Substitute House Bill No. 7032

Public Act No. 99-284

An Act Concerning Managed Care Accountability.

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

Section 1. (NEW) As used in sections 1 to 11, inclusive, of this act:

(1) "Consumer" means an individual who receives or is attempting to receive services from a managed care organization and is a resident of this state.

(2) "Managed care organization" means an insurer, health care center, hospital or medical service corporation or other organization delivering, issuing for delivery, renewing or amending any individual or group health managed care plan in this state.

(3) "Managed care plan" means a product offered by a managed care organization that provides for the financing or delivery of health care services to persons enrolled in the plan through: (A) Arrangements with selected providers to furnish health care services; (B) explicit standards for the selection of participating providers; (C) financial incentives for enrollees to use the participating providers and procedures provided for by the plan; or (D) arrangements that share risks with providers, provided the organization offering a plan described under subparagraph (A), (B), (C) or (D) of this subdivision is licensed by the Insurance Department pursuant to chapter 698, 698a or 700 of the general statutes and that the plan includes utilization review pursuant to sections 38a-226 to 38a-226d, inclusive, of the general statutes.

Sec. 2. (NEW) (a) There is established an Office of Managed Care Ombudsman which shall be within the Insurance Department for administrative purposes only.

(b) The Office of Managed Care Ombudsman may:

(1) Assist health insurance consumers with managed care plan selection by providing information, referral and assistance to individuals about means of obtaining health insurance coverage and services;

(2) Assist health insurance consumers to understand their rights and responsibilities under managed care plans;

(3) Provide information to the public, agencies, legislators and others regarding problems and concerns of health insurance consumers and make recommendations for resolving those problems and concerns;

(4) Assist consumers with the filing of complaints and appeals, including filing appeals with a managed care organization's internal appeal or grievance process and the external appeal process established under section 38a-478n of the general statutes;

(5) Analyze and monitor the development and implementation of federal, state and local laws, regulations and policies relating to health insurance consumers and recommend changes it deems necessary;

(6) Facilitate public comment on laws, regulations and policies, including policies and actions of health insurers;

(7) Ensure that health insurance consumers have timely access to the services provided by the office;

(8) Review the health insurance records of a consumer who has provided written consent for such review;

(9) Create and make available to employers a notice, suitable for posting in the workplace, concerning the services that the Managed Care Ombudsman provides;

(10) Establish a toll-free number, or any other free calling option, to allow customer access to the services provided by the Managed Care Ombudsman;

(11) Pursue administrative remedies on behalf of and with the consent of any health insurance consumers;

(12) Adopt regulations, pursuant to chapter 54 of the general statutes, to carry out the provisions of sections 1 to 11, inclusive, of this act; and

(13) Take any other actions necessary to fulfill the purposes of sections 1 to 11, inclusive, of this act.

Sec. 3. (NEW) (a) The Office of Managed Care Ombudsman shall be under the direction of the Managed Care Ombudsman who shall be appointed by the Governor, with the approval of the General Assembly. The Managed Care Ombudsman 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 ombudsman shall not have served as a director or officer of a managed care organization within two years of appointment. In addition to the Managed Care Ombudsman, the Office of Managed Care Ombudsman 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 Managed Care Ombudsman 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 10 of this act. The Governor shall notify the advisory committee of the pending expiration of the term of an incumbent ombudsman not less than ninety days prior to the final day of the ombudsman's term in office. If a vacancy occurs in the position of ombudsman, the Governor shall notify the advisory committee immediately of the vacancy. The advisory committee shall meet to consider qualified candidates for the position of ombudsman 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 ombudsman'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 ombudsman. 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 ombudsman until the General Assembly meets and confirms the candidate as ombudsman. A candidate serving as acting ombudsman is entitled to compensation and has all the powers, duties and privileges of the ombudsman. An ombudsman shall serve a term of four years, not including any time served as acting ombudsman, and may be reappointed by the Governor or shall remain in the position until a successor is confirmed. Although an incumbent ombudsman 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 ombudsman, the most senior attorney in the Office of Managed Care Ombudsman shall serve as the acting ombudsman until the vacancy is filled pursuant to subsection (a) or (b) of this section. The acting ombudsman has all the powers, duties and privileges of the ombudsman.

Sec. 4. (NEW) (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 Managed Care Ombudsman access to records relating to such consumer.

(b) Any records provided pursuant to this section to the Office of Managed Care Ombudsman shall be exempt from disclosure under the Freedom of Information Act, as defined in section 1-200 of the general statutes.

Sec. 5. (NEW) All state agencies shall comply with reasonable requests of the Office of Managed Care Ombudsman for information and assistance.

Sec. 6. (NEW) In the absence of the written consent of a consumer utilizing the services of the Office of Managed Care Ombudsman or such consumer's guardian or legal representative or of a court order, the Office of Managed Care Ombudsman, its employees and agents, shall not disclose the identity of the consumer.

Sec. 7. (NEW) Each employer, other than a self-insured employer, that provides health insurance benefits to employees shall obtain from the Managed Care Ombudsman and post, in a conspicuous location, a notice concerning the services that the Managed Care Ombudsman provides.

Sec. 8. (NEW) (a) No ombudsman or person employed by the Office of Managed Care Ombudsman 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 ombudsman or person employed by the Office of Managed Care Ombudsman 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 Managed Care Ombudsman.

Sec. 9. (NEW) (a) The Office of Managed Care Ombudsman 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 managed care ombudsman 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 Managed Care Ombudsman in the performance of its duties.

Sec. 10. (NEW) (a) There is established an advisory committee to the Office of Managed Care Ombudsman which shall meet four times a year with the Managed Care Ombudsman and the staff of the Office of Managed Care Ombudsman to review and assess the performance of the Office of Managed Care Ombudsman. 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 Managed Care Ombudsman 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 February first of each year commencing February 1, 2001.

Sec. 11. (NEW) The Managed Care Ombudsman shall submit, not later than January 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 ombudsman. The report shall include, but not be limited to, information regarding: (1) The subject matter, disposition and number of consumer complaints processed by the ombudsman; (2) common problems and concerns discerned by the ombudsman 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 Managed Care Ombudsman.

Sec. 12. (NEW) Except as otherwise provided in title 38a of the general statutes, each insurer, health care center, hospital and medical service corporation or other entity delivering, issuing for delivery, renewing or amending any individual health insurance policy in this state on or after January 1, 2000, providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general statutes, shall complete any coverage determination with respect to such policy and notify the insured or the insured's health care provider of its decision not later than forty-five days after a request for such determination is received by the insurer, health care center, hospital and medical service corporation or other entity. In the case of a denial of coverage, such entity shall notify the insured and the insured's health care provider of the reasons for such denial.

Sec. 13. (NEW) Except as otherwise provided in title 38a of the general statutes, each insurer, health care center, hospital and medical service corporation or other entity delivering, issuing for delivery, renewing or amending any group health insurance policy in this state on or after January 1, 2000, providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general statutes, shall complete any coverage determination with respect to such policy and notify the insured or the insured's health care provider of its decision not later than forty-five days after a request for such determination is received by the insurer, health care center, hospital and medical service corporation or other entity. In the case of a denial of coverage, such entity shall notify the insured and the insured's health care provider of the reasons for such denial.

Sec. 14. (NEW) Not later than January 1, 2000, the Insurance Commissioner shall develop a comprehensive public education outreach program to educate health insurance consumers of the existence of the appeals procedure established in section 38a-478n of the general statutes. The program shall maximize public information concerning the appeals procedure and shall include, but not be limited to: (1) The dissemination of information through mass media, interactive approaches and written materials; (2) involvement of community-based organizations in developing messages and in devising and implementing education strategies; and (3) periodic evaluations of the effectiveness of educational efforts. The Managed Care Ombudsman shall coordinate the outreach program and oversee the education process.

Sec. 15. (NEW) (a) Each individual health insurance policy delivered, issued for delivery, renewed, amended or continued in this state on or after January 1, 2000, shall define the extent to which it provides coverage for experimental treatments.

(b) No such health insurance policy may deny a procedure, treatment or the use of any drug as experimental if such procedure, treatment or drug, for the illness or condition being treated, or for the diagnosis for which it is being prescribed, has successfully completed a phase III clinical trial of the federal Food and Drug Administration.

(c) Any person who has been diagnosed with a condition that creates a life expectancy in that person of less than two years and who has been denied an otherwise covered procedure, treatment or drug on the grounds that it is experimental may request an expedited appeal as provided in section 38a-226c of the general statutes and may appeal a denial thereof to the Insurance Commissioner in accordance with the procedures established in section 38a-478n of the general statutes.

(d) For the purposes of conducting an appeal pursuant to section 38a-478n of the general statutes on the grounds that an otherwise covered procedure, treatment or drug is experimental, the basis of such an appeal shall be the medical efficacy of such procedure, treatment or drug. The entity conducting the review may consider whether the procedure, treatment or drug (1) has been approved by the National Institute of Health or the American Medical Association, (2) is listed in the United States Pharmacopoeia Drug Information Guide for Health Care Professionals (USP-DI), the American Medical Association Drug Evaluations (AMA-DE), or the American Society of Hospital Pharmacists' American Hospital Formulary Service Drug Information (AHFS-DI), or (3) is currently in a phase III clinical trial of the federal Food and Drug Administration.

Sec. 16. (NEW) (a) Each group health insurance policy delivered, issued for delivery, renewed, amended or continued in this state on or after January 1, 2000, shall define the extent to which it provides coverage for experimental treatments.

(b) No such health insurance policy may deny a procedure, treatment or the use of any drug as experimental if such procedure, treatment or drug, for the illness or condition being treated, or for the diagnosis for which it is being prescribed, has successfully completed a phase III clinical trial of the federal Food and Drug Administration.

(c) Any person who has been diagnosed with a condition that creates a life expectancy in that person of less than two years and who has been denied an otherwise covered procedure, treatment or drug on the grounds that it is experimental may request an expedited appeal as provided in section 38a-226c of the general statutes and may appeal a denial thereof to the Insurance Commissioner in accordance with the procedures established in section 38a-478n of the general statutes.

(d) For the purposes of conducting an appeal pursuant to section 38a-478n of the general statutes on the grounds that an otherwise covered procedure, treatment or drug is experimental, the basis of such an appeal shall be the medical efficacy of such procedure, treatment or drug. The entity conducting the review may consider whether the procedure, treatment or drug (1) has been approved by the National Institute of Health or the American Medical Association, (2) is listed in the United States Pharmacopoeia Drug Information Guide for Health Care Professionals (USP-DI), the American Medical Association Drug Evaluations (AMA-DE), or the American Society of Hospital Pharmacists' American Hospital Formulary Service Drug Information (AHFS-DI), or (3) is currently in a phase III clinical trial of the federal Food and Drug Administration.

