Section 38a-477i - [Effective 7/1/2024] Contract provisions containing all-or-nothing clauses, anti-steering clauses, anti-tiering clauses or gas clauses prohibited(a) As used in this section: (1) "All-or-nothing clause" means any provision in a health care contract that: (A) Requires the health carrier or health plan administrator to include all members of a health care provider in a network plan; or(B) Requires the health carrier or health plan administrator to enter into any additional contract with an affiliate of the health care provider as a condition to entering into a contract with such health care provider;(2) "Anti-steering clause" means any provision in a health care contract that restricts the ability of the health carrier or health plan administrator from encouraging an enrollee to obtain a health care service from a competitor of a hospital or health system, including offering incentives to encourage enrollees to utilize specific health care providers such as centers of excellence or any other pay-for-performance program;(3) "Anti-tiering clause" means any provision in a health care contract that: (A) Restricts the ability of the health carrier or health plan administrator to introduce and modify a tiered network plan or assign health care providers into tiers, including a network that tiers providers by cost or quality; or(B) Requires the health carrier or health plan administrator to place all members of a health care provider in the same tier of a tiered network plan;(4) "Gag clause" means any provision in a health care contract that:(A) Restricts the ability of the health care provider, health carrier or health plan administrator to disclose any price or quality information, including, but not limited to, the allowed amount, negotiated rates or discounts, any fees for services or any other claim-related financial obligations included in the provider contract, to any governmental entity as authorized by law or such government entity's contractors or agents, any enrollee, any treating health care provider of an enrollee, plan sponsor or potential eligible enrollees and plan sponsors; or(B) Restricts the ability of either any health care provider, health carrier or health plan administrator to disclose out-of-pocket costs to any enrollee;(5) "Health benefit plan", "network", "network plan" and "tiered network" have the same meanings as provided in section 38a-472f;(6) "Health care contract" means any contract, agreement or understanding, either orally or in writing, entered into, amended, restated or renewed between a health care provider and a health carrier, health plan administrator, plan sponsor or its contractors or agents for delivery of health care services to an enrollee of a health benefit plan;(7) "Health care provider" means any for-profit or nonprofit entity, corporation or organization, parent corporation, member, affiliate, subsidiary or entity under common ownership that is or whose members are licensed or otherwise authorized by this state to furnish, bill for or receive payment for health care service delivery in the normal course of business, including, but not limited to, a health system, hospital, hospital-based facility, freestanding emergency department, imaging center, physician group with eight or more physicians, urgent care center, as defined in section 19a-493d, and any physician or physician group in a practice of fewer than eight physicians that is employed by or an affiliate of any hospital, medical foundation or insurance company;(8) "Health carrier" has the same meaning as provided in section 38a-591a; and(9) "Health plan administrator" means any third-party administrator who acts on behalf of a plan sponsor to administer a health benefit plan.(b) No health care provider, health carrier, health plan administrator or any agent or other entity that contracts on behalf of a health care provider, health carrier, or health plan administrator, may offer, solicit, request, amend, renew or enter into a health care contract on or after July 1, 2024, that directly or indirectly includes any of the following provisions: (1) An all-or-nothing clause;(2) An anti-steering clause;(3) An anti-tiering clause; or(c) Any clause in a health care contract, written policy, written procedure or agreement entered into, renewed or amended on or after July 1, 2024, that is contrary to the provisions set forth in subsection (b) of this section shall be null and void. All remaining clauses of such health care contract, written policy, written procedure or agreement shall remain in effect for the duration of the contract term.(d) Nothing in this section shall be construed to modify, reduce or eliminate the existing privacy protections and standards pursuant to the federal Health Insurance Portability and Accountability Act of 1996, P.L. 104-191, as amended from time to time, the federal Genetic Information Nondiscrimination Act of 2008, P.L. 110-233, as amended from time to time, or the federal Americans with Disabilities Act of 1990, 42 USC 12101, as amended from time to time.Conn. Gen. Stat. § 38a-477i
Added by P.A. 23-0171,S. 19 of the Connecticut Acts of the 2023 Regular Session, eff. 7/1/2024.