SB225: In quality health care accountability and protection, further providing for definitions, for responsibilities of managed care plans, for financial incentives prohibition, for medical gag clause prohibition, for emergency services, for continuity of care, for procedures, for confidentiality, for required disclosure and for internal complaint process, providing for internal complaint process for enrollees, further providing for appeal of complaint, for complaint resolution, for certification and for operational standards, providing for utilization review standards, further providing for internal grievance process, for external grievance process and for records, providing for adverse benefit determinations, further providing for prompt payment of claims, for health care provider and managed care plan protection, for departmental powers and duties and for penalties and sanctions, providing for regulations and further providing for compliance with national accrediting standards and for exceptions; making repeals; and making editorial changes.

Legislative Summary

An Act amending the act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921, in quality health care accountability and protection, further providing for definitions, for responsibilities of managed care plans, for financial incentives prohibition, for medical gag clause prohibition, for emergency services, for continuity of care, for procedures, for confidentiality, for required disclosure and for internal complaint process, providing for internal complaint process for enrollees, further providing for appeal of complaint, for complaint resolution, for certification and for operational standards, providing for utilization review standards, further providing for internal grievance process, for external grievance process and for records, providing for adverse benefit determinations, further providing for prompt payment of claims, for health care provider and managed care plan protection, for departmental powers and duties and for penalties and sanctions, providing for regulations and further providing for compliance with national accrediting standards and for exceptions; making repeals; and making editorial changes.