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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repealed and the following is substituted in lieu thereof (Effective 2
October 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 6
or 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 11
carrier and such participating provider on the end date of such 12
contract period. Upon receipt of any notice of intent to terminate such 13
contract by any health carrier or participating provider, such 14
participating provider shall provide to such health carrier a list of such 15 Bill No. 6782
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participating provider's patients who are covered persons under such 16
health carrier's network plan. In the event that any such notice is not 17
provided by either a participating provider or health carrier, such 18
contract shall either 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, 30
or a parent corporation of a hospital or an intermediary, if the contract 31
is not renewed or is terminated by either the health carrier or the 32
participating provider, the health carrier and the participating 33
provider shall continue to abide by the terms of such contract, 34
including reimbursement terms for all health care services and 35
provisions provided under such contract, for a period of sixty days 36
from the date of termination or, in the case of a nonrenewal, from the 37
end of the contract period. Except as otherwise agreed between such 38
health carrier and such participating provider, the reimbursement 39
terms of any contract entered into by such health carrier and such 40
participating provider during said sixty-day period shall be retroactive 41
to the date of termination or, in the case of a nonrenewal, the end date 42
of the contract period. Such provider shall be deemed out-of-network 43
as of the date of contract termination. This subparagraph shall not 44
apply if the health carrier and participating provider agree, in writing, 45
to the termination or nonrenewal of the contract and the health carrier 46
and participating provider provide the notices required under 47
subparagraphs (A) and (B) of this subdivision. 48 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 66
care provider or a facility at which a covered person is receiving 67
treatment, that is removed from or leaves a health carrier's network 68
pursuant to 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 76
such covered person (I) a list of available participating providers in the 77
same geographic area as such covered person who are of the same 78
health care provider or facility type, and (II) the procedures for how 79 Bill No. 6782
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such covered person may request continuity of care as set forth in this 80
subparagraph. 81
(iii) Such procedures shall provide that: 82
(I) Any request for a continuity of care period shall be made by the 83
covered person or the covered person's authorized representative; 84
(II) A request for a continuity of care period, made by a covered 85
person who meets the requirements under subparagraph (B)(i) of this 86
subdivision or such covered person's authorized representative and 87
whose treating provider was not removed from or did not leave the 88
network for cause, shall be reviewed by the health carrier's medical 89
director after consultation with such treating provider; and 90
(III) For a covered person who is in the second or third trimester of 91
pregnancy, the continuity of care period shall extend through the 92
postpartum period. 93
(iv) The continuity of care period for a covered person who is 94
undergoing an active course of treatment shall extend to the earliest of 95
the following: (I) Termination of the course of treatment by the covered 96
person or the treating provider; (II) ninety days after the date the 97
participating provider is removed from or leaves the network, unless 98
the health carrier's medical director determines that a longer period is 99
necessary; (III) the date that care is successfully transitioned to another 100
participating provider; (IV) the date benefit limitations under the 101
health benefit plan are met or exceeded; or (V) the date the health 102
carrier determines care is no longer medically necessary. 103
(v) The health carrier shall only grant a continuity of care period as 104
provided under subparagraph (B)(iv) of this subdivision if the treating 105
provider agrees, in writing, (I) to accept the same payment from such 106
health carrier and abide by the same terms and conditions as provided 107
in the contract between such health carrier and treating provider when 108
such treating provider was a participating provider, and (II) not to 109
seek any payment from the covered person for any amount for which 110 Bill No. 6782
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such covered person would not have been responsible if the treating 111
provider was still a participating provider. 112
This act shall take effect as follows and shall amend the following
sections:
Section 1 October 1, 2023 38a-472f(g)
INS Joint Favorable