AN ACT CONCERNING HEALTH CARE PRICE, COST AND QUALITY TRANSPARENCY.

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

That the general statutes be amended to require: (1) Each hospital to be a complete member of the Leapfrog Group for the purpose of price and quality transparency and to submit to the Connecticut Health Insurance Exchange the same data it submits to the Leapfrog Group; (2) the Connecticut Health Insurance Exchange to establish and maintain a consumer health information web site (A) that contains information comparing the quality, price and cost of health care services, including, to the extent possible (i) comparative price and cost information for the most common referral or prescribed services categorized by payer and listed by facility, health care provider and provider organization, (ii) comparative quality information by facility, health care provider, provider organization or any other provider grouping for each service or category of services for which comparative price and cost information is provided, (iii) data concerning health care-associated infections and serious reportable events, (iv) definitions of common health insurance and medical terms so consumers may compare health coverage and understand the terms of their coverage, (v) a list of health care provider types, including primary care physicians, nurse practitioners and physician assistants and the types of services each type of health care provider is authorized to provide, (vi) factors consumers should consider when choosing an insurance product or provider group, including provider network, premium, cost-sharing, covered services and tier information, (vii) patient decision aids, (viii) a list of provider services that are physically and programmatically accessible for persons with disabilities, and (ix) descriptions of standard quality measures, (B) that is designed to assist consumers in making informed decisions regarding their medical care and informed choices among health care providers, (C) that presents information in language and a format that is understandable to the average consumer, and (D) the availability of which is publicized to the general public; (3) each health care provider to (A) within two business days prior to an admission, procedure or service, and upon the request by a patient or prospective patient, disclose to the patient or prospective patient, the allowed amount or charge of the admission, procedure or service, including the amount of any facility fee, (B) when scheduling an admission, procedure or service, notify each patient of his or her right to request and obtain information regarding the allowed amount or charge prior to the admission, procedure or service and, upon request, provide such information, (C) post notice of each patient's right to request and obtain such information on charges in a conspicuous place in the health care provider's office, such as the admissions desk, and include such notice in the health care provider's first mailing to each patient; (4) a health care provider who refers a patient to another health care provider that is part of, or represented by, the same provider organization to disclose that the health care providers are part of, or represented by, the same provider organization; (5) the Department of Social Services to submit All Payers Claims Database data to the Connecticut Health Insurance Exchange; (6) each medical bill and explanation of benefits submitted to a patient by a health care provider or insurer to be in language that is clear to an average reader; (7) each insurer to establish a toll-free telephone number and a web site that enables consumers to request and obtain from the insurer, in real time, the estimated or maximum allowed amount or charge for a proposed admission, procedure or service and the estimated amount the insured will be responsible for paying for an admission, procedure or service that is a medically necessary covered benefit based on the information available to the insurer at the time the request is made, including any facility fee, copayment deductible, coinsurance or other out-of-pocket amount for a covered health care benefit; (8) the Insurance Department to adopt standard definitions for terms used by insurers to comply with the provisions of subdivision (7) and a uniform icon, logo or other identifying marker to facilitate accurate comparisons and for ease of use of the web sites; (9) third-party payers to submit provider reimbursement rates to the Connecticut Health Insurance Exchange; and (10) health care providers to submit cost and charge information to the Connecticut Health Insurance Exchange.

Statement of Purpose:

To promote health care cost and quality transparency in a consumer-friendly manner that empowers consumers to make informed decisions regarding their care.