NETWORK ADEQUACY TRANSPARENCY House SponsorsRep. Gregory Harris-Chad Hays-Ann M. Williams-Jeanne M Ives-Tom Demmer, Kelly M. Cassidy, Laura Fine, Patricia R. Bellock, Al Riley, Robyn Gabel, Michael P. McAuliffe, Theresa Mah, Lawrence Walsh, Jr., Brandon W. Phelps, Terri Bryant, Jay Hoffman, Elaine Nekritz, Lou Lang, Margo McDermed, John M. Cabello, Anna Moeller, Robert W. Pritchard, David McSweeney, Stephanie A. Kifowit, Katie Stuart, Barbara Wheeler, André Thapedi, Camille Y. Lilly, Ryan Spain, LaToya Greenwood, Natalie A. Manley, Martin J. Moylan, Kathleen Willis, Sam Yingling, Frances Ann Hurley, Elizabeth Hernandez, Michelle Mussman, Rita Mayfield, Carol Ammons, William Davis, Elgie R. Sims, Jr., Marcus C. Evans, Jr., Cynthia Soto, Mary E. Flowers, Litesa E. Wallace, La Shawn K. Ford, Daniel J. Burke, Luis Arroyo, Brad Halbrook, Deb Conroy, David A. Welter, Emanuel Chris Welch, Jerry Costello, II, John Cavaletto, Barbara Flynn Currie, Sara Feigenholtz, Kelly M. Burke, Justin Slaughter, Grant Wehrli, Arthur Turner, Carol Sente and John Connor Senate Sponsors(Sen. Linda Holmes-Sue Rezin-Michael Connelly-Jacqueline Y. Collins, Emil Jones, III-Don Harmon, Toi W. Hutchinson, Kwame Raoul, Patricia Van Pelt, Melinda Bush, Jennifer Bertino-Tarrant, Mattie Hunter, Napoleon Harris, III, Omar Aquino, Kimberly A. Lightford, Bill Cunningham, Terry Link, Cristina Castro, Donne E. Trotter, Ira I. Silverstein, Karen McConnaughay, Dan McConchie, Dale Fowler, Laura M. Murphy, Julie A. Morrison and Steve Stadelman) 9/15/2017HousePublic Act . . . . . . . . . 100-0502 New Act Creates the Network Adequacy and Transparency Act. Provides that administrators and insurers, prior to going to market, must file with the Department of Insurance for review and approval a description of the services to be offered through a network plan, with certain criteria included in the description. Provides that the network plan shall demonstrate to the Department, prior to approval, a minimum ratio of full-time equivalent providers to plan beneficiaries and maximum travel and distance standards for plan beneficiaries, which shall be established annually by the Department based upon specified sources. Provides that the Department shall conduct quarterly audits of network plans to verify compliance with network adequacy standards. Establishes certain notice requirements. Provides that a network plan shall provide for continuity of care for its beneficiaries under certain circumstances and according to certain requirements. Provides that a network plan shall post electronically a current and accurate provider directory and make available in print, upon request, a provider directory subject to certain specifications. Provides that the Department is granted specific authority to issue a cease and desist order against, fine, or otherwise penalize any insurer or administrator for violations of any provision of the Act. Makes other changes. Effective January 1, 2018.House Committee Amendment No. 1 Replaces everything after the enacting clause. Reinserts the introduced bill with the following changes: Removes the definition of "administrator". Includes in the definition of "insurer" workers compensation insurance and pharmacy benefit managers. Defines "telehealth" and "telemedicine". Removes references to "administrators" throughout the Act. Removes provisions requiring an insurer providing a network plan to file the following information with the Director of Insurance: the method of the