HOUSE DOCKET, NO. 1599 FILED ON: 1/20/2011
HOUSE . . . . . . . . . . . . . . . No. 1227
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:
An Act to further define adverse determinations by insurers.
_______________
PETITION OF:
Name: | District/Address: |
Kay Khan | 11th Middlesex |
HOUSE DOCKET, NO. 1599 FILED ON: 1/20/2011
HOUSE . . . . . . . . . . . . . . . No. 1227
By Ms. Khan of Newton, a petition (accompanied by bill, House, No. 1227) of Kay Khan for legislation to further define adverse determinations by health insurers. Health Care Financing. |
[SIMILAR MATTER FILED IN PREVIOUS SESSION
SEE
HOUSE
, NO. 1079 OF 2009-2010.]
The Commonwealth of Massachusetts
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.
