(1) urges all third party payers and self-insured plans to publish their payment policies, rules, and fee schedules;
(2) pursues all appropriate means to make publication of payment policies and fee schedules a requirement for third party payers and self-insured plans;
(3) will develop model state and federal legislation that would require that all third party payers and self-insured plans publish all payment schedule updates, and changes at least 60 days before such changes in payment schedules are enacted, and that all participating physicians be notified of such changes at least 60 days before changes in payment schedules are enacted.
(4) seeks legislation that would mandate that insurers make available their complete payment schedules, coding policies and utilization review protocols to physicians prior to signing a contract and at least 60 days prior to any changes being made in these policies;
(5) works with the National Association of Insurance Commissioners, develop model state legislation, as well developing national legislation affecting those entities that are subject to ERISA rules; and explore the possibility of adding payer publication of payment policies and fee schedules to the Patient Protection Act; and
(6) supports the following requirements: (a) that all payers make available a copy of the executed contract to physicians within three business days of the request; (b) that all health plan EOBs contain documentation regarding the precise contract used for determining the reimbursement rate; (c) that once a year, all contracts must be made available for physician review at no cost; (d) that no contract may be changed without the physician’s prior written authorization; and (e) that when a contract is terminated pursuant to the terms of the contract, the contract may not be used by any other payer.
Sub. Res. 805, I-95 Appended: Res. 117, A-98 Reaffirmation A-99 Appended: Res. 219, and Reaffirmed: CMS Rep. 6, A-00 Reaffirmation I-01 Reaffirmed and Appended: Res. 704, A-03 Reaffirmation I-04 Reaffirmation A-08 Reaffirmation I-08 Reaffirmed: CMS Rep. 3, I-09 Reaffirmation A-14