Sec. 17. Subsections (l) to (r), inclusive, of section 38a-976 of the general statutes are repealed and the following is substituted in lieu thereof:

(l) "Insurance institution" means any corporation, limited liability company, association, partnership, reciprocal exchange, interinsurer, Lloyd's insurer, fraternal benefit society or other person engaged in the business of insurance, including health care centers, as defined in section 38a-175, medical service corporations, as defined in section 38a-214, managed care organizations, as defined in section 38a-478 and hospital service corporations, as defined in section 38a-199. It shall not include agents or insurance-support organizations.

(m) (1) "Insurance-support organization" means any person who regularly engages, in whole or in part, in the practice of assembling or collecting information concerning individuals for the primary purpose of providing the information to an insurance institution or agent for insurance transactions, including: (A) The furnishing of consumer reports or investigative consumer reports to an insurance institution or agent for use in connection with an insurance transaction, [or] (B) the collection of personal information from insurance institutions, agents or other insurance-support organizations for the purpose of detecting or preventing fraud, material misrepresentation or material nondisclosure in connection with insurance underwriting or insurance claim activity, or (C) collecting medical record information from, disclosing medical record information to, or collecting medical record information on behalf of an insurance institution or agent in the ordinary course of business, including, but not limited to, utilization review companies, benefit management entities, including, but not limited to, pharmaceutical benefit and disease management entities and information or computer management entities. (2) Notwithstanding subdivision (1) of this subsection, the following persons shall not be considered "insurance-support organizations" for purposes of sections 38a-975 to 38a-998, inclusive, as amended by this act: Agents, government institutions, insurance institutions, medical care institutions, [and] medical professionals, pharmacies, universities and schools.

(n) "Insurance transaction" means any transaction involving insurance primarily for personal, family or household needs rather than business or professional needs which involves: (1) The determination of an individual's eligibility for an insurance coverage, benefit or payment, or (2) the servicing of an insurance application, policy, contract or certificate.

(o) "Investigative consumer report" means a consumer report or portion thereof in which information about an individual's character, general reputation, personal characteristics or mode of living is obtained through personal interviews with the person's neighbors, friends, associates, acquaintances or others who may have such knowledge.

(p) "Medical-care institution" means any facility or institution that is licensed to provide health care services to individuals, including but not limited to health care centers, home-health agencies, hospitals, medical clinics, public health agencies, rehabilitation agencies and skilled nursing facilities.

(q) "Medical professional" means any person licensed or certified to provide health care services to individuals, including but not limited to a chiropractor, clinical dietitian, clinical psychologist, dentist, nurse, occupational therapist, optometrist, pharmacist, physical therapist, physician, podiatrist, psychiatric social worker or speech therapist.

(r) "Medical-record information" means personal information which: (1) Relates to [an individual's] the physical, [or] mental or behavioral health condition, medical history or medical treatment of an individual or a member of the individual's family, and (2) is obtained from a medical professional or medical-care institution, from a pharmacy or pharmacist, from the individual, or from the individual's spouse, parent or legal guardian or from the provision of or payment for health care to or on behalf of an individual or a member of the individual's family. The term does not include such information from which personal identifiers that either directly reveal the identity of the patient, or provide a means of identifying the patient, have been removed or have been encrypted or encoded such that the identity of the individual is not revealed without the use of an encryption key or code.

Sec. 18. (NEW) (a) No person, including, but not limited to, insurance institutions, agents, insurance support organizations, health care professionals, medical care centers, pharmacies, pharmaceutical companies, schools and universities, and no person's agent, contractor or employee, shall sell or offer for sale individually identifiable medical record information, as defined in subsection (r) of section 38a-976 of the general statutes, as amended by this act. No person shall disclose, for purposes of marketing, individually identifiable medical record information without the prior written consent of the individual to whom the individually identifiable medical record information pertains or, in the case of a minor, of the minor's parent or guardian. Nothing in this section shall be construed to prohibit (1) a person from disclosing individually identifiable medical record information as permitted under section 38a-988 of the general statutes, any other applicable state or federal law or in connection with a collectively bargained agreement, or (2) a health care provider from transferring individual identifiable medical record information for the purposes of clinical research, utilization review, quality review, performance improvement, billing for services or other functions performed by health care providers or their agents in support of direct patient care, provided (A) in the case of clinical research, no individually identifiable medical record information may be disclosed by the clinical researcher, unless the disclosure would otherwise be permitted, and (B) the entity to whom the information is transferred agrees not to disclose the information unless the disclosure would otherwise be permitted if made by the transferer. Nothing in this section shall be construed to prohibit a person from transferring individually identifiable medical record information to another person as part of a consummated sale of that person to another person or consummated merger by that person with another person or to a successor in interest. For the purposes of this section, "insurance transaction" as used in section 38a-988 of the general statutes shall apply to any insurance including insurance for personal, family, household, business or professional needs, and "insurance institution" as used in said section 38a-988 includes self-insured employers for workers' compensation purposes and third-party administrators.

(b) An individual harmed by a violation of this section may bring an action for equitable relief, damages or both. Any person who violates the provisions of this section shall be liable to the individual harmed for double damages, costs and reasonable attorneys' fees. No action under this section shall be brought but within two years from the date when the violation first occurs or is discovered, or in the exercise of reasonable care should have been discovered, and except that no such action may be brought more than five years from the date of the violation complained of.

Sec. 19. Section 38a-989 of the general statutes is repealed and the following is substituted in lieu thereof:

(a) The commissioner shall have power to examine and investigate into the affairs of every insurance institution or agent doing business in this state to determine whether the institution or agent has been engaged or is engaging in any conduct in violation of sections 38a-975 to 38a-998, inclusive, as amended by this act, or section 18 of this act.

(b) The commissioner shall have the power to examine and investigate into the affairs of every insurance-support organization acting on behalf of an insurance institution or agent which transacts business within this state or without this state which has an effect on a resident of this state in order to determine whether such insurance-support organization has been engaged or is engaging in any conduct in violation of sections 38a-975 to 38a-998, inclusive, as amended by this act, or section 18 of this act.

Sec. 20. Section 38a-990 of the general statutes is repealed and the following is substituted in lieu thereof:

(a) Whenever the commissioner has reason to believe that an insurance institution, agent or insurance-support organization has been engaged or is engaging in conduct in this state which violates this chapter, or if the commissioner believes that an insurance-support organization has been engaged or is engaging in conduct outside this state which has an effect on a resident of this state and which violates sections 38a-975 to 38a-998, inclusive, as amended by this act, or section 18 of this act, [he] the commissioner shall issue and serve upon such insurance institution, agent or insurance-support organization a statement of the charges and a notice of a hearing to be held at a time and place fixed in the notice. The date of such hearing shall not be less than thirty days after the date of service.

(b) At the time and place fixed for such hearing, the insurance institution, agent or insurance-support organization shall have an opportunity to answer the charges against it and present evidence on its own behalf. Upon good cause shown, the commissioner shall permit any adversely affected person to intervene, appear and be heard at such hearing by counsel or in person.

(c) At any hearing conducted pursuant to this section, the commissioner may administer oaths, examine and cross-examine witnesses and receive oral and documentary evidence. [He] The commissioner shall have the power to subpoena witnesses, compel their attendance and require the production of books, papers, records, correspondence or other documents [which he] that the commissioner deems relevant to the hearing. A stenographic record of the hearing shall be made upon the request of any party or at the discretion of the commissioner. If no stenographic record is made and if judicial review is sought, the commissioner shall prepare a statement of the evidence for use on review. Hearings conducted under this section shall be governed by the same rules of evidence and procedure applicable to administrative proceedings conducted under the insurance laws of this state.

(d) Statements of charges, notices, orders and other processes of the commissioner under sections 38a-975 to 38a-998, inclusive, as amended by this act, or section 18 of this act, may be served in the manner provided by law for service of process in civil actions or by registered mail. A copy of the statement of charges, notice, order or other process shall be provided to the person whose rights under said sections have been allegedly violated. A verified return specifying the manner of service, or return receipt in the case of registered mail, shall be sufficient proof of service.

Sec. 21. Section 38a-991 of the general statutes is repealed and the following is substituted in lieu thereof:

For purposes of sections 38a-975 to 38a-998, inclusive, as amended by this act, or section 18 of this act, an insurance-support organization transacting business outside this state which affects a resident of this state shall be deemed to have appointed the commissioner to accept service of process on its behalf as provided in section 38a-25.

Sec. 22. Section 38a-992 of the general statutes is repealed and the following is substituted in lieu thereof:

(a) If, after a hearing pursuant to section 38a-990, as amended by this act, the commissioner determines that the insurance institution, agent or insurance-support organization charged has engaged in conduct or practices in violation of sections 38a-975 to 38a-998, inclusive, as amended by this act, or section 18 of this act, [he] the commissioner shall reduce [his] the findings to writing and shall issue and cause to be served upon such institution, agent or organization a copy of such findings and an order requiring such institution, agent or organization to cease and desist from engaging in such conduct or practices.

(b) If, after a hearing pursuant to section 38a-990, as amended by this act, the commissioner determines that the insurance institution, agent or insurance-support organization charged has not engaged in conduct or practices in violation of sections 38a-975 to 38a-998, inclusive, as amended by this act, or section 18 of this act, [he] the commissioner shall prepare a written report which sets forth [his] the findings of fact and conclusions. Such report shall be served upon the insurance institution, agent or insurance-support organization charged and upon the person, if any, whose rights under said sections were allegedly violated.

(c) The commissioner may modify or set aside any order or report issued under this section until the expiration of the time allowed under section 38a-994, as amended by this act, for filing a petition for review or until such petition is actually filed, whichever occurs first. If, after the expiration of the time allowed under section 38a-994, as amended by this act, for filing a petition for review, no petition has been filed, the commissioner may, after notice and opportunity for hearing, alter, modify or set aside, in whole or in part, any order or report issued under this section whenever conditions of fact or law warrant such action or if the public interest so requires.

Sec. 23. Section 38a-993 of the general statutes is repealed and the following is substituted in lieu thereof:

(a) In any case where a hearing pursuant to section 38a-990, as amended by this act, results in the finding of [an intentional] a negligent violation of sections 38a-975 to 38a-998, inclusive, as amended by this act, or section 18 of this act, the commissioner may, in addition to the issuance of a cease and desist order as prescribed in section 38a-992, as amended by this act, order payment of a penalty of not more than two thousand dollars for each violation but not to exceed twenty thousand dollars in the aggregate for multiple violations.

(b) (1) In any case where a hearing pursuant to section 38a-990, as amended by this act, results in the finding of an intentional violation of sections 38a-975 to 38a-998, inclusive, as amended by this act, the commissioner may, in addition to the issuance of a cease and desist order as prescribed in section 38a-992, as amended by this act, order payment of a penalty of not more than five thousand dollars for each violation but not to exceed fifty thousand dollars in the aggregate for multiple violations.

