HB 2196--
By Representative Tanner
[ol12](By Request) 2-3

AN ACT providing consumer choice of health care provider; enacting the patient protection act. Be it enacted by the Legislature of the State of Kansas: Section 1. This act shall be known and may be cited as the patient protection act. Sec. 2. The legislature finds that a patient should be given the op- portunity to see the health care provider of the patient's choice. In order to assure the residents of the state of Kansas the right to choose the provider of their choice, it is the intent of the legislature to provide the opportunity of providers to participate in health benefit plans. Sec. 3. As used in this act: (a) ``Copayment'' means a type of cost sharing whereby insured or covered persons pay a specified predetermined amount per unit of service or percentage of health care costs with their health care insurer paying the remainder of the charge. The copayment is incurred at the time the service is rendered. The copayment may be a fixed or variable amount. (b) ``Gatekeeper system'' means a system of administration used by any health benefit plan in which a primary care provider furnishes basic patient care and coordinates diagnostic testing, indicated treatment and specialty referral for persons covered by the health benefit plan. (c) ``Health benefit plan'' means any entity or program that provides reimbursement, including capitation, for health care services. (d) ``Health care provider'' means those persons and entities defined as a health care provider under K.S.A. 65-4915, and amendments thereto. (e) ``Health care services'' means services and products provided by a health care provider within the scope of the provider's license. (f) ``Health care insurer'' means any entity, including, but not limited to, insurance companies, hospital and medical service corporations, health maintenance organizations, preferred provider organizations, physician hospital organizations, third-party administrators and prescription benefit management companies authorized to administer, offer or provide health benefit plans. Sec. 4. (a) A health care insurer shall not, directly or indirectly: (1) Impose a monetary advantage or penalty under a health benefit plan that would affect a beneficiary's choice among those health care providers who participate in the health benefit plan according to the terms offered. Monetary advantage or penalty includes higher copayment, a reduction in reimbursement for services or promotion of one health care provider over another by these methods; or (2) impose upon a beneficiary of health care services under a health benefit plan any copayment, fee or condition that is not equally imposed upon all beneficiaries in the same benefit category, class or copayment level under that health benefit plan when the beneficiary is receiving services from a participating health care provider pursuant to that health benefit plan. (3) Prohibit or limit a health care provider that is qualified under subsection (d) of section 3 and is willing to accept the health benefit plan's operating terms and conditions, its schedule of fees, covered expenses, utilization regulations and quality standards, the opportunity to partici- pate in that plan. (b) Nothing in this act shall prevent a health benefit plan from insti- tuting measures designed to maintain quality and to control costs, includ- ing, but not limited to, the utilization of a gatekeeper system, as long as such measures are imposed equally on all providers in the same class. Sec. 5. Nothing in this act shall be construed to require any health care insurer to cover any specific health care service. Provided, however, no condition or measure shall have the effect of excluding any type or class of provider qualified under section 4 to provide that service. Sec. 6. Any person adversely affected by a violation of this act may sue in a court of competent jurisdiction for injunctive relief against the health care insurer and, upon prevailing, in addition to such relief, shall recover damages not less than $1,000, attorney fees and costs. Sec. 7. To avoid impairment of existing contracts, the patient pro- tection act shall apply only to contracts issued or renewed after the ef- fective date of the act. Any provision in a health benefit plan which is executed, delivered or renewed or otherwise contracts for provision of services in this state that is contrary to this act, to the extent of the conflict, shall be void. Sec. 8. It is a violation of this act for any health care insurer or other person or entity to provide any health benefit plan providing for health care services to residents of this state that does not conform to this act, but nothing in this act shall constitute a violation on the basis of actions taken by the health benefit plan to maintain quality, enforce utilization regulations and to control costs. Sec. 9. This act shall take effect and be in force from and after its publication in the statute book.