Bill Text: CT SB00368 | 2016 | General Assembly | Comm Sub

Connecticut Senate Bill 368 (Prior Session Legislation)

NOTE: There are more recent revisions of this legislation. Read Latest Draft

Bill Title: An Act Concerning The Insurance Department's Market Conduct Authority And Data Call Confidentiality, Authorizing Multistate Health Care Centers In Connecticut, Eliminating A Health Carrier Utilization Review Report Filing Requirement, And Concerning Licensure Of Single Purpose Dental Health Care Centers.

Spectrum: Committee Bill

Status: (Passed) 2016-06-10 - Signed by the Governor [SB00368 Detail]

Download: Connecticut-2016-SB00368-Comm_Sub.html

General Assembly		*Substitute Bill No. 368*
*February Session, 2016*		_____SB00368INS___031616____

AN ACT CONCERNING LICENSURE OF SINGLE PURPOSE DENTAL HEALTH CARE CENTERS.

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

Section 1. Section 38a-175 of the 2016 supplement to the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2016):

As used in this section and sections [38a-175] 38a-176 to 38a-194, inclusive, as amended by this act:

(1) "Healing arts" means the professions and occupations licensed under the provisions of chapters 370, 372, 373, 375, 378, 379, 379a, 380, 381, 383 and 400j.

(2) "Carrier" means a health care center, insurer, hospital service corporation, medical service corporation or other entity responsible for the payment of benefits or provision of services under a group contract.

(3) "Commissioner" means the Insurance Commissioner, except when explicitly stated otherwise.

(4) "Evidence of coverage" means a statement of essential features and services of the health care center coverage [which] that is given to the subscriber by the health care center or by the group contract holder.

(5) "Federal Health Maintenance Organization Act" means Title XIII of the Public Health Service Act, 42 USC Subchapter XI, as [from time to time] amended from time to time, or any successor thereto relating to qualified health maintenance organizations.

(6) "Group contract" means a contract for health care services [which] that by its terms limits eligibility to members of a specified group. The group contract may include coverage for dependents.

(7) "Group contract holder" means the person to which a group contract has been issued.

(8) "Health care" includes, but shall not be limited to, the following: [Medical] (A) For a health care center that provides medical and surgical services other than or in addition to dental services, (i) medical, surgical and dental care provided through licensed practitioners, including any supporting and ancillary personnel, services and supplies; (ii) physical therapy service provided through licensed physical therapists upon the prescription of a physician; (iii) psychological examinations provided by registered psychologists; (iv) optometric service provided by licensed optometrists; (v) hospital service, both inpatient and outpatient; (vi) convalescent institution care and nursing home care; (vii) nursing service provided by a registered nurse or by a licensed practical nurse; (viii) home care service of all types required for the health of a person; (ix) rehabilitation service required or desirable for the health of a person; (x) preventive medical services of all and any types; (xi) furnishing necessary appliances, drugs, medicines and supplies; (xii) educational services for the health and well-being of a person; (xiii) ambulance service; and (xiv) any other care, service or treatment related to the prevention or treatment of disease, the correction of defects and the maintenance of the physical and mental well-being of human beings. Any diagnosis and treatment of diseases of human beings required for health care as defined in this section, if rendered, shall be under the supervision and control of the providers; and (B) for a health care center that provides only dental services, dental care provided through licensed practitioners, including any supporting and ancillary personnel, services and supplies.

(9) "Health care center" means: [either:] (A) A person, including a [profit] for-profit or a nonprofit corporation organized under the laws of this state for the purpose of carrying out the activities and purposes set forth in subsection (b) of section 38a-176, as amended by this act, at the expense of the health care center, including the providing of health care [, as herein defined,] to members of the community, including subscribers to one or more plans under an agreement entitling such subscribers to health care in consideration of a basic advance or periodic charge and shall include a health maintenance organization, or (B) a line of business conducted by an organization that is formed [,] pursuant to the laws of this state for the purposes of, but not limited to, carrying out the activities and purposes set forth in subsection (b) of section 38a-176, as amended by this act.

(10) "Individual contract" means a contract for health care services issued to and covering an individual. The individual contract may include dependents of the subscriber.

