Bill Text: CT HB05382 | 2018 | General Assembly | Introduced

Connecticut House Bill 5382 (Prior Session Legislation)

Introduced

Bill Title: An Act Concerning Continuity Of Care And Network Adequacy.

Spectrum: Committee Bill

Status: (Introduced - Dead) 2018-03-02 - Public Hearing 03/06 [HB05382 Detail]

Download: Connecticut-2018-HB05382-Introduced.html


General Assembly		*Raised Bill No. 5382*
*February Session, 2018*		LCO No. 1836
		01836_______INS
Referred to Committee on INSURANCE AND REAL ESTATE
Introduced by:
(INS)

AN ACT CONCERNING CONTINUITY OF CARE AND NETWORK ADEQUACY.

Be it enacted by the Senate and House of Representatives in General Assembly convened:

Section 1. Subsection (g) of section 38a-472f of the 2018 supplement to the general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2018):

(g) (1) (A) A health carrier and participating provider shall provide at least sixty days' written notice to each other before the health carrier removes a participating provider from the network or the participating provider leaves the network. Each participating provider that receives a notice of removal or issues a departure notice shall provide to the health carrier a list of such participating provider's patients who are covered persons under a network plan of such health carrier.

(B) A health carrier shall make a good faith effort to provide written notice, not later than thirty days after the health carrier receives or issues a written notice under subparagraph (A) of this subdivision, to all covered persons who are patients being treated on a regular basis by or at the participating provider being removed from or leaving the network, irrespective of whether such removal or departure is for cause.

(C) The commissioner shall promptly (i) redetermine the sufficiency of a health carrier's network, in the manner specified in subdivision (2) of subsection (c) of this section, when a health system, as defined in section 19a-508c, leaves the health carrier's network, (ii) prepare a written report describing the results of the redetermination, and (iii) post a link to the report in a prominent location on the Insurance Department's Internet web site.

(2) (A) For the purposes of this subdivision:

(i) "Active course of treatment" means (I) a medically necessary, ongoing course of treatment for a life-threatening condition, (II) a medically necessary, ongoing course of treatment for a serious condition, (III) medically necessary care provided during the second or third trimester of pregnancy, [or] (IV) a medically necessary, ongoing course of treatment for a condition for which a treating health care provider attests that discontinuing care by such health care provider would worsen the covered person's condition or interfere with anticipated outcomes, (V) a medically necessary, ongoing course of treatment for, or monitoring or maintenance of, a condition for which a health care provider has treated a covered person during the twelve months immediately preceding the date on which the health care provider was removed from, or left, a health carrier's network pursuant to subdivision (1) of this subsection, or (VI) evaluation or management of a covered condition provided by a health care provider during an appointment that a covered person scheduled with the health care provider before the health care provider was removed from, or left, a health carrier's network pursuant to subdivision (1) of this subsection;

(ii) "Life-threatening condition" means a disease or condition for which the likelihood of death is probable unless the course of such disease or condition is interrupted;

(iii) "Serious condition" means a disease or condition that requires complex ongoing care such as chemotherapy, radiation therapy or postoperative visits, which the covered person is currently receiving; and

(iv) "Treating provider" means a covered person's treating health care provider or a facility at which a covered person is receiving treatment, that is removed from or leaves a health carrier's network pursuant to subdivision (1) of this subsection.

(B) (i) Each health carrier shall establish and maintain reasonable procedures to transition a covered person, who is in an active course of treatment with a participating health care provider or at a participating facility that becomes a treating provider, to another participating provider in a manner that provides for continuity of care.

(ii) In addition to the notice required under subdivision (1) of this subsection, the health carrier shall provide to such covered person (I) a list of available participating providers in the same geographic area as such covered person who are of the same health care provider or facility type, and (II) information regarding the procedures for how such covered person may request continuity of care as set forth in this subparagraph, including, but not limited to, a description of the required form of the continuity of care request, the manner in which such covered person is required to file such request, the process for submitting an expedited request, the date by which the health carrier is required to render a decision regarding such request, and a description of such covered person's appeal rights regarding such decision.

(iii) Such procedures shall provide that:

(I) Any request for a continuity of care period shall be made by the covered person or the covered person's authorized representative;

(II) A request for a continuity of care period, made by a covered person who meets the requirements under subparagraph (B)(i) of this subdivision or such covered person's authorized representative and whose treating provider was not removed from or did not leave the network for cause, shall be reviewed by the health carrier's medical director after consultation with such treating provider; [and]

(III) For a covered person who is in the second or third trimester of pregnancy, the continuity of care period shall extend through the postpartum period;

(IV) A treating health care provider may attest, pursuant to subparagraph (A)(i)(IV) of this subdivision, that discontinuing care by such health care provider would worsen a covered person's condition or interfere with anticipated outcomes; and

(V) If a health carrier does not notify a covered person of the health carrier's decision regarding a request for a continuity of care period, the request shall be deemed to have been approved.

(iv) The continuity of care period for a covered person who is undergoing an active course of treatment shall extend to the earliest of the following: (I) Termination of the course of treatment by the covered person or the treating provider; (II) ninety days after the date the participating provider is removed from or leaves the network, unless the health carrier's medical director determines that a longer period is necessary; (III) the date that care is successfully transitioned to another participating provider; (IV) the date benefit limitations under the health benefit plan are met or exceeded; or (V) the date the health carrier determines care is no longer medically necessary.

(v) The health carrier shall only grant a continuity of care period as provided under subparagraph (B)(iv) of this subdivision if the treating provider agrees, in writing, (I) to accept the same payment from such health carrier and abide by the same terms and conditions as provided in the contract between such health carrier and treating provider when such treating provider was a participating provider, and (II) not to seek any payment from the covered person for any amount for which such covered person would not have been responsible if the treating provider was still a participating provider.


This act shall take effect as follows and shall amend the following sections:
Section 1	July 1, 2018	38a-472f(g)

Statement of Purpose:

To expand the definition of "active course of treatment" within the context of continuity of care, require that the Insurance Commissioner redetermine the sufficiency of a health carrier's network when a health system leaves the health carrier's network and require that health carriers disclose additional information to covered persons regarding continuity of care.

[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.]