Bill Text: CT SB00808 | 2015 | General Assembly | Comm Sub
Bill Title: An Act Concerning The Establishment Of A Dispute Resolution Process For Surprise Bills And Bills For Emergency Services.
Spectrum: Committee Bill
Status: (Introduced - Dead) 2015-05-27 - Senate Recommitted to Insurance and Real Estate [SB00808 Detail]
Download: Connecticut-2015-SB00808-Comm_Sub.html
General Assembly |
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January Session, 2015 |
LCO No. 4093 | ||
*_____SB00808APP___051315____* | |||
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 CONCERNING THE ESTABLISHMENT OF A DISPUTE RESOLUTION PROCESS FOR SURPRISE BILLS AND BILLS FOR EMERGENCY SERVICES.
Be it enacted by the Senate and House of Representatives in General Assembly convened:
Section 1. (NEW) (Effective October 1, 2015) (a) As used in this section:
(1) "Emergency condition" means a medical condition, or a mental or nervous condition as set forth in sections 38a-488a and 38a-514 of the general statutes, that manifests itself by acute symptoms of sufficient severity, including severe pain, such that a prudent layperson possessing an average knowledge of medicine and health could reasonably expect the absence of immediate medical attention to result in (A) placing the health of the individual afflicted with a medical condition in serious jeopardy, or in the case of an individual afflicted with a mental or nervous condition, placing the health of such individual or others in serious jeopardy, (B) serious impairment to such individual's bodily functions, (C) serious dysfunction of any bodily organ or body part of such individual, (D) serious disfigurement of such individual, or (E) a condition described in Section 1867(e)(1)(A) of the Social Security Act, as amended from time to time;
(2) "Emergency services" means, with respect to an emergency condition, (A) a medical screening examination as required under Section 1867 of the Social Security Act, as amended from time to time, that is within the capability of a hospital emergency department, including ancillary services routinely available to such department to evaluate such condition, and (B) such further medical examinations and treatment required under said Section 1867 to stabilize such individual, that are within the capability of the hospital staff and facilities;
(3) "Health care plan" means a health insurance policy or health benefit plan delivered, issued for delivery, renewed, amended or continued in this state that provides coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general statutes;
(4) "Nonparticipating" means not having a contract with a health care plan to provide health care services to an insured under such plan; and
(5) (A) "Surprise bill" means a bill for health care services, other than emergency services, received by: (i) An insured for services rendered by a nonparticipating physician at a participating hospital or participating ambulatory surgical center, where (I) a participating physician is unavailable, (II) a nonparticipating physician renders services without the insured's knowledge or consent, or (III) an unforeseen medical condition arises at the time such services are rendered that requires immediate medical attention; (ii) an insured for services rendered by a nonparticipating health care provider, where such services were referred by a participating physician to such provider without explicit written consent of the insured acknowledging such referral and that the referral may result in costs not covered by the insured's health care plan; or (iii) an uninsured individual for services rendered by a physician at a hospital or an ambulatory surgical center, who did not receive prior disclosure from such physician of the costs for such services, or of a facility fee as required under section 19a-508c of the general statutes.
(B) "Surprise bill" does not include a bill for health care services received by an insured when a participating physician is available and the insured has elected to obtain services from a nonparticipating physician or nonparticipating health care provider.
(b) The Insurance Commissioner and the Commissioner of Public Health shall jointly adopt regulations, in accordance with the provisions of chapter 54 of the general statutes, to establish a dispute resolution process by which a dispute over a bill for emergency services or a surprise bill may be resolved. Such regulations shall include, but need not be limited to, (1) the procedures and standards for such dispute resolution process, (2) the procedures and standards for certifying independent dispute resolution entities, (3) the criteria to be used by independent dispute resolution entities to determine a reasonable fee for health care services or emergency services, and (4) the fees for and payment of such independent dispute resolution entities.
This act shall take effect as follows and shall amend the following sections: | ||
Section 1 |
October 1, 2015 |
New section |
INS |
Joint Favorable |
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PH |
Joint Favorable |
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APP |
Joint Favorable |