PA 10-59—sSB 17

Insurance and Real Estate Committee

Public Health Committee

AN ACT CONCERNING HEALTH CARE PROVIDER RENTAL NETWORK CONTRACT ARRANGEMENTS

SUMMARY: The law allows entities that contract with health care providers (i. e. , “contracting entities”) to give third parties (i. e. , “covered entities”) access to the providers' services, rates, or fees under certain conditions (CGS 42-490, et seq. ). This act makes a violation of the law an unfair or deceptive insurance practice and authorizes the insurance commissioner to adopt regulations. It also (1) requires a contracting entity to update routinely and at least every 90 days its list of covered entities, which must be available to providers by law; (2) establishes requirements for a covered entity that subsequently gives others access to a provider's services, rates, or fees; and (3) permits a health care provider to file legal actions against contracting and covered entities.

EFFECTIVE DATE: October 1, 2010

CONTRACTING ENTITY

By law, each contracting entity that sells, leases, rents, assigns, or grants access to a health care provider's services, rates, or fees must:

1. give a provider who requests it, when first contracting with him or her, a list of all known covered entities to which it may give access to the provider's services, rates, or fees and

2. maintain a website or toll-free number through which a provider can obtain a listing of covered entities having access to his or her services, rates, or fees.

The act requires a contracting entity to update its list of covered entities routinely and at least every 90 days.

COVERED ENTITY

The act establishes requirements for a covered entity that subsequently sells, leases, rents, assigns, or grants access to a provider's services, rates, or fees to another third party. Specifically, such a covered entity must:

1. maintain a website or toll-free number through which a provider can obtain a listing of entities having access to his or her services, rates, or fees and

2. when giving access, inform the contracting entity and its directly-contracted providers of its website address or toll-free number.

The act requires a covered entity to update the list of entities to which it has granted access to providers' services, rates, or fees routinely and at least every 90 days.

BACKGROUND

Connecticut Unfair Insurance Practice Act (CUIPA)

The law prohibits engaging in unfair or deceptive insurance acts or practices. CUIPA authorizes the insurance commissioner to issue regulations, conduct investigations and hearings, issue cease and desist orders, ask the attorney general to seek injunctive relief in Superior Court, impose fines, revoke or suspend licenses, and order restitution.

Fines may be up to (1) $5,000 per violation to a $50,000 maximum or (2) $25,000 per violation to a $250,000 maximum in any six-month period if knowingly committed. The law also imposes a fine of up to $50,000, in addition to or in lieu of a license suspension or revocation, for violating a cease and desist order (CGS 38a-817).

OLR Tracking: JLK: KS: CR: ts