(a)For purposes of this section and sections 19a-904a, 19a-904b and 38a-477d to 38a-477f, inclusive:
(1)“Allowed amount” means the maximum reimbursement dollar amount that an insured's health insurance policy allows for a specific procedure or service;
(2)“Consumer health information Internet web site” means an Internet web site developed and operated by the Office of Health Strategy to assist consumers in making informed decisions concerning their health care and informed choices among health care providers;
(3)“Episode of care” means all health care services related to the treatment of a condition or a service category for such treatment and, for acute conditions, includes health care services and treatment provided from the onset of the condition to its resolution or a service categ
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(a) For purposes of this section and sections 19a-904a, 19a-904b and 38a-477d to 38a-477f, inclusive: (1) “Allowed amount” means the maximum reimbursement dollar amount that an insured's health insurance policy allows for a specific procedure or service; (2) “Consumer health information Internet web site” means an Internet web site developed and operated by the Office of Health Strategy to assist consumers in making informed decisions concerning their health care and informed choices among health care providers; (3) “Episode of care” means all health care services related to the treatment of a condition or a service category for such treatment and, for acute conditions, includes health care services and treatment provided from the onset of the condition to its resolution or a service category for such treatment and, for chronic conditions, includes health care services and treatment provided over a given period of time or a service category for such treatment; (4) “Commissioner” means the Commissioner of Health Strategy; (5) “Health care provider” means any individual, corporation, facility or institution licensed by this state to provide health care services; (6) “Health carrier” means any insurer, health care center, hospital service corporation, medical service corporation, fraternal benefit society or other entity delivering, issuing for delivery, renewing, amending or continuing any individual or group health insurance policy in this state providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 ; (7) “Hospital” has the same meaning as provided in section 19a-490 ; (8) “Out-of-pocket costs” means costs that are not reimbursed by a health insurance policy and includes deductibles, coinsurance and copayments for covered services and other costs to the consumer associated with a procedure or service; (9) “Outpatient surgical facility” has the same meaning as provided in section 19a-493b ; and (10) “Public or private third party” means the state, the federal government, employers, a health carrier, third-party administrator, as defined in section 38a-720 , or managed care organization. (b) (1) Within available resources, the consumer health information Internet web site shall: (A) Contain information comparing the quality, price and cost of health care services, including, to the extent practicable, (i) comparative price and cost information for the health care services and procedures reported pursuant to subsection (c) of this section categorized by payer or listed by health care provider, (ii) links to Internet web sites and consumer tools where consumers may obtain comparative cost and quality information, including The Joint Commission and Medicare hospital compare tool, (iii) definitions of common health insurance and medical terms so consumers may compare health coverage and understand the terms of their coverage, and (iv) factors consumers should consider when choosing an insurance product or provider group, including provider network, premium, cost sharing, covered services and tier information; (B) be designed to assist consumers and institutional purchasers in making informed decisions regarding their health care and informed choices among health care providers and, to the extent practicable, provide reference pricing for services paid by various health carriers to health care providers; (C) present information in language and a format that is understandable to the average consumer; and (D) be publicized to the general public. All information outlined in this section shall be posted on an Internet web site established, or to be established, by the Commissioner of Health Strategy in a manner and time frame as may be organizationally and financially reasonable in his or her sole discretion. (2) Information collected, stored and published by the Office of Health Strategy pursuant to this section is subject to the federal Health Insurance Portability and Accountability Act of 1996, P.L. 104-191, as amended from time to time. (3) The Commissioner of Health Strategy may consider adding quality measures to the consumer health information Internet web site. (c) Not later than January 1, 2018, and annually thereafter, the Commissioner of Health Strategy shall, to the extent the information is available, make available to the public on the consumer health information Internet web site a list of: (1) The fifty most frequently occurring inpatient services or procedures in the state; (2) the fifty most frequently provided outpatient services or procedures in the state; (3) the twenty-five most frequent surgical services or procedures in the state; (4) the twenty-five most frequent imaging services or procedures in the state; and (5) the twenty-five most frequently used pharmaceutical products and medical devices in the state. Such lists may (A) be expanded to include additional admissions and procedures, (B) be based upon those services and procedures that are most commonly performed by volume or that represent the greatest percentage of related health care expenditures, or (C) be designed to include those services and procedures most likely to result in out-of-pocket costs to consumers or include bundled episodes of care. (d) Not later than January 1, 2018, and annually thereafter, to the extent practicable, the Commissioner of Health Strategy shall issue a report, in a form and manner prescribed by the commissioner, that includes the (1) billed and allowed amounts paid to health care providers in each health carrier's network for each service and procedure included pursuant to subsection (c) of this section, and (2) out-of-pocket costs for each such service and procedure. (e) (1) On and after January 1, 2018, each hospital shall, at the time of scheduling a service or procedure for nonemergency care that is included in the report prepared by the Commissioner of Health Strategy pursuant to subsection (d) of this section, regardless of the location or setting where such services are delivered, notify the patient of the patient's right to make a request for cost and quality information. Upon the request of a patient for a diagnosis or procedure included in such report, the hospital shall, not later than three business days after scheduling such service or procedure, provide written notice, electronically or by mail, to the patient who is the subject of the service or procedure concerning: (A) If the patient is uninsured, the amount to be charged for the service or procedure if all charges are paid in full without a public or private third party paying any portion of the charges, including the amount of any facility fee, or, if the hospital is not able to provide a specific amount due to an inability to predict the specific treatment or diagnostic code, the estimated maximum allowed amount or charge for the service or procedure, including the amount of any facility fee; (B) the corresponding Medicare reimbursement amount or, if there is no corresponding Medicare reimbursement amount for such diagnosis or procedure, (i) the approximate amount Medicare would have paid the hospital for the services on the billing statement, or (ii) the percentage of the hospital's charges that Medicare would have paid the hospital for the services; (C) if the patient is insured, the allowed amount, the toll-free telephone number and the Internet web site address of the patient's health carrier where the patient can obtain information concerning charges and out-of-pocket costs; (D) The Joint Commission's composite accountability rating and the Medicare hospital compare star rating for the hospital, as applicable; and (E) the Internet web site addresses for The Joint Commission and the Medicare hospital compare tool where the patient may obtain information concerning the hospital. (2) If the patient is insured and the hospital is out-of-network under the patient's health insurance policy, such written notice shall include a statement that the service or procedure will likely be deemed out-of-network and that any out-of-network applicable rates under such policy may apply.