The legislature's own summary of the bill, or its official long title.
Creates the Transparency in Downcoding Act. Provides that the Act applies to certain policies of health insurance amended, delivered, issued, or renewed on or after the effective date of the Act, except for employee or employer self-insured health benefit plans under the federal Employee Retirement Income Security Act of 1974 and health care provided pursuant to the Workers' Compensation Act or the Workers'…
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Creates the Transparency in Downcoding Act. Provides that the Act applies to certain policies of health insurance amended, delivered, issued, or renewed on or after the effective date of the Act, except for employee or employer self-insured health benefit plans under the federal Employee Retirement Income Security Act of 1974 and health care provided pursuant to the Workers' Compensation Act or the Workers' Occupational Diseases Act. Prohibits a health insurance issuer from using an automated process, system, or tool to downcode a claim; from downcoding a claim based solely on the reported diagnosis codes; and from using downcoding practices in a targeted or discriminatory manner against physicians who routinely treat patients with complex or chronic conditions. Requires downcoding decisions to be made by a physician licensed to practice medicine in all its branches in any United States jurisdiction and of the same or similar specialty as a physician who typically manages the medical condition or disease. Sets forth provisions concerning notification requirements for downcoded claims; the appeal process for downcoded claims; enforcement by the Department of Insurance; and penalties. Provides that any pattern or practice of discriminatory downcoding identified by the Director of Insurance or another regulatory authority shall be subject to enforcement actions, including fines, restitution, or suspension of the health insurance issuer's license in this State. Effective immediately.
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100 steps, oldest first, as the legislature records them.
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SenateFiled with Secretary by Sen. David Koehler
SenateFirst Reading
CommitteeReferred to Assignments · Senate Assignments
CommitteeAssigned to Insurance · Senate Insurance
SenateAdded as Chief Co-Sponsor Sen. Julie A. Morrison
SenateAdded as Co-Sponsor Sen. Laura Fine
CommitteePostponed - Insurance · Senate Insurance
SenateAdded as Co-Sponsor Sen. Andrew S. Chesney
SenateAdded as Co-Sponsor Sen. Christopher Belt
SenateAdded as Co-Sponsor Sen. Graciela Guzmán
SenateAdded as Co-Sponsor Sen. Paul Faraci
SenateAdded as Co-Sponsor Sen. Suzy Glowiak Hilton
SenateAdded as Co-Sponsor Sen. Linda Holmes
SenateAdded as Co-Sponsor Sen. Ram Villivalam
SenateAdded as Co-Sponsor Sen. Mike Porfirio
SenateAdded as Co-Sponsor Sen. Meg Loughran Cappel
SenateAdded as Chief Co-Sponsor Sen. Cristina Castro
SenateAdded as Co-Sponsor Sen. Doris Turner
SenateAdded as Chief Co-Sponsor Sen. Robert Peters
SenateAdded as Co-Sponsor Sen. Sally J. Turner
CommitteePostponed - Insurance · Senate Insurance
SenateAdded as Co-Sponsor Sen. Sue Rezin
SenateAdded as Co-Sponsor Sen. Napoleon Harris, III
