5304-S2 AMS ERWI S2332.2

2SSB 5304 - S AMD  000159

By Senators Erwin and Roach

                                               NOT ADOPTED 3/12/93

    On page 16, line 2, after "state." insert "Participating managed care systems eligible as basic health care providers must permit licensed care providers, on an individual or class basis, to provide health services or care for conditions included in the basic benefit package to the extent that:

(a) The provision of such health services or care is within the health care providers' permitted scope of practice; and

(b) The providers agree to abide by standards related to:

(i) Provision, utilization review, and cost containment of health services;

(ii) Management and administrative procedures; and

(iii) Provision of cost-effective and clinically efficacious health services.

Eligible managed care systems shall develop and implement procedures for:  Disclosure of provider contracting standards developed under this subsection; termination for cause of health care providers who have failed to comply with standards developed under this subsection; and appeal of a certified health plan's determination not to contract with an individual provider or provider group or to terminate a contract for cause."

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