Connecticut Seal

General Assembly

 

Raised Bill No. 17

February Session, 2010

 

LCO No. 39

 

*00039_______INS*

Referred to Committee on Insurance and Real Estate

 

Introduced by:

 

(INS)

 

AN ACT CONCERNING HEALTH CARE PROVIDER RENTAL NETWORK CONTRACT ARRANGEMENTS.

Be it enacted by the Senate and House of Representatives in General Assembly convened:

Section 1. Section 42-490 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2010):

As used in this section and sections 42-491, as amended by this act, and 42-492:

(1) "Contracting entity" means (A) any entity that contracts directly with a health care provider [(A)] (i) for the delivery of health care services, or [(B)] (ii) for the selling, leasing, renting, assigning or granting of access to a contract or terms of a contract, or (B) any covered entity that subsequently sells, leases, rents, assigns or grants access to such provider's health care services, discounted rates or the fees established in such contract. For the purposes of this section, a health care provider is not a contracting entity.

(2) "Covered entity" means any entity that has not contracted directly with a health care provider but that buys, leases, rents, is assigned or accesses a contract or terms of a contract with a health care provider, that is responsible for (A) the payment or coordination of health care services, or (B) the establishment or extension of health care provider networks.

(3) "Health care provider" means any physician, physician group, physician network, independent practice association, physician organization or physician hospital organization.

(4) A contracting entity sells, leases, rents, assigns or grants access to a contract or terms of a contract to a covered entity for the purposes of this section and sections 42-491, as amended by this act, and 42-492 when such contracting entity is not involved in the administration of the benefit plan responsible for the payment of health care services provided by such plan.

Sec. 2. Section 42-491 of the 2010 supplement to the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2010):

(a) Any contracting entity that enters into or renews a contract with a health care provider on or after January 1, 2009, and that sells, leases, rents, assigns or grants access to such provider's health care services, discounted rates or fees shall include in such contract a provision specifically stating that such contracting entity may sell, lease, rent, assign or grant access to such provider's health care services, discounted rates or the fees established in such contract.

(b) Each such contracting entity that sells, leases, rents, assigns or grants access to any covered entity, a physician panel or a health care provider's health care services, discounted rates or fees shall:

(1) Maintain an Internet web site or a toll-free telephone number through which a health care provider may obtain a listing of the covered entities to which such provider's services, discounted rates or fees have been sold, leased, rented, assigned or granted access. Such contracting entity shall update such listing on a routine basis not less than every ninety days; and

(2) Upon request at the time of entering into such contract, provide a list to the health care provider of all known covered entities to which such contracting entity may sell, lease, rent, assign or grant access to such provider's health care services, discounted rates or fees. Such contracting entity shall update such list on a routine basis not less than every ninety days.

(c) Each covered entity shall pay the health care provider's discounted rates or fees in accordance with the terms and conditions set forth in the contract between the contracting entity and such provider.

(d) Subject to any applicable continuity of care requirements, agreements or contractual provisions with a health care provider, a covered entity's right to exercise a contracting entity's rights and responsibilities under a contract shall terminate on the date such contracting entity's contract with such provider is terminated.

(e) On and after January 1, 2009, all remittance advices, whether written or electronic, shall clearly identify the following:

(1) The name of the covered entity responsible for payment to the health care provider; and

(2) The name of the contracting entity through which the payment rate and any discounts are claimed.

(f) On and after January 1, 2009, any contracting entity or covered entity that issues a member identification card shall clearly mark on such card the address of the Internet web site or toll-free telephone number set forth in subdivision (1) of subsection (b) of this section.

Sec. 3. (NEW) (Effective October 1, 2010) (a) Any violation of section 42-491 of the general statutes, as amended by this act, shall be deemed an unfair or deceptive insurance practice under section 38a-816 of the general statutes.

(b) The Insurance Commissioner may adopt regulations, in accordance with chapter 54 of the general statutes, to carry out the provisions of sections 42-490 to 42-493, inclusive, of the general statutes, as amended by this act.

(c) Nothing in this section shall prohibit or limit any claim or action by a health care provider against a contracting entity or covered entity.

This act shall take effect as follows and shall amend the following sections:

Section 1

October 1, 2010

42-490

Sec. 2

October 1, 2010

42-491

Sec. 3

October 1, 2010

New section

Statement of Purpose:

To require listings of covered entities be updated at least every ninety days, to prohibit covered entities from granting subsequent access to third parties to health care services, discounted rates or fees established in contracts between health care providers and contracting entities, and to specify that violations are deemed unfair or deceptive insurance practices under section 38a-816 of the general statutes.

[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not underlined.]