SB0130 Summary

• Amends the Health Maintenance Organization Act to establish that HMOs may voluntarily use a referral system for enrollees to access contracted or employed providers, but such use is not mandatory to obtain a certificate of authority.

• Defines "referral system" as an arrangement where a primary care provider coordinates or manages an enrollee's care by referring them to other providers or specialists.

• Clarifies in the "health care plan" definition that nothing requires HMOs to utilize a referral system for enrollees to access basic health care services and other health care services from contracted or employed providers.

• Effective January 1, 2024.