Title 38a — Title 38a: Insurance
33 chapters · 1,393 sections in this title.
Conn. Gen. Stat. § 38a-591 Compliance with the Patient Protection and Affordable Care Act. Regulations.
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Sec. 38a-591. Compliance with the Patient Protection and Affordable Care Act. Regulations. (a) For purposes of this section, “Affordable Care Act” means the Patient Protection and Affordable Care Act, P.L. 111-148, as amended from time to time, and regulations adopted thereunder.…
Conn. Gen. Stat. § 38a-591a *(See end of section for amended version of subdivision (7) and effective date.) Definitions.
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Sec. 38a-591a. *(See end of section for amended version of subdivision (7) and effective date.) Definitions. As used in this section and sections 38a-591b to 38a-591o, inclusive: (1) “Adverse determination” means: (A) The denial, reduction, termination or failure to provide or ma…
Conn. Gen. Stat. § 38a-591b Health carrier responsibilities re utilization review.
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Sec. 38a-591b. Health carrier responsibilities re utilization review. (a) Sections 38a-591a to 38a-591n, inclusive, shall apply to (1) any health carrier offering a health benefit plan and that provides or performs utilization review including prospective, concurrent or retrospec…
Conn. Gen. Stat. § 38a-591c Utilization review criteria and procedures.
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Sec. 38a-591c. Utilization review criteria and procedures. (a)(1) Each health carrier shall contract with (A) health care professionals to administer such health carrier's utilization review program, and (B) clinical peers to evaluate the clinical appropriateness of an adverse de…
Conn. Gen. Stat. § 38a-591d Utilization review and benefit determinations. Urgent care requests. Information provided in notice of adverse determination.
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Sec. 38a-591d. Utilization review and benefit determinations. Urgent care requests. Information provided in notice of adverse determination. (a)(1) Each health carrier shall maintain written procedures for (A) utilization review and benefit determinations, (B) expedited utilizati…
Conn. Gen. Stat. § 38a-591e Internal grievance process of adverse determinations based on medical necessity. Expedited review of adverse determinations of urgent care requests.
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Sec. 38a-591e. Internal grievance process of adverse determinations based on medical necessity. Expedited review of adverse determinations of urgent care requests. (a)(1) Each health carrier shall establish and maintain written procedures for (A) the review of grievances of adver…
Conn. Gen. Stat. § 38a-591f Internal grievance process of adverse determinations not based on medical necessity.
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Sec. 38a-591f. Internal grievance process of adverse determinations not based on medical necessity. (a) Each health carrier shall establish and maintain written procedures for (1) the review of grievances of adverse determinations that were not based on medical necessity, and (2)…
Conn. Gen. Stat. § 38a-591g External reviews and expedited external reviews.
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Sec. 38a-591g. External reviews and expedited external reviews. (a)(1) A covered person or a covered person's authorized representative may file a request for an external review or an expedited external review of an adverse determination or a final adverse determination in accord…
Conn. Gen. Stat. § 38a-591h Record-keeping requirements. Report to commissioner upon request.
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Sec. 38a-591h. Record-keeping requirements. Report to commissioner upon request. (a)(1) Each health carrier shall maintain written records to document all grievances of adverse determinations it receives, including the notices and claims associated with such grievances, during a …
Conn. Gen. Stat. § 38a-591i Regulations.
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Sec. 38a-591i. Regulations. The commissioner shall adopt regulations, in accordance with chapter 54, to implement the provisions of sections 38a-591a to 38a-591n, inclusive. (P.A. 11-58, S. 62; P.A. 12-102, S. 8.) History: P.A. 11-58 effective July 1, 2011; P.A. 12-102 replaced r…
Conn. Gen. Stat. § 38a-591j Utilization review companies: Licensure. Fees. Investigation of grievances. Duties.
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Sec. 38a-591j. Utilization review companies: Licensure. Fees. Investigation of grievances. Duties. (a) No utilization review company shall conduct utilization review in this state for a health benefit plan under the jurisdiction of the commissioner unless it is licensed by the co…
Conn. Gen. Stat. § 38a-591k Violations. Notice and hearing. Penalties. Appeal.
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Sec. 38a-591k. Violations. Notice and hearing. Penalties. Appeal. (a) Whenever the commissioner has reason to believe that a utilization review company subject to sections 38a-591a to 38a-591j, inclusive, has been or is engaging in conduct in violation of said sections, and that …
Conn. Gen. Stat. § 38a-591l Independent review organizations conducting external reviews and expedited external reviews.
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Sec. 38a-591l. Independent review organizations conducting external reviews and expedited external reviews. (a)(1) The commissioner shall approve independent review organizations eligible to be assigned to conduct external reviews and expedited external reviews under section 38a-…
Conn. Gen. Stat. § 38a-591m Independent review organizations: Conflicts of interest. Liability. Record-keeping requirements. Report to commissioner upon request.
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Sec. 38a-591m. Independent review organizations: Conflicts of interest. Liability. Record-keeping requirements. Report to commissioner upon request. (a) The commissioner shall not assign an independent review organization, and no independent review organization shall assign a cli…
Conn. Gen. Stat. § 38a-591n Documents, communications, information and evidence provided to covered person or covered person's authorized representative upon request.
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Sec. 38a-591n. Documents, communications, information and evidence provided to covered person or covered person's authorized representative upon request. (a)(1) Upon request pursuant to subparagraph (E) of subdivision (1) of subsection (e) of section 38a-591d, the health carrier …
Conn. Gen. Stat. § 38a-591o Restrictions applicable to prospective or concurrent review of certain recurring prescription drugs. Exceptions.
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Sec. 38a-591o. Restrictions applicable to prospective or concurrent review of certain recurring prescription drugs. Exceptions. (a) As used in this section: (1) “Brand name drug” means a drug that is produced or distributed in accordance with an original new drug application appr…
Conn. Gen. Stat. §§ 38a-592 to 38a-594 38a-592 to 38a-594
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Secs. 38a-592 to 38a-594. Reserved for future use.