(2) In any case where a hearing pursuant to section 38a-990, as amended by this act, results in the finding of an intentional violation of section 18 of this act, the commissioner may, in addition to the issuance of a cease and desist order as prescribed in section 38a-992, as amended by this act, order payment of a penalty of not more than twenty thousand dollars for each violation but not to exceed one hundred thousand dollars in the aggregate for multiple violations.

[(b)] (c) Any person who violates a cease and desist order of the commissioner under section 38a-992, as amended by this act, may, after notice and hearing and upon order of the commissioner, be subject to one or more of the following, at the discretion of the commissioner: (1) A penalty of not more than [ten] twenty thousand dollars for each violation; or (2) a penalty of not more than [fifty] one hundred thousand dollars if the commissioner finds that violations have occurred with such frequency as to indicate a general business practice; or (3) suspension or revocation of an insurance institution's or agent's license.

Sec. 24. Section 38a-994 of the general statutes is repealed and the following is substituted in lieu thereof:

(a) Any person aggrieved by an order of the commissioner issued pursuant to sections 38a-975 to 38a-998, inclusive, as amended by this act, or section 18 of this act, may appeal therefrom in accordance with the provisions of section 4-183, except venue for such appeal shall be in the judicial district of Hartford.

(b) No order or report of the commissioner under sections 38a-975 to 38a-998, inclusive, as amended by this act, section 18 of this act, or order of a court to enforce the same shall in any way relieve or absolve any person affected by such order or report from any liability under any other laws of this state.

Sec. 25. (NEW) (a) An insurance institution, agent or insurance support organization that regularly collects, uses or discloses medical record information, as defined in subsection (r) of section 38a-976 of the general statutes, as amended by this act, shall develop and implement written policies, standards and procedures for the management, transfer and security of medical record information, including policies, standards and procedures to guard against the unauthorized collection, use or disclosure of medical record information by the insurance institution, agent or insurance support organization or any employee or agent thereof. Such policies, standards and procedures shall include:

(1) Limitation on access to medical record information by only those persons who need to use the medical record information in order to perform their jobs;

(2) Appropriate training for all employees identified in subdivision (4) of this subsection;

(3) Disciplinary measures for violations of the medical record information policies, standards and procedures;

(4) Identification of the job titles of persons that are authorized to use or disclose medical record information;

(5) Procedures for authorizing and restricting the collection, use or disclosure of medical record information;

(6) Methods for handling, disclosing, storing and disposing of medical record information;

(7) Periodic monitoring of the employees' compliance with the policies, standards and procedures in a manner sufficient for the insurance institution, agent or insurance support organization to determine compliance with this section and to enforce its policies, standards and procedures; and

(8) Additional protection against unauthorized disclosure of sensitive health information, which shall include information regarding: Sexually transmitted diseases; mental health; substance abuse; the human immunodeficiency virus and acquired immune deficiency syndrome; and genetic testing, including the fact that an individual has undergone a genetic test.

(b) An insurance institution, agent or insurance support organization shall make the medical record information policies, standards and procedures developed pursuant to this section available for review by the Insurance Commissioner.

(c) A summary of such policies, standards and procedures shall be made available to enrollees upon enrolment and upon request.

Sec. 26. (NEW) (a) No person shall disclose individually identifiable medical record information, as defined in subsection (r) of section 38a-976 of the general statutes, as amended by this act, with the malicious intent to damage an individual's reputation or character.

(b) Any person who violates subsection (a) of this section shall be fined not more than five hundred dollars or imprisoned not more than three months or both for the first offense and shall be fined not more than two thousand dollars or imprisoned not more than one year or both for each subsequent offense.

Sec. 27. Section 38a-488a of the general statutes is repealed and the following is substituted in lieu thereof:

(a) [No] Each individual health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 delivered, issued for delivery, renewed, amended or continued in this state on or after [October 1, 1997 whether issued by an insurance company, a hospital service corporation, a medical service corporation or a health care center, as defined in section 38a-175, shall be delivered, issued for delivery, renewed or continued in this state and no such policy shall be amended to substantially alter or change benefits or coverage unless persons covered under such policy will be eligible for expenses arising from biologically-based] January 1, 2000, shall provide benefits for the diagnosis and treatment of mental or nervous conditions. [that are at least equal to coverage provided for medical or surgical conditions. For purposes of this section, "biologically-based mental illness" means the following, as defined in the most recent edition of the American Psychiatric Association's "Diagnostic and Statistical Manual of Mental Disorders": Schizophrenia, schizoaffective disorder, major depressive disorder, bipolar disorder, paranoia and other psychotic disorders, obsessive-compulsive disorder, panic disorder and pervasive developmental disorder or autism.] For the purposes of this section, "mental or nervous conditions" means mental disorders, as defined in the most recent edition of the American Psychiatric Association's "Diagnostic and Statistical Manual of Mental Disorders". "Mental or nervous conditions" does not include (1) mental retardation, (2) learning disorders, (3) motor skills disorder, (4) communication disorders, (5) caffeine-related disorders, (6) relational problems, and (7) additional conditions that may be a focus of clinical attention, that are not otherwise defined as mental disorders in the most recent edition of the American Psychiatric Association's "Diagnostic and Statistical Manual of Mental Disorders".

(b) No such policy shall establish any terms, conditions or benefits that place a greater financial burden on an insured for access to diagnosis or treatment of mental or nervous conditions than for diagnosis or treatment of medical, surgical or other physical health conditions.

(c) In the case of benefits payable for the services of a licensed physician, such benefits shall be payable for the same services when such services are lawfully rendered by a psychologist licensed under the provisions of chapter 383 or by such a licensed psychologist in a licensed hospital or clinic.

(d) (1) In the case of benefits payable for the services of a licensed physician or psychologist, such benefits shall be payable for the same services when such services are rendered by a clinical social worker who is licensed under the provisions of chapter 383b and who has passed the clinical examination of the American Association of State Social Work Boards and has completed at least two thousand hours of the post-master's social work experience in a nonprofit agency qualifying as a tax-exempt organization under Section 501(c) of the Internal Revenue Code of 1986 or any subsequent corresponding internal revenue code of the United States, as from time to time amended, in a municipal, state or federal agency or in an institution licensed by the Department of Public Health under section 19a-490. (2) In the case of benefits payable for the services of a licensed physician or psychologist, such benefits shall be payable for the same services when such services are rendered by a social worker who was certified as an independent social worker under the provisions of chapter 383b prior to October 1, 1990. (3) In the case of benefits payable for the services of a licensed physician or psychologist, such benefits shall be payable for the same services when such services are rendered by a licensed marital and family therapist who has completed at least two thousand hours of the post-master's marriage and family therapy work experience in a nonprofit agency qualifying as a tax-exempt organization under Section 501(c) of the Internal Revenue Code of 1986 or any subsequent corresponding internal revenue code of the United States, as from time to time amended, in a municipal, state or federal agency or in an institution licensed by the Department of Public Health under section 19a-490. (4) In the case of benefits payable for the services of a licensed physician or psychologist, such benefits shall be payable for the same services when such services are rendered by a marital and family therapist who was certified under the provisions of chapter 383a prior to October 1, 1992. (5) In the case of benefits payable for the services of a licensed physician or psychologist, such benefits shall be payable for the same services when such services are rendered by a licensed alcohol and drug counselor, as defined in section 20-74s, or a certified alcohol and drug counselor, as defined in section 20-74s.

(e) For purposes of this section, the term "covered expenses" means the usual, customary and reasonable charges for treatment deemed necessary under generally accepted medical standards, except that in the case of a managed care plan, as defined in section 38a-478, "covered expenses" means the payments agreed upon in the contract between a managed care organization, as defined in section 38a-478, and a provider, as defined in section 38a-478.

(f) (1) In the case of benefits payable for the services of a licensed physician, such benefits shall be payable for services rendered in a child guidance clinic or residential treatment facility by a person with a master's degree in social work or by a person with a master's degree in marriage and family therapy under the supervision of a psychiatrist, physician, licensed marital and family therapist, or licensed clinical social worker who is eligible for reimbursement under subdivisions (1) to (4), inclusive, of subsection (d) of this section. (2) In the case of benefits payable for the services of a licensed psychologist under subsection (d) of this section, such benefits shall be payable for services rendered in a child guidance clinic or residential treatment facility by a person with a master's degree in social work or by a person with a master's degree in marriage and family therapy under the supervision of such licensed psychologist, licensed marital and family therapist, or licensed clinical social worker who is eligible for reimbursement under subdivisions (1) to (4), inclusive, of subsection (d) of this section. (3) In the case of benefits payable for the services of a licensed physician, such benefits shall be payable for services rendered in a residential treatment facility by a licensed or certified alcohol and drug counselor who is eligible for reimbursement under subdivision (5) of subsection (d) of this section. (4) In the case of benefits payable for the services of a licensed psychologist under subsection (d) of this section, such benefits shall be payable for services rendered in a residential treatment facility by a licensed or certified alcohol and drug counselor who is eligible for reimbursement under subdivision (5) of subsection (d) of this section.

(g) In the case of benefits payable for the service of a licensed physician practicing as a psychiatrist or a licensed psychologist, under subsection (d) of this section, such benefits shall be payable for outpatient services rendered (1) in a nonprofit community mental health center, as defined by the Department of Mental Health and Addiction Services, in a nonprofit licensed adult psychiatric clinic operated by an accredited hospital or in a residential treatment facility; (2) under the supervision of a licensed physician practicing as a psychiatrist, a licensed psychologist, a licensed marital and family therapist, a licensed clinical social worker or a licensed or certified alcohol and drug counselor who is eligible for reimbursement under subdivisions (1) to (5), inclusive, of subsection (d) of this section; and (3) within the scope of the license issued to the center or clinic by the Department of Public Health or to the residential treatment facility by the Department of Children and Families.

(h) Except in the case of emergency services or in the case of services for which an individual has been referred by a physician affiliated with a health care center, nothing in this section shall be construed to require a health care center to provide benefits under this section through facilities that are not affiliated with the health care center.

(i) In the case of any person admitted to a state institution or facility administered by the Department of Mental Health and Addiction Services, Department of Public Health, Department of Children and Families or the Department of Mental Retardation, the state shall have a lien upon the proceeds of any coverage available to such person or a legally liable relative of such person under the terms of this section, to the extent of the per capita cost of such person's care. Except in the case of emergency services, the provisions of this subsection shall not apply to coverage provided under a managed care plan, as defined in section 38a-478.

