SB 426 — AN ACT CONCERNING CONTRACTS BETWEEN HEALTH CARRIERS AND HEALTH CARE PROVIDERS, AGENTS OR VENDORS, PARTICIPATING PROVIDER DIRECTORIES AND SURPRISE BILLS.

General Assembly   CommitteeSubstitute Bill No.

426 January Session, 2017   LCO*_____SB00426INS___031617____* No.AN ACT CONCERNING CONTRACTS BETWEEN HEALTH CARRIERS AND HEALTH CARE PROVIDERS, AGENTS OR VENDORS, PARTICIPATING PROVIDER DIRECTORIES AND SURPRISE BILLS.

4813   *04813SB00426INS* Referred to Committee on INSURANCE AND REAL ESTATE   Introduced by:

  (INS)   AN ACT CONCERNING CONTRACTS BETWEEN HEALTH CARRIERS AND HEALTH CARE PROVIDERS, AGENTS OR VENDORS, PARTICIPATING PROVIDER DIRECTORIES AND SURPRISE BILLS.

[for the purpose of]of Suchassisting] informationInformation described in subdivisions (1) and (2) of this subsection may be used forto purposesassist such as assisting consumers and institutional purchasers in making informed decisions regarding their health care and informed choices among health care providers and allow comparisons between prices paid by various health carriers to health care providers.

Such print copy shall be provided to the person requesting such copy either (A) in person, or (B) by mail postmarked not later than five business days following the date ofthe request is received by the request.health carrier.

(6) (A) "Surprise bill" means a bill for health care services, other than emergency services, received by an insured for services rendered by an out-of-network health care provider, where such services were rendered by such out-of-network provider (1)(i) at an in-network facility, (2)(ii) during a service or procedure performed by an in-network provider, (3)(iii) or during a service or procedure previously approved or authorized by the health carrier, [and the insured did not knowingly elect to obtain such services from such out-of-network provider] or (4)(iv) upon the referral of an in-network provider and without the express written consent of the insured acknowledging that the in-network provider is referring the insured to an out-of-network provider and that the referral may cause the insured to incur costs not covered by the health carrier.

(B) "Surprise bill" does not include a bill for health care services received by an insured when (i) an in-network health care provider was made available to the insured to render such servicesservices, and[and] (ii) the insured knowingly [elected] and voluntarily consented, in writing, to obtain such services from another health care provider who was out-of-network and acknowledged, in writing, that such services might result in costs not covered by the health carrier.carrier, and (iii) for scheduled health care services, the health care provider obtained such written consent on the earlier of:

For(I) scheduledThe healthdate careon services,which athe health care providerprovider, shallor obtainany suchperson writtenon consentbehalf whenof thesuch providerprovider, firstscheduled discoversa thatdate for the provider isto anrender out-of-network provider or immediately before such services areto rendered,the whicheverinsured; shall occur first.

(II) the date on which the health care provider first discovered that the provider is an out-of-network provider;

or (III) forty-eight hours before the health care provider rendered such services to the insured.

(3) (A) If emergency services were rendered to an insured by an out-of-network health care provider, such health care provider may bill the health carrier directly and the health carrier shall, within fivethirty days, reimburse such health care provider the greatest of the following amounts:

The health carrier shall, not later than thirty days after the out-of-network health care provider renderedbilled such carrier for such services, reimburse the out-of-network health care provider [or insured, as applicable,] for the health care services rendered [at the in-network rate under the insured's health care plan as payment in full, unless such health carrier and health care provider agree otherwise]otherwise.] at the billed amount or, if the health carrier determines that the billed amount is unreasonable, an amount that is not less than the average in-network rate paid to similarly qualified health care providers for the same services in the same region.

3 January 1, 2018 38a-477aa Statement of Purpose:Legislative Commissioners:

ToIn (1)Section prohibit1(a), contracts"[for betweenthe healthpurpose carriersof] andSuch healthinformation caredescribed providers,in orsubdivisions agents(1) orand vendors(2) of healththis caresubsection providers,may frombe proscribingused disclosurefor ofpurposes certainsuch information,as (2)assisting" requirewas thatchanged healthto carriers"[for maintainthe accurate,purpose currentof andassisting] detailedInformation preferreddescribed providerin directories,subdivisions (1) and (3)(2) restrictof surprisethis billssubsection formay healthbe careused services.to assist" for clarity.

[ProposedINS deletionsJoint areFavorable enclosedSubst. in brackets.

Proposed additions are indicated by underline, except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not underlined.] Co-Sponsors:

SEN.

LOONEY, 11th Dist.;

SEN.

FASANO, 34th Dist.

S.B.

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