1. (a) A carrier that uses a physician rating system shall:

   1. (1) establish an appeals process for physicians to use to contest their rating; and

   2. (2) 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:

      1. (i) a notice of the proposed change;
      2. (ii) an explanation of the data used to assess the physician and how the physician may access the data;
      3. (iii) the methodology and measures used to assess the physician;
      4. (iv) an explanation of the right to contest the rating of the physician through the appeals process of the carrier; and
      5. (v) instructions on how to file a timely appeal with the carrier.
2. (b) 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.

3. (c) 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:

   1. (1) where an enrollee can find the physician performance ratings of the carrier;
   2. (2) 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;
   3. (3) 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;
   4. (4) any limitations of the data that the carrier uses to measure physician performance;
   5. (5) the factors and criteria used in the carrier's physician rating system, including quality of performance measures and cost efficiency measures; and
   6. (6) how a physician may appeal a physician rating.

Added by Acts 2009, c. 585, § 1, eff. Jan. 1, 2010; Acts 2009, c. 586, § 1, eff. Jan. 1, 2010.