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Substitute House Bill No. 6310

Public Act No. 11-38

AN ACT CONCERNING CONTRACTS WITH OPHTHALMOLOGISTS AND OPTOMETRISTS.

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

Section 1. Subsection (b) of section 20-138b of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2012):

(b) If any health care center, as defined in section 38a-175, or preferred provider network, as defined in section 38a-479aa, offers health care benefits [which] that provide ophthalmologic care for any person, partnership, corporation, association or group, however organized, such health care center or preferred provider network shall provide optometric care. If the ophthalmologic care provided may be lawfully rendered by an optometrist, such health care center or preferred provider network shall provide the identical eye care coverage and benefits for its members when such care is rendered by an optometrist under contract with such health care center or preferred provider network.

(1) Such health care center or preferred provider network shall [(1)] (A) contract with ophthalmologists and optometrists in a manner [which] that will provide fair and sufficient representation of such providers in relation to the benefits provided by the health care center plan or preferred provider network, and [(2)] (B) equally inform its members of the availability of ophthalmologic and optometric services.

(2) Such health care center or preferred provider network (A) shall provide ophthalmologists and optometrists equal access to all health plans offered by such health care center or health insurance policies offered by a health insurer with which such preferred provider network has entered into a contractual relationship, and (B) shall not restrict participation in such plans or policies based on limitations in services provided by individual ophthalmologists or optometrists. Nothing in this subsection shall be construed as permitting any ophthalmologist or optometrist to perform or provide services beyond their scopes of practice permitted in chapters 370 and 380, respectively.

Approved June 3, 2011