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 health-care 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

Using official source text because the generated explanation was unavailable or could not be confirmed against the official bill 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 health-care 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.

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 health-care 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.

What This Bill Does

• 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 health-care 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.

Limits and Unknowns

• This entry is temporarily using official source text because the generated explanation could not be confirmed against the official bill text during the last sync.

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 health-care 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. 6

AMEND Senate Bill No. 6 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. 6 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. 6 on line 86 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. 6 on line 203 by deleting “

treating physician

” as it appears therein and inserting in lieu thereof “

treating health-care provider

”.

FURTHER AMEND Senate Bill No. 6 on line 203 by deleting “

physician’s scope

” as it appears therein and inserting in lieu thereof “

health-care provider’s scope

”.

FURTHER AMEND Senate Bill No. 6 on line 261 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 health-care 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