S.B. 98 Summary

• Establishes standards for health care insurers that create rating systems (grades, stars, tiers) to designate physician quality, cost efficiency, or clinical performance.

• Requires insurers to include quality-of-care components in physician designations and use accurate statistical analyses adjusted for patient population, case mix, severity, and comorbidities.

• Mandates insurers notify physicians in writing before public disclosure of designations and delay disclosure for 45 days minimum to allow physicians to request information and appeal the designation.

• Requires insurers to provide physicians with detailed descriptions of methodology and data used within 45 days of request, and complete methodology within 30 days of follow-up request, with no trade secret exemption.

• Establishes appeal procedures with decision-making timelines (45 days), written final decisions, and requires insurers to modify designations if appeals are successful; violations constitute unfair and deceptive practices; applies standards to Medicaid program.