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General Assembly Raised Bill No. 6782
January Session, 2023
LCO No. 4349
Referred to Committee on INSURANCE AND REAL ESTATE
Introduced by:
(INS)
AN ACT CONCERNING NOTICES OF TERMINATION OF HEALTH
CARE CONTRACTS.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. Subsection (g) of section 38a-472f of the general statutes is 1
repealed and the following is substituted in lieu thereof (Effective October 2
1, 2023): 3
(g) (1) (A) A health carrier and participating provider shall provide 4
[at least] not less than ninety days' written notice [to each other before 5
the health carrier removes a participating provider from the network or 6
the participating provider leaves the network. Each participating 7
provider that receives a notice of removal or issues a departure notice 8
shall provide to the health carrier a list of such participating provider's 9
patients who are covered persons under a network plan of such health 10
carrier] of any intent to terminate a contract between such health carrier 11
and such participating provider on the end date of such contract period. 12
Upon receipt of any notice of intent to terminate such contract by any 13
health carrier or participating provider, such participating provider 14
shall provide to such health carrier a list of such participating provider's 15 Raised Bill No. 6782
LCO No. 4349 2 of 5
patients who are covered persons under such health carrier's network 16
plan. In the event that any such notice is not provided by either a 17
participating provider or health carrier, such contract shall either 18
automatically renew or be extended. 19
(B) A health carrier shall make a good faith effort to provide written 20
notice, not later than thirty days [after the health carrier receives or 21
issues a written notice under subparagraph (A) of this subdivision] 22
before the date that such participating provider leaves or is removed 23
from such health carrier's network, to all covered persons who are 24
patients being treated on a regular basis by or at the participating 25
provider [being removed from or leaving the network,] irrespective of 26
whether such removal or departure is for cause. 27
(C) For each contract entered into, renewed, amended or continued 28
on or after July 1, [2018] 2024, between a health carrier and a 29
participating provider that is a hospital, as defined in section 38a-493, or 30
a parent corporation of a hospital or an intermediary, if the contract is 31
not renewed or is terminated by either the health carrier or the 32
participating provider, the health carrier and the participating provider 33
shall continue to abide by the terms of such contract, including 34
reimbursement terms for all health care services and provisions 35
provided under such contract, for a period of sixty days from the date 36
of termination or, in the case of a nonrenewal, from the end of the 37
contract period. Except as otherwise agreed between such health carrier 38
and such participating provider, the reimbursement terms of any 39
contract entered into by such health carrier and such participating 40
provider during said sixty-day period shall be retroactive to the date of 41
termination or, in the case of a nonrenewal, the end date of the contract 42
period. Such provider shall be deemed out-of-network as of the date of 43
contract termination. This subparagraph shall not apply if the health 44
carrier and participating provider agree, in writing, to the termination 45
or nonrenewal of the contract and the health carrier and participating 46
provider provide the notices required under subparagraphs (A) and (B) 47
of this subdivision. 48 Raised Bill No. 6782
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(2) (A) For the purposes of this subdivision: 49
(i) "Active course of treatment" means (I) a medically necessary, 50
ongoing course of treatment for a life-threatening condition, (II) a 51
medically necessary, ongoing course of treatment for a serious 52
condition, (III) medically necessary care provided during the second or 53
third trimester of pregnancy, or (IV) a medically necessary, ongoing 54
course of treatment for a condition for which a treating health care 55
provider attests that discontinuing care by such health care provider 56
would worsen the covered person's condition or interfere with 57
anticipated outcomes; 58
(ii) "Life-threatening condition" means a disease or condition for 59
which the likelihood of death is probable unless the course of such 60
disease or condition is interrupted; 61
(iii) "Serious condition" means a disease or condition that requires 62
complex ongoing care such as chemotherapy, radiation therapy or 63
postoperative visits, which the covered person is currently receiving; 64
and 65
(iv) "Treating provider" means a covered person's treating health care 66
provider or a facility at which a covered person is receiving treatment, 67
that is removed from or leaves a health carrier's network pursuant to 68
subdivision (1) of this subsection. 69
(B) (i) Each health carrier shall establish and maintain reasonable 70
procedures to transition a covered person, who is in an active course of 71
treatment with a participating health care provider or at a participating 72
facility that becomes a treating provider, to another participating 73
provider in a manner that provides for continuity of care. 74
(ii) In addition to the notice required under subparagraph (B) of 75
subdivision (1) of this subsection, the health carrier shall provide to such 76
covered person (I) a list of available participating providers in the same 77
geographic area as such covered person who are of the same health care 78
provider or facility type, and (II) the procedures for how such covered 79 Raised Bill No. 6782
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person may request continuity of care as set forth in this subparagraph. 80
(iii) Such procedures shall provide that: 81
(I) Any request for a continuity of care period shall be made by the 82
covered person or the covered person's authorized representative; 83
(II) A request for a continuity of care period, made by a covered 84
person who meets the requirements under subparagraph (B)(i) of this 85
subdivision or such covered person's authorized representative and 86
whose treating provider was not removed from or did not leave the 87
network for cause, shall be reviewed by the health carrier's medical 88
director after consultation with such treating provider; and 89
(III) For a covered person who is in the second or third trimester of 90
pregnancy, the continuity of care period shall extend through the 91
postpartum period. 92
(iv) The continuity of care period for a covered person who is 93
undergoing an active course of treatment shall extend to the earliest of 94
the following: (I) Termination of the course of treatment by the covered 95
person or the treating provider; (II) ninety days after the date the 96
participating provider is removed from or leaves the network, unless 97
the health carrier's medical director determines that a longer period is 98
necessary; (III) the date that care is successfully transitioned to another 99
participating provider; (IV) the date benefit limitations under the health 100
benefit plan are met or exceeded; or (V) the date the health carrier 101
determines care is no longer medically necessary. 102
(v) The health carrier shall only grant a continuity of care period as 103
provided under subparagraph (B)(iv) of this subdivision if the treating 104
provider agrees, in writing, (I) to accept the same payment from such 105
health carrier and abide by the same terms and conditions as provided 106
in the contract between such health carrier and treating provider when 107
such treating provider was a participating provider, and (II) not to seek 108
any payment from the covered person for any amount for which such 109
covered person would not have been responsible if the treating provider 110 Raised Bill No. 6782
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was still a participating provider. 111
This act shall take effect as follows and shall amend the following
sections:
Section 1 October 1, 2023 38a-472f(g)
Statement of Purpose:
To require notification to health carriers, participating providers and
insureds regarding the termination of health care contracts between
health carriers and health care providers.
[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.]