Connecticut 2019 Regular Session

Connecticut Senate Bill SB00038 Compare Versions

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Version 2 (New)

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7	6		General Assembly Committee Bill No. 38
8	7		January Session, 2019
9	8		LCO No. 5468
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12	11		Referred to Committee on INSURANCE AND REAL ESTATE
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14	13
15	14		Introduced by:
16	15		(INS)
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20	19		AN ACT REDUCING THE TIME FRAME FOR URGENT CAR E
21	20		ADVERSE DETERMINATIO N REVIEW REQUESTS AN D EXPEDITED
22	21		EXTERNAL REVIEWS.
23	22		Be it enacted by the Senate and House of Representatives in General
24	23		Assembly convened:
25	24
26	25		Section 1. Subdivision (1) of subsection (c) of section 38a-591d of the 1
27	26		general statutes is repealed and the following is substituted in lieu 2
28	27		thereof (Effective January 1, 2020): 3
29	28		(1) (A) Unless the covered person or the covered person's 4
30	29		authorized representative has failed to provide information necessary 5
31	30		for the health carrier to make a determination and except as specified 6
32	31		under subparagraph (B) of this subdivision, the health carrier shall 7
33	32		make a determination as soon as possible, taking into account the 8
34	33		covered person's medical condition, but not later than [seventy-two] 9
35	34		forty-eight hours after the health carrier receives such request, 10
36	35		provided, if the urgent care request is a concurrent review request to 11
37	36		extend a course of treatment beyond the initial period of time or the 12
38	37		number of treatments, such request is made at least twenty-four hours 13
39	38		prior to the expiration of the prescribed period of time or number of 14
40		-	treatments. 15 Committee Bill No. 38
	39	+	treatments. 15
	40	+	Committee Bill No. 38
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47	45		(B) Unless the covered person or the covered person's authorized 16
48	46		representative has failed to provide information necessary for the 17
49	47		health carrier to make a determination, for an urgent care request 18
50	48		specified under subparagraph (B) or (C) of subdivision (38) of section 19
51	49		38a-591a, the health carrier shall make a determination as soon as 20
52	50		possible, taking into account the covered person's medical condition, 21
53	51		but not later than twenty-four hours after the health carrier receives 22
54	52		such request, provided, if the urgent care request is a concurrent 23
55	53		review request to extend a course of treatment beyond the initial 24
56	54		period of time or the number of treatments, such request is made at 25
57	55		least twenty-four hours prior to the expiration of the prescribed period 26
58	56		of time or number of treatments. 27
59	57		Sec. 2. Subdivision (1) of subsection (d) of section 38a-591e of the 28
60	58		general statutes is repealed and the following is substituted in lieu 29
61	59		thereof (Effective January 1, 2020): 30
62	60		(d) (1) The health carrier shall notify the covered person and, if 31
63	61		applicable, the covered person's authorized representative, in writing 32
64	62		or by electronic means, of its decision within a reasonable period of 33
65	63		time appropriate to the covered person's medical condition, but not 34
66	64		later than: 35
67	65		(A) For prospective review and concurrent review requests, thirty 36
68	66		calendar days after the health carrier receives the grievance; 37
69	67		(B) For retrospective review requests, sixty calendar days after the 38
70	68		health carrier receives the grievance; 39
71	69		(C) For expedited review requests, except as specified under 40
72	70		subparagraph (D) of this subdivision, [seventy-two] forty-eight hours 41
73	71		after the health carrier receives the grievance; and 42
74	72		(D) For expedited review requests of a health care service or course 43
75	73		of treatment specified under subparagraph (B) or (C) of subdivision 44
76	74		(38) of section 38a-591a, twenty-four hours after the health carrier 45
77		-	~~receives the grievance. 46~~ Committee Bill No. 38
	75	+	Committee Bill No. 38
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	80	+	receives the grievance. 46
84	81		Sec. 3. Subdivision (1) of subsection (i) of section 38a-591g of the 47
85	82		general statutes is repealed and the following is substituted in lieu 48
86	83		thereof (Effective January 1, 2020): 49
87	84		(i) (1) The independent review organization shall notify the 50
88	85		commissioner, the health carrier, the covered person and, if applicable, 51
89	86		the covered person's authorized representative in writing of its 52
90	87		decision to uphold, reverse or revise the adverse determination or the 53
91	88		final adverse determination, not later than: 54
92	89		(A) For external reviews, forty-five calendar days after such 55
93	90		organization receives the assignment from the commissioner to 56
94	91		conduct such review; 57
95	92		(B) For external reviews involving a determination that the 58
96	93		recommended or requested health care service or treatment is 59
97	94		experimental or investigational, twenty calendar days after such 60
98	95		organization receives the assignment from the commissioner to 61
99	96		conduct such review; 62
100	97		(C) For expedited external reviews, except as specified under 63
101	98		subparagraph (D) of this subdivision, as expeditiously as the covered 64
102	99		person's medical condition requires, but not later than [seventy-two] 65
103	100		forty-eight hours after such organization receives the assignment from 66
104	101		the commissioner to conduct such review; 67
105	102		(D) For expedited external reviews involving a health care service or 68
106	103		course of treatment specified under subparagraph (B) or (C) of 69
107	104		subdivision (38) of section 38a-591a, as expeditiously as the covered 70
108	105		person's medical condition requires, but not later than twenty-four 71
109	106		hours after such organization receives the assignment from the 72
110	107		commissioner to conduct such review; and 73
111	108		(E) For expedited external reviews involving a determination that 74
112	109		the recommended or requested health care service or treatment is 75
113		-	experimental or investigational, as expeditiously as the covered 76
114		-	person's medical condition requires, but not later than five calendar 77 Committee Bill No. 38
	110	+	Committee Bill No. 38
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	115	+	experimental or investigational, as expeditiously as the covered 76
	116	+	person's medical condition requires, but not later than five calendar 77
121	117		days after such organization receives the assignment from the 78
122	118		commissioner to conduct such review. 79
123	119		This act shall take effect as follows and shall amend the following
124	120		sections:
125	121
126	122		Section 1 January 1, 2020 38a-591d(c)(1)
127	123		Sec. 2 January 1, 2020 38a-591e(d)(1)
128	124		Sec. 3 January 1, 2020 38a-591g(i)(1)
129	125
130		-	INS Joint Favorable
	126	+	Statement of Purpose:
	127	+	To reduce the time frame for urgent care adverse determination review
	128	+	requests and expedited external reviews from seventy-two to forty-
	129	+	eight hours.
	130	+	[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline,
	131	+	except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is
	132	+	not underlined.]
	133	+
	134	+	Co-Sponsors: SEN. LOONEY, 11th Dist.
	135	+
	136	+	S.B. 38
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131	138