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1 New Paragraph; Managed Care Law; Provider Contract Standards. Amend RSA 420-J:8 by inserting after paragraph XVIII the following new paragraph:
XIX.(a) Each health care provider contract with a health carrier shall refer to the provider manual only as an administrative tool and use such provider manual only for administrative purposes. The provider manual shall not contain, nor shall it be used to effectuate, material changes to, or provisions that conflict with, the prevailing provider contract or health benefit plan member certificates that impact consumer health care coverage or clinical care.
(b) Disputes regarding such changes shall be referred to the department, which shall establish rules under RSA 541-A to resolve such disputes, including any remedies deemed appropriate by the commissioner.
2 Effective Date. This act shall take effect 60 days after its passage.
Text to be added highlighted in green.
1 New Paragraph; Managed Care Law; Provider Contract Standards. Amend RSA 420-J:8 by inserting after paragraph XVIII the following new paragraph:
XIX.(a) Each health care provider contract with a health carrier shall refer to the provider manual only as an administrative tool and use such provider manual only for administrative purposes. The provider manual shall not contain, nor shall it be used to effectuate, material changes to, or provisions that conflict with, the prevailing provider contract or health benefit plan member certificates that impact consumer health care coverage or clinical care.
(b) Disputes regarding such changes shall be referred to the department, which shall establish rules under RSA 541-A to resolve such disputes, including any remedies deemed appropriate by the commissioner.
2 Effective Date. This act shall take effect 60 days after its passage.