§ 38a-477h — Participating provider directories.

Connecticut § 38a-477h

• Jurisdiction: Connecticut
• Title 38a: Insurance
• Ch. 700c: Health Insurance

Text

(a) As used in this section: (1) “Covered person”, “facility” and “health carrier” have the same meanings as provided in section 38a-591a, (2) “health care provider” has the same meaning as provided in subsection (a) of section 38a-477aa, and (3) “intermediary”, “network”, “network plan” and “participating provider” have the same meanings as provided in subsection (a) of section 38a-472f. (b) (1) Each health carrier shall post on its Internet web site a current and accurate participating provider directory, updated at least monthly, for each of its network plans. The health carrier shall ensure that consumers are able to view all of the current participating providers for a network plan through a clearly identifiable link or tab on such health carrier's Internet web site, without being required to create or access an account or enter a policy or contract number. (2) Each health carrier shall provide, upon request from a covered person or a covered person's representative, a print copy of such directory or of requested information from such directory. (c) (1) A health carrier shall include in each such electronic or print directory the following information in plain language: (A) A description of the criteria the health carrier used to build its network; (B) if applicable, a description of the criteria the health carrier used to tier its participating providers; (C) if applicable, a description of how the health carrier designates the different participating provider tiers or levels in the network and identifies, for each specific participating provider, in which tier each is placed, such as by name, symbols or grouping, to allow a consumer to be able to identify the participating provider tiers; and (D) if applicable, a statement that authorization or referral may be required to access some participating providers. (2) Each such directory shall also include a customer service electronic mail address and telephone number or an Internet web site address that covered persons or consumers may use to notify the health carrier of any inaccurate participating provider information in such directory. (3) Each health carrier shall make it clear for each such electronic or print directory which directory applies to which network plan, such as by including the specific name of the network plan as marketed and issued in this state. (4) Each such electronic or print directory shall accommodate the communication needs of individuals with disabilities and include an Internet web site address or information regarding available assistance for individuals with limited English proficiency. (d) (1) The health carrier shall make available through an electronic participating provider directory, for each of its network plans, the following information in a searchable format: (A) For health care providers, (i) the health care provider's name, gender, participating office location or locations, specialty, if applicable, medical group affiliations, if any, facility affiliations, if applicable, participating facility affiliations, if applicable, (ii) any languages other than English spoken by such health care provider, (iii) whether such health care provider is accepting new patients, and (iv) if such health care provider is accepting new patients, whether such health care provider is accepting new patients on an outpatient services basis; (B) For hospitals, the hospital name, the hospital type, such as acute, rehabilitation, children's or cancer, the participating hospital location and the hospital's accreditation status; and (C) For facilities other than hospitals, by type, the facility name, the facility type, the types of health care services performed at the facility and the participating facility location or locations and telephone number or numbers. (2) In addition to the information required under subdivision (1) of this subsection, the health carrier shall make available through the electronic directory specified under subdivision (1) of this subsection, for each of its network plans, the following information: (A) For health care providers, the health care provider's contact information, board certification and any languages other than English spoken by clinical staff, if applicable; (B) For hospitals, the hospital's telephone number; and (C) For facilities other than hospitals, the facility's telephone number. (3) (A) Each health carrier shall make available in print, upon request, the following participating provider directory information for the applicable network plan: (i) For health care providers, (I) the health care provider's name, contact information, specialty, if applicable and participating office location or locations, (II) any languages other than English spoken by such health care provider, (III) whether such health care provider is accepting new patients, and (IV) if such health care provider is accepting new patients, whether such health care provider is accepting new patients on an outpatient services basis; (ii) For hospitals, the hospital name, the hospital type, such as acute, rehabilitation, children's or cancer and the participating hospital location and telephone number; and (iii) For facilities other than hospitals, by type, the facility name, the facility type, the types of health care services performed at the facility and the participating facility location or locations and telephone number or numbers. (B) Each health carrier shall include with the print directory information under subparagraph (A) of this subdivision and in the print participating provider directory under subdivision (2) of subsection (a) of this section a statement that the information provided or included is accurate as of the date of printing, that covered persons or prospective covered persons should consult the health carrier's electronic participating provider directory on such health carrier's Internet web site and that covered persons may call the telephone number on such covered person's insurance card for more information. (4) For the information required to be included in a participating provider directory pursuant to subdivisions (1) and (2) of this subsection, each health carrier shall make available through such directory the sources of such information and any limitations on such information, if applicable. (e) Each health carrier shall periodically audit at least a reasonable sample size of its participating provider directories for accuracy and retain documentation of such audit to be made available to the commissioner upon request.

Legislative History

(P.A. 16-205, S. 3; P.A. 17-154, S. 1.) History: P.A. 16-205 effective January 1, 2017; P.A. 17-154 amended Subsec. (d) by adding Subdivs. (1)(A)(iv) and (3)(A)(i)(IV) re disclosure of information concerning health care providers accepting new patients on an outpatient services basis and made technical changes, effective January 1, 2018.