February 14, 08

 

2008-R-0138

Revised

 

Mandated Providers and Facilities for Health Insurance

 

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

 

·         Licensed physician assistant

·         Certified nurse practitioner

·         Certified psychiatric-mental health clinical nurse specialist

·         Certified nurse mid-wife

38a-503b

38a-530b

 

·         Obstetrician-gynecologist

·         Nurse mid-wife

·         Advanced practice nurse

38a-507

38a-534

·         Licensed chiropractor

 

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

 

·         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

 

38a-523 (Optional benefit for group health insurance that insurer must offer)

·         Comprehensive rehabilitation facility

38a-553

 

·         Hospital

·         Skilled nursing facility

·         Licensed alcohol treatment facility

 

JKL:ts