l9n/ Connecticut

2007 Regular Session

House Bill 7055

AN ACT CONCERNING MEDICAL NECESSITY AND EXTERNAL APPEALS.

Became law as Public Act 07-75, signed May 30, 2007, 113 days after it was filed.

What it does

The synopsis the General Assembly published with the bill.

To establish a statutory definition of "medical necessity" or "medically necessary" for health insurance coverage to ensure consistency throughout health insurance policies; to create a presumption that a procedure or treatment is medically necessary if the utilization review company's credentialed health care provider orders such procedure or treatment. The utilization review company has the burden of proof of demonstrating that the prescribed procedure or treatment is not medically necessary; to allow a health insurer to cancel a policy based on patient misrepresentations on the insurance application only if the insurer can prove that such misrepresentations were made with the intent to deceive; to extend the time period in which a patient may file an external appeal with the Insurance Department from thirty days to sixty days; to require the utilization review company to provide an enrollee a written notice explaining the insurer's position that a particular service is not medically necessary; and to require the utilization review company to provide a patient with a hearing, which may be held by telephone, before making a decision on an appeal of a denial of a claim and to make the reviewing practitioner available for such hearing.

Sponsors

Who carried the bill in each chamber, and who signed on. Each name leads to the member's page.

In the House of Representatives

1 co-sponsor

Kevin D. Witkos

In the Senate

    2 co-sponsors

    Donald E. Williams Jr., Joan V. Hartley

    Its course

    February 6 to May 30, 2007, on one scale. In the top row each mark is a day something happened; taller marks are busier days.

    Each committee stop sits inside its chamber.

    Every action21 actions on 12 days

    In the House of RepresentativesFeb 6 to May 386 days

    Insurance and Real Estate CommitteeFeb 6 to Feb 2721 days

    In the SenateMay 3 to May 1613 days

    Waiting to be sentMay 16 to May 248 days

    With the GovernorMay 24 to May 306 days

    Amendments

    Each amendment offered, and what became of it.

    • House of Representatives floor amendmentAdopted

      Adopted May 3 · Adopted May 16

    • House of Representatives floor amendmentAdopted

      Adopted May 3 · Adopted May 16

    Text

    Each version as the General Assembly printed it.

    l9n doesn't hold this bill's text yet.

    What happened

    In l9n's words, one line for each step. Every action as the General Assembly published it is below.

    In the House of Representatives Feb 6 – May 3

    1. Feb 6Introduced and sent to Insurance and Real Estate Committee
    2. Feb 16Heard in Insurance and Real Estate Committee
    3. Feb 27Insurance and Real Estate Committee recommended a substitute for it
    4. May 3The House of Representatives adopted House of Representatives Amendment A
    5. The House of Representatives adopted House of Representatives Amendment B
    6. Passed the House of Representatives with House of Representatives Amendments A and B

    In the Senate May 7 – May 16

    1. May 7Arrived in the Senate
    2. May 16The Senate adopted House of Representatives Amendments A and B
    3. Passed the Senate with House of Representatives Amendments A and B

    To the Governor May 23 – May 30

    1. May 23Numbered Public Act 07-75
    2. May 24Sent to the Secretary of the State
    3. May 30Signed by the Governor
    All 21 actions, as published
    1. Feb 6REF. TO JOINT COMM. ONBoth houses
    2. Feb 16PUBLIC HEARINGBoth houses
    3. Feb 27Joint Favorable SubstituteBoth houses
    4. Mar 2FILED WITH LCOBoth houses
    5. Mar 7REFERRED TO OLR, OFABoth houses
    6. Mar 13RPTD. OUT OF LCOBoth houses
    7. Mar 13FAV. RPT., TABLED FOR HOUSE CALENDARHouse of Representatives
    8. Mar 13HOUSE CALENDAR NUMBERHouse of Representatives
    9. Mar 13FILE NO.Both houses
    10. May 3HOUSE ADOPTED HOUSE AMEND. SCH.House of Representatives
    11. May 3HOUSE ADOPTED HOUSE AMEND. SCH.House of Representatives
    12. May 3HOUSE PASSED, HOUSE AMEND. SCH.House of Representatives
    13. May 7FAV. RPT., TAB. FOR CAL., SEN.Senate
    14. May 7SENATE CALENDAR NUMBERSenate
    15. May 7FILE NO.Both houses
    16. May 16SEN. ADOPTED HO. AMEND. SCH.Senate
    17. May 16SEN. PASSED, HO. AMEND. SCH.Senate
    18. May 16ON CONSENT CALENDAR /IN CONCURRENCESenate
    19. May 23PUBLIC ACTBoth houses
    20. May 24TRANSMITTED TO SECRETARY OF THE STATEBoth houses
    21. May 30SIGNED BY GOVERNORGovernor