Connecticut Seal

General Assembly

 

Substitute Bill No. 303

    February Session, 2018

 

*_____SB00303PH____032718____*

AN ACT CONCERNING OUTPATIENT CLINICS, URGENT CARE CENTERS AND FREESTANDING EMERGENCY DEPARTMENTS.

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

Section 1. Subsection (l) of section 19a-508c of the 2018 supplement to the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2018):

(l) Notwithstanding the provisions of this section, [on and after January 1, 2017,] no hospital, health system or hospital-based facility shall collect a facility fee for (1) outpatient health care services that use a current procedural terminology evaluation and management (CPT E/M) code and are provided at a hospital-based facility located off-site from a hospital campus, other than a hospital emergency department [, located off-site from a hospital campus] that is operated as a provider-based entity, as defined in 42 CFR 413.65, and authorized under Medicare rules to bill for emergency procedures, or (2) outpatient health care services, other than those provided in an emergency department located off-site from a hospital campus, received by a patient who is uninsured of more than the Medicare rate. Notwithstanding the provisions of this subsection, in circumstances when an insurance contract that is in effect on July 1, 2016, provides reimbursement for facility fees prohibited under the provisions of this section, a hospital or health system may continue to collect reimbursement from the health insurer for such facility fees until the date of expiration of such contract. A violation of this subsection shall be considered an unfair trade practice pursuant to chapter 735a.

Sec. 2. Section 19a-493d of the 2018 supplement to the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2018):

(a) For purposes of this section:

(1) "Outpatient clinic" means an organization operated by a municipality or a corporation, other than a hospital, that provides (A) ambulatory medical care, including preventive and health promotion services, (B) dental care, or (C) mental health services in conjunction with medical or dental care for the purpose of diagnosing or treating a health condition that does not require the patient's overnight care; [and]

(2) "Urgent care center" means a free-standing facility, distinguished from an emergency department setting, that is licensed as an outpatient clinic under section 19a-491 and that (A) provides treatment of medical conditions that do not require critical or emergent intervention for a life-threatening or potentially permanent disabling condition, (B) offers treatment of such conditions without requiring an appointment, and (C) provides services during times of the day, weekends or holidays when primary care provider offices are not customarily open to patients; and

(3) "Freestanding emergency department" means a free-standing facility that (A) is structurally separate and distinct from a hospital, (B) provides emergency care, and (C) is a department of a hospital licensed under chapter 368v.

(b) On or after April 1, 2018, no person acting individually or jointly with any other person shall establish, conduct, operate or maintain an urgent care center without obtaining a license as an outpatient clinic under section 19a-491 from the Department of Public Health.

(c) The Office of Health Strategy shall adopt regulations, in accordance with the provisions of chapter 54, to require an outpatient clinic, urgent care center and freestanding emergency department to display signage that clearly indicates whether it is (1) an outpatient clinic, urgent care center or freestanding emergency department, and (2) owned by a hospital or hospital system.

[(c)] (d) The Commissioner of Public Health may implement policies and procedures as necessary to carry out the provisions of this section while in the process of adopting the policies and procedures as regulations, provided notice of intent to adopt the regulations is published in accordance with the provisions of chapter 54.

[(d)] (e) The Commissioner of Social Services may establish rates of payment to providers practicing in urgent care centers. The Commissioner of Social Services may implement policies and procedures as necessary to carry out the provisions of this section while in the process of adopting the policies and procedures as regulations, provided notice of intent to adopt the regulations is published in accordance with the provisions of section 17b-10 not later than twenty days after the date of implementation.

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

Section 1

October 1, 2018

19a-508c(l)

Sec. 2

October 1, 2018

19a-493d

Statement of Legislative Commissioners:

In Section 1, "CFR 413.65" was changed to "42 CFR 413.65" for accuracy.

PH

Joint Favorable Subst.