(11) "Individual practice association" means a partnership, corporation, association [,] or other legal entity [which] that has entered into a services arrangement with health care professionals licensed in this state to provide services to enrollees of a health care center.

(12) "Insolvent" or "insolvency" means, with respect to an organization, that the organization has been declared insolvent and placed under an order of liquidation by a court of competent jurisdiction.

(13) "Net worth" means the excess of total admitted assets over total liabilities, but the liabilities shall not include fully subordinated debt, as [defined] that term is used in section 38a-193.

(14) "Member" or "enrollee" means an individual who is enrolled in a health care center.

(15) "Person" means an individual, corporation, limited liability company, partnership, association, trust or any other legal entity.

(16) "Uncovered expenditures" means the cost of health care services that are covered by a health care center, for which an enrollee would also be liable in the event of the health care center's insolvency, and for which no alternative arrangements have been made that are acceptable to the commissioner. [Uncovered expenditures shall] "Uncovered expenditures" does not include expenditures for services when a provider has agreed not to bill the enrollee even though the provider is not paid by the health care center or for services that are guaranteed, insured or assumed by a person other than the health care center.

(17) "Enrolled population" means a group of persons, defined as to probable age, sex and family composition, [which] that receives health care from a health care center in consideration of a basic advance or periodic charge.

(18) "Participating provider" means a provider who, under an express or implied contract with the health care center or with its contractor or subcontractor, has agreed to provide health care services to enrollees with an expectation of receiving payment, other than copayment or deductible, directly or indirectly from the health care center.

(19) "Provider" means any licensed health care professional or facility, including individual practice associations.

(20) "Subscriber" means an individual whose employment or other status, except family dependency, is the basis for eligibility for enrollment in the health care center, or in the case of an individual contract, the person in whose name the contract is issued.

Sec. 2. Section 38a-176 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2016):

(a) Each [such] health care center shall be governed by sections 38a-175 to [38a-192] 38a-194, inclusive, as amended by this act, and by the other applicable laws of the state to the extent not inconsistent with the provisions of said sections.

(b) (1) The nature of the activities to be conducted and the purposes to be carried out by a health care center include, but are not limited to: [(1)] (A) Establishing, maintaining and operating facilities whereby health care [, as hereinbefore defined,] may be provided at the expense of the health care center; [(2)] and (B) providing health care (i) directly by its health care center employees who, when required by law, shall be duly licensed to render such service, or (ii) by agreement or by indemnity arrangement with any hospital, hospital service corporation, medical service corporation, medical group clinic or person qualified and licensed to render any health care service, or (iii) by both methods [; (3) entering] set forth in subparagraphs (B)(i) and (B)(ii) of this subdivision.

(2) For a health care center that provides medical and surgical services other than or in addition to dental services, the nature of the activities to be conducted and the purposes to be carried out by such health care center, in addition to those set forth in subdivision (1) of this subsection, include, but are not limited to: (A) Entering into agreements with any governmental agency, or any provider for the training of personnel under the direction of persons licensed to practice any healing art; [(4)] (B) establishing, operating and maintaining a medical service center, clinic or any such other facility as shall be necessary for the prevention, study, diagnosis and treatment of human ailments and injuries and to promote medical, surgical, dental and general health education, scientific education, research and learning; [(5)] (C) marketing, enrolling and administering a health care plan; [(6)] (D) contracting with insurers licensed in this state, including hospital service corporations and medical service corporations; [(7)] (E) offering, in addition to health services, benefits covering out-of-area or emergency services; [(8)] (F) providing health services not included in the health care plan on a fee-for-service basis; and [(9)] (G) entering into contracts in furtherance of the purposes of sections 38a-175 to 38a-192, inclusive, as amended by this act.

(3) A health care center that provides only dental services shall not be required to conduct activities set forth in subdivision (2) of this subsection.

