04-173, S. 2; P.A. 93-338 expanded the scope of the Health Reinsurance Association to include “health care centers”, increased membership of the board of directors of the Health Reinsurance Association from seven to nine, adding two representatives of health care centers and added new Subsec. Clinical trials: Standardized forms. (c) defining “home health agency” as Subsec. (D) The number of insureds by coverage tier, including, but not limited to, single, two-person and family including dependents, by month; (2) Include in such information specified in subdivision (1) of this subsection only health information that has had identifiers removed, as set forth in 45 CFR 164.514, is not individually identifiable, as defined in 45 CFR 160.103, and is permitted to be disclosed under the Health Insurance Portability and Accountability Act of 1996, P.L. (H) and (I) re advertisement procedures and qualification as acceptable alternative mechanism, respectively, redesignating existing Subpara. P.A. The code they wanted to use was CPT 99397 which is the wrong one for my age; it should be CPT 99396. 87-275 amended Subsec. 06-196 made a technical change in Subsec. (6) Each independent review organization shall maintain written records as set forth in subsection (e) of section 38a-591m. (a)(7) by deleting “private” re licensed clinical laboratory in clause (iii), effective June 7, 2006; P.A. The report shall contain (1) an aggregation of the information submitted to the commissioner pursuant to subsection (a) of this section for the immediately preceding calendar year, and (2) such other information as the commissioner, in the commissioner's discretion, deems relevant for the purposes of this section. History: Sec. Sec. (P.A. Sec. (Formerly Sec. Regulations. 86-366, S. 2; P.A. (e) re posting of data on Insurance Department's web site, effective July 1, 2010; P.A. Sec. (b) re effective date of rates and rate standards; P.A. (x) and (y); P.A. 01-101 defined, in new Subsec. 100.). 91-407, S. 6, 42; June Sp. (7); P.A. Sec. Learn CPT Code for MRI Brain, Breast, Lumbar Spine and Shoulder billing. Sec. Sec. 18-159, S. 1; P.A. 87-274, S. 2; P.A. 17-2, S. (d) The fee information received by a provider pursuant to subdivision (1) of subsection (b) of this section is proprietary and shall be confidential, and the procedure adopted pursuant to this section may contain penalties for the unauthorized distribution of fee information, which may include termination of the participating provider contract. Mandatory coverage for pain management. An issuer shall not use or change premium rates for a long-term care policy or certificate unless the rates have been filed with the Insurance Commissioner. (a) Subject to the provisions of subsection (b) of this section, each individual health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 delivered, issued for delivery, amended, renewed or continued in this state shall provide coverage for expenses arising from human leukocyte antigen testing, also referred to as histocompatibility locus antigen testing, for A, B and DR antigens for utilization in bone marrow transplantation. Sec. Sec. Gag clauses prohibited. Any rate filings or rate revisions shall demonstrate that anticipated claims in relation to premiums when combined with actual experience to date can be expected to comply with the loss ratio requirement of this section. Any individual or any such entity that fails to provide timely notice shall be fined not more than two thousand dollars for each violation. 38a-542 for similar provisions re group policies. See Sec. 18-68 made a technical change in Subsec. (a) Providers, hospitals and institutions that provide routine patient care services as set forth in subsection (a) of section 38a-504d as part of a clinical trial that meets the requirements of sections 38a-504a to 38a-504g, inclusive, and is approved for coverage by the insurer or health care center shall not bill the insurer or health care center or the insured person for any facility, ancillary or professional services or costs that are not routine patient care services as set forth in subsection (a) of section 38a-504d or for any product or service that is paid by the entity sponsoring or funding the clinical trial. 98-27 amended Subsec. (P.A. 12-145, S. 18; P.A. 38a-573. The time periods shall commence at the time of delivery. (d) Each insurance company, fraternal benefit society, hospital service corporation, medical service corporation, health care center or other entity in the state issuing Medicare supplement policies or certificates for plan “A”, “B” or “C”, or any combination thereof, to persons eligible for Medicare by reason of age, shall offer for sale the same such policies or certificates to persons eligible for Medicare by reason of disability. 12-145, S. 59; P.A. (a), redesignated existing Subsec. Sec. No group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 delivered, issued for delivery, amended, renewed or continued in this state shall deny coverage for health care services rendered to treat any injury sustained by any person when such injury is alleged to have occurred or occurs under circumstances in which (1) such person has an elevated blood alcohol content, or (2) such person has sustained such injury while under the influence of intoxicating liquor or any drug or both. (3) Payment of such reasonable expenses as may be necessary to compensate the commissioner in connection with the proceedings under this subsection, which shall be dedicated exclusively to the regulation of utilization review. 