Connecticut 2021 Regular Session

Connecticut Senate Bill SB01048 Compare Versions

Version 1 (Old)

Version 2 (New)

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3		-	LCO 3660 \\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-01048-R01-
4		-	SB.docx
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	3	+	LCO No. 3660 1 of 2
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7	5		General Assembly Raised Bill No. 1048
8	6		January Session, 2021
9	7		LCO No. 3660
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12	10		Referred to Committee on INSURANCE AND REAL ESTATE
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14	12
15	13		Introduced by:
16	14		(INS)
	15	+
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20	19		AN ACT CONCERNING RE IMBURSEMENTS FOR CER TAIN
21	20		COVERED HEALTH BENEF ITS.
22	21		Be it enacted by the Senate and House of Representatives in General
23	22		Assembly convened:
24	23
25	24		Section 1. (NEW) (Effective July 1, 2022) (a) Each insurer, health care 1
26	25		center, hospital service corporation, medical service corporation, 2
27	26		preferred provider network or other entity that enters into, renews or 3
28	27		amends a contract with a health care provider on or after July 1, 2022, to 4
29	28		provide covered benefits to insureds or enrollees in this state shall 5
30	29		include in such contract: 6
31	30		(1) A provision requiring such insurer, health care center, hospital 7
32	31		service corporation, medical service corporation, preferred provider 8
33	32		network or other entity to: 9
34	33		(A) Reimburse the contracting health care provider for a covered 10
35	34		outpatient benefit that uses a current procedural terminology 11
36	35		evaluation and management (CPT E/M) code, current procedural 12
37	36		terminology assessment and management (CPT A/M) code or drug 13
38		-	infusion code in an amount that does not vary based on the facility 14 Raised Bill No. 1048
	37	+	infusion code in an amount that does not vary based on the facility 14
	38	+	where the contracting health care provider provides such benefit; and 15 Raised Bill No. 1048
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42		-	R01-SB.docx }
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45		-	where the contracting health care provider provides such benefit; and 15
	42	+	LCO No. 3660 2 of 2
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46	44		(B) Use equal reimbursement rates for all contracting health care 16
47	45		providers in the same geographic region, as determined by the 17
48	46		Insurance Commissioner and regardless of the employer or affiliation of 18
49	47		any contracting health care provider, for each covered outpatient benefit 19
50	48		described in subparagraph (A) of this subdivision if the reimbursement 20
51	49		for such covered outpatient benefit is made on a fee-for-benefit basis or 21
52	50		on the basis of bundled benefits per diagnosis, condition, procedure or 22
53	51		another standardized bundle of health care benefits; and 23
54	52		(2) A conspicuous statement that such contract complies with the 24
55	53		provisions of subdivision (1) of this subsection. 25
56	54		(b) The Insurance Commissioner shall adopt regulations, in 26
57	55		accordance with the provisions of chapter 54 of the general statutes, to 27
58	56		implement the provisions of this section. 28
59	57		This act shall take effect as follows and shall amend the following
60	58		sections:
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62	60		Section 1 July 1, 2022 New section
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64		-	INS Joint Favorable
	62	+	Statement of Purpose:
	63	+	To require certain health insurers, preferred provider networks and
	64	+	other entities to include certain provisions in contracts with health care
	65	+	providers regarding reimbursement for certain covered health benefits.
	66	+	[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except
	67	+	that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not
	68	+	underlined.]
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