February 14, 08 |
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2008-R-0138 Revised
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Mandated Providers and Facilities for Health Insurance |
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By: Janet L. Kaminski Leduc, Associate Legislative Attorney |
You asked for a list of health care providers and facilities that Connecticut law requires health insurance policies to cover. This report has been updated by OLR Report 2015-R-0273.
In Connecticut, health insurance mandates are contained in Chapter 700c of the general statutes.
Table 1 provides a list of the mandated providers (e.g., social worker, nurse practitioner). Table 2 provides a list of mandated facilities (e.g., residential treatment facility).
See OLR Research Report 2007-R-0703 for a list of the mandated benefits (e.g., mammograms, mental health services).
Due to federal preemption, state insurance mandates generally do not apply to self-insured plans. (For more information, see OLR Research Report 2005-R-0753, Self-Insurance Benefit Plans and Insurance Mandates.)
Table 1: Connecticut Health Care Insurance Mandated Providers
CGS § |
Provider |
38a-488a 38a-514 |
· Licensed physician · Licensed psychiatrist · Licensed psychologist · Licensed clinical social worker · Independent social worker certified before October 1, 1990 · Licensed marital and family therapist · Marital and family therapist certified before October 1, 1992 · Licensed alcohol and drug counselor · Certified alcohol and drug counselor · Licensed professional counselor |
38a-491 38a-517 |
· Licensed dentist |
38a-492i 38a-518i |
· Pain management specialist
(i.e., a physician credentialed by the American Academy of Pain Management or who is a board-certified anesthesiologist, neurologist, oncologist, or radiation oncologist with additional training in pain management) |
38a-496 38a-524 |
· Licensed occupational therapist |
38a-499 38a-526
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· Licensed physician assistant · Certified nurse practitioner · Certified psychiatric-mental health clinical nurse specialist · Certified nurse mid-wife |
38a-503b 38a-530b
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· Obstetrician-gynecologist · Nurse mid-wife · Advanced practice nurse |
38a-507 38a-534 |
· Licensed chiropractor
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38a-523 (Optional benefit for group health insurance that insurer must offer) |
Comprehensive rehabilitation services provided by:
· Physician · Physical therapist · Occupational therapist · Nurse · Psychologist · Audiologist · Speech therapist · Social workers · Respiratory therapist |
38a-553
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· Physician · Registered nurse · Social worker · Licensed physical therapist |
Table 2: Connecticut Health Care Insurance Mandated Facilities
CGS § |
Facility |
38a-488a 38a-514 |
· Licensed hospital or clinic · Child guidance clinic · Residential treatment facility · Nonprofit community mental health center · Nonprofit licensed adult psychiatric clinic |
38a-498b 38a-525b |
· State mobile field hospital (formerly known as critical access hospitals) |
38a-502 38a-529 |
· State Veterans’ Home
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38a-523 (Optional benefit for group health insurance that insurer must offer) |
· Comprehensive rehabilitation facility |
38a-553
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· Hospital · Skilled nursing facility · Licensed alcohol treatment facility |
JKL:ts