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Senate Committee on Managed Care and Consumer Protections, Interim - 74th R.S. (1995)

Committee Members
David Sibley, Chair
David Cain
Chris Harris
Frank Madla
Jane Nelson
Charges
• Evaluate the ability of managed care organizations to provide adequate access to medical care. Examine Health Maintenance Organization (HMO) licensing standards as they relate to physician/patient rations, specialty physician/patient ratios, scope of medical coverage and geographic coverage requirements.
• Study the incidence of emergency room utilization and the standards used to establish eligibility by an HMO for emergency room services.
• Evaluate the requirements of an HMO to have adequate and effective consumer appeals processes in place for denied services, prescription drugs, etc.
• Evaluate the standards of consumer education, in terms of availability and scope, and determine the extent to which they are, or should, be governed by regulation or statue.
• Assess the process by which "medical necessity" is determined by an HMO, who may participate in establishing the criteria, if the process is governed by current or pending regulations and if the standards need enhancement.
• The Interim Committee should study each of the above items and make recommendations based on its findings. In making its recommendations, the Interim Committee should consider whether modifications need to be addressed through state agency rule making authority or statutorily by the Legislature.

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