marketing plan and certain written policies and procedures. Provides that insurers shall provide the Director a description of how the use of telemedicine, telehealth, or mobile care services may be used to partially meet the network adequacy standards (rather than a description of each network hospital of the percentage of physicians in certain specialties who practice in the hospital are in the insurer's network). Provides that the Department shall consider establishing ratios for certain physicians or other providers (rather than requiring ratios at a minimum to include certain physicians or other providers). Provides that maximum travel and distance standards for network plan beneficiaries established annually by the Department shall be done in consultation with the Department of Public Health. Removes the requirement that the network plan must demonstrate, prior to approval, that it has contracted with physicians who specialize in certain areas in sufficient numbers at any in-network facility or in-network hospital so patients have reasonable access to the in-network physicians. Provides that the network plan shall demonstrate sufficient inpatient services. Provides that the network plan may consider use of other health care service delivery options. Provides that the Director may (rather than shall) conduct periodic (rather than semi-annual) audits of the accuracy of provider directories. Removes language granting the Director specific authority to issue a cease and desist order against, fine, or otherwise penalize any insurer for violations of any provision of the Act. Makes other changes.House Floor Amendment No. 2 Provides that the Act applies to an individual or group policy of accident and health insurance with a network plan amended, delivered, issued, or renewed in this State on or after January 1, 2019. Defines "authorized representative". Removes references to "exchange plans or Medicare Advantage Plans". Removes language that requires insurers to file a description of services for review prior to going to market. In provisions concerning notice of renewal or termination, includes language that primary care providers must notify active affected patients of nonrenewal or termination of the provider from the network plan, except in the case of incapacitation. Adds provisions concerning facility nonparticipating provider transparency. Makes other changes. Provides that the bill takes effect upon becoming law (rather than on January 1, 2018).Senate Committee Amendment No. 1 In provisions concerning network adequacy, removes language providing that the network plan shall demonstrate sufficient inpatient services, including services by preferred providers who specialize in emergency medicine, anesthesiology, pathology, and radiology. Removes provisions concerning facility nonparticipating provider transparency. 1/10/2017HousePrefiled with Clerk by Rep. Gregory Harris 1/11/2017HouseAdded Chief Co-Sponsor Rep. Chad Hays 1/11/2017HouseAdded Chief Co-Sponsor Rep. Ann M. Williams 1/11/2017HouseAdded Chief Co-Sponsor Rep. Jeanne M Ives 1/11/2017HouseAdded Chief Co-Sponsor Rep. Tom Demmer 1/11/2017HouseAdded Co-Sponsor Rep. Kelly M. Cassidy 1/11/2017HouseAdded Co-Sponsor Rep. Laura Fine 1/11/2017HouseFirst Reading 1/11/2017HouseReferred to Rules Committee 1/19/2017HouseAdded Co-Sponsor Rep. Patricia R. Bellock 1/24/2017HouseAdded Co-Sponsor Rep. Al Riley 1/25/2017HouseAssigned to Insurance: Health & Life Committee 1/26/2017HouseAdded Co-Sponsor