Sec. 28. Section 38a-514 of the general statutes is repealed and the following is substituted in lieu thereof:

[Notwithstanding any provision to the contrary in the general statutes, except as provided in subsection (k) of this section, no]

(a) Except as provided in subsection (j) of this section, each group health insurance policy, [whether issued by an insurance company, a hospital service corporation, a medical service corporation or a health care center, as defined in section 38a-175, shall be delivered, issued for delivery or renewed in this state and no such policy shall be amended to substantially alter or change benefits or coverages unless persons covered under such policy will be eligible for benefits for expense arising from mental or nervous conditions which are at least equal to the following minimum requirements:] providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469, delivered, issued for delivery, renewed, amended or continued in this state on or after January 1, 2000, shall provide benefits for the diagnosis and treatment of mental or nervous conditions. For the purposes of this section, "mental or nervous conditions" means mental disorders, as defined in the most recent edition of the American Psychiatric Association's "Diagnostic and Statistical Manual of Mental Disorders". "Mental or nervous conditions" does not include (1) mental retardation, (2) learning disorders, (3) motor skills disorder, (4) communication disorders, (5) caffeine-related disorders, (6) relational problems, and (7) additional conditions that may be a focus of clinical attention, that are not otherwise defined as mental disorders in the most recent edition of the American Psychiatric Association's "Diagnostic and Statistical Manual of Mental Disorders".

[(a) In the case of benefits based upon confinement as an inpatient in a hospital or a residential treatment facility, whether or not operated by the state, the period of confinement for which benefits shall be payable shall be at least sixty days in any calendar year. For purposes of this section, the term "residential treatment facility" means a treatment center for children and adolescents which provides residential care and treatment for emotionally disturbed individuals and is licensed by the Department of Children and Families and is accredited as a residential treatment center by the Council on Accreditation or the Joint Commission on Accreditation of Health Organizations.

(b) In the case of benefits based upon partial hospitalization, coverage shall be available for at least one hundred twenty sessions in any calendar year. Such coverage may be on an exchange basis with the inpatient benefits in subsection (a) of this section in the following manner: If the cost per session does not exceed fifty per cent of the cost of one inpatient day at the average semiprivate rate at the hospital where the session is conducted, two sessions of partial hospitalization shall equal one inpatient day. If the cost per session exceeds fifty per cent of the cost of one such inpatient day, each session shall equal one inpatient day. For purposes of this section, the term "partial hospitalization" means continuous treatment consisting of not less than four hours and not more than twelve hours in any twenty-four-hour period under a program based in a hospital or residential treatment facility, whether or not operated by the state.

(c) In the case of major medical expense coverage, benefits, after the applicable deductible, shall be at a fifty per cent rate for covered expenses incurred by the insured while other than an inpatient in a hospital or residential treatment facility, and benefits shall be available for such expenses during any calendar year up to a maximum of two thousand dollars. Additional benefits of up to a maximum of two thousand dollars in any calendar year for covered expenses incurred by the insured while other than an inpatient in a hospital shall be provided at the option of the group policyholder. Such benefits shall be subject to the applicable deductible or copayment provisions which shall not be less favorable to the insured than the contract's deductible or copayment provisions for other disease or injury.]

(b) No such group policy shall establish any terms, conditions or benefits that place a greater financial burden on an insured for access to diagnosis or treatment of mental or nervous conditions than for diagnosis or treatment of medical, surgical or other physical health conditions.

[(d)] (c) In the case of benefits payable for the services of a licensed physician, such benefits shall be payable for the same services when such services are lawfully rendered by a psychologist licensed under the provisions of chapter 383 or by such a licensed psychologist in a licensed hospital or clinic.

[(e)] (d) (1) In the case of benefits payable for the services of a licensed physician or psychologist, such benefits shall be payable for the same services when such services are rendered by a clinical social worker who is licensed under the provisions of chapter 383b and who has passed the clinical examination of the American Association of State Social Work Boards and has completed at least two thousand hours of the post-master's social work experience in a nonprofit agency qualifying as a tax-exempt organization under Section 501(c) of the Internal Revenue Code of 1986 or any subsequent corresponding internal revenue code of the United States, as from time to time amended, in a municipal, state or federal agency or in an institution licensed by the Department of Public Health under section 19a-490. (2) In the case of benefits payable for the services of a licensed physician or psychologist, such benefits shall be payable for the same services when such services are rendered by a social worker who was certified as an independent social worker under the provisions of chapter 383b prior to October 1, 1990. (3) In the case of benefits payable for the services of a licensed physician or psychologist, such benefits shall be payable for the same services when such services are rendered by a licensed marital and family therapist who has completed at least two thousand hours of the post-master's marriage and family therapy work experience in a nonprofit agency qualifying as a tax-exempt organization under Section 501(c) of the Internal Revenue Code of 1986 or any subsequent corresponding internal revenue code of the United States, as from time to time amended, in a municipal, state or federal agency or in an institution licensed by the Department of Public Health under section 19a-490. (4) In the case of benefits payable for the services of a licensed physician or psychologist, such benefits shall be payable for the same services when such services are rendered by a marital and family therapist who was certified under the provisions of chapter 383a prior to October 1, 1992. (5) In the case of benefits payable for the services of a licensed physician or psychologist, such benefits shall be payable for the same services when such services are rendered by a licensed alcohol and drug counselor, as defined in section 20-74s, or a certified alcohol and drug counselor, as defined in section 20-74s.

[(f)] (e) For purposes of this section, the term "covered expenses" means the usual, customary and reasonable charges for treatment deemed necessary under generally accepted medical standards, except that in the case of a managed care plan, as defined in section 38a-478, "covered expenses" means the payments agreed upon in the contract between a managed care organization, as defined in section 38a-478, and a provider, as defined in section 38a-478.

[(g)] (f) (1) In the case of benefits payable for the services of a licensed physician, such benefits shall be payable for services rendered in a child guidance clinic or residential treatment facility by a person with a master's degree in social work or by a person with a master's degree in marriage and family therapy under the supervision of a psychiatrist, physician, licensed marital and family therapist or licensed clinical social worker who is eligible for reimbursement under subdivisions (1) to (4), inclusive, of subsection [(e)] (d) of this section. (2) In the case of benefits payable for the services of a licensed psychologist under subsection [(c)] (d) of this section, such benefits shall be payable for services rendered in a child guidance clinic or residential treatment facility by a person with a master's degree in social work or by a person with a master's degree in marriage and family therapy under the supervision of such licensed psychologist, licensed marital and family therapist or licensed clinical social worker who is eligible for reimbursement under subdivisions (1) to (4), inclusive, of subsection [(e)] (d) of this section. (3) In the case of benefits payable for the services of a licensed physician, such benefits shall be payable for services rendered in a residential treatment facility by a licensed or certified alcohol and drug counselor who is eligible for reimbursement under subdivision (5) of subsection (d) of this section. (4) In the case of benefits payable for the services of a licensed psychologist under subsection (d) of this section, such benefits shall be payable for services rendered in a residential treatment facility by a licensed or certified alcohol and drug counselor who is eligible for reimbursement under subdivision (5) of subsection (d) of this section.

[(h)] (g) In the case of benefits payable for the service of a licensed physician practicing as a psychiatrist or a licensed psychologist, under subsection [(c) or] (d) of this section, such benefits shall be payable for outpatient services rendered (1) in a nonprofit community mental health center, as defined by the Department of Mental Health and Addiction Services, in a nonprofit licensed adult psychiatric clinic operated by an accredited hospital or in a residential treatment facility; (2) under the supervision of a licensed physician practicing as a psychiatrist, a licensed psychologist, a licensed marital and family therapist, [or] a licensed clinical social worker or a licensed or certified alcohol and drug counselor who is eligible for reimbursement under subdivisions (1) to [(4)] (5), inclusive, of subsection [(e)] (d) of this section; and (3) within the scope of the license issued to the center or clinic by the Department of Public Health or to the residential treatment facility by the Department of Children and Families.

[(i)] (h) Except in the case of emergency services or in the case of services for which an individual has been referred by a physician affiliated with a health care center, nothing in this section shall be construed to require a health care center to provide benefits under this section through facilities that are not affiliated with the health care center.

[(j)] (i) In the case of any person admitted to a state institution or facility administered by the Department of Mental Health and Addiction Services, Department of Public Health, Department of Children and Families or the Department of Mental Retardation, the state shall have a lien upon the proceeds of any coverage available to such person or a legally liable relative of such person under the terms of this section, to the extent of the per capita cost of such person's care. Except in the case of emergency services the provisions of this subsection shall not apply to coverage provided under a managed care plan, as defined in section 38a-478.

[(k)] (j) A group health insurance policy may exclude the benefits required by this section if such benefits are included in a separate policy issued to the same group by an insurance company, health care center, hospital service corporation, medical service corporation or fraternal benefit society. Such separate policy, which shall include the benefits required by this section and the benefits required by section 38a-533, shall not be required to include any other benefits mandated by this title.

[(l)] (k) In the case of benefits based upon confinement in a residential treatment facility, such benefits shall be payable only in situations in which (A) the insured has a serious mental illness which substantially impairs the person's thought, perception of reality, emotional process, or judgment or grossly impairs behavior as manifested by recent disturbed behavior, (B) the insured has been confined in a hospital for such illness for a period of at least three days immediately preceding such confinement in a residential treatment facility and (C) such illness would otherwise necessitate continued confinement in a hospital if such care and treatment were not available through a residential treatment center for children and adolescents.

[(m)] (l) The services rendered for which benefits are to be paid for confinement in a residential treatment facility must be based on an individual treatment plan. For purposes of this section, the term "individual treatment plan" means a treatment plan prescribed by a physician with specific attainable goals and objectives appropriate to both the patient and the treatment modality of the program.

Sec. 29. Section 38a-533 of the general statutes is repealed and the following is substituted in lieu thereof:

[(a) For purposes of this section: (1) "Effective treatment" means a program of therapy prescribed by a physician licensed pursuant to the provisions of chapter 370, and certification by such a physician of the establishment for the patient of a comprehensive follow-up program; (2) "medical complications of alcoholism" means such diseases as cirrhosis of the liver, gastrointestinal bleeding, pneumonia, and delirium tremens; (3) "substance abuse" means alcoholism, or drug dependence as defined in subdivision (18) of section 21a-240; (4) "continued" means the anniversary date of the issuance of a policy after which the policy remains in effect until cancelled.]

[(b)] (a) Except as provided in subsection [(e)] (c) of this section, [every] each group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), [(6),] (11) and (12) of section 38a-469 shall provide coverage for expenses incurred in connection with [confinement for treatment of substance abuse or] medical complications of alcoholism pursuant to diagnosis or recommendation by a physician licensed pursuant to the provisions of chapter 370. As used in this section, "medical complications of alcoholism" means such diseases as cirrhosis of the liver, gastrointestinal bleeding, pneumonia, and delirium tremens.

[(c) Confinement for treatment of substance abuse or medical]

(b) Medical complications of alcoholism [in a hospital, other than in a part of a hospital used primarily for such treatment unless otherwise provided for in such contract,] shall be recognized to the extent specified in the contract for confinement for any other disease.

