History: P.A. 03-169 added Subsecs. (c) and (d) re referrals to commissioner re preferred provider networks and re list
of complaints against managed care organizations and preferred provider networks, respectively; P.A. 05-102 renamed
the Office of Managed Care Ombudsman the Office of the Healthcare Advocate, and renamed the Managed Care Ombudsman the Healthcare Advocate; P.A. 05-280 added new Subsec. (e) re establishment by Managed Care Ombudsman of
process for communication among mental health care providers and others, effective July 13, 2005 (Revisor's note: Pursuant
to P.A. 05-102 a reference to "Managed Care Ombudsman" in provision re reports was changed editorially by the Revisors
to "Healthcare Advocate").
Sec. 38a-1042. Appointment. (a) The Office of the Healthcare Advocate shall be
under the direction of the Healthcare Advocate who shall be appointed by the Governor,
with the approval of the General Assembly. The Healthcare Advocate shall be an elector
of the state with expertise and experience in the fields of health care, health insurance
and advocacy for the rights of consumers, provided the Healthcare Advocate shall not
have served as a director or officer of a managed care organization within two years
of appointment. In addition to the Healthcare Advocate, the Office of the Healthcare
Advocate shall consist of a staff of not more than three persons, which staff may be
increased as the requirements and resources of the office permit.
(b) The Governor shall make the initial appointment of the Healthcare Advocate
from a list of candidates prepared and submitted, not later than June 1, 2000, to the
Governor by the advisory committee established pursuant to section 38a-1049. The
Governor shall notify the advisory committee of the pending expiration of the term of
an incumbent Healthcare Advocate not less than ninety days prior to the final day of the
Healthcare Advocate's term in office. If a vacancy occurs in the position of Healthcare
Advocate, the Governor shall notify the advisory committee immediately of the vacancy.
The advisory committee shall meet to consider qualified candidates for the position of
Healthcare Advocate and shall submit a list of not more than five candidates to the
Governor ranked in order of preference, not more than sixty days after receiving notice
from the Governor of the pending expiration of the Healthcare Advocate's term or the
occurrence of a vacancy. The Governor shall designate, not more than sixty days after
receipt of the list of candidates from the advisory committee, one candidate from the
list for the position of Healthcare Advocate. If, after the list is submitted to the Governor
by the advisory committee, any candidate withdraws from consideration, the Governor
shall designate a candidate from those remaining on the list. If the Governor fails to
designate a candidate within sixty days of receipt of the list from the advisory committee,
the advisory committee shall refer the candidate with the highest ranking on the list to
the General Assembly for confirmation. If the General Assembly is not in session at the
time of the Governor's or advisory committee's designation of a candidate, the candidate
shall serve as the acting Healthcare Advocate until the General Assembly meets and
confirms the candidate as Healthcare Advocate. A candidate serving as acting
Healthcare Advocate is entitled to compensation and has all the powers, duties and
privileges of the Healthcare Advocate. A Healthcare Advocate shall serve a term of
four years, not including any time served as acting Healthcare Advocate, and may be
reappointed by the Governor or shall remain in the position until a successor is confirmed. Although an incumbent Healthcare Advocate may be reappointed, the Governor
shall also consider additional candidates from a list submitted by the advisory committee
as provided in this section.
(c) Upon a vacancy in the position of the Healthcare Advocate, the most senior
attorney in the Office of the Healthcare Advocate shall serve as the acting Healthcare
Advocate until the vacancy is filled pursuant to subsection (a) or (b) of this section. The
acting Healthcare Advocate has all the powers, duties and privileges of the Healthcare
Advocate.
(P.A. 99-284, S. 3; P.A. 05-102, S. 9.)
History: P.A. 05-102 renamed the Office of Managed Care Ombudsman the Office of the Healthcare Advocate and
made conforming changes.
Sec. 38a-1043. Access to information. (a) Each managed care organization shall,
when presented with the written consent of the consumer or the consumer's guardian or
legal representative, provide to the Office of the Healthcare Advocate access to records
relating to such consumer.
(b) Any records provided pursuant to this section to the Office of the Healthcare
Advocate shall be exempt from disclosure under the Freedom of Information Act, as
defined in section 1-200.
(P.A. 99-284, S. 4l; P.A. 05-102, S. 10.)
History: P.A. 05-102 renamed the Office of Managed Care Ombudsman the Office of the Healthcare Advocate.
Sec. 38a-1044. State agency information and assistance. All state agencies shall
comply with reasonable requests of the Office of the Healthcare Advocate for information and assistance.
(P.A. 99-284, S. 5; P.A. 05-102, S. 11.)
History: P.A. 05-102 renamed the Office of Managed Care Ombudsman the Office of the Healthcare Advocate.
