Legislative Session number- 83

Bill Name: SF2617

Relating to health, providing for patient protections; clarifying and+ modifying
the provision prohibiting accident and health insurers from +retroactively
denying coverage for preauthorized expenses, requiring communication +to the
enrollee of service or treatment coverage at the same time as the +determination
of medical necessity; expanding the provisions prohibiting health +plan company
retaliatory action against health care providers or enrollees or +patients,
authorizing enrollees or patients to participate in utilization +reviews and to
seek a second opinion; requiring utilization review organizations, +health plan
companies or claims administrators determining care as inappropriate,
unreasonable or medically unnecessary to provide copies of the +procedures used
to enrollees seeking the care, requiring the physician reviewer to be+ available
to discuss the determination with the attending physician and +enrollee;
strengthening a certain requirement of health plan companies to cover+ mental
health services; defining specialist for specialty care access +purposes and
imposing certain mandatory referral requirements on health plan +companies;
clarifying certain referral procedures disclosure requirements; +requiring
health plan companies to promptly evaluate the treatment needs of +enrollees
seeking treatment for medical conditions; requiring and providing for+ enrollee
or prospective enrollee access to evidence of coverage and drug +formularies;
prohibiting health plans providing coverage for prescription drugs +from
limiting or excluding coverage of a drug removed from the formulary +during the
term of the enrollee contract under certain conditions; modifying +certain
standards for external review of adverse determinations (ra)