Bill Title: Creates the Health Carrier External Review Act. Sets forth standards for independent external review procedures for adverse determinations by a health carrier against a covered person. Provides that the Act applies to an entity subject to the insurance laws and regulations of this State or subject to the jurisdiction of the Director and that contracts or offers to contract concerning any costs of health care. Requires health carriers to notify covered persons and their health care providers in writing of the covered person's right to request an external review as provided by the Act. Sets forth notice requirements. Provides that a request for an external review shall not be made until the covered person has exhausted the health carrier's internal grievance process. Sets forth requirements for standard external reviews and expedited external reviews. Provides that an external review decision is binding on the health carrier and binding on the covered person except to the extent the covered person has other remedies available. Sets forth minimum qualifications for independent review organizations and provides that the Director shall approve independent review organizations eligible to be assigned to conduct external reviews. Provides that each health carrier shall maintain written records of external review requests for each calendar year and submit a report to the Director by March 1 of each year. Provides that the health carrier shall be solely responsible for paying the cost of external reviews. Sets forth disclosure requirements. Amends the Managed Care Reform and Patient Rights Act to provide that an enrollee may appeal adverse decisions in accordance with the Health Carrier External Review Act. Deletes a provision concerning external independent review. Makes other changes. Contains a severability clause. Effective January 1, 2010.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Engrossed - Dead) 2009-05-08 - Rule 19(a) / Re-referred to Rules Committee [SB1506 Detail]

Text: Latest bill text (Engrossed) [HTML]

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