General Assembly Raised Bill No. 6517
January Session, 2013 LCO No. 3634
*_____HB06517PRI___031513____*
Referred to Committee on PROGRAM REVIEW AND INVESTIGATIONS
Introduced by:
(PRI)
General Assembly
Raised Bill No. 6517
January Session, 2013
LCO No. 3634
*_____HB06517PRI___031513____*
Referred to Committee on PROGRAM REVIEW AND INVESTIGATIONS
Introduced by:
(PRI)
AN ACT IMPLEMENTING THE RECOMMENDATIONS OF THE LEGISLATIVE PROGRAM REVIEW AND INVESTIGATIONS COMMITTEE CONCERNING THE INSURANCE DEPARTMENT'S DUTIES, MENTAL HEALTH PARITY COMPLIANCE CHECKS AND THE EXTERNAL REVIEW APPLICATION PROCESS.
Be it enacted by the Senate and House of Representatives in General Assembly convened:
Section 1. Section 38a-472d of the general statutes is amended by adding subsection (c) as follows (Effective October 1, 2013):
(NEW) (c) The Insurance Department shall prominently display a link on the department's Internet web site to the Office of the Healthcare Advocate's Internet web site, along with a statement that said office can provide health care consumers or their authorized representatives with free assistance throughout the coverage decision process.
Sec. 2. Section 38a-478l of the general statutes is amended by adding subsection (e) as follows (Effective from passage):
(NEW) (e) Beginning with the consumer report card to be distributed not later than October 15, 2013, the commissioner shall analyze annually the data submitted under subparagraphs (E) and (F) of subdivision (1) of subsection (b) of this section for statistically significant differences in such data among the health care centers and licensed health insurers included in the consumer report card. The commissioner shall investigate any such differences to determine whether further action by the commissioner is warranted.
Sec. 3. (Effective from passage) (a) (1) Not later than September 1, 2013, the Insurance Commissioner shall submit a report, in accordance with the provisions of section 11-4a of the general statutes, to the joint standing committees of the General Assembly having cognizance of matters relating to insurance and public health on the method the Insurance Department shall use to check for compliance with state and federal mental health parity laws by health insurance companies and other entities under its jurisdiction. In selecting such method, the commissioner shall examine and assess for fitness the methods set forth by the United States Department of Labor and URAC, in addition to any other methods discovered by or brought to the attention of the Insurance Department.
(2) As part of the evaluation process, the commissioner shall hold at least one public meeting at which stakeholders, including, but not limited to, relevant state agency personnel, health insurance companies and the general public, are invited to share their input and propose other compliance check methods.
(b) The report under subsection (a) of this section shall describe and address the comments shared at the public meeting or meetings, include an assessment of each potential method examined and append written comments and suggestions of the Healthcare Advocate.
(c) On or before October 1, 2013, the commissioner shall begin such compliance checks using the compliance check method selected.
Sec. 4. Section 38a-478a of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2013):
On March first annually, the Insurance Commissioner shall submit a report to the Governor and to the joint standing committees of the General Assembly having cognizance of matters relating to public health and insurance, concerning the commissioner's responsibilities under the provisions of sections 38a-478 to 38a-478u, inclusive, 38a-479aa, 38a-591a to 38a-591h, inclusive, and 38a-993. The report shall include: (1) A summary of the quality assurance plans submitted by managed care organizations pursuant to section 38a-478c along with suggested changes to improve such plans; (2) suggested modifications to the consumer report card developed under the provisions of section 38a-478l, as amended by this act; (3) a summary of the commissioner's procedures and activities in conducting market conduct examinations of utilization review companies and preferred provider networks, including, but not limited to: (A) The number of desk and field audits completed during the previous calendar year; (B) a summary of findings of the desk and field audits, including any recommendations made for improvements or modifications; (C) a description of complaints concerning managed care companies, and any preferred provider network that provides services to enrollees on behalf of the managed care organization, including a summary and analysis of any trends or similarities found in the managed care complaints filed by enrollees; (4) a summary of the complaints concerning managed care organizations received by the Insurance Department's Consumer Affairs Division and the commissioner under section 38a-591g, including a summary and analysis of any trends or similarities found in the complaints received; (5) a summary of any violations the commissioner has found against any managed care organization or any preferred provider network that provides services to enrollees on behalf of the managed care organization; [and] (6) a summary of the issues discussed related to health care or managed care organizations at the Insurance Department's quarterly forums throughout the state; and (7) a summary of the method used by the department to check for compliance with state and federal mental health parity laws by health insurance companies and other entities under its jurisdiction, and results of such compliance checks.
Sec. 5. (Effective from passage) Not later than July 31, 2013, the Insurance Department shall request the United States Department of Health and Human Services for a determination as to whether, when filing a request for an external review or expedited external review as set forth in section 38a-591g of the general statutes, a covered person or a covered person's authorized representative, as both terms are defined in section 38a-591a of the general statutes, may submit (1) a copy of the notice of final adverse determination, or adverse determination if such covered person has been deemed to have exhausted the health carrier's internal grievance process or may file an external review or expedited external review pursuant to section 38a-591g of the general statutes, or (2) a copy of the covered person's health carrier identification card, rather than both. If the United States Department of Health and Human Services determines a copy of either such notice or such identification card is sufficient for purposes of filing an external review or expedited external review, the Insurance Department shall comply with such determination. If the United States Department of Health and Human Services determines a copy of both such notice and such identification card are required, the Insurance Department shall include in any guide or materials it provides to consumers concerning external review and expedited external review processes, a statement that the covered person or the covered person's authorized representative may request, free of charge, a copy of the notice of final adverse determination or adverse determination or a copy of the covered person's health carrier identification card or both from the health carrier.
This act shall take effect as follows and shall amend the following sections:
Section 1 October 1, 2013 38a-472d
Sec. 2 from passage 38a-478l
Sec. 3 from passage New section
Sec. 4 October 1, 2013 38a-478a
Sec. 5 from passage New section
This act shall take effect as follows and shall amend the following sections:
Section 1
October 1, 2013
38a-472d
Sec. 2
from passage
38a-478l
Sec. 3
from passage
New section
Sec. 4
October 1, 2013
38a-478a
Sec. 5
from passage
New section
PRI Joint Favorable
PRI
Joint Favorable