Connecticut Senate Bill SB00335

Connecticut 2020 Regular Session

• Introduced: 2/27/20
• Refer: 2/27/20
• Report Pass: 3/10/20

Caption

An Act Concerning The Role Of Clinical Peers In Adverse Determination And Utilization Reviews.

Impact

The enactment of SB00335 is expected to bring significant changes to state law regarding how health carriers conduct utilization reviews and handle adverse determinations. By mandating that clinical peers have specific qualifications and the authority to reverse adverse decisions, the bill intends to improve patient outcomes and ensure that health care professionals are involved in critical decisions regarding patient care. This could lead to a more equitable health care system where patients may find it easier to appeal unfavorable decisions regarding their treatment options.

Summary

SB00335, titled 'An Act Concerning The Role Of Clinical Peers In Adverse Determination And Utilization Reviews', aims to redefine the criteria and authority surrounding the role of clinical peers in the process of reviewing and determining benefits related to health care services. The bill outlines the qualifications necessary for individuals classified as clinical peers, emphasizing the need for them to hold appropriate licenses and certifications relevant to the medical conditions under review. Through these updates, the bill seeks to enhance the accountability and reliability of adverse determinations made by health carriers.

Contention

While proponents of SB00335 argue that defining the role of clinical peers will empower healthcare professionals and lead to better patient care, there are concerns about the implementation of these requirements. Critics fear that the new regulations might create additional bureaucratic hurdles for health care providers and insurers, potentially slowing down the process of care and complicating benefit determinations. This bill is viewed as part of a broader dialogue on health care reform and insurance practices in the state, highlighting the tensions between patient advocacy and the operational efficiency of health carriers.