Establishes procedure for removal of health care facility from provider network and certain circumstances to allow for special enrollment period.
Impact
The bill introduces a 15-business day coverage period during which negotiations must take place between the health care facility and the insurance provider. This period is designed to allow time for both parties to reach an agreement before any changes impact the patients who rely on those services. If negotiations fail, a special enrollment period of 30 days will be made available for individuals affected, allowing them to select new health benefits plans and ensure continuity of care.
Summary
Senate Bill S1995 establishes clear procedures that must be adhered to when a health care facility is either removed from a health care provider's network or voluntarily leaves it. The bill mandates that prior to any removal, both the health care facility and the insurance carrier must provide electronic notice of the potential change, ensuring that all parties are informed, including the Department of Banking and Insurance. The legislation emphasizes the importance of communication, proposing that subscribers in affected areas also receive notice outlining the situation and its implications.
Contention
One notable point of contention is the responsibility that health care carriers have regarding claims after the initial 15-day negotiation period. If an agreement is not reached, the affected health care network will be considered out-of-network, which could lead to higher out-of-pocket costs for patients. Critics may argue that this could place a financial burden on patients who have to navigate the complexities of sudden changes in their insurance coverage and its potential implications on their health care access.
Carry Over
Establishes procedure for removal of health care facility from provider network and certain circumstances to allow for special enrollment period.