H.B. 1563                                                     VETOES

(2) THE APPROPRIATE STANDARDS AND OPERATING REQUIREMENTS
NECESSARY TO ENHANCE THE COORDINATION AND INTEGRATION OF CARE
RENDERED TO ENROLLEES OF A HEALTH NETWORK;

(3) THE PROCEDURES AND PERFORMANCE MEASURES TO EXERCISE
APPROPRIATE OVERSIGHT OF THE COST AND UTILIZATION OF SERVICES
RENDERED BY HEALTH NETWORKS;

(4) THE STANDARDS NECESSARY TO ENSURE THAT HEALTH NETWORKS
ESTABLISH ONGOING QUALITY ASSURANCE AND UTILIZATION PROGRAMS THAT
STRESS HEALTH OUTCOMES AND THE APPROPRIATE USE OF PRACTICE
PARAMETERS;

(5) THE STANDARDS NECESSARY TO ENSURE THAT HEALTH
NETWORKS:

(I)      ENROLL INDIVIDUALS WHO ARE BROADLY REPRESENTATIVE
OF THE VARIOUS AGE, RACIAL, ETHNIC, AND INCOME GROUPS WITHIN THEIR
REGIONAL AREA; AND

(II)     DO NOT USE THE DESIGN OF THEIR HEALTH CARE PROVIDER
NETWORK OR MARKETING EFFORTS TO DISCOURAGE ENROLLMENT FROM HIGH
RISK OR SPECIAL NEEDS POPULATIONS;

(6) THE NECESSARY STANDARDS TO HELP ENSURE THAT HEALTH
NETWORKS ARE ACCOUNTABLE TO THE REGIONS AND COMMUNITIES THEY
SERVICE INCLUDING:

(I) THE GOVERNANCE OF THE HEALTH NETWORK; AND

(II) THE COMMITMENT TO IMPROVING THE OVERALL COMMUNITY
HEALTH STATUS AND SERVICE TO THE UNINSURED;

(7) THE NECESSARY SOLVENCY AND RESERVE REQUIREMENTS FOR
INTEGRATED HEALTH NETWORKS THAT CONTRACT DIRECTLY WITH INDIVIDUALS
OR EMPLOYERS AND RETAIN THE RISK FOR DELIVERING HEALTH BENEFITS;

(8) IN CONSULTATION WITH THE ATTORNEY GENERAL'S OFFICE, THE
NEED TO AMEND EXISTING STATE LAWS TO REMOVE CURRENT BARRIERS OR
DISINCENTIVES TO THE PROMOTION AND FORMATION OF HEALTH NETWORKS
INCLUDING:

(I) THE ANTITRUST LAWS; AND

(II) CERTIFICATE OF NEED LAWS;

(9) THE EFFECT OF MANAGED CARE AND MANAGED CARE
REGULATION IN OTHER STATES ON HEALTH CARE SERVICE DELIVERY AND ON
COST CONTAINMENT IN THOSE STATES;

(10) THE CAPACITY OF HEALTH CARE NETWORKS TO PROVIDE A CHOICE
OF ANY HEALTH CARE PROVIDER TO THEIR SUBSCRIBERS OR ENROLLEES;

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