provides that if an insured person who has a high deductible health plan self-pays a claim for a covered service, the paid claim shall count towards the insured’s deductible, regardless of whether or not the service was provided by an in-network or out-of-network provider. A high deductible health plan shall notify its insureds that cash-pay may be lower than insurancenegotiated prices.
provides that a contracted entity that uses a prior authorization process for health care services may not require a participating provider to obtain prior authorization for a particular health care service if, in the most recent 6-month evaluation period the contracted entity has approved or would have approved not less than 90% of the prior authorization requests submitted by the provider for the particular health care service. Contracted entities may evaluate participating providers to determine whether the provider qualifies for the exemption. The exemption shall remain in effect until the 13th day after the [...]
requires each health benefit plan to provide coverage for biomarker testing and to provide evidence of such coverage. The document showing the plan covers biomarker testing shall include labeled indications for tests that are approved or cleared by the United States Food and Drug Administration (FDA), tests for a drug that is approved by the FDA, precautions on FDA approved drug labels, national coverage determinations or Medicare administrative contractor local coverage determinations, and nationally recognized clinical practice guidelines and consensus statements. The insured shall also have access to a clear, readily available, and convenient [...]
Long-term care; eliminating certificate of need requirements for long-term care facilities and psychiatric and chemical dependency facilities.