Insurance and Real Estate Committee

JOINT FAVORABLE REPORT

Bill No.:

HB-6310

Title:

AN ACT CONCERNING CERTAIN HEALTH CARE PROVIDER NETWORK ARRANGEMENTS.

Vote Date:

3/15/2011

Vote Action:

Joint Favorable Substitute

PH Date:

2/22/2011

File No.:

SPONSORS OF BILL:

Insurance and Real Estate Committee

REASONS FOR BILL:

The bill ensures that insurers contract with both ophthalmologists and optometrists, and inform patients of the availability of both, so the patient can choose freely what type of eyecare provider to see. It does this by requiring health care centers and preferred provider networks to contract with ophthalmologists and optometrists in substantially the same manner.

REASON FOR SUBSTITUTE LANGUAGE:

The substitute language clarifies the manner in which equal access for ophthalmologists and optometrists will be required, and stipulates that nothing in the bill will be construed as permitting services beyond current statutory scope of practice.

RESPONSE FROM ADMINISTRATION/AGENCY:

None expressed.

NATURE AND SOURCES OF SUPPORT:

Brian T. Lynch, legislative and legal affairs director for the CT Optometric Association, and private practicing optometrist in Branford, CT, testified in support of the bill. He stated, “In 1993, the Legislature passed an act attempting to preserve a patient's right to select the eye care provider that he or she wished to use. The Freedom of Choice in Eye Care Provider Act protected the patients of both optometrists, as well as ophthalmologists, from being directed by health care centers to a provider they didn't choose to use.”

He also stated, “Not only did the act ensure that both professions would be part of the panel, but it also assured that the provider's scope would not be limited to less than what is statutorily defined. Insurers would inform patients of the availability of both providers, as well as insurers would enroll a sufficient number of both providers to meet patients' needs. The statute has served the public well until recently. Some HMOs have chosen to exploit a loophole within the statute and circumvent its legislative intent by requiring an optometrist to join a vision care carve-out in order to be on their medical provider panel. This provision is … designed to discourage optometrists from participation in their plan, thus denying patient's access to the provider of their choice.”

In concluding his testimony he stated, “The Harkin Amendment to the Patient Protection and Affordable Health Care Act is very clear that no group, health plan, or health insurer will be allowed to discriminate against a group of providers based upon licensure. [With this bill] you will be bringing our current Freedom of Choice Act into alignment with the soon to be enacted federal statutes. [The bill] helps to preserve a patient's right to choose the eye care provider that he or she desires.

NATURE AND SOURCES OF OPPOSITION:

Debbie Osborn, executive director for the Connecticut Society of Eye Physicians for the Connecticut ENT Society, the Connecticut Urologists and the Connecticut Dermatologists, testified in opposition to the bill. She stated, “The ophthalmologists in this state do have to contract in the same exact way as the optometrists. If my [organization's] doctors want to do routine eye care, they have to join that carve out. So there is no difference here. But I think that what we have to keep in mind is that we want to keep the highest standard of care in this state. And if the insurers feel that there are providers out there that they want to give better rates to because they may have better fellowship training or expertise, I think we should allow them to do that.”

David Emmel, a board certified ophthalmologist practicing in Wethersfield and also the president of the Connecticut Society of Eye Physicians, testified in opposition to the bill. He stated, “We appreciate the intent of this bill and understand that our optometric colleagues are not happy with the insurers, and neither are we or any of the other providers. But we are opposed to this bill for several reasons. First and foremost, our professions are not identical, regardless of what you think about their individual merits. They are based on different degrees, different training, different paradigms, and often, different modalities of treatment. It is understandable that insurers might choose to deal with them differently.”

He also stated, “In a progressively more monopolistic environment, this bill is potentially anti-competitive, creating a hurdle to market entry and limiting competition by preventing a smaller insurance payer from selecting a small group of highly trained providers that supply the full spectrum of care from office to surgery. To ensure the best care value, we should always aim to broaden, not narrow competition among our payers.”

In concluding his testimony he stated, “Right now, even within each profession, our providers are treated differently by payers based on their training and expertise... It would probably be impossible for insurers to actually comply with this bill because of that problem. This bill, furthermore, does nothing to promote patient choice. If all types of providers are to be lumped together, transparency becomes even more of a challenge… In order to allow patients to make informed decisions about their care, the system must let them identify providers by degree, by their training, and by their scope, and not simply lump them all together. This bill will create problems for patients and for health care in general, and even for insurers. It will be difficult to administer, and it will be unfair in its effect on providers.”

CT Association of Health Plans, submitted written testimony stating that while the intent is laudable of any mandate under consideration, the cost impact to the industry must be weighed. In simple terms, all mandated coverage beyond the required essential benefits (as will be determined by HHS) will be at the State's expense. Those costs may not be delegated to the individual purchaser of insurance or the insurer.” It also stated, “There are benefit mandates and then there are administrative mandates both of which add appreciable cost to the underlying premium.”

Reported by: Sheila McCreven

Date: March 25, 2011