Bill > S523

This bill establishes accountability for managed care organizations, which are entities that manage health care services to control quality, accessibility, utilization, or costs for a specific group of people called enrollees. The bill amends existing law to state that these organizations, referred to as "carriers" or "managed care entities," must exercise ordinary care when making health care treatment decisions and can be held liable for damages if their failure to do so directly harms an enrollee. This liability extends to decisions made by their employees or agents over whom they have influence or control. A defense for these organizations would be if they, or their representatives, did not control or influence the treatment decision, or if they did not deny or delay payment for prescribed treatment. Importantly, this bill does not require these organizations to provide treatment not covered by an enrollee's health care plan, nor does it create liability for employers purchasing coverage, pharmacies, or certain provider organizations that are not licensed by the state insurance division. The bill also clarifies that these new provisions do not reduce any existing obligations of carriers or managed care entities.