305 Ill. Comp. Stat. § 5/5-30.3. Empowering meaningful patient choice in Medicaid Managed Care: Medical Assistance – Illinois
Status: Enacted Year Enacted: 2016
Each medicaid managed care entity shall have an updated provider directory. Medicaid Managed Care Entities shall publish on their respective websites a formulary for each plan offered and make the formularies easily understandable and publicly …
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305 Ill. Comp. Stat. § 5/5-30.5. Managed care; automatic assignment: Medical Assistance – Illinois
Status: Enacted Year Enacted: 2017
Medicaid enrollees shall be automatically enrolled in plans thought an algorithm which is designed to preserveexisting provider-beneficiary relationships that takes into account quality scores and other operational proficiency criteria developed, defined, and adopted by the …
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35 Pa. Cons. Stat. § 448.802a. Definitions: Health Care Facilities Act – Pennsylvania
Status: Enacted Year Enacted: 1980
The following words and phrases when used in this chapter shall have, unless the context clearly indicates otherwise, the meanings given them in this section.
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35 Pa. Cons. Stat. § 448.804. Administration: Health Care Facilities Act – Pennsylvania
Status: Enacted Year Enacted: 1980
The department shall administer this chapter so as to encourage innovation and experimentation in health care and health care facilities consistent with the provisions of this chapter and shall encourage contributions of private funds and …
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35 Pa. Stat. and Cons. Stat. Ann. §§ 449.1 through 449.19: Health Care Cost Containment Act – Pennsylvania
Status: Enacted Year Enacted: 1986
Governs initiatives for cost containment of health care costs including the establishment of a Health Care Cost Containment Council, provisions regarding health care for the medically indigent, implementation of mandated health benefits, making data accumlated …
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40 Pa. Cons. Stat. § 991.2162. External grievance process: Quality Health Care Accountability and Protection – Pennsylvania
Status: Enacted Year Enacted: 1998
A managed care plan shall establish and maintain an external grievance process by which an enrollee or a health care provider with the written consent of the enrollee may appeal the denial of a grievance …
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40 Pa. Stat. and Cons. Stat. Ann. §§ 323.1 through 323.8: The Insurance Department Act of 1921 — Examinations – Pennsylvania
Status: Enacted Year Enacted: 1992
The purpose of this article is to provide an effective and efficient system for examining the activities, operations, financial condition and affairs of all persons transacting the business of insurance in this Commonwealth and all …
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40 Pa. Stat. and Pa. Cons. Stat. Ann. §§ 991.2101 through 991.2194: Quality Health Care Accountability and Protection – Pennsylvania
Status: Enacted Year Enacted: 1998
Provisions governing managed care plans to ensure quality health care including prohibitions on financial incentives and gag clauses, standards regarding utilization review, prompt paymen of claims, and general responsibilities of managed care plans. Requires the …
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410 Ill. Comp. Stat. §§ 50/1 through 50/5: Medical Patient Rights Act – Illinois
Status: Enacted Year Enacted: 1979
Patients have a right, regardless of source of payment, to examine and receive a reasonable explanation of his total bill for services rendered by his physician or health care provider, including the itemized charges for …
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42 R.I. Gen. Laws § 42-7.2-16. Medicaid System Reform 2008: Office of Health and Human Services – Rhode Island
Status: Enacted Year Enacted: 2008
Authorizes various state departments to authorized to design options that further the reforms in Medicaid initiated in 2008 to ensure that the program: utilizes competitive and value based purchasing to maximize the available service options, …
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42 R.I. Gen. Laws §§ 42-12.4-1 through 42-12.4-9: Rhode Island Medicaid Remform Act of 2008 – Rhode Island
Status: Enacted Year Enacted: 2008
The executive office of health and human services and the department of human services are authorized and shall apply for and obtain a global waiver and/or any necessary waivers and/or state plan amendments from the …
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820 Ill. Comp. Stat. § 305/8.2. Fee schedule: Workers’ Compensation Act – Illinois
Status: Enacted Year Enacted: 2005
Statute regulates medical fee schedules and requires the Commission to establish and maintain fee schedules for health care services. If the Commission finds that there is a significant limitation on access to quality health care, …
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A 1532 (see companion bill S 3330) – New York
Introduced: 2017 Status: Inactive / Dead
Enacts the “safe staffing for quality care act” to require acute care facilities and nursing homes to implement certain direct-care nurse to patient ratios in all nursing units; sets minimum staffing requirements; requires every such …
A 1720 (see companion bill S 972) – New Jersey
Introduced: 2018 Status: Inactive / Dead
REGULATES PHYSICIAN PROFILING PROGRAMS USED BY MANAGED CARE NETWORKS. Physician profiling programs are relatively new, and are designed to evaluate physicians participating in managed care plan networks, by measuring physicians’ performance based on quality and …
A 1872 – New Jersey
Introduced: 2018 Status: Inactive / Dead
ESTABLISHES “NEW JERSEY TASK FORCE ON TIERED HEALTH INSURANCE NETWORKS.” The purpose of the task force is to study the recent trend towards tiered health insurance networks, identify the impact of tiered health insurance networks …
A 1946 – New Jersey
Introduced: 2018 Status: Inactive / Dead
ALLOWS PHYSICIANS TO JOINTLY NEGOTIATE WITH CARRIERS OVER CONTRACTUAL TERMS AND CONDITIONS. The bill permits two or more independent physicians who are practicing in the geographic service area of a carrier to jointly negotiate with the …