[(d) Confinement in a facility established primarily for the treatment of substance abuse and licensed for such care by the state, or in a part of a hospital used primarily for such treatment, shall be recognized to the extent specified in the contract, but only in connection with effective treatment of substance abuse or medical complications of alcoholism, either for a period of at least forty-five days within any period of twelve consecutive months commencing with admission to such a facility or such part of a hospital or for a period of at least forty-five days within any calendar year.]

[(e)] (c) A group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), [(6),] (11) and (12) of section 38a-469 may exclude the benefits required by this section if such benefits are included in a separate policy issued to the same group by an insurance company, health care center, hospital service corporation, medical service corporation or fraternal benefit society. Such separate policy, which shall include the benefits required by this section, [and the benefits required by section 38a-514,] shall not be required to include any other benefits mandated by this title.

[(f)] (d) The provisions of this section shall apply to any group health insurance policy delivered or issued for delivery, renewed or continued in this state on and after [October 1, 1990] January 1, 2000, and to any group health insurance policy which is thereafter amended to substantially alter or change benefits or coverages.

Sec. 30. Subdivision (15) of section 38a-816 of the general statutes is repealed and the following is substituted in lieu thereof:

(15) (A) Failure to pay accident and health claims, including, but not limited to, claims for payment or reimbursement to health care providers, [within forty-five days, or as otherwise stipulated by contract, of receipt by an insurer of the claimant's proof of loss form or the health care provider's request for payment filed in accordance with the insurer's practices or procedures,] within the time periods set forth in subparagraph (B) of this subdivision, unless the Insurance Commissioner determines that a legitimate dispute exists as to coverage, liability or damages or that the claimant has fraudulently caused or contributed to the loss. Any insurer who fails to pay such a claim or request [with] within the [forty-five-day period] time periods set forth in subparagraph (B) of this subdivision shall pay the claimant or health care provider the amount of such claim plus interest at the rate of fifteen per cent per annum, in addition to any other penalties which may be imposed pursuant to sections 38a-11, 38a-25, 38a-41 to 38a-53, inclusive, 38a-57 to 38a-60, inclusive, 38a-62 to 38a-64, inclusive, 38a-76, 38a-83, 38a-84, 38a-117 to 38a-124, inclusive, 38a-129 to 38a-140, inclusive, 38a-146 to 38a-155, inclusive, 38a-283, 38a-288 to 38a-290, inclusive, 38a-319, 38a-320, 38a-459, 38a-464, 38a-815 to 38a-819, inclusive, as amended by this act, 38a-824 to 38a-826, inclusive, and 38a-828 to 38a-831, inclusive. Whenever the interest due a claimant or health care provider pursuant to this section is less than one dollar, the insurer shall deposit such amount in a separate interest-bearing account in which all such amounts shall be deposited. At the end of each calendar year each such insurer shall donate such amount to The University of Connecticut Health Center.

(B) Each insurer shall pay claims not later than forty-five days after receipt by the insurer of the claimant's proof of loss form or the health care provider's request for payment filed in accordance with the insurer's practices or procedures, except that when there is a deficiency in the information needed for processing a claim, the insurer shall (i) send written notice to the claimant or health care provider, as the case may be, of all alleged deficiencies in information needed for processing a claim not later than thirty days after the insurer receives a claim for payment or reimbursement under the contract, and (ii) pay claims for payment or reimbursement under the contract not later than thirty days after the insurer receives the information requested.

Sec. 31. (NEW) (a) Each managed care organization, as defined in section 38a-478 of the general statutes, shall be subject to the provisions of sections 38a-815 to 38a-819, inclusive, of the general statutes.

(b) The Insurance Commissioner may examine the affairs of any managed care organization licensed to do business in this state in order to determine whether such managed care organization has been or is engaged in any unfair method of competition or in any unfair or deceptive act or practice prohibited by section 38a-816 of the general statutes, as amended by this act. The commissioner may adopt regulations, in accordance with the provisions of chapter 54 of the general statutes, to implement the provisions of this section.

Sec. 32. Section 38a-816 of the general statutes is amended by adding subdivision (21) as follows:

(NEW) (21) With respect to a managed care organization, as defined in section 38a-478, failing to establish a confidentiality procedure for medical record information, as required by section 25 of this act.

Sec. 33. (NEW) (a) For purposes of this section: "Department" means the Department of Public Health, and "physician" means a physician licensed pursuant to chapter 370 of the general statutes.

(b) The department, after consultation with the Connecticut Medical Examining Board and the Connecticut State Medical Society shall collect the following information to create an individual profile on each physician for dissemination to the public:

(1) The name of the medical school attended by the physician and the date of graduation;

(2) The site, training, discipline and inclusive dates of the physician's postgraduate medical education required pursuant to the applicable licensure section of the general statutes;

(3) The area of the physician's practice specialty;

(4) The address of the physician's primary practice location or primary practice locations, if more than one;

(5) A list of languages, other than English, spoken at the physician's primary practice locations;

(6) An indication of any disciplinary action taken against the physician by the department or by the state board;

(7) Any current certifications issued to the physician by a specialty board of the American Board of Medical Specialties;

(8) The hospitals and nursing homes at which the physician has admitting privileges;

(9) Any appointments of the physician to Connecticut medical school faculties and an indication as to whether the physician has current responsibility for graduate medical education;

(10) A listing of the physician's publications in peer reviewed literature;

(11) A listing of the physician's professional services, activities and awards;

(12) Any hospital disciplinary actions against the physician that resulted, within the past ten years, in the termination or revocation of the physician's hospital privileges for a medical disciplinary cause or reason, or the resignation from, or nonrenewal of, medical staff membership or the restriction of privileges at a hospital taken in lieu of or in settlement of a pending disciplinary case related to medical competence in such hospital;

(13) A description of any criminal conviction of the physician for a felony within the last ten years. For the purposes of this subdivision, a physician shall be deemed to be convicted of a felony if the physician pleaded guilty or was found or adjudged guilty by a court of competent jurisdiction or has been convicted of a felony by the entry of a plea of nolo contendere; and

(14) To the extent available, and consistent with the provisions of subsection (c) of this section, all medical malpractice court judgments and all medical malpractice arbitration awards against the physician in which a payment was awarded to a complaining party during the last ten years, and all settlements of medical malpractice claims against the physician in which a payment was made to a complaining party within the last ten years.

(c) Any report of a medical malpractice judgment or award against a physician made under subdivision (14) of subsection (b) of this section shall comply with the following: (1) Dispositions of paid claims shall be reported in a minimum of three graduated categories indicating the level of significance of the award or settlement; (2) information concerning paid medical malpractice claims shall be placed in context by comparing an individual physician's medical malpractice judgments, awards and settlements to the experience of other physicians licensed in Connecticut who perform procedures and treat patients with a similar degree of risk; (3) all judgment award and settlement information reported shall be limited to amounts actually paid by or on behalf of the physician; and (4) comparisons of malpractice payment data shall be accompanied by (A) an explanation of the fact that physicians treating certain patients and performing certain procedures are more likely to be the subject of litigation than others and that the comparison given is for physicians who perform procedures and treat patients with a similar degree of risk; (B) a statement that the report reflects data for the last ten years and the recipient should take into account the number of years the physician has been in practice when considering the data; (C) an explanation that an incident giving rise to a malpractice claim may have occurred years before any payment was made due to the time lawsuits take to move through the legal system; (D) an explanation of the effect of treating high-risk patients on a physician's malpractice history; and (E) an explanation that malpractice cases may be settled for reasons other than liability and that settlements are sometimes made by the insurer without the physician's consent. Information concerning all settlements shall be accompanied by the following statement: "Settlement of a claim may occur for a variety of reasons that do not necessarily reflect negatively on the professional competence or conduct of the physician. A payment in settlement of a medical malpractice action or claim should not be construed as creating a presumption that medical malpractice has occurred."

(d) Pending malpractice claims against a physician and actual amounts paid by or on behalf of a physician in connection with a malpractice judgment, award or settlement shall not be disclosed by the department to the public. This subsection shall not be construed to prevent the department from investigating and disciplining a physician on the basis of medical malpractice claims that are pending.

(e) Prior to the initial release of a physician's profile to the public, the department shall provide the physician with a copy of the physician's profile. Additionally, any amendments or modifications to the profile that were not supplied by the physician or not generated by the department itself shall be provided to the physician for review prior to release to the public. A physician shall have sixty days from the date the department mails or delivers the prepublication copy to dispute the accuracy of any information that the department proposes to include in such profile and to submit a written statement setting forth the basis for such dispute. If a physician does not notify the department that the physician disputes the accuracy of such information within such sixty-day period, the department shall make the profile available to the public and the physician shall be deemed to have approved the profile and all information contained therein. If a physician notifies the department that the physician disputes the accuracy of such information in accordance with this subsection, the physician's profile shall be released to the public without the disputed information, but with a statement to the effect that information in the identified category is currently the subject of a dispute and is therefore not currently available. Not later than thirty days after the department's receipt of notice of a dispute, the department shall review any information submitted by the physician in support of such dispute and determine whether to amend the information contained in the profile. In the event that the department determines not to amend the disputed information, the disputed information shall be included in the profile with a statement that such information is disputed by the physician.

(f) A physician may elect to have the physician's profile omit information provided pursuant to subdivisions (9) to (11), inclusive, of subsection (b) of this section. In collecting information for such profiles and in the dissemination of such profiles, the department shall inform physician's that they may choose not to provide the information described in said subdivisions (9) to (11), inclusive.

(g) Each profile created pursuant to this section shall include the following statement: "This profile contains information that may be used as a starting point in evaluating the physician. This profile should not, however, be your sole basis for selecting a physician."

(h) The department shall maintain a web site on the Internet for use by the public in obtaining profiles of physicians.

(i) No state law that would otherwise prohibit, limit or penalize disclosure of information about a physician shall apply to disclosure of information required by this section.

(j) All information provided by a physician pursuant to this section shall be subject to the penalties of false statement, pursuant to section 53a-157b of the general statutes.

(k) A physician shall notify the department of any changes to the information required in subdivisions (3), (4), (5), (7), (8) and (13) of subsection (b) of this section not later than sixty days after such change.