Sec. 38a-1045. Confidentiality of consumer identity. In the absence of the written consent of a consumer utilizing the services of the Office of the Healthcare Advocate
or such consumer's guardian or legal representative or of a court order, the Office of
the Healthcare Advocate, its employees and agents, shall not disclose the identity of the
consumer.
(P.A. 99-284, S. 6; P.A. 05-102, S. 12.)
History: P.A. 05-102 renamed the Office of Managed Care Ombudsman the Office of the Healthcare Advocate.
Sec. 38a-1046. Employers required to post advocate services. Each employer,
other than a self-insured employer, that provides health insurance benefits to employees
shall obtain from the Healthcare Advocate and post, in a conspicuous location, a notice
concerning the services that the Healthcare Advocate provides.
(P.A. 99-284, S. 7; P.A. 05-102, S. 13.)
History: P.A. 05-102 renamed the Managed Care Ombudsman the Healthcare Advocate.
Sec. 38a-1047. Conflicts of interest. (a) No Healthcare Advocate or person employed by the Office of the Healthcare Advocate may:
(1) Have a direct involvement in the licensing, certification or accreditation of a
managed care organization;
(2) Have a direct ownership or investment interest in a managed care organization;
(3) Be employed by or participate in the management of a managed care organization; or
(4) Receive or have the right to receive, directly or indirectly, remuneration under
a compensation arrangement with a managed care organization.
(b) No Healthcare Advocate or person employed by the Office of the Healthcare
Advocate may knowingly accept employment with a managed care organization for a
period of one year following termination of that person's services with the Office of the
Healthcare Advocate.
(P.A. 99-284, S. 8; P.A. 05-102, S. 14.)
History: P.A. 05-102 renamed the Office of the Managed Care Ombudsman the Office of the Healthcare Advocate and
made conforming changes.
Sec. 38a-1048. Acceptance of gifts and grants. Separate account established.
(a) The Office of the Healthcare Advocate may apply for and accept grants, gifts and
bequests of funds from other states, federal and interstate agencies and independent
authorities and private firms, individuals and foundations, for the purpose of carrying
out its responsibilities.
(b) There is established within the General Fund a Healthcare Advocate account
that shall be a separate nonlapsing account. Any funds received under this section shall,
upon deposit in the General Fund, be credited to said account and may be used by the
Office of the Healthcare Advocate in the performance of its duties.
(P.A. 99-284, S. 9; P.A. 05-102, S. 15.)
History: P.A. 05-102 renamed the Office of Managed Care Ombudsman the Office of the Healthcare Advocate and
made conforming changes.
Sec. 38a-1049. Advisory committee established. Report required by committee. (a) There is established an advisory committee to the Office of Healthcare Advocate
which shall meet four times a year with the Healthcare Advocate and the staff of the
Office of the Healthcare Advocate to review and assess the performance of the Office
of the Healthcare Advocate. The advisory committee shall consist of six members appointed one each by the president pro tempore of the Senate, the speaker of the House
of Representatives, the majority leader of the Senate, the majority leader of the House
of Representatives, the minority leader of the Senate and the minority leader of the
House of Representatives. Each member of the advisory committee shall serve a term
of five years and may be reappointed at the conclusion of that term. All initial appointments to the advisory committee shall be made not later than March 1, 2000.
(b) The advisory committee shall make an annual evaluation of the effectiveness
of the Office of Healthcare Advocate and shall submit the evaluation to the Governor
and the joint standing committees of the General Assembly having cognizance of matters
relating to public health and insurance not later than April first of each year commencing
February 1, 2001.
(P.A. 99-284, S. 10; P.A. 05-15, S. 1; 05-102, S. 16.)
History: P.A. 05-15 amended Subsec. (b) to substitute "April first" for "February first"; P.A. 05-102 renamed the Office
of Managed Care Ombudsman the Office of the Healthcare Advocate and made conforming changes.
Sec. 38a-1050. Report required by advocate. Contents. The Healthcare Advocate shall submit, not later than March first of each year, a report to the Governor and
the joint standing committees of the General Assembly having cognizance of matters
relating to public health and insurance concerning the activities of the Healthcare Advocate. The report shall include, but not be limited to, information regarding: (1) The
subject matter, disposition and number of consumer complaints processed by the
Healthcare Advocate; (2) common problems and concerns discerned by the Healthcare
Advocate from the consumer complaints and other relevant sources; (3) the need, if any,
for administrative, legislative or executive remedies to assist consumers; and (4) the
fiscal accounts of the Office of the Healthcare Advocate.
(P.A. 99-284, S. 11; P.A. 05-15, S. 2; 05-102, S. 17.)
History: P.A. 05-15 substituted "March first" for "January first" re reports; P.A. 05-102 renamed the Office of Managed
Care Ombudsman the Office of the Healthcare Advocate and made conforming changes.