Section 991.2113 - Medical gag clause prohibition(a) No managed care plan may penalize or restrict a health care provider from discussing: (1) the process that the plan or any entity contracting with the plan uses or proposes to use to deny payment for a health care service;(2) medically necessary and appropriate care with or on behalf of an enrollee, including information regarding the nature of treatment; risks of treatment; alternative treatments; or the availability of alternate therapies, consultation or tests; or(3) the decision of any managed care plan to deny payment for a health care service.(b) A provision to prohibit or restrict disclosure of medically necessary and appropriate health care information contained in a contract with a health care provider is contrary to public policy and shall be void and unenforceable.(c) No managed care plan shall terminate the employment of or a contract with a health care provider for any of the following:(1) Advocating for medically necessary and appropriate health care consistent with the degree of learning and skill ordinarily possessed by a reputable health care provider practicing according to the applicable legal standard of care.(2) Filing a grievance pursuant to the procedures set forth in this article.(3) Protesting a decision, policy or practice that the health care provider, consistent with the degree of learning and skill ordinarily possessed by a reputable health care provider practicing according to the applicable legal standard of care, reasonably believes interferes with the health care provider's ability to provide medically necessary and appropriate health care.(d) Nothing in this section shall: (1) Prohibit a managed care plan from making a determination not to pay for a particular medical treatment, supply or service, enforcing reasonable peer review or utilization review protocols or making a determination that a health care provider has or has not complied with appropriate protocols.(2) Be construed as requiring a managed care plan to provide, reimburse for or cover counseling, referral or other health care services if the plan: (i) objects to the provision of that service on moral or religious grounds; and(ii) makes available information on its policies regarding such health care services to enrollees and prospective enrollees.1921, May 17, P.L. 682, No. 284, § 2113, added 1998, June 17, P.L. 464, No. 68, § 1, effective 1/1/1999.