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General Assembly Raised Bill No. 1048
January Session, 2021
LCO No. 3660
Referred to Committee on INSURANCE AND REAL ESTATE
Introduced by:
(INS)
AN ACT CONCERNING RE IMBURSEMENTS FOR CERTAIN
COVERED HEALTH BENEF ITS.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. (NEW) (Effective July 1, 2022) (a) Each insurer, health care 1
center, hospital service corporation, medical service corporation, 2
preferred provider network or other entity that enters into, renews or 3
amends a contract with a health care provider on or after July 1, 2022, to 4
provide covered benefits to insureds or enrollees in this state shall 5
include in such contract: 6
(1) A provision requiring such insurer, health care center, hospital 7
service corporation, medical service corporation, preferred provider 8
network or other entity to: 9
(A) Reimburse the contracting health care provider for a covered 10
outpatient benefit that uses a current procedural terminology 11
evaluation and management (CPT E/M) code, current procedural 12
terminology assessment and management (CPT A/M) code or drug 13
infusion code in an amount that does not vary based on the facility 14 Raised Bill No. 1048
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where the contracting health care provider provides such benefit; and 15
(B) Use equal reimbursement rates for all contracting health care 16
providers in the same geographic region, as determined by the 17
Insurance Commissioner and regardless of the employer or affiliation of 18
any contracting health care provider, for each covered outpatient benefit 19
described in subparagraph (A) of this subdivision if the reimbursement 20
for such covered outpatient benefit is made on a fee-for-benefit basis or 21
on the basis of bundled benefits per diagnosis, condition, procedure or 22
another standardized bundle of health care benefits; and 23
(2) A conspicuous statement that such contract complies with the 24
provisions of subdivision (1) of this subsection. 25
(b) The Insurance Commissioner shall adopt regulations, in 26
accordance with the provisions of chapter 54 of the general statutes, to 27
implement the provisions of this section. 28
This act shall take effect as follows and shall amend the following
sections:
Section 1 July 1, 2022 New section
INS Joint Favorable