NOTE: As provided in LFC policy, this report is intended for use by the standing finance committees of the legislature.  The Legislative Finance Committee does not assume responsibility for the accuracy of the information in this report when used in any other situation.

The LFC is only preparing FIRs on bills referred to the Senate Finance Committee, the Senate Ways and Means Committee, the House Appropriations and Finance Committee and the House Taxation and Revenue Committee. The chief clerks are responsible for preparing and issuing all other bill analyses.

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(Parenthesis ( ) Indicate Expenditure Decreases)

Relates to SB4

SOURCES OF INFORMATION

LFC Files

SUMMARY

Synopsis of Bill

The bill requires that claims submitted by participating providers to health maintenance organizations (HMO) shall have interest paid to the provider at the rate of one and one-half percent a month, compounded monthly on the amount of the claim not paid within 30 days or on the portion of the claim not under dispute. A HMO shall notify a provider in writing if there is a problem with payment of a claim.

The Insurance Division of the Public Regulation Commission shall promulgate rules requiring HMOs to promptly notify both governmental and private providers.

CONFLICT/DUPLICATION/COMPANIONSHIP/RELATIONSHIP

SB49 almost duplicates SB4, except that SB49 would not require payment of interest on the portion of a claim submitted to the HMO that is not in dispute and does not require additional information for adjudication if the HMO fails to pay the undisputed or substantiated portion of the claim within 30 days; and SB49 does not apply to claims that are not submitted electronically.

RAE/njw