Loading chat...
GA HB1151
Bill
Status
Introduced
3/10/2020
Primary Sponsor
Kim Schofield
Click for details
AI Summary
- Requires health carriers offering network plans to maintain provider networks sufficient in number and type to ensure covered persons can access all covered services without unreasonable travel or delay, with specific maximum wait times (10 business days for primary care, 15 for specialists/mental health) and travel distances (30 minutes/miles for urban primary care up to 60 minutes/miles for rural specialist care)
- Mandates that health carriers file network adequacy access plans with the Insurance Commissioner for approval beginning July 1, 2021, with the department certifying or disapproving network adequacy annually
- Requires every carrier-provider contract to include a consumer hold harmless provision prohibiting providers from balance billing covered persons for amounts owed by the carrier, and requires carriers to provide out-of-network services at in-network cost-sharing rates when the network lacks a sufficient or available provider type
- Establishes continuity of care protections requiring 60 days' written notice before a provider leaves or is removed from a network, with transitional care extending up to 90 days for patients in active treatment and through the postpartum period for pregnant patients in their second or third trimester
- Directs the Commissioner to create a standard two-page continuity of care authorization form by October 1, 2020, developed with input from an advisory committee of physicians, consumers, and insurers, and grants consumers a private right of action for carrier violations of the continuity of care provisions
Legislative Description
Health Benefit Plan Network Access and Adequacy Act; enact
Last Action
House Second Readers
3/13/2020
Full Bill Text
No bill text available