Bill > H0221

This bill expands health insurance coverage to include treatment for Down syndrome, alongside existing coverage for autism spectrum disorder, through therapies like speech, occupational, physical, and applied behavior analysis. It also mandates that health insurers and pharmacy benefits managers (companies that manage prescription drug benefits for health plans) must use a specific, two-page prior authorization form approved by the Financial Services Commission for medical procedures, treatments, or prescription drug benefits, unless an electronic process is provided. Furthermore, hospitals, ambulatory surgical centers, specialty hospitals, and urgent care centers must adhere to certain provisions related to nonparticipating provider coverage and payment collection limitations as a condition of their licensure, and hospitals will be required to post information on their websites about contracted health insurers and healthcare practitioners. The bill also establishes new rules for a statewide provider and health plan claim dispute resolution program, including requirements for settlement offers and the process for reviewing disputes, and clarifies that the provisions regarding nonparticipating provider coverage and payment collection limitations will apply to group health insurance.