Sec. 34. Section 20-13c of the general statutes is repealed and the following is substituted in lieu thereof:

The board is authorized to restrict, suspend or revoke the license or limit the right to practice of a physician or take any other action in accordance with section 19a-17, for any of the following reasons: (1) Physical illness or loss of motor skill, including, but not limited to, deterioration through the aging process; (2) emotional disorder or mental illness; (3) abuse or excessive use of drugs, including alcohol, narcotics or chemicals; (4) illegal, incompetent or negligent conduct in the practice of medicine; (5) possession, use, prescription for use, or distribution of controlled substances or legend drugs, except for therapeutic or other medically proper purposes; (6) misrepresentation or concealment of a material fact in the obtaining or reinstatement of a license to practice medicine; (7) failure to adequately supervise a physician assistant; (8) failure to fulfill any obligation resulting from participation in the National Health Service Corps; (9) failure to maintain professional liability insurance or other indemnity against liability for professional malpractice as provided in subsection (a) of section 20-11b; [or] (10) failure to provide information requested by the department for purposes of completing a health care provider profile, as required by section 33 of this act; or (11) violation of any provision of this chapter or any regulation established hereunder. In each case, the board shall consider whether the physician poses a threat, in [his] the practice of medicine, to the health and safety of any person. If the board finds that the physician poses such a threat, the board shall include such finding in its final decision and act to suspend or revoke the license of said physician.

Sec. 35. Section 38a-478m of the general statutes is repealed and the following is substituted in lieu thereof:

(a) Each managed care organization shall establish and maintain an internal grievance procedure to assure that enrollees may seek a review of any grievance that may arise from a managed care organization's action or inaction, other than action or inaction based on utilization review, and obtain a timely resolution of any such grievance. Such grievance procedure shall comply with the following requirements:

(1) Enrollees shall be informed of the grievance procedure at the time of initial enrolment and at not less than annual intervals thereafter, which notification may be met by inclusion in an enrolment agreement or update. Enrollees shall also be informed of the grievance procedure when a decision has been made not to certify an admission, service or extension of stay.

(2) Notices to enrollees describing the grievance procedure shall explain: (A) The process for filing a grievance with the managed care organization, which may be communicated orally, electronically or in writing; (B) that the enrollee, a person acting on behalf of an enrollee, including the enrollee's health care provider, may make a request for review of a grievance; and (C) the time periods within which the managed care organization must resolve the grievance.

(b) All reviews conducted under this section shall be resolved not later than sixty days from the date the enrollee commences the complaint, unless an extension is requested by the enrollee.

Sec. 36. Section 31-128c of the general statutes is repealed and the following is substituted in lieu thereof:

Each employer shall, within a reasonable time after receipt of a written request from an employee, permit an inspection of medical records pertaining to such employee which may be in such employer's possession. Such inspection shall take place during regular business hours at a location at or reasonably near the employee's place of employment and shall be made by a physician chosen by such employee or by a physician chosen by the employer with such employee's consent. Each employer who has medical records shall be required to keep any medical records pertaining to a particular employee for at least one year after the termination of such employee's employment. Medical records, if kept by an employer, [may] shall be kept separately and not as part of any personnel file.

Sec. 37. (NEW) Each individual health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general statutes delivered, issued for delivery, renewed or continued in this state on or after January 1, 2000, that provides coverage for outpatient prescription drugs shall not deny coverage for an insured for any drug that the insurer removes from its list of covered drugs, or otherwise ceases to provide coverage for, if (1) the insured was using the drug for the treatment of a chronic illness prior to the removal or cessation of coverage, (2) the insured was covered under the policy for the drug prior to the removal or cessation of coverage, and (3) the insured's attending health care provider states in writing, after the removal or cessation of coverage, that the drug is medically necessary and lists the reasons why the drug is more medically beneficial than the drugs on the list of covered drugs. Such benefits shall be subject to the same terms and conditions applicable to all other benefits under such policies.

Sec. 38. (NEW) Each group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general statutes delivered, issued for delivery, renewed or continued in this state on or after January 1, 2000, that provides coverage for outpatient prescription drugs shall not deny coverage for an insured for any drug that the insurer removes from its list of covered drugs, or otherwise ceases to provide coverage for, if (1) the insured was using the drug for the treatment of a chronic illness prior to the removal or cessation of coverage, (2) the insured was covered under the policy for the drug prior to the removal or cessation of coverage, and (3) the insured's attending health care provider states in writing, after the removal or cessation of coverage, that the drug is medically necessary and lists the reasons why the drug is more medically beneficial than the drugs on the list of covered drugs. Such benefits shall be subject to the same terms and conditions applicable to all other benefits under such policies.

Sec. 39. Subsection (l) of section 38a-988 of the general statutes is repealed and the following is substituted in lieu thereof:

(l) Made to an affiliate whose only use of the information will be in connection with an audit of the insurance institution or agent or the marketing of an insurance product or service, provided (1) with regard to individually identifiable medical records information, written consent of the individual to whom the individually identifiable medical record pertains is obtained prior to disclosure for marketing purposes, and (2) the affiliate agrees not to disclose the information for any other purpose or to unaffiliated persons.

Sec. 40. (NEW) Each individual health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general statutes delivered, issued for delivery, renewed or continued in this state on or after January 1, 2000, shall provide coverage for general anesthesia, nursing and related hospital services provided in conjunction with in-patient dental services if the following conditions are met:

(1) The anesthesia, nursing and related hospital services are deemed medically necessary by the treating dentist or oral surgeon and the patient's primary care physician in accordance with the health insurance policy's requirements for prior authorization of services; and

(2) The patient is either (A) a child under the age of four who is determined by a licensed dentist, in conjunction with a licensed physician who specializes in primary care, to have a dental condition of significant dental complexity that it requires certain dental procedures to be performed in a hospital, or (B) a person who has a developmental disability, as determined by a licensed physician who specializes in primary care, that places the person at serious risk. The expense of such anesthesia, nursing and related hospital services shall be deemed a medical expense under such health insurance policy and shall not be subject to any limits on dental benefits under such policy.

Sec. 41. (NEW) Each group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general statutes delivered, issued for delivery, renewed or continued in this state on or after January 1, 2000, shall provide coverage for general anesthesia, nursing and related hospital services provided in conjunction with in-patient dental services if the following conditions are met:

(1) The anesthesia, nursing and related hospital services are deemed medically necessary by the treating dentist or oral surgeon and the patient's primary care physician in accordance with the health insurance policy's requirements for prior authorization of services; and

(2) The patient is either (A) a child under the age of four who is determined by a licensed dentist, in conjunction with a licensed physician who specializes in primary care, to have a dental condition of significant dental complexity that it requires certain dental procedures to be performed in a hospital, or (B) a person who has a developmental disability, as determined by a licensed physician who specializes in primary care, that places the person at serious risk. The expense of such anesthesia, nursing and related hospital services shall be deemed a medical expense under such health insurance policy and shall not be subject to any limits on dental benefits under such policy.

Sec. 42. (NEW) The Commissioner of Social Services, to the extent permitted by federal law, shall amend the Medicaid state plan to provide coverage for general anesthesia, nursing and related hospital services provided in conjunction with dental services, provided such anesthesia, nursing and related hospital services are provided in conjunction with in-patient dental services if the following conditions are met:

(1) The anesthesia, nursing and related hospital services are deemed medically necessary by the treating dentist or oral surgeon and the patient's primary care physician in accordance with the department's requirements for prior authorization of services, if required; and

(2) The patient is either (A) a child under the age of four who is determined by a licensed dentist, in conjunction with a licensed physician who specializes in primary care, to have a dental condition of significant dental complexity that it requires certain dental procedures to be performed in a hospital, or (B) a person who has a developmental disability, as determined by a licensed physician who specializes in primary care, that places the person at serious risk. The expense of such anesthesia, nursing and related hospital services shall be deemed a medical expense under such health insurance policy and shall not be subject to any limits on dental benefits under such policy.

Sec. 43. (NEW) (a) Each individual health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general statutes, delivered, issued for delivery, renewed or continued in this state on or after January 1, 2000, shall provide coverage for outpatient self-management training for the treatment of insulin-dependent diabetes, insulin-using diabetes, gestational diabetes and non-insulin-using diabetes if the training is prescribed by a licensed health care professional who has appropriate state licensing authority to prescribe such training. As used in this section, "outpatient self-management training" includes, but is not limited to, education and medical nutrition therapy. Diabetes self-management training shall be provided by a certified, registered or licensed health care professional trained in the care and management of diabetes and authorized to provide such care within the scope of the professional's practice.

(b) Benefits shall cover: (1) Initial training visits provided to an individual after the individual is initially diagnosed with diabetes that is medically necessary for the care and management of diabetes, including, but not limited to, counseling in nutrition and the proper use of equipment and supplies for the treatment of diabetes, totaling a maximum of ten hours; (2) training and education that is medically necessary as a result of a subsequent diagnosis by a physician of a significant change in the individual's symptoms or condition which requires modification of the individual's program of self-management of diabetes, totaling a maximum of four hours; and (3) training and education that is medically necessary because of the development of new techniques and treatment for diabetes totaling a maximum of four hours.

(c) Benefits provided pursuant to this section shall be subject to the same terms and conditions applicable to all other benefits under such policies.

Sec. 44. (NEW) (a) Each group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general statutes, delivered, issued for delivery, renewed or continued in this state on or after January 1, 2000, shall provide coverage for outpatient self-management training for the treatment of insulin-dependent diabetes, insulin-using diabetes, gestational diabetes and non-insulin-using diabetes if the training is prescribed by a licensed health care professional who has appropriate state licensing authority to prescribe such training. As used in this section, "outpatient self-management training" includes, but is not limited to, education and medical nutrition therapy. Diabetes self-management training shall be provided by a certified, registered or licensed health care professional trained in the care and management of diabetes and authorized to provide such care within the scope of the professional's practice.

(b) Benefits shall cover: (1) Initial training visits provided to an individual after the individual is initially diagnosed with diabetes that is medically necessary for the care and management of diabetes, including, but not limited to, counseling in nutrition and the proper use of equipment and supplies for the treatment of diabetes, totaling a maximum of ten hours; (2) training and education that is medically necessary as a result of a subsequent diagnosis by a physician of a significant change in the individual's symptoms or condition which requires modification of the individual's program of self-management of diabetes, totaling a maximum of four hours; and (3) training and education that is medically necessary because of the development of new techniques and treatment for diabetes totaling a maximum of four hours.

(c) Benefits provided pursuant to this section shall be subject to the same terms and conditions applicable to all other benefits under such policies.

Sec. 45. (NEW) Each individual health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general statutes delivered, issued for delivery, renewed or continued in this state on or after January 1, 2000, shall provide coverage for laboratory and diagnostic tests, including, but not limited to, prostate specific antigen (PSA) tests, to screen for prostate cancer for men who are symptomatic, whose biological father or brother has been diagnosed with prostate cancer, and for all men fifty years of age or older.

Sec. 46. (NEW) Each group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general statutes delivered, issued for delivery, renewed or continued in this state on or after January 1, 2000, shall provide coverage for laboratory and diagnostic tests, including, but not limited to, prostate specific antigen (PSA) tests, to screen for prostate cancer for men who are symptomatic, whose biological father or brother has been diagnosed with prostate cancer, and for all men fifty years of age or older.

