-Contributed by R+C’s Health Law Group
Effective October 1, 2015, this legislation requires the Connecticut Health Insurance Exchange (HIX) to establish, by July 1, 2016, a consumer health information website that contains information comparing the quality, price, and cost of health care services among health care providers in Connecticut. The HIX website must include price and cost information for the most common inpatient diagnoses and procedures, outpatient procedures, and surgical and imaging procedures based on a list published by the Department of Public Health (DPH) and the Insurance Department (DPH List). This information will be listed by health care provider and categorized by third-party payer. The HIX website must also include information to assist consumers in making informed health care decisions, such as what to consider when choosing a health care provider, as well as links to the Joint Commission and Medicare websites, where consumers can obtain information to compare the quality of health care providers. The information must be publicized in a language and format understandable to the average consumer. Notwithstanding the above, the legislation allows the HIX sole discretion on the manner and timeframe for posting information to the consumer health website.
Under this new legislation, as of January 1, 2017, hospitals will be required to inform a patient of the right to request cost and quality information at the time of scheduling a diagnosis or procedure for nonemergency care that is on the DPH List. If the patient requests such information regarding the diagnosis or procedure, a hospital must, within three business days, provide the patient information on (1) the amount the patient will be charged if uninsured, including the amount of a facility fee; (2) the Medicare reimbursement amount; (3) if the patient is insured, the allowed amount and the insurer’s contact information so that the patient may obtain additional information regarding charges and out-of-pocket costs; (4) the hospital’s Joint Commission composite accountability rating and Medicare star rating; and (5) the website addresses for the Joint Commission and Medicare hospital compare tool. If the patient is insured and the hospital is out-of-network under the insurance policy, the hospital’s notice must also state that out-of-network rates may apply.