House committee passes amended Senate Bill 480 requiring provider documentation and clinical-peer review

A House committee voted 12-0, with one member excused, to pass an amended version of Senate Bill 480 that adds documentation requirements for unanticipated care and a clinical-peer-review requirement for insurer determinations.

Dr. Johnson, who presented amendment number 6, told the committee the amendment contains four main changes. "There's really 4 pieces that we're working on in the amendment," Dr. Johnson said, adding the first requires a provider to give the insurer a reason when an unanticipated procedure or service occurs during an episode of care so there is documentation on the front end.

The amendment also incorporates clinical-peer-review language similar to House Bill 1003 so that an insurer reviewer will be a clinician familiar with the specialty under dispute, Dr. Johnson said. "When you call and have this back and forth with an insurer that there's a like person on the other end, whether it's a physical therapist or a physician or a nurse practitioner, somebody who understands that specialty," he said.

Other provisions in the amendment reset chronic-condition reviews to an annual schedule rather than an indefinite or more frequent review, and clarify coverage when an enrollee changes plans so a receiving plan is not required to cover benefits the new plan does not itself offer.

Committee members asked technical questions and discussed remaining language that staff and sponsors plan to refine before second reading; Dr. Johnson said he and Dr. Barrett would continue work on a provision in the draft to ensure decisions are limited to medical necessity.

A motion "to pass as amended" carried on a roll call that produced 12 yes votes and one excused member. The committee record shows the tally as 12-0; Representative Porter was excused during the roll call.

The committee chair thanked staff and closed the meeting after the two bills on the agenda were addressed.