Connecticut Governor Dannel Malloy recently signed into
law Public Act No. 16-205, "An Act Concerning
Standards and Requirements for Health Carriers' Provider
Networks and Contracts Between Health Carriers and Participating
Providers."
Under the new law, any contract between a healthcare provider and a
health carrier entered into, renewed or amended on or after January
1, 2017 must include, among other things, specific wording on
"hold harmless" provisions for covered persons;
insolvency provisions and protections; medical record release
requirements for participating providers; disclosure of all
provisions or documents incorporated into the participation
agreement by reference and timely notice of any changes thereto;
and a 60-day notice requirement for termination.
The new law requires each carrier to develop standards for
selecting and, if applicable, tiering participating providers,
but expressly maintains a health carrier's right to approve or
disapprove the participation status of a healthcare provider or
facility. Additionally, the law requires the health carrier to file
information with the state's Insurance Commission on the
adequacy of its participating provider network and any material
change to its existing network.
In addition to health insurers, Connecticut law defines
"health carrier" to include any other entity that
contracts to "provide, deliver, arrange for, pay for or
reimburse any of the costs of health care services, including a
sickness and accident insurance company, a health care center, a
managed care organization, a hospital service corporation, a
medical service corporation or any other entity providing a plan of
health insurance, health benefits or health care
services."
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.
