No. SB 46
Filed under Insurance.
Nonparticipating and Out-of-network Nurse Registries and Home Health Agencies; Prohibiting state group health insurance plans and state-contracted health maintenance organizations, the Agency for Health Care Administration, Medicaid managed care plans, individual health insurers, and health maintenance organizations, respectively, and any persons responsible for administering claims on behalf of such plans, organizations, agency, or insurers, from restricting participants, recipients, enrollees, policyholders, and subscribers from obtaining care from nonparticipating or out-of-network licensed nurse registries or home health agencies; revising applicability for group health insurance, blanket health insurance, and franchise health insurance, etc.
Plain English Summary
AI-GENERATEDState group health plans, Medicaid, Medicaid managed care plans, individual and group health insurers, and HMOs can no longer stop a patient from getting care from a licensed nurse registry or home health agency outside their network.
These plans also cannot steer, require, or unduly influence a patient toward an in-network provider instead, going beyond simply allowing out-of-network care.
Out-of-network nurse registries and home health agencies must be paid the same rate as in-network providers for the same services, overriding the usual out-of-network reimbursement rules for health insurers and HMOs.
AIBars state group health plans, Medicaid, Medicaid managed care plans, individual health insurers, and HMOs from restricting patients from obtaining care from a nonparticipating or out-of-network nurse registry or home health agency licensed under part III of chapter 400.
AIGoes beyond banning outright restriction: these plans also may not steer, require, or unduly influence a patient to use a preferred or in-network nurse registry or home health agency instead of the out-of-network one the patient chose.
AIRequires nonparticipating and out-of-network nurse registries and home health agencies to be reimbursed at the same rate as in-network providers for equivalent services, removing the usual pay gap between in- and out-of-network care.
AIAdds the individual-policy version of this rule to the list of provisions that also apply to group health insurance, blanket health insurance, and franchise health insurance, so those policies get the same protections as individual policies.
AIFor individual health insurers, expressly overrides sections 627.6471 and 627.64194, the general statutes that otherwise govern steering practices and out-of-network reimbursement, so those existing rules give way to this bill's requirements for nurse registries and home health agencies specifically.