Sec. 47. (NEW) Each individual health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general statutes delivered, issued for delivery, renewed or continued in this state on or after January 1, 2000, shall provide coverage for Lyme disease treatment including not less than thirty days of intravenous antibiotic therapy, sixty days of oral antibiotic therapy, or both, and shall provide further treatment if recommended by a board certified rheumatologist, infectious disease specialist or neurologist licensed in accordance with chapter 370 of the general statutes.

Sec. 48. (NEW) Each group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general statutes delivered, issued for delivery, renewed or continued in this state on or after January 1, 2000, shall provide coverage for Lyme disease treatment including not less than thirty days of intravenous antibiotic therapy, sixty days of oral antibiotic therapy, or both, and shall provide further treatment if recommended by a board certified rheumatologist, infectious disease specialist or neurologist licensed in accordance with chapter 370 of the general statutes.

Sec. 49. Section 20-138b of the general statutes is repealed and the following is substituted in lieu thereof:

(a) No person shall interfere with the exercise by any other person of [his] the person's free choice in the selection of a licensee under either chapter 370 or this chapter for vision training or care.

(b) If any health care center, as defined in section 38a-175 or preferred provider network, as defined in section 19a-647b, offers health care benefits which provide ophthalmologic care for any person, partnership, corporation, association or any group however organized, such health care center or preferred provider network shall provide optometric care. If the ophthalmologic care provided may be lawfully rendered by an optometrist, such health care center or preferred provider network shall provide the identical eye care coverage and benefits for its members when such care is rendered by an optometrist under contract with such health care center or preferred provider network. Such health care center or preferred provider network shall (1) contract with ophthalmologists and optometrists in a manner which will provide fair and sufficient representation of such providers in relation to the benefits provided by the health care center plan or preferred provider network, and [,] (2) equally inform its members of the availability of ophthalmologic and optometric services.

(c) The Insurance Commissioner may adopt regulations, in accordance with chapter 54, to carry out the provisions of subsection (b) of this section.

Sec. 50. Section 17b-293 of the general statutes is repealed and the following is substituted in lieu thereof:

(a) The HUSKY Plan, Part B shall provide the following minimum benefit coverage:

(1) No copayments for preventive care and services;

(2) No copayments for inpatient physician and hospital, outpatient surgical, ambulance and for emergency medical conditions, skilled nursing, home health, hospice and short-term rehabilitation and physical therapy, occupational and speech therapies, lab and x-ray, preadmission testing, prosthetics, durable medical equipment other than powered wheelchairs, dental exams every six months, x-rays, fillings, fluoride treatments and oral surgery. For purposes of this subdivision, in accordance with the National Committee for Quality Assurance, an emergency medical condition is a condition such that a prudent lay-person, acting reasonably, would have believed that emergency medical treatment is needed;

(3) Outpatient physician visits, hearing examinations, nurse midwives, nurse practitioners, podiatrists, chiropractors and natureopaths;

(4) Prescription drugs;

(5) Eye care and optical hardware;

(6) Orthodontia;

(7) Mental health inpatient maximum of sixty days with allowable substitution of alternative levels of care and outpatient maximum of thirty visits with supplemental coverage available under a HUSKY Plus program for medically eligible enrollees, provided coverage under the HUSKY Plan, Part B and HUSKY Plus programs shall be consistent with the provisions of the Mental Health Parity Act, Public Law 104-204, [and section 38a-514a] sections 38a-488a, 38a-514 and 38a-533, as amended by this act;

(8) Substance abuse, detoxification and inpatient for drugs sixty days and alcohol forty-five days and outpatient sixty visits per calendar year maximum with supplemental coverage available under a HUSKY Plus program for medically eligible enrollees;

(9) Under the HUSKY Plan, Part B no deductibles shall be charged; no preexisting condition exclusion shall be applied and there shall be no annual or lifetime benefit maximums and no coinsurance.

(b) The commissioner may establish a schedule of reasonable copayments for coverage provided under subdivisions (3) to (8), inclusive, of subsection (a) of this section.

Sec. 51. Section 38a-478a of the general statutes is repealed and the following is substituted in lieu thereof:

On March 1, 1999, and annually thereafter, the Insurance Commissioner shall submit a report, to the Governor and to the joint standing committees of the General Assembly having cognizance of matters relating to public health and relating to insurance and real estate, concerning the commissioner's responsibilities under the provisions of sections 19a-647, 38a-226 to 38a-226d, inclusive, 38a-478 to 38a-478u, inclusive, [38a-514a] and 38a-993. The report shall include: (1) A summary of the quality assurance plans submitted by managed care organizations pursuant to section 38a-478c along with suggested changes to improve such plans; (2) suggested modifications to the consumer report card developed under the provisions of section 38a-478l; (3) a summary of the commissioner's procedures and activities in conducting market conduct examinations of utilization review companies, including, but not limited to: (A) The number of desk and field audits completed during the previous calendar year; (B) a summary of findings of the desk and field audits, including any recommendations made for improvements or modifications; (C) a description of complaints concerning managed care companies, including a summary and analysis of any trends or similarities found in the managed care complaints filed by enrollees; (4) a summary of the complaints received by the Insurance Department's Consumer Affairs Division and the commissioner under section 38a-478n, including a summary and analysis of any trends or similarities found in the complaints received; (5) a summary of any violations the commissioner has found against any managed care organization; and (6) a summary of the issues discussed related to health care or managed care organizations at the Insurance Department's quarterly forums throughout the state.

Sec. 52. Section 38a-478b of the general statutes is repealed and the following is substituted in lieu thereof:

(a) Each managed care organization, as defined in section 38a-478, that fails to file the data, reports or information required by sections 19a-647, 38a-226 to 38a-226d, inclusive, 38a-478 to 38a-478u, inclusive, [38a-514a] and 38a-993 shall pay a late fee of one hundred dollars per day for each day from the due date of such data, reports or information to the date of filing. Each managed care organization that files incomplete data, reports or information shall be so informed by the commissioner, shall be given a date by which to remedy such incomplete filing and shall pay said late fee commencing from the new due date.

(b) On June 1, 1998, and annually thereafter, the commissioner shall submit, to the Governor and to the joint standing committees of the General Assembly having cognizance of matters relating to public health and matters relating to insurance and real estate, a list of those managed care organizations that have failed to file any data, report or information required by sections 19a-647, 38a-226 to 38a-226d, inclusive, 38a-478 to 38a-478u, inclusive, [38a-514a] and 38a-993.

Sec. 53. Section 38a-478s of the general statutes is repealed and the following is substituted in lieu thereof:

(a) Nothing in sections 38a-478 to 38a-478o, inclusive, shall be construed to apply to the arrangements of managed care organizations offered to individuals covered under self-insured employee welfare benefit plans established pursuant to the federal Employee Retirement Income Security Act of 1974.

(b) The provisions of sections 38a-478 to 38a-478o, inclusive, [and 38a-514a] shall not apply to any plan that provides for the financing or delivery of health care services solely for the purposes of workers' compensation benefits pursuant to chapter 568.

Sec. 54. Section 38a-478t of the general statutes is repealed and the following is substituted in lieu thereof:

The Commissioner of Public Health may request and shall receive any data, report or information filed with the Insurance Commissioner pursuant to the provisions of sections 19a-647, 38a-226 to 38a-226d, inclusive, 38a-478 to 38a-478u, inclusive, [38a-514a] and 38a-993.

Sec. 55. Section 38a-478u of the general statutes is repealed and the following is substituted in lieu thereof:

The Insurance Commissioner shall adopt regulations in accordance with the provisions of chapter 54 to implement the provisions of sections 19a-647, 38a-226 to 38a-226d, inclusive, 38a-478 to 38a-478u, inclusive, [38a-514a] and 38a-993.

Sec. 56. Subsection (a) of section 17a-450a of the general statutes is repealed and the following is substituted in lieu thereof:

(a) The Department of Mental Health and Addiction Services shall constitute a successor department to the Department of Mental Health. Whenever the words "Commissioner of Mental Health" are used or referred to in the following general statutes, the words "Commissioner of Mental Health and Addiction Services" shall be substituted in lieu thereof and whenever the words "Department of Mental Health" are used or referred to in the following general statutes, the words "Department of Mental Health and Addiction Services" shall be substituted in lieu thereof: 2c-2b, 4-5, 4-38c, 4-60i, 4-77a, 4a-12, 4a-16, 5-142, 8-206d, 10-19, 10-71, 10-76d, 13b-38n, 17a-14, 17a-26, 17a-31, 17a-33, 17a-218, 17a-246, 17a-450, 17a-451, 17a-452, 17a-453, 17a-454, 17a-455, 17a-456, 17a-457, 17a-458, 17a-459, 17a-460, 17a-463, 17a-464, 17a-465, 17a-466, 17a-467, 17a-468, 17a-470, 17a-471, 17a-472, 17a-473, 17a-474, 17a-476, 17a-478, 17a-479, 17a-480, 17a-481, 17a-482, 17a-483, 17a-484, 17a-498, 17a-499, 17a-502, 17a-506, 17a-510, 17a-511, 17a-512, 17a-513, 17a-519, 17a-528, 17a-560, 17a-561, 17a-562, 17a-565, 17a-576, 17a-581, 17a-582, 17a-675, 17b-28, 17b-222, 17b-223, 17b-225, 17b-359, 17b-420, 17b-694, [17a-675,] 19a-82, 19a-495, 19a-498, 19a-507a, 19a-507c, 19a-576, 19a-583, 20-14i, 20-14j, 21a-240, 21a-301, 22a-224, 27-122a, 31-222, 38a-514, [38a-539,] 46a-28, 51-51o, 52-146h and 54-56d.

