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2012 -- H 7326 | |
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LC00890 | |
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STATE OF RHODE ISLAND | |
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IN GENERAL ASSEMBLY | |
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JANUARY SESSION, A.D. 2012 | |
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A N A C T | |
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RELATING TO HEALTH AND SAFETY - HEALTH CARE SERVICES | |
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Introduced By: Representatives Corvese, Ajello, Handy, Walsh, and Malik | |
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Date Introduced: February 02, 2012 | |
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Referred To: House Corporations | |
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It is enacted by the General Assembly as follows: | |
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SECTION 1. Chapter 23-17.12 of the General Laws entitled "Health Care Services - |
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Utilization Review Act" is hereby amended by adding thereto the following section: |
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23-17.12-18. Prospective assessment form. – (a) Notwithstanding any other provision |
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of law, on and after January 1, 2013, a payor shall accept only the prospective assessment form |
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developed pursuant to subsection (c) of this section when requiring prospective assessment for |
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any benefits provided under a payor’s health insurance plan. |
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(b) If a payor fails to utilize or accept the prospective assessment form, or fails to respond |
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within the statutory response period set forth in section 23-17.12-9 of the General Laws upon |
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receipt of a completed prospective assessment request from a provider pursuant to the submission |
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of the prospective assessment form developed as described in subsection (c), the prospective |
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assessment request shall be deemed to have been granted. |
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(c) On or before July 1, 2012, the department of health and the office of the health |
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insurance commissioner shall jointly develop a uniform prospective assessment form. |
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Notwithstanding any other provision of law, on or after January 1, 2013, or six (6) months after |
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the form is developed, whichever is later, every provider shall use such prospective assessment |
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form to request prospective assessment and every payor shall accept such form as sufficient to |
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request prospective assessment. |
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(d) The prospective assessment form developed pursuant to subsection (c) shall meet the |
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following criteria: |
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(1) The form shall not exceed two (2) pages; |
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(2) The form shall be made electronically available by the department and the payor; |
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(3) The completed form may be electronically submitted from the provider to the payor; |
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(4) The department of health and the office of the health insurance commissioner shall |
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develop the form with input from interested parties from at least one public meeting; and |
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(5) The department of health and the office of the health insurance commissioner, in |
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development of the standardized form, shall take into consideration the following: |
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(i) Existing prior authorization forms established by the federal Centers for Medicare and |
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Medicaid Services; and |
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(ii) National standards pertaining to electronic prior authorization. |
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SECTION 2. This act shall take effect on January 1, 2013. |
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LC00890 | |
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EXPLANATION | |
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BY THE LEGISLATIVE COUNCIL | |
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OF | |
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A N A C T | |
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RELATING TO HEALTH AND SAFETY - HEALTH CARE SERVICES | |
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This act would require the department of health and the office of the health insurance |
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commissioner to develop a standardized form for providers to use when requesting prospective |
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assessments from payors. |
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This act would take effect as of January 1, 2013. |
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LC00890 | |
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