OLR Bill Analysis

SB 1047

AN ACT CONCERNING SELF-REFERRAL FOR IMAGING SERVICES.

SUMMARY:

This bill prohibits specified health care practitioners from charging patients, insurers, or other responsible third-party payors for performing the “technical components” of CAT scans, PET scans, and MRIs if they, or someone they directly supervise, did not actually perform the service. (The bill does not specify what constitutes the technical components of these imaging services. ) The prohibition applies to physicians, chiropractors, podiatrists, naturopaths, and optometrists.

Under the bill, radiological facilities and imaging centers must directly bill the patient or third-party payor for their services. They cannot bill the practitioner who requested the service.

Anyone violating the bill's prohibition commits an unfair or deceptive trade practice.

EFFECTIVE DATE: October 1, 2009

BACKGROUND

Connecticut Unfair Trade Practices Act (CUTPA)

The law prohibits businesses from engaging in unfair and deceptive acts or practices. CUTPA allows the consumer protection commissioner to define by regulation what constitutes an unfair trade practice, investigate complaints, issue cease and desist orders, order restitution in cases involving less than $ 5,000, enter into consent agreements, ask the attorney general to seek injunctive relief, and accept voluntary statements of compliance. The act also allows individuals to sue. Courts may issue restraining orders; award actual and punitive damages, costs, and reasonable attorneys fees; and impose civil penalties of up to $ 5,000 for willful violations and $ 25,000 for violation of a restraining order.

Related Law

PA 06-106 limits the copayments for all MRI, CAT scan, and PET scan services performed in-network. It limits the copayments for MRIs and CAT scans to no more than (1) $ 375 for all such services annually and (2) $ 75 for each one. It limits the copayments for PET scans to no more than (1) $ 400 for all such scans annually and (2) $ 100 for each one. These copayment limits do not apply (1) if the physician ordering the imaging service performs it or is in the same practice group as the physician who performs it and (2) to high deductible health plans designed to be compatible with federally qualified health savings accounts.

COMMITTEE ACTION

Public Health Committee

Joint Favorable