Managed Care Reform Continues
Recently, the governor signed into law an extensive managed care reform package.
Senator Kemp Hannon (R-Garden City) weighed in saying, “This law is the result of long hours of difficult work and policy negotiation, over the course of several years, with multiple perspectives throughout the industry coming together to achieve consensus that reaches the initial goal set at the start: keep the consumer protected, the health providers protected, and the health insurers doing their job.”
“The compromises are part of an ongoing conversation held because reform needed to take place,” continued Senator Hannon, the ranking Republican member of the committee and one who had a significant role in the bill. “All those involved recognized the previous statutes, made in 1996, 1998, 2007, in public health law and insurance law, were not the conclusive, but the first steps, of managed care reforms.”
The bill addresses the following: eases the patient referral process to specialists and improves grievance procedures; regarding external appeals in terms of rare disease, the treatment is to be evaluated based on whether it is beneficial to the patient, versus mere comparison to standard treatment; utilization review of post-hospital care is to be completed in a tighter time frame, with home health care covered in interim, during the time decision is pending; timely processing and payment of health care claims to health care providers; prior notification by insurers and HMO’s of adverse reimbursement; allows for provisional credentialing of new health care professionals; external appeal may be pursued with concurrent adverse determination; network hospitals and providers no longer designated as non-participating because one or more other providers rendering services to the insured/enrollee for the same/relative medical condition, is out of network.
The reforms have started and implementation of Chapter 237 of the Laws of 2009 will continue over the next 17 months. For further legislative information and to sign up for email updates, visit Senator Hannon’s website, www.kemphannon.com.
