SB0192 - Various health care matters.

1 Co-Sponsor

Various health care matters. Makes changes to the law governing administrative adjudication and to provisions related to managed care organizations. Provides that if a physician has entered into a provider agreement with the office of Medicaid policy and planning (office) or a managed care organization and the physician, subject to the provider agreement, provides professional services to individuals participating in the state Medicaid program, the office or the managed care organization shall promptly compensate the physician for the professional services in accordance with the provider agreement. Prohibits any delay in or denial of compensation to the physician unless the cause of the delay or denial is specifically provided for in: (1) the Medicaid managed care law; (2) an administrative rule adopted under the Medicaid managed care law; (3) the federal administrative rules on Medicaid managed care; or (4) the provider agreement. Defines "antiretroviral" as a drug used to prevent a retrovirus, such as the human immunodeficiency virus (HIV), from replicating. Provides, for purposes of the Medicaid program and the children's health insurance program, that an FDA approved drug that is prescribed for the treatment or prevention of HIV or acquired immunodeficiency syndrome (AIDS), including antiretrovirals, shall not be subject to: (1) prior authorization; (2) a step therapy protocol; or (3) any other protocol that could restrict or delay the dispensing of the drug. Prohibits a health plan (including a policy of accident and sickness insurance, a health maintenance organization contract, the state employee self-insurance program and prepaid health care delivery plan, and a Medicaid risk based managed care program) from imposing or enforcing: (1) a prior authorization requirement; (2) a step therapy protocol requirement; or (3) any other protocol requirement; if imposing or enforcing the requirement could restrict or delay the dispensing to a covered individual of an FDA approved drug, including an antiretroviral, that is prescribed for the treatment or prevention of HIV or AIDS. States that a home health agency is not required to conduct a tuberculosis test on a job applicant before the individual has contact with a patient. Repeals a statute that requires certain personal services agency employees or agents to complete a tuberculosis test. Authorizes the establishment of home health agency cooperative agreements. (A similar law enacted in 2022 expired on July 1, 2023.) Makes statements and findings of the general assembly concerning home health agency cooperative agreements. Specifies that a home health agency may contract directly or indirectly through a network of home health agencies. Exempts: (1) a remote location of a hospital; and (2) a free standing emergency department or other provider-based entity; from health care billing requirements. Allows a pharmacist to administer an immunization that is recommended by the federal Centers for Disease Control and Prevention Advisory Committee on Immunization Practices to a group of individuals under a drug order, under a prescription, or according to a protocol approved by a physician if certain conditions are met. (Current law allows a pharmacist to administer specified immunizations to a group of individuals under a drug order, under a prescription, or according to a protocol approved by a physician if certain conditions are met.) Removes a provision allowing a pharmacist to administer pneumonia immunizations to individuals who are at least 50 years of age.