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General Assembly Raised Bill No. 6620
January Session, 2023
LCO No. 3172
Referred to Committee on INSURANCE AND REAL ESTATE
Introduced by:
(INS)
AN ACT PROMOTING COMPETITION IN CONTRACTS BETWEEN
HEALTH CARRIERS AND HEALTH CARE PROVIDERS.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. (NEW) (Effective October 1, 2023) (a) As used in this section: 1
(1) "All-or-nothing clause" means any provision in a health care 2
contract that: 3
(A) Requires the health carrier or health plan administrator to include 4
all members of a health care provider in a network plan; or 5
(B) Requires the health carrier or health plan administrator to enter 6
into any additional contract with an affiliate of the health care provider 7
as a condition to entering into a contract with such health care provider; 8
(2) "Anti-steering clause" means any provision in a health care 9
contract that restricts the ability of the health carrier or health plan 10
administrator from encouraging an enrollee to obtain a health care 11
service from a competitor of a hospital or health system, including 12
offering incentives to encourage enrollees to utilize specific health care 13 Raised Bill No. 6620
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providers; 14
(3) "Anti-tiering clause" means any provision in a health care contract 15
that: 16
(A) Restricts the ability of the health carrier or health plan 17
administrator to introduce and modify a tiered network plan or assign 18
health care providers into tiers; or 19
(B) Requires the health carrier or health plan administrator to place 20
all members of a health care provider in the same tier of a tiered network 21
plan; 22
(4) "Gag clause" means any provision in a health care contract that: 23
(A) Restricts the ability of the health care provider, health carrier or 24
health plan administrator to disclose any price or quality information, 25
including, but not limited to, the allowed amount, negotiated rates or 26
discounts, any fees for services or any other claim-related financial 27
obligations included in the provider contract, to any governmental 28
entity as authorized by law or its contractors or agents, any enrollee, any 29
treating health care provider of an enrollee, plan sponsor or potential 30
eligible enrollees and plan sponsors; or 31
(B) Restricts the ability of either any health care provider, health 32
carrier or health plan administrator to disclose out-of-pocket costs to 33
any enrollee; 34
(5) "Health benefit plan", "network", "network plan", "participating 35
provider" and "tiered network" have the same meanings as provided in 36
section 38a-472f of the general statutes; 37
(6) "Health care contract" means any contract, agreement or 38
understanding, either orally or in writing, entered into, amended, 39
restated or renewed between a health care provider and a health carrier, 40
health plan administrator, plan sponsor or its contractors or agents for 41
delivery of health care services to an enrollee of a health benefit plan; 42 Raised Bill No. 6620
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(7) "Health care provider" means any for-profit or nonprofit entity, 43
corporation or organization, parent corporation, member, affiliate, 44
subsidiary or entity under common ownership that is or whose 45
members are licensed or otherwise authorized by this state to furnish, 46
bill for or receive payment for health care service delivery in the normal 47
course of business, including, but not limited to, a health system, 48
hospital, hospital-based facility, freestanding emergency department, 49
imaging center, large physician group with eight or more physicians, 50
physician staffing organization, urgent care center and any physician or 51
physician group in a practice of fewer than eight physicians that is 52
employed by or an affiliate of any hospital, medical foundation, 53
insurance company or other similar entity; 54
(8) "Health carrier" has the same meaning as provided in section 38a-55
591a of the general statutes; 56
(9) "Health plan administrator" means any third-party administrator 57
who acts on behalf of a plan sponsor to administer a health benefit plan; 58
and 59
(10) "Most-favored health carrier or health plan administrator clause" 60
means any provision of a health care contract that: 61
(A) Prohibits or grants any health carrier or health plan administrator 62
an option to prohibit any health care provider from contracting with 63
another entity to provide health care services at the same or lower price 64
than the payment specified in the health care contract; 65
(B) Requires or grants any health carrier or health plan administrator 66
an option to require any health care provider to accept a lower payment 67
in the event the health care provider agrees to provide health care 68
services to another entity at a lower price; 69
(C) Requires or grants any health carrier or health plan administrator 70
an option to require termination or renegotiation of an existing health 71
care contract if such health care provider agrees to provide health care 72
services to another entity at the same or lower price; or 73 Raised Bill No. 6620
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(D) Restricts any health carrier or health plan administrator, not party 74
to the health care contract, from paying the same or lower rates for items 75
or services than the contracting health carrier or health plan 76
administrator pays for such items or services. 77
(b) Except as provided in subsections (d) and (e) of this section, no 78
health care provider, health carrier, health plan administrator or any 79
agent or other entity that contracts on behalf of a health care provider, 80
health carrier, or health plan administrator, may offer, solicit, request, 81
amend, renew or enter into a health care contract on or after January 1, 82
2024, that directly or indirectly includes any of the following provisions: 83
(1) An all-or-nothing clause; 84
(2) An anti-steering clause; 85
(3) An anti-tiering clause; 86
(4) A gag clause; or 87
(5) A most-favored health carrier or health plan administrator clause. 88
(c) Except as provided in subsections (d) and (e) of this section, any 89
clause in a health care contract, written policy, written procedure or 90
agreement entered into, renewed or amended on or after January 1, 91
