On June 6, 2018, Connecticut Governor Dannel P. Malloy signed into law Public Act No. 18-115 “An Act Concerning Disputes Between Health Carriers and Participating Providers That Are Hospitals” (PA 18-115). This legislation updates state laws concerning the departure or removal of a hospital from an insurance carrier’s provider network. PA 18-115 takes effect July 1, 2018.
Under current law, a health insurance carrier or a health care provider participating in the carrier’s provider network must give 60 days’ prior written notice to the other before the health carrier removes the provider from the network or the provider leaves the network. PA 18-115 increases that minimum prior notice period from 60 to 90 days.
PA 18-115 also requires health carriers and participating providers that are hospitals (or a parent company of a hospital) to continue to comply with the terms of a participating provider contract that is not renewed or is terminated (including its reimbursement terms) for an additional 60 days after the effective date of such non-renewal or termination, except in certain circumstances.
- First, this new requirement only applies to participating provider contracts entered into, renewed, amended or continued on or after July 1, 2018.
- Second, this new requirement does not apply if the health carrier and the hospital mutually agree in writing to the termination or renewal of the contract and the parties provide all notices of such termination or non-renewal that are required by law in Connecticut.
- Notice requirements applicable to health carriers and/or participating providers in these circumstances include the 90-day notice period for termination or non-renewal of a participating provider agreement described above, as well as the requirement that a health carrier make a good faith effort to provide written notice to affected patients within 30 days after issuing or receiving notice of the termination or non-renewal of a participating provider from the carrier’s network, regardless of whether the termination or non-renewal is for cause.
Finally, PA 18-115 provides that if the health carrier and participating hospital enter into a new contract during the 60-day extension period, the reimbursement terms of the new contract are retroactive to the date the previous contract ended, unless the parties expressly agree otherwise.