Sec. 38a-478u-3 - Annual filing requirements

ยง 38a-478u-3. Annual filing requirements

Each managed care organization shall file annually the information specified below.

(1) Quality Assurance Reports

(A) A summary report on its quality assurance plan inclusive of, but not limited to, information on complaints relating to providers and quality of care, decisions related to patient requests for coverage and prior authorization statistics. All information provided shall be as of the prior calendar year and shall pertain to Connecticut business only. In order for the statistical information to be provided in a manner permitting comparison across plans, each managed care organization shall be required to complete a form provided by the Insurance Department.

(B) Where Health Plan Employer Data and Information Set (HEDIS) data is required for the summary report, managed care organizations who do not provide HEDIS information to the National Committee for Quality Assurance shall have provided equivalent data upon submission of a completed consumer report card survey as required by subsection (2).

(2) Consumer Report Card

A survey based on prior calendar year information to be submitted on a form adopted by the commissioner.

(3) Model Provider Contracts

Model provider contracts that contain the provisions currently in force in the contracts with providers who participate in networks utilized in this state by the managed care organizations. In a case where a managed care organization does not contract directly with providers, the managed care organization shall also provide written assurance that it will not enter into agreements with networks or other entities whose provider contracts violate any of the provisions of Public Act 97-99. If requested by the commissioner, a copy of any signed individual contract shall be filed but proprietary fee schedule information may be withheld or redacted.

(4) Financial Arrangements

A written description of the types of financial arrangements between the managed care organization and hospitals, utilization review companies, physicians and other entities that provide health care services or supplies to enrollees. "Financial arrangements" means the terms which are the basis for compensation for services and supplies provided to enrollees.

(Adopted effective April 5, 1999)

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