CT
Connecticut Senate Bill SB00417

Connecticut 2015 Regular Session

Connecticut Senate Bill SB00417 Compare Versions

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1-Senate Bill No. 417
1+General Assembly Committee Bill No. 417
2+January Session, 2015 LCO No. 3258
3+ *_____SB00417INS___031215____*
4+Referred to Committee on INSURANCE AND REAL ESTATE
5+Introduced by:
6+(INS)
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3-Public Act No. 15-139
8+General Assembly
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10+Committee Bill No. 417
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12+January Session, 2015
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14+LCO No. 3258
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16+*_____SB00417INS___031215____*
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18+Referred to Committee on INSURANCE AND REAL ESTATE
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20+Introduced by:
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22+(INS)
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524 AN ACT CONCERNING CONFERENCES BETWEEN HEALTH CARRIERS' CLINICAL PEERS AND HEALTH CARE PROFESSIONALS.
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726 Be it enacted by the Senate and House of Representatives in General Assembly convened:
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928 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 Subdivision (3) of subsection (a) of section 38a-591d of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2015):
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11-(3) (A) At the time a health carrier notifies a covered person, a covered person's authorized representative or a covered person's health care professional 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, the health carrier shall notify the covered person's health care professional (i) of the opportunity for a conference as provided in subparagraph (B) of this subdivision, and (ii) that such conference shall not be considered a grievance of such initial adverse determination as long as a grievance has not been filed as set forth in subparagraph (B) of this subdivision.
30+(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.
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13-(B) After a health carrier notifies 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] the health carrier [may] shall offer a covered person's health care professional the opportunity to confer, at the request of the covered person's health care professional, 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.
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35+This act shall take effect as follows and shall amend the following sections:
36+Section 1 October 1, 2015 38a-591d(a)(3)
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38+This act shall take effect as follows and shall amend the following sections:
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40+Section 1
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42+October 1, 2015
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44+38a-591d(a)(3)
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48+INS Joint Favorable
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50+INS
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52+Joint Favorable