PA 17-157—HB 5140

Insurance and Real Estate Committee

AN ACT CONCERNING REIMBURSEMENTS TO HEALTH CARE PROVIDERS FOR SUBSTANCE ABUSE SERVICES

SUMMARY: This act requires certain health insurance policies to pay out-of-network health care providers eligible for reimbursement directly for the diagnosis or treatment rendered in Connecticut of a substance use disorder. It does so by deeming that an insured receiving such a diagnosis or treatment has assigned his or her reimbursement benefits and other rights under the health insurance policy to the provider.

Under the act, providers may collect from the insured any copayment, deductible, and other out-of-pocket costs due under the policy but are prohibited from otherwise billing; charging; collecting a deposit from; seeking compensation, remuneration, or reimbursement from; or having any recourse against the insured for the diagnosis or treatment.

EFFECTIVE DATE: January 1, 2018

APPLICABILITY

The act applies to individual and group health insurance policies issued, delivered, renewed, amended, or continued in Connecticut that cover (1) basic hospital expenses; (2) basic medical-surgical expenses; (3) major medical expenses, or (4) hospital or medical services, including those provided through an HMO. (Due to the federal Employee Retirement Income Security Act, state insurance mandates do not apply to self-insured benefit plans.)

By law, these health insurance policies must cover the diagnosis and treatment of mental or nervous conditions, including substance use disorders, provided by (1) a licensed physician, advanced practice registered nurse, psychologist, clinical social worker, marital and family therapist, or professional counselor; (2) certain certified marital and family therapists or independent social workers; or (3) licensed or certified alcohol and drug counselors.