Rep. Robyn Gabel 2/3/2017HouseAdded Co-Sponsor Rep. Michael P. McAuliffe 2/3/2017HouseAdded Co-Sponsor Rep. Theresa Mah 2/8/2017HouseAdded Co-Sponsor Rep. Lawrence Walsh, Jr. 2/8/2017HouseAdded Co-Sponsor Rep. Brandon W. Phelps 2/8/2017HouseAdded Co-Sponsor Rep. Terri Bryant 2/8/2017HouseAdded Co-Sponsor Rep. Jay Hoffman 2/8/2017HouseAdded Co-Sponsor Rep. Elaine Nekritz 2/8/2017HouseAdded Co-Sponsor Rep. Lou Lang 2/8/2017HouseAdded Co-Sponsor Rep. Margo McDermed 2/8/2017HouseAdded Co-Sponsor Rep. John M. Cabello 2/9/2017HouseAdded Co-Sponsor Rep. Anna Moeller 2/9/2017HouseAdded Co-Sponsor Rep. Robert W. Pritchard 2/9/2017HouseAdded Co-Sponsor Rep. David McSweeney 2/10/2017HouseAdded Co-Sponsor Rep. Stephanie A. Kifowit 2/10/2017HouseAdded Co-Sponsor Rep. Katie Stuart 2/15/2017HouseAdded Co-Sponsor Rep. Barbara Wheeler 2/15/2017HouseAdded Co-Sponsor Rep. André Thapedi 2/16/2017HouseAdded Co-Sponsor Rep. Camille Y. Lilly 2/16/2017HouseAdded Co-Sponsor Rep. Ryan Spain 2/16/2017HouseAdded Co-Sponsor Rep. LaToya Greenwood 2/16/2017HouseAdded Co-Sponsor Rep. Natalie A. Manley 2/16/2017HouseAdded Co-Sponsor Rep. Martin J. Moylan 2/16/2017HouseAdded Co-Sponsor Rep. Kathleen Willis 2/16/2017HouseAdded Co-Sponsor Rep. Sam Yingling 2/22/2017HouseAdded Co-Sponsor Rep. Frances Ann Hurley 2/23/2017HouseAdded Co-Sponsor Rep. Elizabeth Hernandez 2/23/2017HouseAdded Co-Sponsor Rep. Michelle Mussman 2/23/2017HouseAdded Co-Sponsor Rep. Rita Mayfield 2/23/2017HouseAdded Co-Sponsor Rep. Carol Ammons 2/23/2017HouseAdded Co-Sponsor Rep. William Davis 2/23/2017HouseAdded Co-Sponsor Rep. Elgie R. Sims, Jr. 2/23/2017HouseAdded Co-Sponsor Rep. Marcus C. Evans, Jr. 2/23/2017HouseAdded Co-Sponsor Rep. Cynthia Soto 2/23/2017HouseAdded Co-Sponsor Rep. Mary E. Flowers 2/23/2017HouseAdded Co-Sponsor Rep. Litesa E. Wallace 2/23/2017HouseAdded Co-Sponsor Rep. La Shawn K. Ford 2/23/2017HouseAdded Co-Sponsor Rep. Daniel J. Burke 2/23/2017HouseAdded Co-Sponsor Rep. Luis Arroyo 2/24/2017HouseAdded Co-Sponsor Rep. Brad Halbrook 2/24/2017HouseAdded Co-Sponsor Rep. Deb Conroy 2/24/2017HouseAdded Co-Sponsor Rep. David A. Welter 2/24/2017HouseAdded Co-Sponsor Rep. Emanuel Chris Welch 2/24/2017HouseAdded Co-Sponsor Rep. Jerry Costello, II 3/1/2017HouseAdded Co-Sponsor Rep. John Cavaletto 3/10/2017HouseHouse Committee Amendment No. 1 Filed with Clerk by Rep. Gregory Harris 3/10/2017HouseHouse Committee Amendment No. 1 Referred to Rules Committee 3/13/2017HouseHouse Committee Amendment No. 1 Rules Refers to Insurance: Health & Life Committee 3/14/2017HouseHouse Committee Amendment No. 1 Adopted in Insurance: Health & Life Committee; by Voice Vote 3/14/2017HouseDo Pass as Amended / Short Debate Insurance: Health & Life Committee; 016-000-000 3/15/2017HousePlaced on Calendar 2nd Reading - Short Debate 3/16/2017HouseAdded Co-Sponsor Rep. Barbara Flynn Currie 3/20/2017HouseAdded Co-Sponsor Rep. Sara Feigenholtz 3/21/2017HouseAdded Co-Sponsor Rep. Kelly M. Burke 3/29/2017HouseHouse Floor Amendment No. 2 Filed with Clerk by Rep. Gregory Harris 3/29/2017HouseHouse Floor Amendment No. 2 Referred to Rules Committee 4/4/2017HouseHouse Floor Amendment No. 2 Rules Refers to Insurance: Health & Life Committee 4/4/2017HouseAdded Co-Sponsor Rep. Justin Slaughter 4/5/2017HouseAdded Co-Sponsor Rep. Grant Wehrli 4/6/2017HouseHouse Floor Amendment No. 2 Recommends Be Adopted Insurance: Health & Life Committee; 013-001-002 4/6/2017HouseAdded Co-Sponsor Rep. Arthur Turner 4/7/2017HouseSecond Reading - Short