Bill Text: CT SB00023 | 2017 | General Assembly | Comm Sub
Bill Title: An Act Requiring Setting-neutral Reimbursement Policies In Contracts Between Health Carriers And Health Care Providers.
Spectrum: Committee Bill
Status: (Introduced - Dead) 2017-03-01 - Referred to Joint Committee on Insurance and Real Estate [SB00023 Detail]
Download: Connecticut-2017-SB00023-Comm_Sub.html
General Assembly |
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January Session, 2017 |
LCO No. 4559 | ||
*04559SB00023INS* | |||
Referred to Committee on INSURANCE AND REAL ESTATE |
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Introduced by: |
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(INS) |
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AN ACT REQUIRING SETTING-NEUTRAL REIMBURSEMENT POLICIES 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. Section 38a-472i of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2017):
[Each insurer, health care center, hospital service corporation, medical service corporation or fraternal benefit society that delivers, issues for delivery, renews, amends or continues an individual or group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 in this state, and contracts directly with a physician or physician group or physician organization to provide medical services under such policy shall, at such contracted physician's or physician's group's or physician's organization's request, establish a payment amount for the physician's professional services component of colonoscopy or endoscopic services covered under such policy, that is the same regardless of where the physician's professional services are performed. Such payment amount for the physician's professional services shall not be less than the amount that would otherwise be paid to such contracted physician or physician group or physician organization if the services are performed at a facility other than an outpatient surgical facility, as defined in section 19a-493b. Nothing in this section shall prohibit a contracted physician or physician group or physician organization from agreeing to a different payment methodology for colonoscopy or endoscopic services.]
(a) Each health insurer, health care center, hospital service corporation, medical service corporation, preferred provider network or other entity that contracts with health care providers to provide health care services to its insureds or enrollees shall include in each such contract that is entered into, renewed or amended on or after October 1, 2017, setting-neutral reimbursement policies as recommended by the Medicare Payment Advisory Commission's June 2013, Report to the Congress: Medicare and the Health Care Delivery System. Such reimbursement policies shall, at a minimum, (1) require reimbursement that is the same for all health care providers regardless of the setting where the services are performed for (A) evaluation and management visits, (B) services classified by said commission as Group 1 ambulatory payment classification in said report, and (C) ambulatory surgical procedures and services identified by said commission as appropriate for equal reimbursement, and (2) limit reimbursement differentials to only the amount necessary for the actual cost of packaging ancillary services for services classified by said commission as Group 2 ambulatory payment classification in said report.
(b) Each contract under subsection (a) of this section shall include a conspicuous statement that the contract complies with setting-neutral reimbursement policies as required by law.
This act shall take effect as follows and shall amend the following sections: | ||
Section 1 |
October 1, 2017 |
38a-472i |
Statement of Purpose:
To require setting-neutral reimbursement policies to be included in contracts between health insurers and other entities that contract with health care providers for the provision of health care services.
[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.]