HB 1993

Present law prohibits a health insurance issuer or a managed health insurance issuer from engaging in the following:  Den ying a licensed medical laboratory the right to participate as a participating provider in a policy, contract, or plan on the same terms and conditions as are offered to another medical laboratory under the policy, contract, or plan . However, this prohibition does not prohibit such a n issuer from establishing rates or fees that may be higher in nonurban areas, or in specific instances where the issuer determines it necessary to contract with a particular provider in order to meet network adequacy standards or patient care need s.  Preventing a person who is a party to or beneficiary of a policy, contract, or plan from selecting a licensed medical laboratory of the person's choice to furnish the medical laboratory services offered under the contract, policy, or plan as long as the medical laboratory is a participating provider under the same terms and conditions of the contract, policy, or plan as those offered to another medical laboratory. This bill generally prohibits a health insurance issuer or a managed health insurance issuer from reimburs ing a non-network medical laboratory that is eligible to participate as a participating provider for testing services at a rate that is less than the federal centers for medicare and medicaid services' clinical laboratory fee schedule for medical laboratorie s in this state. However, a managed health insurance issuer may require that, in order to receive such rate of reimbursement, a non-network medica l laboratory must meet the same performance metrics required of in-network medical laboratories.