Debate 4/7/2017HouseHouse Floor Amendment No. 2 Adopted 4/7/2017HousePlaced on Calendar Order of 3rd Reading - Short Debate 4/7/2017HouseAdded Co-Sponsor Rep. Carol Sente 4/24/2017HouseThird Reading - Short Debate - Passed 110-002-001 4/25/2017SenateArrive in Senate 4/25/2017SenatePlaced on Calendar Order of First Reading 4/25/2017SenateChief Senate Sponsor Sen. Linda Holmes 4/25/2017SenateAdded as Alternate Chief Co-Sponsor Sen. Michael Connelly 4/25/2017SenateAdded as Alternate Chief Co-Sponsor Sen. Jacqueline Y. Collins 4/25/2017SenateFirst Reading 4/25/2017SenateReferred to Assignments 4/25/2017SenateAdded as Alternate Co-Sponsor Sen. Emil Jones, III 4/26/2017SenateAdded as Alternate Chief Co-Sponsor Sen. Don Harmon 4/26/2017SenateAdded as Alternate Chief Co-Sponsor Sen. Sue Rezin 4/26/2017SenateAdded as Alternate Co-Sponsor Sen. Toi W. Hutchinson 4/26/2017SenateAdded as Alternate Co-Sponsor Sen. Kwame Raoul 4/26/2017SenateAdded as Alternate Co-Sponsor Sen. Patricia Van Pelt 4/26/2017SenateAdded as Alternate Co-Sponsor Sen. Melinda Bush 4/26/2017SenateAdded as Alternate Co-Sponsor Sen. Jennifer Bertino-Tarrant 4/26/2017SenateAdded as Alternate Co-Sponsor Sen. Mattie Hunter 4/26/2017SenateAdded as Alternate Co-Sponsor Sen. Napoleon Harris, III 4/27/2017SenateAdded as Alternate Co-Sponsor Sen. Omar Aquino 4/27/2017SenateAdded as Alternate Co-Sponsor Sen. Kimberly A. Lightford 4/27/2017SenateAdded as Alternate Co-Sponsor Sen. Bill Cunningham 4/27/2017SenateAdded as Alternate Co-Sponsor Sen. Terry Link 4/28/2017SenateAdded as Alternate Co-Sponsor Sen. Cristina Castro 5/2/2017SenateAdded as Alternate Co-Sponsor Sen. Donne E. Trotter 5/2/2017SenateAdded as Alternate Co-Sponsor Sen. Ira I. Silverstein 5/3/2017SenateAdded as Alternate Co-Sponsor Sen. Karen McConnaughay 5/3/2017SenateAssigned to Insurance 5/3/2017SenateSenate Committee Amendment No. 1 Filed with Secretary by Sen. Linda Holmes 5/3/2017SenateSenate Committee Amendment No. 1 Referred to Assignments 5/9/2017SenateSenate Committee Amendment No. 1 Assignments Refers to Insurance 5/10/2017SenateSenate Committee Amendment No. 1 Adopted 5/11/2017SenateDo Pass as Amended Insurance; 010-000-000 5/11/2017SenatePlaced on Calendar Order of 2nd Reading May 12, 2017 5/12/2017SenateSecond Reading 5/12/2017SenatePlaced on Calendar Order of 3rd Reading May 15, 2017 5/15/2017SenateAdded as Alternate Co-Sponsor Sen. Dan McConchie 5/17/2017SenateAdded as Alternate Co-Sponsor Sen. Dale Fowler 5/26/2017SenateAdded as Alternate Co-Sponsor Sen. Laura M. Murphy 5/26/2017SenateAdded as Alternate Co-Sponsor Sen. Julie A. Morrison 5/26/2017SenateAdded as Alternate Co-Sponsor Sen. Steve Stadelman 5/26/2017SenateThird Reading - Passed; 053-000-000 5/28/2017HouseArrived in House 5/28/2017HousePlaced on Calendar Order of Concurrence Senate Amendment(s) 1 5/28/2017HouseSenate Committee Amendment No. 1 Motion Filed Concur Rep. Gregory Harris 5/28/2017HouseSenate Committee Amendment No. 1 Motion to Concur Referred to Rules Committee 5/29/2017HouseSenate Committee Amendment No. 1 Motion to Concur Recommends Be Adopted Rules Committee; 005-000-000 6/24/2017HouseSenate Committee Amendment No. 1 House Concurs 098-000-000 6/24/2017House3/5 Vote Required 6/24/2017HouseHouse Concurs 6/24/2017HousePassed Both Houses 6/26/2017HouseAdded Co-Sponsor Rep. John Connor 7/21/2017HouseSent to the Governor 9/15/2017HouseGovernor Approved 9/15/2017HouseEffective Date September 15, 2017 9/15/2017HousePublic Act . . . . . . . . . 100-0502