Chapter 176O - HEALTH INSURANCE CONSUMER PROTECTIONS

Section 176O:1 - Definitions
Section 176O:2 - Bureau of managed care
Section 176O:3 - Complaints against carriers; notice; hearing
Section 176O:4 - Refusal of carriers to contract with eligible health care providers solely because providers have practiced good faith advocacy on behalf of patients
Section 176O:5 - Contracts; liability
Section 176O:5A - Adoption of code standards and guidelines
Section 176O:5B - Adoption of policies and procedures for enforcement of Sec. 176O:5A
Section 176O:5C - Failure of carrier to comply with coding standards; penalty
Section 176O:5D - Establishment of base fee schedule for evaluation and management services for behavioral health providers
Section 176O:6 - Evidence of coverage to be delivered to covered adults by health, dental, and vision care providers; contents
Section 176O:7 - Information provided by carrier upon enrollment or request
Section 176O:8 - Failure by carrier to file annual statement; fine
Section 176O:9 - Utilization review programs; annual attestations
Section 176O:9A - Agreements or contracts between carriers and health care providers; prohibited provisions
Section 176O:9B - Risk certificate required
Section 176O:10 - Contractual financial incentive plans
Section 176O:11 - Rights of health benefit plans to include as providers religious non-medical providers
Section 176O:12 - Utilization review
Section 176O:12A - Step therapy; clinical review criteria
Section 176O:12B - Commission on step therapy protocols
Section 176O:13 - Formal internal grievance process; expedited resolution policy
Section 176O:14 - Review panel; patient protection office
Section 176O:15 - Continued treatment by involuntarily disenrolled physicians and providers; specialty health care coverage
Section 176O:16 - Clinical decisions regarding medical treatment made by treating physicians; payment for health care services ordered by treating physicians or primary care provider
Section 176O:17 - Regulations; promulgation
Section 176O:18 - Liability for behavioral health manager
Section 176O:19 - Contact information for behavioral health manager
Section 176O:20 - Information required from behavioral health manager; submission of material changes; workers' compensation; preferred provider arrangements
Section 176O:21 - Annual comprehensive financial statements detailing carrier costs
Section 176O:22 - Participation in medical assistance program as condition for participation in carrier provider network
Section 176O:23 - Disclosure by carrier of estimated or maximum allowed amount or charge for proposed admission; toll-free telephone number and website for consumers
Section 176O:24 - Internal appeals processes for risk-bearing provider organizations; third-party advocates; external review process
Section 176O:25 - Prior authorization forms
Section 176O:26 - Standardized processes and procedures for determination of health benefit plan eligibility
Section 176O:27 - Summary of payments form
Section 176O:28 - Provider directories; contents; audits; print copies; customer service contact information; accommodations; accuracy; updates
Section 176O:29 - Standard credentialing forms for health care providers; promulgation of regulations
Section 176O:30 - [Effective 4/8/2025] Report to commission regarding drugs provided with no cost-sharing