Bill Text: CT SB01090 | 2013 | General Assembly | Introduced

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Bill Title: An Act Decreasing The Time Frame For Certain Adverse Determination Grievances.

Spectrum: Committee Bill

Status: (Introduced - Dead) 2013-03-08 - Public Hearing 03/12 [SB01090 Detail]

Download: Connecticut-2013-SB01090-Introduced.html

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General Assembly		Raised Bill No. 1090
January Session, 2013		LCO No. 2571
		*02571_______INS*
Referred to Committee on INSURANCE AND REAL ESTATE
Introduced by:
(INS)

AN ACT DECREASING THE TIME FRAME FOR CERTAIN ADVERSE DETERMINATION GRIEVANCES.

Be it enacted by the Senate and House of Representatives in General Assembly convened:

Section 1. Subdivision (1) of subsection (c) of section 38a-591d of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2013):

(1) Unless the covered person or the covered person's authorized representative has failed to provide information necessary for the health carrier to make a determination, the health carrier shall make a determination as soon as possible, taking into account the covered person's medical condition, but not later than [seventy-two] twenty-four hours after the health carrier receives such request, provided, if the urgent care request is a concurrent review request to extend a course of treatment beyond the initial period of time or the number of treatments, such request is made at least twenty-four hours prior to the expiration of the prescribed period of time or number of treatments;

Sec. 2. Subdivision (1) of subsection (d) of section 38a-591e of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2013):

(d) (1) The health carrier shall notify the covered person and, if applicable, the covered person's authorized representative, in writing or by electronic means, of its decision within a reasonable period of time appropriate to the covered person's medical condition, but not later than:

(A) For prospective review and concurrent review requests, thirty calendar days after the health carrier receives the grievance;

(B) For retrospective review requests, sixty calendar days after the health carrier receives the grievance; and

(C) For expedited review requests, [seventy-two] twenty-four hours after the health carrier receives the grievance.

Sec. 3. Subdivision (1) of subsection (i) of section 38a-591g of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2013):

(i) (1) The independent review organization shall notify the commissioner, the health carrier, the covered person and, if applicable, the covered person's authorized representative in writing of its decision to uphold, reverse or revise the adverse determination or the final adverse determination, not later than:

(A) For external reviews, forty-five calendar days after such organization receives the assignment from the commissioner to conduct such review;

(B) For external reviews involving a determination that the recommended or requested health care service or treatment is experimental or investigational, twenty calendar days after such organization receives the assignment from the commissioner to conduct such review;

(C) For expedited external reviews, as expeditiously as the covered person's medical condition requires, but not later than [seventy-two] twenty-four hours after such organization receives the assignment from the commissioner to conduct such review; and

(D) For expedited external reviews involving a determination that the recommended or requested health care service or treatment is experimental or investigational, as expeditiously as the covered person's medical condition requires, but not later than five calendar days after such organization receives the assignment from the commissioner to conduct such review.

This act shall take effect as follows and shall amend the following sections:
Section 1	October 1, 2013	38a-591d(c)(1)
Sec. 2	October 1, 2013	38a-591e(d)(1)
Sec. 3	October 1, 2013	38a-591g(i)(1)

Statement of Purpose:

To decrease the time for review decisions to be made by health carriers and independent review organizations for certain adverse determination grievances from seventy-two hours to twenty-four hours.

[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not underlined.]