Favorable Report to Fair Contracting Bill from NC House Health Committee
June 29th, 2009
The House Health Committee gave a favorable report this week to legislation that will address unfair business practices of health plans in contracting with physicians. See S877 – Health Plan Provider Contracts / Transparency (Clodfelter, D-Mecklenburg). The bill was not changed by the House Health Committee and will be heard next in the House Insurance Committee. The bill contains the following requirements:
- A health benefit plan or insurer shall send any proposed contract amendment that modifies the fee schedule to an individual identified in advance by the health care provider. The proposed amendment shall be dated, labeled “Amendment,” signed by the health benefit plan or insurer, and include an effective date for the proposed amendment.
- A health care provider shall be given at least 60 days from the date of receipt to object to the proposed fee schedule amendment.
- If a health care provider objects to a proposed amendment, then the proposed amendment is not effective and the initiating health benefit plan or insurer shall be entitled to terminate the contract upon 60 days written notice to the health care provider.
- A health benefit plan or insurer shall provide a copy of its policies and procedures to a health care provider prior to execution of a new or amended contract and annually to all contracted health care providers.
- The policies and procedures of a health benefit plan or insurer shall not conflict with or override any term of a contract, including contract fee schedules. In the event of a conflict between a policy or procedure and the language in a contract, the contract language shall prevail.
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