Bill Text: MA H1079 | 2009-2010 | 186th General Court | Introduced
Bill Title: Further define adverse determinations by health insurers
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2010-08-30 - Accompanied a study order, see H05006 [H1079 Detail]
Download: Massachusetts-2009-H1079-Introduced.html
The Commonwealth of Massachusetts
_______________
PRESENTED BY:
Kay Khan
_______________
To the
Honorable Senate and House of Representatives of the Commonwealth of
Massachusetts in General
Court assembled:
The undersigned legislators and/or citizens respectfully petition for the passage of the accompanying bill:
An Act to further define adverse determinations by insurers.
_______________
PETITION OF:
|
Name: |
District/Address: |
|
Kay Khan |
11th Middlesex |
|
Thomas P. Kennedy |
Second Plymouth and Bristol |
[SIMILAR MATTER FILED IN PREVIOUS
SESSION
SEE HOUSE, NO. 3534 OF 2007-2008.]
The Commonwealth of
Massachusetts
_______________
In the Year Two Thousand and Nine
_______________
An Act to further define adverse determinations by insurers.
Be
it enacted by the Senate and House of Representatives in General Court
assembled, and by the authority of the same, as follows:
Section 1 of Chapter 176O of the General Laws is amended by adding the following new sentence after the word “effectiveness” in the definition of “Adverse determination”:
Provided however, that in making said adverse determination, the carrier or its designated utilization review organization shall defer to the judgment of the treating clinician unless there is a preponderance of evidence that the requested admission, continued stay or other health care service does not meet the requirements for coverage based on medical necessity, appropriateness of health care setting and level of care, or effectiveness.