Sec. 3. Section 38a-177 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2016):

[Health care may be provided (a)] A health care center may provide health care (1) directly [by a health care center] or by its employees or contractors licensed by this state to render such services, or by contract or by indemnity arrangement with any hospital, hospital service corporation, medical service corporation or person qualified and licensed to render any health care service or by both methods; and [(b)] (2) by other methods to the extent permitted under the Federal Health Maintenance Organization Act and the regulations adopted thereunder from time to time unless otherwise determined by the commissioner by regulation. A health care center may also enter into agreements with hospitals or individuals approved by their respective state regulating board, licensed to practice any of the healing arts, for the training of personnel under the direction of persons licensed to practice the profession or healing art. A health care center may also maintain a clinic or clinics for the prevention, study, diagnosis and treatment of human ailments and injuries by licensed persons and to promote medical, surgical, dental [and] or scientific research and learning.

Sec. 4. Section 38a-179 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2016):

(a) If the health care center is organized as a nonprofit, nonstock corporation, the care, control and disposition of the property and funds of each such corporation and the general management of its affairs shall be vested in a board of directors. Each such corporation shall have the power to adopt bylaws for the governing of its affairs, which bylaws shall prescribe the number of directors, their term of office and the manner of their election, subject to the provisions of sections 38a-175 to 38a-192, inclusive, as amended by this act. The bylaws may be adopted and repealed or amended by the affirmative vote of two-thirds of all the directors at any meeting of the board of directors duly held upon at least ten days' notice, provided notice of such meeting shall specify the proposed action concerning the bylaws to be taken at such meeting. The bylaws of the corporation shall provide that the board of directors shall include representation from persons engaged in the healing arts and from persons who are eligible to receive health care from the corporation, subject to the following provisions: (1) One-quarter of the board of directors shall be persons engaged in the different fields in the healing arts, at least two of whom shall be a physician and a dentist, [;] except for a health care center that provides only dental services, one-quarter of the board of directors shall be persons engaged in the dental or related fields; and (2) one-quarter of the board of directors shall be subscribers who are eligible to receive health care from the health care center, but no such representative need be seated until the first annual meeting following the approval by the commissioner of the initial agreement or agreements to be offered by the corporation, and there shall be only one representative from any group covered by a group service agreement.

(b) If the health care center is not organized as a nonprofit, nonstock corporation, management of its affairs shall be in accordance with other applicable laws of the state, provided [that] the health care center shall establish and maintain a mechanism to afford its members an opportunity to participate in matters of policy and operation, such as an advisory panel, advisory referenda on major policy decisions or other similar mechanisms.

Sec. 5. Section 38a-180 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2016):

(a) Any clinic established [hereunder] under sections 38a-175 to 38a-192, inclusive, as amended by this act, including a clinic [which] that is a part of a medical service center or other facility, shall be subject to approval as a clinic by the Commissioner of Public Health pursuant to the standards established by [him] said commissioner for approved clinics.

(b) Any person licensed to practice any of the healing arts or occupations employed by a health care center governed by sections 38a-175 to 38a-192, inclusive, as amended by this act, shall not be subject to reprimand or discipline because [he] such person is an employee of the health care center or because such health care center may be engaged in rendering health care or related care through its own employees, [provided] except such person shall otherwise remain subject to reprimand or discipline by the state regulating board governing such profession or occupation as provided by law for [his] such person's act or acts for unlawful, unprofessional or immoral conduct. [by the state regulating board governing such profession or occupation as provided by law.]

(c) (1) No health care center [which] that provides medical and surgical services other than or in addition to dental services that contracts with an individual practice association may prohibit any practitioner of the healing arts from participating in such health care center solely on the basis of [his] such practitioner's profession. No person may interfere with the exercise by any other person of his or her free choice in the selection of a practitioner [in] of the healing arts who is participating in the health care center.

(2) No health care center that provides only dental services that contracts with an individual practice association may prohibit any practitioner of the healing arts from participating in such health care center solely on the basis of such practitioner's profession if such practitioner is licensed to perform services offered by such health care center. No person may interfere with the exercise by any other person of his or her free choice in the selection of a practitioner of the healing arts who is participating in the health care center.


This act shall take effect as follows and shall amend the following sections:
Section 1	October 1, 2016	38a-175
Sec. 2	October 1, 2016	38a-176
Sec. 3	October 1, 2016	38a-177
Sec. 4	October 1, 2016	38a-179
Sec. 5	October 1, 2016	38a-180