CS/CS/CS/HB 221 - Health Care Services

• Requires health insurance plans and health maintenance contracts to cover treatment of Down syndrome through speech therapy, occupational therapy, physical therapy, and applied behavior analysis, effective April 1, 2009.

• Establishes a standardized two-page prior authorization form approved by the Financial Services Commission for health insurers and pharmacy benefits managers without electronic prior authorization processes, effective January 1, 2017.

• Creates new insurer liability requirements for nonparticipating provider payments, making insurers solely liable for emergency and certain nonemergency services and prohibiting providers from balance billing patients beyond copayments, coinsurance, and deductibles.

• Requires hospitals to post on their websites names and hyperlinks for contracted health insurers and health maintenance organizations, practitioner contact information, and a disclosure statement informing patients that practitioners may not participate with the same insurers as the hospital.

• Establishes settlement offer procedures in the statewide provider and health plan claim dispute resolution program with specific thresholds (90-110 percent of offer amount) and modifies disciplinary grounds for health care providers and insurers for willful non-compliance with out-of-network reimbursement requirements.