Bill Text: CT SB00197 | 2014 | General Assembly | Comm Sub

Connecticut Senate Bill 197 (Prior Session Legislation)

Bill Title: An Act Decreasing The Time Frames For Urgent Care Adverse Determination Review Requests.

Spectrum: Bipartisan Bill

Status: (Engrossed - Dead) 2014-04-19 - House Calendar Number 419 [SB00197 Detail]

Download: Connecticut-2014-SB00197-Comm_Sub.html


General Assembly		*Raised Bill No. 197*
*February Session, 2014*		LCO No. 1073
		_____SB00197INS___030514____
Referred to Committee on INSURANCE AND REAL ESTATE
Introduced by:
(INS)

AN ACT DECREASING THE TIME FRAMES FOR URGENT CARE ADVERSE DETERMINATION REVIEW REQUESTS.

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

Section 1. Subdivision (1) of subsection (c) of section 38a-591d of the 2014 supplement to the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2014):

(1) [(A)] Unless the covered person or the covered person's authorized representative has failed to provide information necessary for the health carrier to make a determination, [and except as specified under subparagraph (B) of this subdivision,] the health carrier shall make a determination as soon as possible, taking into account the covered person's medical condition, but not later than [seventy-two] twenty-four hours after the health carrier receives such request, provided, if the urgent care request is a concurrent review request to extend a course of treatment beyond the initial period of time or the number of treatments, such request is made at least twenty-four hours prior to the expiration of the prescribed period of time or number of treatments.

[(B) Unless the covered person or the covered person's authorized representative has failed to provide information necessary for the health carrier to make a determination, for an urgent care request specified under subparagraph (B) or (C) of subdivision (38) of section 38a-591a, the health carrier shall make a determination as soon as possible, taking into account the covered person's medical condition, but not later than twenty-four hours after the health carrier receives such request, provided, if the urgent care request is a concurrent review request to extend a course of treatment beyond the initial period of time or the number of treatments, such request is made at least twenty-four hours prior to the expiration of the prescribed period of time or number of treatments.]

Sec. 2. Subdivision (1) of subsection (d) of section 38a-591e of the 2014 supplement to the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2014):

(d) (1) The health carrier shall notify the covered person and, if applicable, the covered person's authorized representative, in writing or by electronic means, of its decision within a reasonable period of time appropriate to the covered person's medical condition, but not later than:

(A) For prospective review and concurrent review requests, thirty calendar days after the health carrier receives the grievance;

(B) For retrospective review requests, sixty calendar days after the health carrier receives the grievance; and

(C) For expedited review requests, [except as specified under subparagraph (D) of this subdivision, seventy-two] twenty-four hours after the health carrier receives the grievance. [; and]

[(D) For expedited review requests of a health care service or course of treatment specified under subparagraph (B) or (C) of subdivision (38) of section 38a-591a, twenty-four hours after the health carrier receives the grievance.]

Sec. 3. Subdivision (1) of subsection (i) of section 38a-591g of the 2014 supplement to the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2014):

(i) (1) The independent review organization shall notify the commissioner, the health carrier, the covered person and, if applicable, the covered person's authorized representative in writing of its decision to uphold, reverse or revise the adverse determination or the final adverse determination, not later than:

(A) For external reviews, forty-five calendar days after such organization receives the assignment from the commissioner to conduct such review;

(B) For external reviews involving a determination that the recommended or requested health care service or treatment is experimental or investigational, twenty calendar days after such organization receives the assignment from the commissioner to conduct such review;

(C) For expedited external reviews, [except as specified under subparagraph (D) of this subdivision,] as expeditiously as the covered person's medical condition requires, but not later than [seventy-two] twenty-four hours after such organization receives the assignment from the commissioner to conduct such review; and

[(D) For expedited external reviews involving a health care service or course of treatment specified under subparagraph (B) or (C) of subdivision (38) of section 38a-591a, as expeditiously as the covered person's medical condition requires, but not later than twenty-four hours after such organization receives the assignment from the commissioner to conduct such review; and]

[(E)] (D) For expedited external reviews involving a determination that the recommended or requested health care service or treatment is experimental or investigational, as expeditiously as the covered person's medical condition requires, but not later than five calendar days after such organization receives the assignment from the commissioner to conduct such review.


This act shall take effect as follows and shall amend the following sections:
Section 1	October 1, 2014	38a-591d(c)(1)
Sec. 2	October 1, 2014	38a-591e(d)(1)
Sec. 3	October 1, 2014	38a-591g(i)(1)