15-247 amended Subsec. The Eighth edition of Medical Insurance: A Revenue Cycle Process Approach emphasizes the revenue cycle—ten steps that clearly identify all the components needed to successfully manage the medical insurance claims process . Definitions. 76.). (f) as (e) and added exception for managed care plans, redesignated former Subsecs. (4) (A) Not later than one business day after the preliminary review of an external review request or the day the preliminary review of an expedited external review request is completed, the health carrier shall notify the commissioner, the covered person and, if applicable, the covered person's authorized representative in writing whether the request for an external review or an expedited external review is complete and eligible for such review. (i) to (k) and (o); P.A. as necessary; P.A. Deductibles. Each individual health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (6), (10), (11) and (12) of section 38a-469, delivered, issued for delivery, renewed, amended or continued in this state shall provide coverage for hypodermic needles or syringes prescribed by a prescribing practitioner, as defined in subdivision (24) of section 20-571, for the purpose of administering medications for medical conditions, provided such medications are covered under the policy. Sess. (2), delete “skills” in Subdiv. Group health insurance policy to contain definition of “medically necessary” or “medical necessity”. (a) and amended same to insert reference to American College of Radiology, add exception re Subsec. 38a-542c for similar provisions re group policies. (d) to require coverage on the same basis as for outpatient prescription drugs; P.A. Sec. (a)(1) As used in this section, “long-term care policy” means any individual health insurance policy delivered or issued for delivery to any resident of this state on or after July 1, 1986, that is designed to provide, within the terms and conditions of the policy, benefits on an expense-incurred, indemnity or prepaid basis for necessary care or treatment of an injury, illness or loss of functional capacity provided by a certified or licensed health care provider in a setting other than an acute care hospital, for at least one year after an elimination period (A) not to exceed one hundred days of confinement, or (B) of over one hundred days but not to exceed two years of confinement, provided such period is covered by an irrevocable trust in an amount estimated to be sufficient to furnish coverage to the grantor of the trust for the duration of the elimination period. (c) re groups of between 3 and 25 employees or members; Sec. (b)(8) that written notice be delivered not only to the insured but also to any dependents listed on the application and any subsequent revisions thereto; (Revisor's note: When P.A. (A) and add “of an entire breast or breasts” and delete reference to American College of Radiology in Subpara. 97-268, S. 2; June 18 Sp. 10-5, S. 33; P.A. 97-112 replaced “home for the aged” with “residential care home”; P.A. Provision of service to certain low-income individuals. (5) Diabetic ketoacidosis devices in accordance with the insured's diabetes treatment plan, including, but not limited to, diabetic ketoacidosis devices prescribed and dispensed pursuant to subsection (d) of section 20-616 once during a policy year. History: P.A. (8) “Clinical review criteria” means the written screening procedures, decision abstracts, clinical protocols and practice guidelines used by the health carrier to determine the medical necessity and appropriateness of health care services. Sec. Subpoenas. Appeals. 03-199 substituted “may adopt” for “shall adopt” re regulations; P.A. ; and (3) 2794, 42 USC 300gg-94. (1949 Rev., S. 6183; 1951, S. 2840d; P.A. 84-375, S. 2, 4; P.A. P.A. (B) The health carrier shall make such records available for examination by covered persons, to the extent such records are permitted to be disclosed by law, the commissioner and appropriate federal oversight agencies upon request. Sec. 38a-479iii. 38a-520 for similar provisions re group policies. 38a-550a for similar provisions re group policies. (d) to add exception re health underwriting if required premium or subscription fee and completed application materials are not provided before expiration of thirty-one-day period; P.A. Sec. (b) and amended same to add “diagnosis and”, delete references to physical therapy, speech therapy and occupational therapy services and the American Psychiatric Association's “Diagnostic and Statistical Manual of Mental Disorders”, delete provisions re limitation on coverage and add provision re autism spectrum disorder to be considered an illness, deleted former Subsec. Sec. Sec. 38a-478n with “section 38a-591g” in Subsec. (B) Such further medical examination and treatment, to the extent they are within the capability of the staff and facilities available at a hospital, to stabilize a patient. (b) No insurance company, fraternal benefit society, hospital service corporation, medical service corporation or health care center may deliver or issue for delivery any Medicare supplement policy that has an anticipated loss ratio of less than sixty-five per cent for any individual Medicare supplement policy defined in Section 1882(g) of Title XVIII of the Social Security Act, 42 USC 1395ss(g), as amended. 10.).
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