Sec. 57. Subsection (a) of section 19a-1c of the general statutes is repealed and the following is substituted in lieu thereof:

(a) Whenever the words "Commissioner of Public Health and Addiction Services" are used or referred to in the following sections of the general statutes, the words "Commissioner of Public Health" shall be substituted in lieu thereof and whenever the words "Department of Public Health and Addiction Services" are used or referred to in the following sections of the general statutes, the words "Department of Public Health" shall be substituted in lieu thereof: 1-21b, 2-20a, 3-129, 4-5, 4-38c, 4-60i, 4-67e, 4a-12, 4a-16, 4a-51, 5-169, 7-22a, 7-41a, 7-42, 7-44, 7-45, 7-47a, 7-48, 7-49, 7-51, 7-52, 7-53, 7-54, 7-55, 7-56, 7-59, 7-60, 7-62a, 7-62b, 7-62c, 7-65, 7-70, 7-72, 7-73, 7-74, 7-127e, 7-504, 7-536, 8-159a, 8-206d, 8-210, 10-19, 10-71, 10-76d, 10-203, 10-204a, 10-207, 10-212, 10-212a, 10-214, 10-215d, 10-253, 10-282, 10-284, 10-292, 10a-132, 10a-155, 10a-162a, 12-62f, 12-263a, 12-407, 12-634, 13a-175b, 13a-175ee, 13b-38n, 14-227a, 14-227c, 15-121, 15-140r, 15-140u, 16-19z, 16-32e, 16-43, 16-50c, 16-50d, 16-50j, 16-261a, 16-262l, 16-262m, 16-262n, 16-262o, 16-262q, 16a-36, 16a-36a, 16a-103, 17-585, 17a-20, 17a-52, 17a-154, 17a-219c, 17a-220, 17a-277, 17a-509, 17a-688, 17b-6, 17b-99, 17b-225, 17b-234, 17b-265, 17b-288, 17b-340, 17b-341, 17b-347, 17b-350, 17b-351, 17b-354, 17b-357, 17b-358, 17b-406, 17b-408, 17b-420, 17b-552, 17b-611, 17b-733, 17b-737, 17b-748, 17b-803, 17b-808, 17b-851a, 19a-1d, 19a-4i, 19a-6, 19a-6a, 19a-7b, 19a-7c, 19a-7d, 19a-7e, 19a-7f, 19a-7g, 19a-7h, 19a-9, 19a-10, 19a-13, 19a-14, 19a-14a, 19a-14b, 19a-15, 19a-17, 19a-17a, 19a-17m, 19a-17n, 19a-19, 19a-20, 19a-21, 19a-23, 19a-24, 19a-25, 19a-25a, 19a-26, 19a-27, 19a-28, 19a-29, 19a-29a, 19a-30, 19a-30a, 19a-32, 19a-32a, 19a-33, 19a-34, 19a-35, 19a-36, 19a-36a, 19a-37, 19a-37a, 19a-37b, 19a-40, 19a-41, 19a-42, 19a-43, 19a-44, 19a-45, 19a-47, 19a-48, 19a-49, 19a-50, 19a-51, 19a-52, 19a-53, 19a-54, 19a-55, 19a-56a, 19a-56b, 19a-57, 19a-58, 19a-59, 19a-59a, 19a-59b, 19a-59c, 19a-59d, 19a-60, 19a-61, 19a-69, 19a-70, 19a-71, 19a-72, 19a-73, 19a-74, 19a-75, 19a-76, 19a-79, 19a-80, 19a-82 to 19a-91, inclusive, 19a-92a, 19a-93, 19a-94, 19a-94a, 19a-102a, 19a-103, 19a-104, 19a-105, 19a-108, 19a-109, 19a-110, 19a-110a, 19a-111, 19a-111a, 19a-111e, 19a-112a, 19a-112b, 19a-112c, 19a-113, 19a-113a, 19a-115, 19a-116, 19a-121, 19a-121a, 19a-121b, 19a-121c, 19a-121d, 19a-121e, 19a-121f, 19a-122b, 19a-123d, 19a-124, 19a-125, 19a-148, 19a-175, 19a-176, 19a-178, 19a-179, 19a-180, 19a-181a, 19a-182, 19a-183, 19a-184, 19a-186, 19a-187, 19a-195a, 19a-200, 19a-201, 19a-202, 19a-204, 19a-207, 19a-208, 19a-215, 19a-219, 19a-221, 19a-223, 19a-229, 19a-241, 19a-242, 19a-243, 19a-244, 19a-245, 19a-250, 19a-252, 19a-253, 19a-255, 19a-257, 19a-262, 19a-269, 19a-270, 19a-270a, 19a-279l, 19a-310, 19a-311, 19a-312, 19a-313, 19a-320, 19a-323, 19a-329, 19a-330, 19a-331, 19a-332, 19a-332a, 19a-333, 19a-341, 19a-401, 19a-402, 19a-406, 19a-409, 19a-420, 19a-421, 19a-422, 19a-423, 19a-424, 19a-425, 19a-426, 19a-427, 19a-428, 19a-490, 19a-490c, 19a-490d, 19a-490e, 19a-490g, 19a-491, 19a-491a, 19a-491b, 19a-492, 19a-493, 19a-493a, 19a-494, 19a-494a, 19a-495, 19a-496, 19a-497, 19a-499, 19a-500, 19a-501, 19a-503, 19a-504, 19a-504c, 19a-505, 19a-506, 19a-507a, 19a-507b, 19a-507c, 19a-507d, 19a-508, 19a-509a, 19a-512, 19a-514, 19a-515, 19a-517, 19a-518, 19a-519, 19a-520, 19a-521, 19a-521a, 19a-523, 19a-524, 19a-526, 19a-527, 19a-528, 19a-530, 19a-531, 19a-533, 19a-534a, 19a-535, 19a-535a, 19a-536, 19a-537, 19a-538, 19a-540, 19a-542, 19a-547, 19a-550, 19a-551, 19a-554, 19a-581, 19a-582, 19a-584, 19a-586, 19a-630, 19a-631, 19a-634, 19a-637, 19a-638, 19a-639, 19a-645, 19a-646, 19a-663, 19a-673, 19a-675, 20-8, 20-8a, 20-9, 20-10, 20-11, 20-11a, 20-11b, 20-12, 20-12a, 20-13, 20-13a, 20-13b, 20-13d, 20-13e, 20-14, 20-14j, 20-17, 20-18, 20-18a, 20-18b, 20-20, 20-27, 20-28a, 20-28b, 20-29, 20-37, 20-39a, 20-40, 20-45, 20-54, 20-55, 20-57, 20-58a, 20-59, 20-66, 20-68, 20-70, 20-71, 20-73, 20-73a, 20-74, 20-74a, 20-74i, 20-74aa, 20-74dd, 20-86b, 20-86c, 20-86d, 20-86f, 20-86h, 20-90, 20-92, 20-93, 20-94, 20-94a, 20-96, 20-97, 20-99, 20-99a, 20-101a, 20-102aa to 20-102ee, inclusive, 20-103a, 20-106, 20-107, 20-108, 20-109, 20-110, 20-114, 20-122a, 20-122b, 20-122c, 20-123a, 20-126b, 20-126h, 20-126j, 20-126k, 20-126l, 20-126o, 20-126p, 20-126q, 20-126r, 20-126u, 20-127, 20-128a, 20-129, 20-130, 20-133, 20-138a, 20-138c, 20-139a, 20-140a, 20-141, 20-143, 20-146, 20-146a, 20-149, 20-153, 20-154, 20-162n, 20-162p, 20-188, 20-189, 20-190, 20-192, 20-193, 20-195a, 20-195m, 20-195p, 20-196, 20-198, 20-199, 20-200, 20-202, 20-206, 20-206a, 20-206m, 20-206p, 20-207, 20-211, 20-212, 20-213, 20-214, 20-217, 20-218, 20-220, 20-221, 20-222, 20-222a, 20-223, 20-224, 20-226, 20-227, 20-228, 20-229, 20-231, 20-235a, 20-236, 20-238, 20-241, 20-242, 20-243, 20-247, 20-250, 20-252, 20-252a, 20-255a, 20-256, 20-258, 20-262, 20-263, 20-267, 20-268, 20-269, 20-271, 20-272, 20-341d, 20-341e, 20-341f, 20-341g, 20-341m, 20-358, 20-361, 20-365, 20-396, 20-402, 20-404, 20-406, 20-408, 20-416, 20-474 to 20-476, inclusive, 20-571, 20-578, 21-7, 21a-11, 21a-86a, 21a-86c, 21a-116, 21a-138, 21a-150, 21a-150a, 21a-150b, 21a-150c, 21a-150d, 21a-150f, 21a-150j, 21a-240, 21a-249, 21a-260, 21a-274, 21a-283, 22-6f, 22-6g, 22-6i, 22-131, 22-150, 22-152, 22-165, 22-332b, 22-344, 22-358, 22a-29, 22a-54, 22a-65, 22a-66a, 22a-66l, 22a-66z, 22a-115, 22a-119, 22a-134g, 22a-134bb, 22a-137, 22a-163a, 22a-163i, 22a-176, 22a-191, 22a-192, 22a-208q, 22a-231, 22a-240, 22a-240a, 22a-295, 22a-300, 22a-308, 22a-337, 22a-352, 22a-354i, 22a-354k, 22a-354w, 22a-354x, 22a-354aa, 22a-355, 22a-356, 22a-358, 22a-361, 22a-363b, 22a-371, 22a-378, 22a-423, 22a-424, 22a-426, 22a-430, 22a-434a, 22a-449i, 22a-471, 22a-474, 22a-601, 25-32, 25-32b, 25-32c, 25-32d, 25-32e, 25-32f, 25-32g, 25-32h, 25-32i, 25-32k, 25-32l, 25-33, 25-33a, 25-33c, 25-33d, 25-33e, 25-33f, 25-33g, 25-33h, 25-33i, 25-33j, 25-33k, 25-33l, 25-33n, 25-34, 25-35, 25-36, 25-37a, 25-37b, 25-37c, 25-37d, 25-37e, 25-37f, 25-37g, 25-39a, 25-39b, 25-39c, 25-40, 25-43b, 25-43c, 25-46, 25-49, 25-102gg, 25-128, 25-129, 25-137, 26-22, 26-119, 26-141b, 26-192a, 26-192b, 26-192c, 26-192e, 26-236, 27-140aa, 31-23, 31-40u, 31-51u, 31-101, 31-106, 31-111a, 31-111b, 31-121a, 31-222, 31-374, 31-397, 31-398, 31-400, 31-401, 31-402, 31-403, 32-23x, 38a-180, 38a-199, 38a-214, 38a-514, [38a-539,] 38a-583, 45a-743, 45a-745, 45a-749, 45a-750, 45a-757, 46a-28, 46a-126, 46b-26, 46b-172a, 47a-52, 52-146f, 52-146k, 52-473a, 52-557b, 53-332, 54-102a, 54-102b, 54-142k, 54-203.

Sec. 58. The Commissioner of Public Health shall conduct a study on whether additional categories of health care providers should be added to section 33 of this act creating public access to profiles on physicians. On or before January 1, 2001, the commissioner shall submit a report on the commissioner's findings and recommendations to the joint standing committee of the General Assembly having cognizance of matters relating to public health, in accordance with the provisions of section 11-4a of the general statutes.

Sec. 59. Sections 38a-514a and 38a-539 of the general statutes are repealed.

Sec. 60. This act shall take effect from its passage, except that sections 1 to 13, inclusive, 30 and 31 and 33 to 35, inclusive, and 49 shall take effect October 1, 1999, sections 15 and 16, 27 to 29, inclusive, 37 and 38, 40 to 48, inclusive, 50 to 57, inclusive, and 59 shall take effect January 1, 2000, and sections 17 to 26, inclusive, 32, 36 and 39 shall take effect July 1, 2000.

Approved June 29, 1999

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