Researcher: JKL Page 1 4/6/22
OLR Bill Analysis
sSB 416
AN ACT PROMOTING COMPETITION IN CONTRACTS BETWEEN
HEALTH CARRIERS AND HEALTH CARE PROVIDERS.
SUMMARY
This bill prohibits certain anticompetitive provisions in health care
contracts. It also authorizes the insurance commissioner to adopt
implementing regulations.
Specifically, the bill prohibits health insurance carriers, health care
providers, and health plan administrators (i.e., third-party
administrators or TPAs), or their agents or other entities acting on their
behalf, from offering, soliciting, requesting, amending, renewing, or
entering into a health care contract that includes, directly or indirectly,
(1) all-or-nothing, anti-steering, or anti-tiering clauses or (2) any other
anticompetitive clause the commissioner adopts in accordance with the
Uniform Administrative Procedure Act (i.e., in regulations).
Under the bill, any contract, procedure, or agreement with one of
these clauses is null and void, except other clauses of a contract remain
in effect for the duration of the contract term.
By law, anyone violating a provision of Title 38a of the general
statutes for which no other penalty is provided is subject to a fine of up
to $15,000 (CGS § 38a-2).
EFFECTIVE DATE: January 1, 2023
DEFINITIONS
All-Or-Nothing Clause
Under the bill, an “all-or-nothing clause” is a health care contract
provision that requires health insurance carriers or TPAs to (1) include
all members of a health care provider in a network plan or (2) contract
with the provider’s affiliate as a condition of entering into the contract. 2022SB-00416-R000362-BA.DOCX
Researcher: JKL Page 2 4/6/22
Anti-Steering Clause
An “anti-steering clause” is a health care contract provision that
limits the health insurance carrier’s or TPA’s ability to encourage
enrollees to obtain health care from a hospital’s or health system’s
competitor, including offering incentives that encourage enrollees to use
specific providers.
Anti-Tiering Clause
The bill defines an “anti-tiering clause” as a health care contract
provision that (1) restricts the health insurance carrier’s or TPA’s ability
to introduce or modify a tiered network plan or assign providers into
tiers or (2) requires the carrier or TPA to place all members of a provider
in the same tier of a tiered network plan.
By law, a “tiered network” is a network that places some or all types
of health care providers and facilities into specific groups to which
different participating provider reimbursement, access requirements, or
cost sharing apply for the same health care services (CGS § 38a-472f).
COMMITTEE ACTION
Insurance and Real Estate Committee
Joint Favorable
Yea 17 Nay 0 (03/22/2022)