This legislation (P.A. 16-77) makes substantive and technical changes related to Public Act 15-146, a major public health and health care bill passed by the Connecticut Legislature during its 2015 Legislative Session.
CONNECTICUT HEALTH INSURANCE EXCHANGE CONSUMER INFORMATION WEBSITE
Under current law, Connecticut’s Health Insurance Exchange (HIX) is required, within available resources, to establish and maintain a consumer health information website by July 1, 2016. The HIX website must include price and cost information for the most common inpatient diagnoses and procedures, outpatient procedures, and surgical and imaging procedures, listed by health care provider and categorized by third-party payer, based on a list published by the Department of Public Health (DPH) and the Insurance Department (CID) on their websites (Joint Report).
Current law provides that, starting January 1, 2017, hospitals will be required to inform a patient of the patient’s right to request cost and quality information at the time of scheduling a diagnosis or procedure for nonemergency care listed on the Joint Report. 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.
P.A. 16-77 delays the implementation date for requiring hospitals to provide patients with notice of their right to request cost and quality information. Under this legislation, hospitals will not be required to provide such notices until 180 days after the CID and the DPH issue the Joint Report on their websites. Additionally, in the event a patient’s diagnosis or procedure has no corresponding Medicare reimbursement amount, this legislation requires a hospital to
instead notify the patient of either the approximate amount or the percentage of the hospital’s charges that Medicare would have paid for the services. P.A. 16-77 also clarifies that the location or setting of scheduled nonemergency care is immaterial for purposes of implicating the notice requirement.
HEALTH INSURER CONSUMER INFORMATION WEBSITES
Current law requires health insurance carriers in Connecticut to maintain a website and toll-free telephone number to allow consumers to obtain insurance cost and network information related to specific procedures and providers by July 1, 2016. P.A. 16-77 delays the deadline for establishing this website until January 1, 2017, and also exempts all health insurance carriers with less than 40,000 covered lives in Connecticut from having to maintain such a website.
This post was co-authored by Stephen W. Aronson, Lisa M. Boyle, Leslie J. Levinson, Brian D. Nichols, Lisa M. Thompson, Theodore J. Tucci, Pamela H. Del Negro, Meaghan Mary Cooper, Nathaniel T. Arden, Conor O. Duffy and Erica S. Youngerman and is being shared from our Health Law Pulse publication. If you’re interested in getting updates on developments in health care, we invite you to subscribe to our publication.