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General Assembly Substitute Bill No. 6620
January Session, 2023
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
providers; 14
(3) "Anti-tiering clause" means any provision in a health care contract 15
that: 16 Substitute Bill No. 6620
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(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 such government entity's contractors or 29
agents, any enrollee, any treating health care provider of an enrollee, 30
plan sponsor or potential 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" and "tiered 35
network" have the same meanings as provided in section 38a-472f of the 36
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
(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 Substitute Bill No. 6620
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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, physician group with eight or more physicians, urgent 50
care center, as defined in section 19a-493d of the general statutes, and 51
any physician or physician group in a practice of fewer than eight 52
physicians that is employed by or an affiliate of any hospital, medical 53
foundation or insurance company; 54
(8) "Health carrier" has the same meaning as provided in section 38a-55
591a of the general statutes; and 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
(b) No health care provider, health carrier, health plan administrator 59
or any agent or other entity that contracts on behalf of a health care 60
provider, health carrier, or health plan administrator, may offer, solicit, 61
request, amend, renew or enter into a health care contract on or after 62
January 1, 2024, that directly or indirectly includes any of the following 63
provisions: 64
(1) An all-or-nothing clause; 65
(2) An anti-steering clause; 66
(3) An anti-tiering clause; or 67
(4) A gag clause. 68
(c) Any clause in a health care contract, written policy, written 69
procedure or agreement entered into, renewed or amended on or after 70
January 1, 2024, that is contrary to the provisions set forth in subsection 71
(b) of this section shall be null and void. All remaining clauses of such 72
health care contract, written policy, written procedure or agreement 73
shall remain in effect for the duration of the contract term. 74 Substitute Bill No. 6620
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(d) Nothing in this section shall be construed to modify, reduce or 75
eliminate the existing privacy protections and standards pursuant to the 76
federal Health Insurance Portability and Accountability Act of 1996, P.L. 77
104-191, as amended from time to time, the federal Genetic Information 78
Nondiscrimination Act of 2008, P.L. 110-233, as amended from time to 79
time, or the federal Americans with Disabilities Act of 1990, 42 USC 80
12101, as amended from time to time. 81
(e) The Attorney General may: 82
(1) Issue in writing and cause to be served upon any parties to a 83
health care contract by subpoena, a demand requiring that such parties 84
submit to the Attorney General any records from a health care contract 85
that are necessary for the Attorney General to investigate suspected 86
violations of subsection (b) of this section; or 87
(2) Seek a temporary or permanent injunction and such other relief as 88
may be appropriate to enjoin a health care provider, health carrier, 89
health plan administrator or any agent or other entity that contracts on 90
behalf of a health care provider, health carrier or health plan 91
administrator from continuing to enforce contract provisions that 92
violate the requirements as set forth in subsection (b) of this section. If 93
the court determines that any such violation exists, it may grant such 94
injunctive relief and such other relief as justice may require and may set 95
a time period within which such health care provider, health carrier, 96
health plan administrator or any agent or other entity that contracts on 97
behalf of a health care provider, health carrier or health plan 98
administrator shall comply with any such order. 99
This act shall take effect as follows and shall amend the following
sections:
Section 1 October 1, 2023 New section
INS Joint Favorable Subst.
JUD Joint Favorable Substitute Bill No. 6620
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