Introduced By: Representatives Reilly, Iwuc, Rose, Almeida and Giannini
Date Introduced : January 28, 1999
It is enacted by the General Assembly as follows:
SECTION 1. Title 23 of the General Laws entitled "Health and Safety" is hereby amended by adding thereto the following chapter:
{ADD 23-17.18-1. Modification of health plans. -- ADD} {ADD (a) A health plan may materially modify the terms of a participating agreement it maintains with a physician only if the plan disseminates in writing by mail, to the physician the contents of the proposed modification and an explanation, in nontechnical terms, of the modification's impact. ADD}
{ADD (b) The health plan shall provide the physician an opportunity to amend or terminate the physician contract with the health plan within sixty (60) days of receipt of the notice of modification. Any termination of a physician contract made pursuant to this section shall be effective fifteen (15) calendar days from the mailing of the notice of termination in writing by mail, to the health plan. The termination shall not affect the method of payment or reduce the amount of reimbursement to the physician by the health plan for any patient in active treatment for an acute medical condition at the time the patient's physician terminates his, her or its physician contract with the health plan until the active treatment is concluded or, if earlier, one (1) year after the termination and, with respect to the patient, during the active treatment period the physician shall be subject to all the terms and conditions of the terminated physician contract, including but not limited to all reimbursement provisions which limit the patient's liability. ADD}
{ADD (c) Nothing in this section shall apply to accident-only, specified disease, hospital indemnity, medicare supplement, long-term care, disability income, or other limited benefit health insurance policies. ADD}
SECTION 2. Section 27-20-5.2 of the General Laws in Chapter 27-20 entitled "Nonprofit Medical Service Corporations" is hereby repealed.
{DEL 27-20-5.2. Contracts for medical services. -- DEL}{DEL
(a) A nonprofit medical service corporation may modify the terms
of a medical services agreement it maintains with a physician
if the nonprofit medical service corporation: DEL}
{DEL (1) disseminates in writing by certified mail, return
receipt requested, to the physician the contents of the proposed
modification and an explanation, in nontechnical terms, of the
modification's impact; the nonprofit medical service corporation
shall provide the physician an opportunity to amend or terminate
the agreement with the nonprofit medical service corporation within
sixty (60) days of receipt of the notice of modification. Any
termination of a physician agreement made pursuant to this section
shall be effective fifteen (15) calendar days from the mailing
of the notice of termination in writing by certified mail, return
receipt requested, to the nonprofit medical service corporation.
The termination shall not affect the method of payment or reduce
the amount of reimbursement to the physician by the nonprofit
medical service corporation for any patient in active treatment
for an acute medical condition at the time the patient's physician
terminates his or her medical service agreement until the active
treatment is concluded or if earlier, one year after the termination
and with respect to the patient and during the active treatment
period, the physician shall be subject to all of the terms and
conditions of the terminated medical service agreement, including
but not limited to all reimbursement provisions which limit the
patient's liability, or any of all rules, regulations, policies,
and agreements incorporated by reference which apply to his or
her physician agreement; and DEL}
{DEL (2) reimburse each physician the reasonable cost of photocopying
any records or documents required to be submitted to the nonprofit
medical service corporation for any reason. DEL}
{DEL (b) This section shall apply to all physician agreements
in effect on June 17, 1991 and any agreements entered into thereafter. DEL}
SECTION 3. This act shall take effect on October 1, 1999 and shall apply to incidents occurring on and after the effective date.
