Connecticut 2019 Regular Session

Connecticut Senate Bill SB00327 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1	1
2	2
	3	+	LCO No. 2099 1 of 1
3	4
4		-	LCO No. 5470 1 of 4
5		-
6		-	General Assembly Committee Bill No. 327
	5	+	General Assembly Proposed Bill No. 327
7	6		January Session, 2019
8		-	LCO No. ~~5470~~
	7	+	LCO No. 2099
9	8
10	9
11	10		Referred to Committee on INSURANCE AND REAL ESTATE
12	11
13	12
14	13		Introduced by:
15		-	~~(INS)~~
	14	+	SEN. LOONEY, 11th Dist.
16	15
17	16
18	17
19	18		AN ACT REQUIRING HEALTH INSURANCE COVERAGE FOR
20	19		MEDICALLY NECESSARY AMBULANCE SERVICES AT AN IN -
21	20		NETWORK LEVEL AND PROHIBITING BALANCE BILLING FOR SUCH
22	21		SERVICES.
23	22		Be it enacted by the Senate and House of Representatives in General
24	23		Assembly convened:
25	24
26		-	Section 1. Subsections (a) and (b) of section 20-7f of the general 1
27		-	statutes are repealed and the following is substituted in lieu thereof 2
28		-	(Effective January 1, 2020): 3
29		-	(a) For purposes of this section: 4
30		-	(1) "Request payment" includes, but is not limited to, submitting a 5
31		-	bill for services not actually owed or submitting for such services an 6
32		-	invoice or other communication detailing the cost of the services that is 7
33		-	not clearly marked with the phrase "This is not a bill". 8
34		-	(2) "Health care provider" means a person licensed to provide health 9
35		-	care services under chapters 370 to 373, inclusive, chapters 375 to 383b, 10
36		-	inclusive, chapters 384a to [384c] 384d, inclusive, or chapter 400j. 11
37		-	(3) "Enrollee" means a person who has contracted for or who 12
38		-	Committee Bill No. 327
39		-
40		-
41		-	LCO No. 5470 2 of 4
42		-
43		-	participates in a health care plan for such enrollee or such enrollee's 13
44		-	eligible dependents. 14
45		-	(4) "Coinsurance, copayment, deductible or other out-of-pocket 15
46		-	expense" means the portion of a charge for services covered by a health 16
47		-	care plan that, under the plan's terms, it is the obligation of the enrollee 17
48		-	to pay. 18
49		-	(5) "Health care plan" has the same meaning as provided in 19
50		-	subsection (a) of section 38a-477aa. 20
51		-	(6) "Health carrier" has the same meaning as provided in subsection 21
52		-	(a) of section 38a-477aa. 22
53		-	(7) "Emergency services" has the same meaning as provided in 23
54		-	subsection (a) of section 38a-477aa. 24
55		-	(8) "Medically necessary ambulance services" has the same meaning 25
56		-	as that term is used in sections 38a-498 and 38a-525, as amended by 26
57		-	this act. 27
58		-	(b) It shall be an unfair trade practice in violation of chapter 735a for 28
59		-	any health care provider to request payment from an enrollee, other 29
60		-	than a coinsurance, copayment, deductible or other out-of-pocket 30
61		-	expense, for (1) health care services or a facility fee, as defined in 31
62		-	section 19a-508c, covered under a health care plan, (2) emergency 32
63		-	services covered under a health care plan and rendered by an out-of-33
64		-	network health care provider, [or] (3) a surprise bill, as defined in 34
65		-	section 38a-477aa, or (4) medically necessary ambulance services in an 35
66		-	amount that exceeds the amount allowed under section 38a-498 or 38a-36
67		-	525, as amended by this act. 37
68		-	Sec. 2. Subsection (a) of section 38a-498 of the general statutes is 38
69		-	repealed and the following is substituted in lieu thereof (Effective 39
70		-	January 1, 2020): 40
71		-	(a) Each individual health insurance policy providing coverage of 41
72		-	Committee Bill No. 327
73		-
74		-
75		-	LCO No. 5470 3 of 4
76		-
77		-	the type specified in subdivisions (1), (2), (4), (6), (10), (11) and (12) of 42
78		-	section 38a-469 delivered, issued for delivery, renewed, amended or 43
79		-	continued in this state shall provide coverage for medically necessary 44
