Bill Text: MS SB2605 | 2017 | Regular Session | Introduced
Bill Title: Vision insurance; prohibit provider contracts from establishing or limiting fees for noncovered services.
Spectrum: Slight Partisan Bill (Republican 6-2)
Status: (Failed) 2017-01-31 - Died In Committee [SB2605 Detail]
Download: Mississippi-2017-SB2605-Introduced.html
MISSISSIPPI LEGISLATURE
2017 Regular Session
To: Insurance; Accountability, Efficiency, Transparency
By: Senator(s) Blackwell, Dearing, Parker, Caughman, Massey, Younger, Seymour, Barnett
Senate Bill 2605
AN ACT TO PROHIBIT PROVIDER CONTRACTS FOR VISION SERVICES IN HEALTH AND VISION INSURANCE PLANS OR VISION CARE DISCOUNT PLANS FROM ESTABLISHING OR LIMITING FEES FOR NONCOVERED SERVICES; TO PROHIBIT A PROVIDER FROM CHARGING MORE FOR SERVICES AND MATERIALS THAT ARE NONCOVERED SERVICES UNDER A VISION PLAN THAN HIS USUAL AND CUSTOMARY RATE FOR THOSE SERVICES AND MATERIALS; AND FOR RELATED PURPOSES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:
SECTION 1. (1) No agreement between an insurer or an entity that writes vision insurance and an optometrist or ophthalmologist for the provision of vision services on a preferred or in-network basis to plan members or insurance subscribers in connection with coverage under a stand-alone vision care plan, a vision care discount plan, a medical plan, or health insurance policy may require that an optometrist or ophthalmologist provide services or materials at a fee limited or set by the plan or insurer unless the services or materials are reimbursed as covered services under the contract.
(2) A provider shall not charge more for services and materials that are noncovered services under a vision care plan, vision care discount plan, or insurer than his or her usual and customary rate for those services and materials.
(3) The amount of a contractual discount shall not result in a fee less than the vision care plan, vision care discount plan, or health plan would pay for covered services and materials but for the application of an enrollee's contractual limitations of deductibles, copayments and coinsurance.
(4) Reimbursement paid by the vision care plan, vision care discount plan, or insurer for covered services and materials, regardless of supplier or optical lab used to obtain materials, shall be reasonable, shall be clearly listed on a fee schedule that is made available to the vision care provider prior to accepting the contract from the vision care plan, vision care discount plan, or insurer, and shall not provide nominal reimbursement or advertise services and materials to be covered with additional copay or coinsurance if the vision care plan, vision care discount plan, or insurer do not reimburse for the services or materials in order to claim that services and materials are covered services.
(5) For purposes of this section:
(a) "Contractual discount" means a percentage reduction from a provider's usual and customary rate for covered services and materials required under a participating provider agreement.
(b) "Covered services" means services and materials for which reimbursement from the vision care plan, vision care discount plan, or insurer is provided for by an enrollee's plan contract, or for which a reimbursement would be available but for the application of the enrollee's contractual limitations of deductibles, copayments, and coinsurance.
(c) "Materials" includes, but is not limited to, lenses, devices containing lenses, prisms, lens treatments and coatings, contact lenses, orthoptics, vision training, and prosthetic devices to correct, relieve, or treat defects or abnormal conditions of the human eye or its adnexa.
(d) "Vision care plan" means any policy of insurance that is issued by a health care entity that provides coverage of vision services.
(f) "Provider of vision services" means optometrists and ophthalmologists that provide vision care services and materials.
(6) A participating provider agreement between a vision care plan, vision care discount plan, or insurer and a vision care provider shall not restrict or limit, directly or indirectly, the vision care provider's choice of optical labs or choice of sources and suppliers of services or materials provided by the vision care provider to an individual who is insured by the insurer. No vision care plan, vision care discount plan or insurer shall change the terms, discounts or reimbursement rates contained therein, regardless of supplier or fabricating lab used to supply materials, without a signed acknowledgement of written agreement from the eye care provider.
(7) No agreement between a vision care plan, vision care discount plan, or insurer and a vision care provider shall require that an eye care provider must participate with or be credentialed by any specific vision care plan or vision care discount plan as a condition for participating in the health care network of the insurer to provide covered medical services to enrollees.
SECTION 2. This act shall take effect and be in force from and after July 1, 2017.
