This Amendment clarifies that a health-care provider may determine that a covered health-care service delivered on an expedited basis is an “urgent health-care service.” In addition, this Amendment provides that any compensation paid to a health-care provider or consulting healthcare provider for review of a clean pre-authorization request submitted by a health-care provider other than a physician, or of an appeal from an adverse determination of such a request, may not be contingent upon the outcome of the review.

Plain English Breakdown

The candidate explanation included a claim about ensuring compensation independence for appeal reviews, which is not explicitly stated in the official source material. This was removed to adhere strictly to the provided information.

Health-Care Provider Urgency Determination and Compensation

This amendment allows health-care providers to decide if expedited services are urgent and ensures that compensation for reviewing pre-authorization requests is not tied to the outcome of those reviews.

What This Bill Does

• Allows health-care providers, not just physicians, to determine if a covered service provided quickly is an 'urgent health-care service'.
• Requires that any payment given to a health-care provider or consultant for reviewing pre-authorization requests must be made regardless of the review's outcome.

Who It Names or Affects

• Health-care providers who deliver urgent services and review pre-authorization requests.
• Consulting health-care providers involved in reviewing pre-authorization requests or handling appeals.

Terms To Know

Urgent Health-Care Service

A medical service that needs to be provided quickly because it is necessary for the patient's immediate well-being.

Pre-Authorization Request

An application submitted by a health-care provider asking for approval before providing certain services or treatments.

Limits and Unknowns

• The bill does not specify how compensation amounts are determined.
• It is unclear if there will be additional regulations to implement these changes.

Official Summary Text

This Amendment clarifies that a health-care provider may determine that a covered health-care service delivered on an expedited basis is an “urgent health-care service.”
In addition, this Amendment provides that any compensation paid to a health-care provider or consulting healthcare provider for review of a clean pre-authorization request submitted by a health-care provider other than a physician, or of an appeal from an adverse determination of such a request, may not be contingent upon the outcome of the review.

Current Bill Text

Legislation Document

SPONSOR:

Sen. Townsend

DELAWARE STATE SENATE

153rd GENERAL ASSEMBLY

SENATE AMENDMENT NO. 1

TO

SENATE BILL NO. 12

AMEND Senate Bill No. 12 on line 27 by deleting “

treating physician

” as it appears therein and inserting in lieu thereof “

treating health-care provider

”.

FURTHER AMEND Senate Bill No. 12 on line 27 by deleting “

physician’s scope

” as it appears therein and inserting in lieu thereof “

health-care provider’s scope

”.

FURTHER AMEND Senate Bill No. 12 on line 85 by inserting “

Any compensation paid to the health-care provider or consulting health-care provider may not be contingent upon the outcome of the review of the clean pre-authorization request or appeal from an adverse determination.

” after “

health-care provider.

” therein.

FURTHER AMEND Senate Bill No. 12 on line 200 by deleting “

treating physician

” as it appears therein and inserting in lieu thereof “

treating health-care provider

”.

FURTHER AMEND Senate Bill No. 12 on line 200 by deleting “

physician’s scope

” as it appears therein and inserting in lieu thereof “

health-care provider’s scope

”.

FURTHER AMEND Senate Bill No. 12 on line 257 by inserting “

Any compensation paid to the health-care provider or consulting health-care provider may not be contingent upon the outcome of the review of the clean pre-authorization request or appeal from an adverse determination.

” after “

health-care provider.

” therein.

SYNOPSIS

This Amendment clarifies that a health-care provider may determine that a covered health-care service delivered on an expedited basis is an “urgent health-care service.”

In addition, this Amendment provides that any compensation paid to a health-care provider or consulting healthcare provider for review of a clean pre-authorization request submitted by a health-care provider other than a physician, or of an appeal from an adverse determination of such a request, may not be contingent upon the outcome of the review.

Author: Senator Townsend