Amendment #76 to H3899

Protecting Licensed Intellectual Property While Maintaining Healthcare Transparency

Ms. Khan of Newton moves to amend the bill by inserting before section 3 the following sections:-

Section X.  Section 16 of chapter 6D, as added by section 15 of chapter 224 of the acts of 2012, is hereby amended by striking out the following:- “Utilization review criteria, medical necessity criteria and protocols must be made available to the public at no charge regardless of proprietary claims.”

Section X.  Section 12 of chapter 176O, as amended by section 199 of chapter 224 of the acts of 2012, is hereby amended, in the fourth sentence, by striking out the following:- “but must disclose such criteria to a provider or subscriber upon request.” and inserting in place thereof the following:- “but must disclose the relevant portion of such criteria to the provider and/or subscriber in the event of an adverse coverage determination.”

Section X.  Section 16 of chapter 176O, as amended by section 202 of chapter 224 of the acts of 2012, is hereby amended, by inserting after the words “general public” the following:- “Provided, however, that a carrier shall not be required to disclose licensed, proprietary medical necessity guidelines criteria purchased by a carrier or utilization review organization on its website, but must disclose the relevant portion of such criteria to the provider and/or subscriber in the event of an adverse coverage determination.”