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<section article="gin" article_name="Insurance" number="15-1703" title_number="15" title_name="Health Insurance" subtitle_number="17" subtitle_name="Regulation of Physician Rating Systems">
  <level label="a">
    <text>A carrier that uses a physician rating system shall:</text>
    <level label="1">
      <text>establish an appeals process for physicians to use to contest their rating; and</text>
    </level>
    <level label="2">
      <text>at least 45 days before making available to enrollees any new or revised quality of performance or  cost–efficiency evaluations or any new or revised inclusions or exclusions from a physician rating system, provide each physician included in the physician rating system with:</text>
      <level label="i">
        <text>a notice of the proposed change;</text>
      </level>
      <level label="ii">
        <text>an explanation of the data used to assess the physician and how the physician may access the data;</text>
      </level>
      <level label="iii">
        <text>the methodology and measures used to assess the physician;</text>
      </level>
      <level label="iv">
        <text>an explanation of the right to contest the rating of the physician through the appeals process of the carrier; and</text>
      </level>
      <level label="v">
        <text>instructions on how to file a timely appeal with the carrier.</text>
      </level>
    </level>
  </level>
  <level label="b">
    <text>If a physician files a timely appeal, as defined by the carrier, regarding the rating of the physician under a physician rating system, the carrier may not disclose the rating of the physician or make a change in the quality of performance or  cost–efficiency ratings of the physician until the carrier completes its investigation and renders a decision on the appeal.</text>
  </level>
  <level label="c">
    <text>A carrier shall post the following information prominently on the section of the carrier’s Web site that discloses the rating of a physician to enrollees or to the public:</text>
    <level label="1">
      <text>where an enrollee can find the physician performance ratings of the carrier;</text>
    </level>
    <level label="2">
      <text>a disclosure that physician performance ratings are only a guide to choosing a physician because the ratings have a risk of error and should not be the sole basis for selecting a physician;</text>
    </level>
    <level label="3">
      <text>an explanation of the physician rating system, including the basis on which physician performance is measured and the basis for determining that a physician is not currently rated due to insufficient data or a pending appeal;</text>
    </level>
    <level label="4">
      <text>any limitations of the data that the carrier uses to measure physician performance;</text>
    </level>
    <level label="5">
      <text>the factors and criteria used in the carrier’s physician rating system, including quality of performance measures and cost efficiency measures; and</text>
    </level>
    <level label="6">
      <text>how a physician may appeal a physician rating.</text>
    </level>
  </level>
</section>
