State Law
08/22/2023
Rhode Island
Section 27-18.8-3
Certification of network plans
Anti-retaliation, Continuity of Care Post-Contract, Credentialing-Patient Demographics, Directories, Most Favored Nation, Termination
ARC Advocacy Resources
Imposes deadlines within which a health insurer must process a complete credentialing application: thirty (30) days for primary care physicians and forty-five (45) days for other specialists. The model bill also states that credentialing due to economic factors must be adjusted to take into account the case mix, age, severity of illness, etc., and that during the credentialing process, health insurers must pay the physician for providing services to subscribers.
Credentialing-Deadlines, Credentialing-Due Process-Denial of Contract, Credentialing-Patient Demographics, Credentialing-Payment Issues, Model Legislation
ARC Advocacy Resources
A red-lined version of the NAIC’s model bill to assist medical societies in states where the NAIC model has been introduced or where the medical society would like to propose network adequacy legislation.
Amendments, Anti-gag clause, Anti-retaliation, Continuity of Care Post-Contract, Credentialing-Patient Demographics, Directories, Model Legislation, Network Adequacy, Prohibited financial incentives, Termination
State Law
07/28/2023
California
Section 2240.1
Adequacy and Accessibility of Provider Services
Credentialing-Patient Demographics, Network Adequacy
State Law
08/10/2023
Nebraska
Section 44-4109.01
Policies or contracts; requirements
Credentialing-Due Process-Denial of Contract, Credentialing-Patient Demographics, Termination-Due Process
State Law
08/24/2023
Texas
Section 3.3706
Designation as a Preferred Provider, Decision to Withhold Designation, Termination of a Preferred Provider, Review of Process
Credentialing-Due Process-Denial of Contract, Credentialing-Patient Demographics, Profiling, Termination, Termination-Due Process
State Law
08/26/2023
Virginia
Section 5-408-170
Provider Credentialing and Recredentialing
Credentialing-Deadlines, Credentialing-Patient Demographics, Credentialing-Payment Issues, Termination-Due Process
State Law
08/26/2023
Vermont
Reg. H-2009-03
Consumer protection and quality requirements for managed care organizations
Amendments, Anti-gag clause, Anti-retaliation, Continuity of Care Post-Contract, Credentialing-Due Process-Denial of Contract, Credentialing-Patient Demographics, Directories, ERISA-Med. Nec. Decisions-Deadlines, Liability-insurer shifting to physician, Medical Necessity-Definition, Network Adequacy, OON-Payment Issues, Prohibited financial incentives, Retroactive Denial, State Medical Necessity Appeals-Deadlines, Termination, Termination-Due Process, U.R. Criteria
State Law
08/28/2023
Washington
Section 284-170-411
Selection of participating providers-Credentialing and unfair discrimination
Credentialing-Patient Demographics
State Law
08/22/2023
Rhode Island
Part 9. Network Plans
Amendments, Anti-retaliation, Continuity of Care Post-Contract, Credentialing-Deadlines, Credentialing-Patient Demographics, Credentialing-Payment Issues, Directories, Most Favored Nation, Network Adequacy, Profiling, Termination
