Beginning January 28, 2017, Connecticut hospitals must start notifying patients who schedule certain non-emergency diagnoses or procedures of their right to request related cost and quality information. This new requirement applies to patients whose diagnoses and procedures are included in the annual report issued jointly by the Connecticut Insurance Department (CID) and Department of Public Health (DPH). The notice must be provided at the time of scheduling the service, regardless of the location or setting where the service is delivered.
Upon the request of a patient for a diagnosis or procedure included in the report, the hospital must provide the patient with a written notice, electronically or by mail, that contains the following, not later than three business days after the diagnosis or procedure is scheduled:
- The corresponding Medicare reimbursement amount (or, if there is no corresponding Medicare reimbursement amount: (i) the approximate amount Medicare would have paid the hospital for the services on the billing statement, or (ii) the percentage of the hospital’s charges that Medicare would have paid the hospital for the services);
- The Joint Commission’s composite accountability rating and the Medicare hospital compare star rating for the hospital, as applicable; and
- The Internet web site addresses for The Joint Commission and the Medicare hospital compare tool where the patient may obtain information concerning the hospital.
Additional information must be provided depending on whether the patient is insured or uninsured:
- If the patient is insured, the notice must include the allowed amount, the toll-free telephone number and Internet web site address of the patient’s health carrier where the patient can obtain information concerning charges and out-of-pocket costs. If the hospital is out-of-network, a statement that the diagnosis or procedure will likely be deemed out-of-network and that any out-of-network applicable rates under the policy may apply must be added; and
- If the patient is uninsured, the notice must include the amount to be charged for the diagnosis or procedure if all charges are paid in full without a public or private third party paying any portion of the charges, including the amount of any facility fee (or, if the hospital is not able to provide a specific amount due to an inability to predict the specific treatment or diagnostic code, the estimated maximum allowed amount or charge, including the facility fee).
What is the CID/DPH Joint Report?
Under Public Act 15-146 (codified at Connecticut General Statutes §38a-1084a(c)), the CID and DPH must annually report to the Connecticut Health Insurance Exchange and make available to the public on their websites a list of: (1) the 50 most frequently occurring inpatient primary diagnoses and procedures in Connecticut; (2) the 50 most frequently provided outpatient procedures performed in the state; (3) the 25 most frequent surgical procedures performed in the state; and (4) the 25 most frequent imaging procedures performed in the state. The first report was issued on August 1, 2016 and can be accessed here.
Action Steps to Take Now
Connecticut hospitals are strongly advised to familiarize themselves with the diagnoses and procedures listed in the report and to develop policies to follow when patients are scheduled for the procedures listed in the report. In addition, hospitals can start drafting those portions of the written notice that can be prepared ahead of time so that they can respond to patient requests in a timely manner.
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