SB 2641

Abstract

Amends the Network Adequacy and Transparency Act. Provides that the Department of Insurance shall determine whether the network plan at each in-network hospital and facility has a sufficient number of hospital-based medical specialists to ensure that covered persons have reasonable and timely access to such in-network physicians and the services they direct or supervise. Defines "hospital-based medical specialists". Senate Floor Amendment No. 1 Replaces everything after the enacting clause. Amends the Network Adequacy and Transparency Act. Provides that an insurer providing a network plan must file with the Director of Insurance a description of the process for monitoring health plan beneficiaries' timely in-network access to physician specialist services. Provides that an insurer providing a network plan shall file an insurer's monitoring report for each network hospital and facility, which shall include, but is not limited to, the number and percentage of physician providers under contract in each of the specialties of emergency medicine, anesthesiology, radiology, and pathology practicing in the in-network hospital or facility when such providers are not employees of the hospital or facility. Requires every insurer to demonstrate to the Director that each in-network hospital and facility has a sufficient number of hospital-based medical specialists to ensure that covered persons have reasonable and timely access to such in-network physicians and the services they direct or supervise. Defines "hospital-based medical specialists". House Floor Amendment No. 1 Replaces everything after the enacting clause. Amends the Network Adequacy and Transparency Act. Provides that, beginning January 1, 2026, every insurer shall demonstrate to the Director of Insurance that each in-network hospital has at least one radiologist, pathologist, anesthesiologist, and emergency room physician as a preferred provider in a network plan. Provides that the Department of Insurance may, by rule, require additional types of hospital-based medical specialists to be included as preferred providers in each in-network hospital in a network plan.