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OLR Bill Analysis
sHB 6620
AN ACT PROMOTING COMPETITION IN CONTRACTS BETWEEN
HEALTH CARRIERS AND HEALTH CARE PROVIDERS.
SUMMARY
This bill prohibits health care providers, health carriers (i.e., insurers
and HMOs), health plan administrators, or any agent or entity
contracting on their behalf from offering, soliciting, requesting,
amending, renewing, or entering a health care contract on or after
January 1, 2024, that includes an all-or-nothing clause, anti-steering
clause, anti-tiering clause, or gag clause.
The bill makes null and void any of these clauses in a health care
contract (i.e., an oral or written agreement to provide services under a
health benefit plan), written policy or procedure, or agreement.
However, it specifies that (1) all remaining clauses remain in effect for
the contract’s duration and (2) that it does not modify, reduce, or
eliminate any existing privacy protections and standards under the
federal Health Insurance Portability and Accountability, Genetic
Information Nondiscrimination, or federal Americans with Disabilities
acts.
The bill authorizes the attorney general to enforce its provisions,
including by seeking a permanent injunction against violators.
EFFECTIVE DATE: October 1, 2023
PROHIBITED CLAUSES
Under the bill, an “all-or-nothing clause” requires health carriers or
health plan administrators to (1) include all members of a health care
provider in a network plan or (2) contract with a provider’s affiliate as a
condition of contracting with the provider. 2023HB-06620-R000326-BA.DOCX
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An “anti-steering clause” restricts a carrier or administrator from
encouraging an enrollee to get healthcare services from a competing
hospital or health system, including by offering incentives for enrollees
to use specific healthcare providers.
An “anti-tiering clause” (1) restricts health carriers from introducing
or modifying a tiered network plan or assigning providers to tiers or (2)
requires a health carrier to assign all health care provider members to
the same tier.
A “gag clause” restricts a health care provider, carrier, or
administrator from disclosing certain information to a government
entity (or its contractors or agents), enrollee or their treating provider,
plan sponsor or potential eligible enrollees. The information is any price
or quality information, including allowed amounts, negotiated rates or
discounts, fees for services, or other claim related financial obligations.
It also includes a clause that restricts the ability of a health care provider,
carrier, or plan administrator to disclose out of pocket costs to enrollees.
Applicability to Health Care Providers
The bill defines a health care provider as a physician group with (1)
eight or more members or (2) less than eight members that are employed
by or are an affiliate of a hospital, medical foundation, or insurance
company. A health care provider is also a for-profit or nonprofit entity,
corporation or organization, parent corporation, member, affiliate,
subsidy, or entity under common ownership that is authorized by
Connecticut to bill or receive payment for health care services in the
normal course of business. It also includes hospitals, hospital-based
facilities, health systems, freestanding emergency departments, and
imaging centers.
ENFORCEMENT
Under the bill, the attorney general may subpoena any parties to a
health care contract to require them to submit related records needed to
investigate suspected violations of the bill. The attorney general may
seek temporary or permanent injunctions and other relief as appropriate
to enjoin a health care provider, carrier, administrator, or other 2023HB-06620-R000326-BA.DOCX
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contracting entity from enforcing the prohibited contract clauses. If the
court determines a contract violation exists, it may grant injunctive relief
and other relief as justice may require. It may also set a deadline for the
violating party to comply with an order.
BACKGROUND
Related Bill
sSB 983, favorably reported by the Insurance and Real Estate
Committee, contains substantially similar contract provisions.
COMMITTEE ACTION
Insurance and Real Estate Committee
Joint Favorable Substitute
Yea 12 Nay 0 (03/14/2023)