HB 6308 - Healthcare Reform Summary

• Establishes partnership health plans for nonstate public employers and nonprofit employers through the Comptroller, with coverage beginning January 1, 2012 for public employers and January 1, 2013 for nonprofits, with actuarial review to prevent adverse risk selection.

• Creates comprehensive utilization review and external appeal procedures for health carriers, including expedited reviews for urgent care requests, internal grievance processes, and independent external review by the Insurance Commissioner with 72-hour turnaround for expedited cases.

• Implements dependent coverage extensions to age 26 for individual and group health plans, eliminates preexisting condition exclusions for individuals under 18, and removes lifetime limits on essential health benefits in compliance with federal healthcare reform requirements.

• Regulates third-party administrators and establishes licensing requirements including surety bonds, written agreements with insurers, fiduciary account requirements, and restrictions on contingency-based compensation to protect consumer funds.

• Establishes the Office of Health Reform and Innovation to coordinate state and federal healthcare reform implementation, creates the SustiNet Health Care Cabinet to advise on integrated healthcare system development, and implements data reporting requirements for hospitals and insurers to support healthcare cost containment efforts.