80		-	ambulance services for persons covered by the policy at an in-network 45
81		-	level, including, but not limited to, at an in-network level of cost-46
82		-	sharing. The hospital policy shall be primary if a person is covered 47
83		-	under more than one policy. The policy shall, as a minimum 48
84		-	requirement, cover such services whenever any person covered by the 49
85		-	contract is transported when medically necessary by ambulance to a 50
86		-	hospital. Such benefits shall be subject to any policy provision which 51
87		-	applies to other services covered by such policies, except that such 52
88		-	benefits shall be covered at an in-network level, including, but not 53
89		-	limited to, at an in-network level of cost-sharing. Notwithstanding any 54
90		-	other provision of this section, such policies shall not be required to 55
91		-	provide benefits in excess of the maximum allowable rate established 56
92		-	by the Department of Public Health in accordance with section 19a-57
93		-	177. 58
94		-	Sec. 3. Subsection (a) of section 38a-525 of the general statutes is 59
95		-	repealed and the following is substituted in lieu thereof (Effective 60
96		-	January 1, 2020): 61
97		-	(a) Each group health insurance policy providing coverage of the 62
98		-	type specified in subdivisions (1), (2), (4), (6), (11) and (12) of section 63
99		-	38a-469 delivered, issued for delivery, renewed, amended or continued 64
100		-	in this state shall provide coverage for medically necessary ambulance 65
101		-	services for persons covered by the policy at an in-network level, 66
102		-	including, but not limited to, at an in-network level of cost-sharing. 67
103		-	The hospital policy shall be primary if a person is covered under more 68
104		-	than one policy. The policy shall, as a minimum requirement, cover 69
105		-	such services whenever any person covered by the contract is 70
106		-	transported when medically necessary by ambulance to a hospital. 71
107		-	Such benefits shall be subject to any policy provision which applies to 72
108		-	other services covered by such policies, except that such benefits shall 73
109		-	be covered at an in-network level, including, but not limited to, at an 74
110		-	Committee Bill No. 327
111		-
112		-
113		-	LCO No. 5470 4 of 4
114		-
115		-	in-network level of cost-sharing. Notwithstanding any other provision 75
116		-	of this section, such policies shall not be required to provide benefits in 76
117		-	excess of the maximum allowable rate established by the Department 77
118		-	of Public Health in accordance with section 19a-177. 78
119		-	This act shall take effect as follows and shall amend the following
120		-	sections:
121		-
122		-	Section 1 January 1, 2020 20-7f(a) and (b)
123		-	Sec. 2 January 1, 2020 38a-498(a)
124		-	Sec. 3 January 1, 2020 38a-525(a)
125		-
	25	+	That sections 20-7f, 38a-498 and 38a-525 of the general statutes be 1
	26	+	amended to (1) require health insurance coverage for medically 2
	27	+	necessary ambulance services at an in-network level, including an in-3
	28	+	network level of cost sharing, and (2) prohibit balance billing for 4
	29	+	medically necessary ambulance services. 5
126	30		Statement of Purpose:
127	31		To require health insurance coverage for medically necessary
128		-	ambulance services at an in-network level, including, but not limited
129		-	to, at an in-network level of cost sharing, and prohibit balance billing
130		-	for such services.
131		-	[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline,
132		-	except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is
133		-	not underlined.]
134		-
135		-	Co-Sponsors: SEN. LOONEY, 11th Dist.
136		-
137		-	S.B. 327
138		-
139		-
	32	+	ambulance services at an in-network level, including an in-network
	33	+	level of cost sharing, and prohibit balance billing for such services.