Managed care organization contracts; notice to providers.

Plain English Breakdown

The official source material does not specify the exact method of notification, nor does it outline consequences for non-compliance by health insurance companies.

Health Plan Changes: Notifying Doctors

This law requires health insurance companies to inform doctors when patients switch from fee-for-service or another managed care plan to a new managed care organization under the state's medical assistance program.

What This Bill Does

• Requires the Department of Medical Assistance Services to include provisions in contracts with managed care organizations that mandate notification to providers about any patient who switches plans.

Who It Names or Affects

• Health insurance companies
• Doctors and other healthcare providers
• Patients on the state's medical assistance program

Terms To Know

Managed Care Organization (MCO)

A type of health insurance company that manages healthcare services for a group of people.

Fee-for-service plan

A type of health insurance where patients pay for each service they receive, like doctor visits or hospital stays.

Limits and Unknowns

• The bill does not specify how the notification to doctors should be made.
• It is unclear what happens if a managed care organization fails to notify providers about plan changes.

Official Summary Text

Department of Medical Assistance Services; managed care organization contracts; notice to providers.
Requires the Department of Medical Assistance Services to include in all of its managed care organization contracts provisions requiring that the managed care organization notify all known providers of any new enrollee who was previously enrolled in a fee-for-service plan or another managed care plan under the state plan for medical assistance services that such enrollee has changed health plans.

Current Bill Text

A BILL to amend the Code of Virginia by adding a section numbered
32.1-330.6
, relating to Department of Medical Assistance Services; managed care organization contracts; notice to providers.

Be it enacted by the General Assembly of Virginia:

1. That the Code of Virginia is amended by adding a section numbered

32.1-330.6
as follows:

§ 32.1-
330.6
.
M
anaged care
organization
c
ontracts
; notice to providers
.

The Department
shall
include in all of its

managed care organization contracts provisions requiring that the managed care organization

notify
all known providers of a
ny
new
enrollee
who was previously
enrol
led
in a fee-for-service
plan

or another managed care plan
under the state
plan for medical assistance services
that
such
enrollee has changed
health plans.