Connecticut Seal

General Assembly

 

Proposed Bill No. 807

 

January Session, 2015

 

LCO No. 2547

 

*02547*

Referred to Committee on INSURANCE AND REAL ESTATE

 

Introduced by:

 

SEN. LOONEY, 11th Dist.

SEN. FASANO, 34th Dist.

 

AN ACT CONCERNING FAIRNESS AND EFFICIENCY IN INSURANCE CONTRACTING.

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

That the general statutes be amended to: (1) Require the Insurance Commissioner to adopt regulations, in accordance with the provisions of chapter 54 of the general statutes, to develop a pilot program for tiered network plans that, without limiting the total number of health care providers or restricting the choice of health care providers within the plan, will require insurers that offer individual and small group health insurance policies to offer at least one tiered network plan and run for not less than three years. A tiered network plan shall (A) reward insureds for choosing low-cost, high-quality health care providers by offering lower copayments, deductibles or other out-of-pocket expenses, (B) limit variations in insureds' cost sharing between provider tiers to reasonable levels while providing adequate access to covered services at all tier levels including the lower cost-sharing tier, and (C) limit premiums for such plan to at least ten per cent lower than the premiums the insurer's nontiered plans that are actuarially similar. The commissioner, in consultation with the Healthcare Advocate and the chief executive officer of the Connecticut Health Insurance Exchange, shall annually review and report to the General Assembly on the implementation of the pilot program, including enrollment, utilization trends, costs, quality of care and outcomes for insureds and satisfaction of insureds, and shall make recommendations for any modifications to the program; (2) prohibit hospitals and health systems from (A) requiring insurers to contract with all health care provider locations or facilities within their system or for all services they offer, and (B) requiring insurers to pay the hospital rate for services provided in outpatient facilities or health care providers' offices; (3) prohibit hospitals from billing under the hospital's tax identification number for services provided outside the hospital; (4) require hospitals located in the same market to negotiate separately with insurers and health care providers even if such hospitals are commonly owned; (5) prohibit the inclusion of contract provisions that prohibit or limit the disclosure of price, cost or claims information; and (6) require the development and use of (A) uniform industry coding and billing and claim forms, and (B) standard forms for, including, but not limited to, benefit summaries, out-of-pocket expense explanations and prior authorization requests.

Statement of Purpose:

To promote the use of low-cost, high-quality health care providers, mitigate the anticompetitive effects of hospital consolidations and encourage administrative efficiency.