ARC Model Legislation and Advocacy Resources

Explore ARC model legislation and other resources assisting in managed care advocacy

ARC Advocacy Resources

Anti-gag Clause/Protecting Physicians from Retaliation Model Bill

Provides comprehensive protections for physicians from health insurer retaliation for both physician communications with patients and communications with regulators/legislators.

Anti-gag clause, Anti-retaliation, Model Legislation
ARC Advocacy Resources

Credentialing Deadlines Model Bill

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

Prohibiting Most Favored Nations Clause Act

Uses most favored nation (MFN) clauses in physician managed-care contracts. Dominant health insurers can force physicians to give discounts to the dominant insurer that the physician may have given to other insurers or payers. This model bill prohibits health insurers from putting MFN clauses in physician contracts.

Model Legislation, Most Favored Nation
ARC Advocacy Resources

Prompt Payment Model Bill

Ensures that physicians are treated fairly and receive timely payment when they make claims for payment to health insurers and other payers.

Model Legislation, Prompt Payment Deadlines
ARC Advocacy Resources

Physician Profiling Programs and Network Determination Act

Gives physicians due process rights to help protect themselves when health insurers want to give the public information about physicians’ performance.

Model Legislation, Profiling
ARC Advocacy Resources

Coordinate Care Organizations Act

Model Legislation, Risk—Physicians Taking
ARC Advocacy Resources

Protected: Limiting Insurer Unilateral Amendments Model Bill

Requires health insurers to give physicians key payment data and prohibits a health insurer from making a material change to a contract more than once a year.

Amendments, Model Legislation
ARC Advocacy Resources

Fee Schedule/Taking Risk Disclosure Model Bill

Ensures that payers give physicians complete and accurate information concerning fee for services reimbursement, as well as a wide variety of risk arrangements, e.g., capitation, to make sure that physicians are fully anticipate expected revenue as well as be empowered to managed successfully any risk they have assumed.

Fee Schedules, Model Legislation, Payment Edits, Payment Rules, Risk—Physicians Taking
ARC Advocacy Resources

Termination Protection Model Bill

Requires a health insurer to give a physician specific fair process rights, e.g., a hearing, before either officially denying the physician’s request to join an insurer’s network or terminating a physician’s managed care contract or network participation.

Model Legislation, Termination-Due Process
ARC Advocacy Resources

Surprise Bill Model Act

Prevents patients from being financially penalized for receiving unanticipated out-of-network care in an emergency situation or when the patient did not have the ability or control to select services from an in-network health care professional.  It also would reduce patient exposure to unanticipated out-of-network care in the first place through measurable network adequacy requirements and incentives for insurers to offer fair contracts to providers.

Model Legislation