This act will amend several sections of the general statutes to ensure that utilization reviews are conducted fairly and transparently. By requiring reviews to be performed by licensed health professionals and mandating that decisions not to certify services must be based on accurate and complete information, the legislation aims to enhance accountability among utilization review companies. Furthermore, it introduces guidelines for expedited appeals in cases deemed emergency or life-threatening, thereby reinforcing patient rights and access to necessary medical services.
Summary
SB01082, titled 'An Act Concerning Utilization Review,' aims to clarify and improve the standards governing utilization review companies in Connecticut. The bill seeks to define the procedures for how these companies assess the necessity and appropriateness of healthcare services provided to individuals. It emphasizes the importance of timely determinations, ensuring that individuals receive the right care without unnecessary delays due to administrative hurdles. The bill establishes specific protocols for notification and documentation, requiring that enrollees and providers receive clear communication about the decisions made during the review process.
Contention
Despite its intentions, the bill has generated discussion regarding the potential for abuse by utilization review companies. Critics argue that the bill does not go far enough to protect patients from low-quality reviews that may prioritize cost savings over patient care. Moreover, there are concerns about the adequacy of oversight regarding the denial processes and whether sufficient safeguards are in place to challenge adverse determinations. Stakeholders in the healthcare community urge for a more robust framework that not only clarifies requirements but also emphasizes patient-centered care and collaboration between providers and review entities.
An Act Concerning Insurance Coverage For Breast Magnetic Resonance Imaging And Extending The Notification Period To Insurers Following The Birth Of A Child.
Prior authorization for health insurance; to provide for a legislative management study; to provide for a legislative management report; and to provide an effective date.