2024, that is contrary to the provisions set forth in subsection (b) of this 92
section shall be null and void. All remaining clauses of such health care 93
contract, written policy, written procedure or agreement shall remain in 94
effect for the duration of the contract term. 95
(d) Any party to a health care contract that contains a provision as set 96
forth in subdivisions (1) to (5), inclusive, of subsection (b) of this section 97
may apply for a waiver of the requirements of subsection (b) of this 98
section by submitting to the Insurance Commissioner the following: 99
(1) A copy of the health care contract; 100
(2) The name and business address of each party to the health care 101 Raised Bill No. 6620
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contract and each location where each party to the health care contract 102
provides health care services; and 103
(3) Any information to demonstrate that such health care contract 104
improves the welfare of consumers in this state in a way that could not 105
have been accomplished through less restrictive alternative means. 106
(e) The Insurance Commissioner shall approve or deny such waiver 107
submitted pursuant to subsection (d) of this section not later than sixty 108
days after receipt of such application for a waiver by a party to a health 109
care contract. The Insurance Commissioner may approve a waiver to 110
allow a contract to include a clause specified in subsection (b) of this 111
section upon finding that: (1) The health care contract improves the 112
welfare of consumers in this state to such a degree that the 113
procompetitive benefits of including the provision outweigh any harms 114
to competition; (2) such improvement to the welfare of consumers in this 115
state could not have been accomplished through less restrictive 116
alternative means; and (3) the health care contract does not constitute a 117
contract, combination or conspiracy in restraint of trade pursuant to the 118
provisions of chapter 624 of the general statutes. 119
(f) The provisions of subsection (b) of this section shall not apply to a 120
partnership plan, as defined in section 3-123aaa of the general statutes, 121
or a state employee plan, as defined in section 3-123rrr of the general 122
statutes. 123
(g) Nothing in this section shall be construed to limit network design 124
or cost or quality initiatives by a group health plan, health carrier or an 125
administrator working on behalf of a plan sponsor, including an 126
accountable care organization, exclusive provider organization, 127
network that tiers health care providers by cost or quality or that steer 128
enrollees to centers of excellence or other pay-for-performance 129
programs. 130
(h) Nothing in this section shall be construed to modify, reduce or 131
eliminate the existing privacy protections and standards pursuant to the 132
federal Health Insurance Portability and Accountability Act of 1996, P.L. 133 Raised Bill No. 6620
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104-191, as amended from time to time, the federal Genetic Information 134
Nondiscrimination Act of 2008, P.L. 110-233, as amended from time to 135
time, or the federal Americans with Disabilities Act of 1990, 42 USC 136
12101, as amended from time to time. 137
(i) The Attorney General may: 138
(1) Issue in writing and cause to be served upon any parties to a 139
health care contract by subpoena, a demand requiring that such parties 140
submit to the Attorney General any records from a health care contract 141
that are necessary for the Attorney General to investigate suspected 142
violations of subsection (b) of this section; 143
(2) Seek a temporary or permanent injunction and such other relief as 144
may be appropriate to enjoin a health care provider, health carrier, 145
health plan administrator or any agent or other entity that contracts on 146
behalf of a health care provider, health carrier or health plan 147
administrator from continuing to enforce contract provisions that 148
violate the requirements as set forth in subsection (b) of this section. If 149
the court determines that any such violation exists, it may grant such 150
injunctive relief and such other relief as justice may require and may set 151
a time period within which such health care provider, health carrier, 152
health plan administrator or any agent or other entity that contracts on 153
behalf of a health care provider, health carrier or health plan 154
administrator shall comply with any such order. 155
(j) The Insurance Commissioner may: 156
(1) Inspect records and papers of any health carrier, health plan 157
administrator or any agent or other entity that contracts on behalf of a 158
health carrier or health plan administrator that pertain to health care 159
contract negotiation; 160
(2) Require any health carrier, health plan administrator or any agent 161
or other entity that contracts on behalf of a health carrier or health plan 162
administrator to produce a list of all health care contracts or pricing 163
arrangements entered into during the preceding twelve months; 164 Raised Bill No. 6620
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(3) Except as provided in subsections (d) and (e) of this section, assess 165
any health carrier, health plan administrator or any agent or other entity 166
that contracts on behalf of a health carrier or health plan administrator 167
an administrative penalty in an amount not to exceed five thousand 168
dollars for each day that such health carrier, health plan administrator 169
or any agent or other entity that contracts on behalf of a health carrier 170
or health plan administrator violates subsection (b) of this section; and 171
(4) Refer any health care contract to the Attorney General to review 172
for compliance with subsection (b) of this section. 173
This act shall take effect as follows and shall amend the following
sections:
Section 1 October 1, 2023 New section
Statement of Purpose:
To exclude the following in contracts between health carriers and health
care providers: (1) All-or-nothing clauses; (2) anti-steering clauses; (3)
anti-tiering clauses; (4) gag clauses; and (5) most-favored health carrier
or health plan administrator clauses.
[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except
that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not
underlined.]