| SB 0853 | Regulation of HMOs With Regard to Emergency Services |
| Sponsor: | MCKENNA | ||
| LR Number: | L2194.02I | Fiscal Note: | 2194-02 |
| Committee: | Corrections and General Laws | ||
| Last Action: | 02/27/96 - Voted Do Pass S Corrections & General Laws Committee | ||
| Title: | |||
| Effective Date: | August 28, 1996 | ||
SB 853 - This act regulates the actions of health maintenance organizations (HMOs) with regard to access to emergency services. Emergency services are defined as a medical condition with symptoms of sufficient severity that a lay person would believe a visit to an emergency facility is warranted. HMOs must provide 24 hour access to emergency services.
HMO plans must reimburse emergency service providers even if
they do not have a contractual arrangement with those providers.
HMOs assume full legal and financial responsibility for a patient
if the HMO acts against the recommendations of the attending
physician of an individual following emergency services.
According to the provisions of this act, HMOs may not
retrospectively deny the authorization for an evaluation or
treatment.
TOM MORTON