Amendment #872 to H4000

Proprietary Medical Information Disclosure

Mr. Mariano of Quincy moves to amend the bill by adding the following three sections:

"SECTION  XXXX.  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.” and inserting in its place the following:- “Utilization review criteria, medical necessity criteria and protocols must be made available:

(a) with a notice of adverse determination;

(b) upon request to an insured who has not received a notice of adverse determination or to such insured’s provider, the applicable criteria and protocols related to specific diagnosis or treatments; and

(c) upon request to the Office of Patient Protection and the Division of Insurance provided that such criteria and protocols shall not be public records and shall be exempt from disclosure under clause Twenty-sixth of section 7 of chapter 4 and section 10 of Chapter 66”.

“SECTION XXXX. Section 12 of chapter 176O, as amended in the fourth sentence by section 199 of chapter 224 of the acts of 2012, is hereby amended by striking out the following:-“but must disclose such criteria to a provider or subscriber upon request.” and inserting in its place the following:- “but must disclose such criteria as required by section 16 of chapter 6D”.

“SECTION XXXX. 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 or criteria purchased by a carrier or utilization review organization on its website, but must disclose such criteria as required by section 16 of chapter 6D”.