HB 1973 Accident and sickness insurance; utilization review.
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Accident and sickness insurance; utilization review. Establishes standards for utilization review and for appeals from adverse utilization review decisions. The bill requires each entity performing utilization review to develop standards and criteria that are objective, clinically valid and compatible with established principles of health care. Additionally, such entities are required to develop utilization review plans conforming to certain criteria. Utilization review entities are required to be accessible to both patients and providers at least 40 hours per week during normal business hours. Treating providers are to be notified of any adverse utilization review decision within two working days of the decision. Additionally, the bill requires utilization review entities to make good faith efforts to obtain information from providers before rendering adverse decisions.

The bill also establishes methods for (i) reconsideration of any adverse decision and (ii) appeals from such decisions. Decisions on appeals are to be rendered by a peer of the treating health care provider who (i) did not participate in the adverse decision or any prior reconsideration thereof, (ii) is not employed by or a director of the utilization review entity and (iii) is licensed to practice in Virginia or under a comparable licensing law of another state as a peer of the treating health care provider. The bill prohibits penalizing any health care provider who invokes the appeals process or advocates on behalf of his patients to the utilization review entity. Utilization review records must be maintained by the review entity for five years. The Department of Medical Assistance Services' internal utilization review procedures are exempted from most of the bill's requirements.

Full text:
01/20/95  House: Presented & ordered printed LD2083484  pdf
02/02/95  House: Committee substitute printed LD1584484-H1  pdf
02/24/95  House: Bill text as passed House and Senate (HB1973ER)  pdf
04/10/95  House: Reenrolled bill text (HB1973ER)  pdf
04/17/95  Governor: Acts of Assembly Chapter text (CHAP0745)  pdf

Senate amendments
Senate amendments rejected
Governor's recommendation

01/20/95  House: Presented & ordered printed LD2083484
01/20/95  House: Referred to Committee on Corporations, Insurance and Banking
02/02/95  House: Reported from C. I. B. w/sub. (21-Y 0-N)
02/02/95  House: Committee substitute printed LD1584484-H1
02/03/95  House: Read first time
02/04/95  House: Read second time
02/04/95  House: Committee substitute agreed to LD1584484-H1
02/04/95  House: Engrossed by House - com. sub. LD1584484-H1
02/05/95  House: Read third time and passed House (98-Y 1-N)
02/05/95  House: VOTE: PASSAGE (98-Y 1-N)
02/05/95  House: Communicated to Senate
02/06/95  Senate: Read first time
02/06/95  Senate: Referred to Committee on Commerce and Labor
02/13/95  Senate: Reported from C. & L. with amendments (14-Y 0-N)
02/14/95  Senate: Constitutional reading dispensed (39-Y 0-N)
02/14/95  Senate: VOTE: CONST. READING DISPENSED (39-Y 0-N)
02/15/95  Senate: Passed by for the day
02/16/95  Senate: Read third time
02/16/95  Senate: Reading of amendments waived
02/16/95  Senate: Committee amendments agreed to
02/16/95  Senate: Reading of amendment waived
02/16/95  Senate: Floor amendment rejected (Holland, E.M.)
02/16/95  Senate: Engrossed by Senate as amended
02/16/95  Senate: Passed Senate with amendments (40-Y 0-N)
02/16/95  Senate: VOTE: PASSAGE (40-Y 0-N)
02/17/95  House: Placed on Calendar
02/20/95  House: Senate amendments agreed to by House (97-Y 1-N)
02/20/95  House: VOTE: ADOPTION (97-Y 1-N)
02/24/95  House: Bill text as passed House and Senate (HB1973ER)
02/28/95  House: Enrolled
03/01/95  Senate: Signed by President
03/02/95  House: Signed by Speaker
03/27/95  House: Governor's recommendation received by House
04/06/95  House: House concurred in Gov's recommendation (97-Y 0-N)
04/06/95  House: VOTE: ADOPTION (97-Y 0-N)
04/06/95  Senate: Senate concurred in Gov's recommendation (40-Y 0-N)
04/06/95  Senate: VOTE: ADOPT GOV. RECOMMEND. (40-Y 0-N)
04/06/95  Governor: Governor's recommendation adopted
04/06/95  House: Reenrolled
04/06/95  House: Signed by Speaker as reenrolled
04/06/95  Senate: Signed by President as reenrolled
04/06/95  House: Enacted, Chapter 745 (effective 7/1/95)
04/10/95  House: Reenrolled bill text (HB1973ER)
04/17/95  Governor: Acts of Assembly Chapter text (CHAP0745)