OLR Bill Analysis

sHB 6310

AN ACT CONCERNING CONTRACTS WITH OPHTHALMOLOGISTS AND OPTOMETRISTS.

SUMMARY:

This bill requires an HMO that provides benefits for ophthalmologic and optometric services to provide opthalmologists (licensed physicians specializing in ophthalmology) and optometrists equal access to all health plans it offers. It prohibits an HMO from restricting participation in a plan based on the service limitations of individual optometrists or opthalmologists. It also specifies that providing equal access to all health plans does not permit any such provider to perform or provide services outside of his or her scope of practice.

Current law requires an HMO providing ophthalmologic care benefits to also provide optometric care. If ophthalmologic care can be legally provided by an optometrist, than the HMO must provide the same eye care coverage and benefits for services they perform. HMOs must contract with both types of specialists in a fair and sufficient manner and equally inform enrollees of the availability of opthalmologic and optometric services.

EFFECTIVE DATE: October 1, 2011

COMMITTEE ACTION

Insurance and Real Estate Committee

Joint Favorable Substitute

Yea

14

Nay

6

(03/15/2011)