MS HB737

Managed care plans must provide participating providers with electronic or CD-ROM access to complete fee schedules showing allowable amounts for all Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes used in covered services.

Managed care plans must establish a Physician Advisory Committee with 12 members (including the chief medical officer as chair) composed of participating providers, and must publicly disclose committee recommendations and the plan's responses on its provider website.

Managed care plans must establish a Billing Dispute External Review Process to resolve disputes with participating providers over coding application and payment rules when the amount in dispute exceeds $500.00.

Managed care plans are prohibited from unilaterally amending material contract provisions, requiring separate agreements when hospitals offer master agreements, imposing telemedicine requirements beyond state law, or enforcing contracts exceeding five years or containing automatic renewal clauses.

Managed care plans cannot be certified or recertified unless the commissioner determines the operating entity has not maintained excessive surplus; the commissioner must publish regulations within 90 days defining excessive surplus and fair distribution plans.