This Fiscal Note is not an official copy and should not be quoted or cited.
Fiscal Note - SB 0853 - Regulation of HMOs With Regard to Emergency Services
L.R. NO. 2194-02
BILL NO. SB 853
SUBJECT: Insurance-Medical, Hospitals
TYPE: Original
DATE: February 19, 1996
FISCAL SUMMARY
ESTIMATED NET EFFECT ON STATE FUNDS
FUND AFFECTED FY 1997 FY 1998 FY 1999
All State Funds (Unknown) (Unknown) (Unknown)
Total Estimated
Net Effect on All
State Funds (UNKNOWN) (UNKNOWN) (UNKNOWN)
ESTIMATED NET EFFECT ON FEDERAL FUNDS
FUND AFFECTED FY 1997 FY 1998 FY 1999
None
Total Estimated
Net Effect on All
Federal Funds $0 $0 $0
ESTIMATED NET EFFECT ON LOCAL FUNDS
FUND AFFECTED FY 1997 FY 1998 FY 1999
Local Government $0 $0 $0
FISCAL ANALYSIS
ASSUMPTION
Officials from the Department of Insurance stated that passage of this
legislation would have no fiscal impact on their agency. However, the
passage of more than one similar proposal could require the INS to request
increased appropriations to cover cumulative administrative cost.
Officials from the Department of Corrections, Department of Conservation,
Department of Public Safety, Department of Health, Office of Administration,
and the Department of Highway and Transportation stated that passage of this
legislation would have no fiscal impact on their agency.
Officials from the Department of Social Services reported that this proposal
would require that the request for authorization for medically necessary
services arising from emergency room screening exams must be denied within
thirty minutes or they are deemed to be approved. The current MC+ Medicaid
managed care contracts do not include the thirty minute requirement. DOS
believes there would be costs incurred by the health maintenance
organizations to meet the thirty minute time limit but its current contracts
include a limit on administrative expense and consequently the additional
cost could not be passed on to DOS and the state Medicaid program.
Officials from the Consolidated Health Care Plan did not respond to our
fiscal impact request.
Oversight assumes this proposal will generate costs to the Consolidated
Health Care Plan in an unknown amount.
Oversight does not have available information concerning health plans for
local governments and has not shown a fiscal impact to them.
FISCAL IMPACT-State Government FY 1997 FY 1998 FY 1999
(10 Months)
ALL STATE FUNDS
Cost - Consolidated Health Care Plan
Increased health care cost (Unknown) (Unknown) (Unknown)
Estimated Net Effect on All State
Funds (Unknown) (Unknown) (Unknown)
FISCAL IMPACT - Local Government FY 1997 FY 1998 FY 1999
(10 Mo.)
$0 $0 $0
DESCRIPTION
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.
This legislation is not federally mandated, would not duplicate any other
program and would not require additional capital improvements or rental
space.
SOURCES OF INFORMATION
Department of Insurance
Department of Corrections
Department of Conservation
Department of Public Safety
Department of Health
Department of Social Services
Office of Administration
Department of Highway and Transportation
Not Responding: Consolidated Health Care Plan