Senate Passes Landmark Bipartisan Hospital and Health Care Reforms

Senate President Martin M. Looney (D-New Haven) along with Senate Minority Leader Len Fasano (R-North Haven) today led passage of a comprehensive package of hospital and health care reforms. The legislative package was drafted in response to a shifting healthcare landscape and is the result of discussions held over the past 6 months by the bipartisan Hospitals Roundtable, a group created and co-chaired by Looney and Fasano.

“This historic bill represents bold action protecting consumers from the anticompetitive practices that have increased costs for consumers,” said Sen. Looney. “The legislation sets a framework which will make information on cost and quality available to both individual patients as well as institutional purchasers. I want to thank, my friend, Sen. Fasano for his leadership and partnership on this important issue.”

“This collaborative effort marks a tremendous step forward for health care in our state,” said Senator Fasano. “I applaud Sen. Looney for his leadership and partnership.”

The bipartisan legislative package:

• Presents comprehensive initiatives to reduce costs for consumers
• Maintains access to affordable quality care
• Empowers consumers to make the best health care decisions for them and their families
• Supports low cost high quality providers to ensure continued diversity and competition in the market

Price Transparency

• Develop a consumer health information website that allows consumers to compare cost and quality data across all payers and providers and enables them to make informed choices regarding their care
• Require providers to give consumers timely information regarding the price of scheduled procedures and services and report allowed amounts and prices charged for the most common inpatient and outpatient procedures
• Require prescription drug disclosures regarding coverage, out of pocket costs, prior authorization requirements

Surprise Billing

• Require insurers to cover the costs of emergency medical services, no balance billing
• Prevent out-of-network providers from billing patients for services when the patient had no notice of the providers’ out of network status.
• Hold patients harmless in terms of out-of-pocket costs if a surprise bill occurs because no in network provider is available, an out of network provider fails to inform a patient that they are out of network, or an out of network provider provides service at an in-network facility without patient’s knowledge or consent.

Facility Fees

• Bans the fees for Evaluation and Management visits (simple office visits) in community based physician offices where facility fees have traditionally never been charged and limits facility fees for the uninsured to the Medicare rate
• Protects insureds from multiple copays for facility fees
• Enhance transparency by requiring physician practices to notify patients if they are acquired by a hospital and will therefore be charging facility fees. Also requires facility fees be labeled as such on all billing.

Site Neutral Reimbursements

• Insurers will provide equal reimbursement to all providers for common outpatient services, regardless of whether they are employed by a hospital or are independent

Health Information Exchange

• Enables health records to follow the patient
• Will establish a State Health Information Exchange to allow patients and providers of their choice real time access to complete medical records
• Tasks the Department of Social Services with issuing an RFP to contract with an existing successful state or regional exchange to operate and manage a similar exchange program in Connecticut.
• Discourages providers and vendors from imposing barriers on sharing information by making such activity an unfair trade practice

Hospital Sales

• Amends existing certificate of need process that already applies to all sales to focus on maintaining competition in the market and a level playing field for all sales
• Requires a Cost and Market Impact Review for sales involving large hospital systems and for profits
• Factors to consider when approving an application include consolidation in the market that may lessen competition and raise prices and total health care spending
• Require purchasers to submit five year post sale service plan (three year if sale involved a large health system or for-profit entity) and disclose executive officer financial incentives or agreements that may be contingent on the sale

Future Studies

• Authorizes existing Health Care Cabinet to examine cost containments models in other states, consider establishing health care cost growth benchmarks, analyze cost data, and consider policy recommendation to enhance competition, improve cost effectiveness and improve quality of care
• Working Group of the Health Care Cabinet to conduct a Price Disparity Study to identify extant of variation between providers, causes and recommend policies to reduce disparity
• Develop a Community Hospital Support Program to assist community hospitals in (a) modernizing infrastructure to improve care coordination and integrate resources and (b) adopting electronic medical records and data systems to support the analytics necessary to manage population health and participate in modern care and payment models.