OLR Bill Analysis

SB 74 (File 177, as amended by Senate "B")*

AN ACT PROHIBITING DIFFERENTIAL PAYMENT RATES TO HEALTH CARE PROVIDERS BASED ON SITE OF SERVICE.

SUMMARY:

This bill requires certain insurers, upon request of physicians, physician groups, or physician organizations contracting directly with them, to establish a uniform health care provider reimbursement rate for the professional physician services component of colonoscopy or endoscopic services that their policies cover. It requires that the component be the same regardless of where the physician renders the service (e. g. , an office vs. a hospital).

The bill specifies that the uniform payment cannot be less than the amount that would otherwise be paid to the physician, group, or organization if the services were performed at a facility other than an outpatient surgical facility.

The bill applies to individual and group health insurance policies delivered, issued, renewed, amended, or continued in Connecticut that contract directly with physicians, physician groups, or physician organizations and cover (1) basic hospital expenses; (2) basic medical-surgical expenses; (3) major medical expenses; and (4) hospital or medical services, including coverage under an HMO plan.

The bill does not prohibit physicians, physician groups, or physician organizations from agreeing to different payment methodologies for such services.

*Senate Amendment “B” (1) specifies that the bill applies only to insurers directly contracting with physicians, physician groups, or physician organizations; (2) applies the provisions only to covered colonoscopy or endoscopic services; (3) requires the establishment of a rate only upon request; and (4) allows the physicians, groups, or organizations to agree to different payment methodologies.

EFFECTIVE DATE: October 1, 2009

COMMITTEE ACTION

Insurance and Real Estate Committee

Joint Favorable

Public Health Committee

Joint Favorable