shall be
appointed by the
President
of the Senate, and one shall be appointed by the Speaker of the House.
The
purpose of the Commission shall be to develop recommendations for strengthening
the
role of the state's primary care providers within the health care system,
including, legislative
recommendations
regarding the creation of a state-authorized and state-monitored mechanism
allowing
primary care providers to jointly negotiate health care provider and
participation
agreements
with health insurers.
Forthwith
upon passage of this resolution, the members of the commission shall meet at
the
call of the Health Insurance Commissioner who shall provide suitable quarters
and staff for
said
commission. Vacancies in said commission shall be filled in like manner as the
original
appointment.
The
membership of said commission shall receive no compensation for their services.
RESOLVED,
That the commission shall report its findings and recommendations to the
General
Assembly no later than January 1, 2008 and said commission shall expire on May
1,
2008.
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LC03290
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