General Assembly Raised Bill No. 429
February Session, 2010 LCO No. 2041
*02041_______PH_*
Referred to Committee on Public Health
Introduced by:
(PH)
General Assembly
Raised Bill No. 429
February Session, 2010
LCO No. 2041
*02041_______PH_*
Referred to Committee on Public Health
Introduced by:
(PH)
AN ACT CONCERNING MOST-FAVORED-NATION CLAUSES IN HEALTH CARE CONTRACTS.
Be it enacted by the Senate and House of Representatives in General Assembly convened:
Section 1. (NEW) (Effective October 1, 2010) (a) As used in this section:
(1) "Medical provider" means a person licensed in this state under chapter 370, 372, 373, 375, 379, 380 or 383 of the general statutes, or a group or organization of such individuals, or a hospital licensed under chapter 368v of the general statutes.
(2) "Contracting health organization" means an insurer, health care center, hospital service corporation, medical service corporation, fraternal benefit society or other entity that offers individual or group health insurance, or individual or group managed care plans, in this state.
(3) "Payer" means a contracting health organization or any entity that makes payments or reimbursements to a medical provider for medical services rendered by such provider, including payments and reimbursements made by the Department of Social Services for medical assistance programs operated or administered by the department.
(4) "Managed care plan" has the same meaning as provided in section 38a-478 of the general statutes.
(5) "Most-favored-nation clause" means a contractual provision that:
(A) Prohibits, or grants a contracting health organization an option to prohibit, a medical provider from contracting with another payer to provide health care services at a lower rate than the payment or reimbursement rate specified in the contract with the contracting health organization;
(B) Requires, or grants a contracting health organization an option to require, a medical provider to accept a lower payment or reimbursement rate if the medical provider agrees to provide health care services to any other payer at a lower rate;
(C) Requires, or grants a contracting health organization an option to require, termination or renegotiation of an existing health care contract if a medical provider agrees to provide health care services to any other payer at a lower rate; or
(D) Requires a medical provider to disclose the medical provider's contractual payment or reimbursement rates with other payers.
(b) No contract between a contracting health organization and a medical provider or hospital shall contain a most-favored-nation clause.
(c) The provisions of this section shall not apply to group hospitalization and medical and surgical insurance plans, as set forth in subsection (a) of section 5-259 of the general statutes, or any dental plan offered in connection with, or in addition to, such group hospitalization and medical and surgical insurance plan.
This act shall take effect as follows and shall amend the following sections:
Section 1 October 1, 2010 New section
This act shall take effect as follows and shall amend the following sections:
Section 1
October 1, 2010
New section
Statement of Purpose:
To prohibit the use of most-favored-nation clauses in contracts between insurers and medical providers or hospitals.
[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not underlined.]