Section 6: Therapeutic Contact Lenses
Permits a physician or an optometrist to dispense and sell therapeutic contact lenses in-office, as long as dispensing the medication contained in the lenses is within his or her scope of practice.
Permits a physician or an optometrist to dispense and sell therapeutic contact lenses in-office, as long as dispensing the medication contained in the lenses is within his or her scope of practice.
Directs relevant policymaking agencies to consider the special needs of children and pediatric patients when developing and utilizing data standards, quality measurement systems, wellness initiatives, or making comparisons of costs and prices. Policymakers may require that comparative data and reports related to pediatric patients and providers be segregated from adult patients and providers.
Establishes a special commission to study the impact of reducing the number of health plans that a health insurance provider may maintain and offer to individuals and employers.
Directs the Division of Insurance (DOI), in consultation with the Executive Office of Health and Human Services, to establish regulations by December 1, 2011 to simplify health care facility and provider administrative duties of processing claims for health care services. At a minimum, the regulations must create a standard prior authorization form for providers and must specify uniform standards for determining member eligibility and processing provider appeals of denied claims. Establishes a new commission to study the feasibility and financial implications of mandating a single claims administration system that would require the participation of all public and private health insurance payers, other than Medicare, in the Commonwealth. DOI must consult with this commission before adopting regulations under this section.
Directs the Secretary of Health and Human Services to organize a working group consisting of many state agencies and health care community stakeholders to identify ways to streamline health care administration requirements and reduce reporting requirements through the use of a single all-payer database.
The group must issue a report to the legislature by April 1, 2011 identifying steps each agency will take to collectively simplify administrative and reporting requirements.
Allows individuals to renew health insurance coverage in 2010 outside of the biannual open enrollment period of January 1 through February 15 and July 1 through August 15 if the coverage will expire before the following open enrollment period in 2011 for a period of less than one year. Note that Section 27 of this Act reduces the biannual open enrollment period to only one annual open enrollment period during July 1 through August 15 effective January 1, 2011.
Instructs the Department of Public Health to organize a statewide advisory committee to develop and recommend a standard set of quality measurements for health care providers by January 1, 2011. The governor must appoint 6 representatives of health facility and provider organizations to join 10 state officials on the advisory committee.
In developing the Standard Quality Measure Set for 2010, the committee may only consider adopting state and federal quality and safety measures already in existence. In 2011, the committee may consider amending the Set to include nationally recognized quality measures that are not yet developed. At a minimum, the Set must include measures specified in this section.
The advisory committee must annually recommend to DPH updates to the Standard Quality Measure Set by each November 1st.
Instructs the Division of Health Care Finance and Policy (DHCFP), in consultation with the Division of Insurance, to establish regulations directing hospitals to calculate and report all costs, including inpatient and outpatient costs and direct and indirect costs. Calculations must include costs and cost trends for labor, debt-related expenses, advertising and marketing, insurance, health information technology, management, research, academic costs, contributions, and all business operation costs. Before adopting final regulations, DHCFP must consult with designated stakeholders.
Instructs the Division of Health Care Finance and Policy (DHCFP), in consultation with the Division of Insurance, to establish regulations directing health insurance carriers to calculate and report relative prices paid to health care facilities and providers. In the regulations, DHCFP must specify a method to account for a uniform mix of products and services and all non-claims related payments to providers.
Instructs the Division of Health Care Finance and Policy (DHCFP), in consultation with the Division of Insurance, to establish regulations directing health insurance carriers to calculate and report health status adjusted total medical expenses for provider groups determined by zip code. In the regulations, DHCFP must specify a uniform method for calculating total medical expenses among each provider group, determine which non-claim related payments must be included in the calculations, account for health status and number of patients within each group, and specify reporting requirements.