CT SB00807

Insurance Commissioner shall establish a pilot program by January 1, 2016 requiring health insurers and health care entities to offer at least one tiered provider network policy with lower copayments and deductibles for choosing low-cost, high-quality providers, running for not less than three years.

Base premiums for tiered network policies must be at least 10 percent lower than comparable non-tiered policies, with cost-sharing variations that are reasonable and provide adequate access at all tier levels.

Insurance Commissioner and Commissioner of Public Health must jointly develop standard forms for health care billing, benefit summaries, prior authorization requests, and other industry forms by January 1, 2016, and submit proposed legislation by February 1, 2016.

Hospitals must negotiate separately with insurers and health care providers even if commonly owned; contracts cannot require insurers to contract with all provider locations or prohibit price and claims information disclosure.

All health insurers and entities contracting with health care providers must implement site-neutral reimbursement policies requiring equal payment for evaluation/management visits and certain ambulatory procedures regardless of service location, effective October 1, 2015.