General Assembly Committee Bill No. 417
January Session, 2015 LCO No. 3258
*03258SB00417INS*
Referred to Committee on INSURANCE AND REAL ESTATE
Introduced by:
(INS)
General Assembly
Committee Bill No. 417
January Session, 2015
LCO No. 3258
*03258SB00417INS*
Referred to Committee on INSURANCE AND REAL ESTATE
Introduced by:
(INS)
AN ACT CONCERNING CONFERENCES BETWEEN HEALTH CARRIERS' CLINICAL PEERS AND HEALTH CARE PROFESSIONALS.
Be it enacted by the Senate and House of Representatives in General Assembly convened:
Section 1. Subdivision (3) of subsection (a) of section 38a-591d of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2015):
(3) After a covered person, a covered person's authorized representative or a covered person's health care professional is notified of an initial adverse determination that was based, in whole or in part, on medical necessity, of a concurrent or prospective utilization review or of a benefit request, a health carrier [may] shall offer a covered person's health care professional the opportunity to confer with a clinical peer of such health carrier, provided such covered person, covered person's authorized representative or covered person's health care professional has not filed a grievance of such initial adverse determination prior to such conference. Such conference shall not be considered a grievance of such initial adverse determination.
This act shall take effect as follows and shall amend the following sections:
Section 1 October 1, 2015 38a-591d(a)(3)
This act shall take effect as follows and shall amend the following sections:
Section 1
October 1, 2015
38a-591d(a)(3)
Statement of Purpose:
To require health carriers to offer to a covered person's health care professional, after an initial adverse determination based in whole or in part on medical necessity, of a concurrent or prospective utilization review or of a benefit request, the opportunity to confer with a clinical peer of such health carrier.
[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.]
Co-Sponsors: SEN. LOONEY, 11th Dist.
Co-Sponsors:
SEN. LOONEY, 11th Dist.
S.B. 417