This bulletin requests information needed to implement Public-Act 97-99 - An Act Concerning Managed Care

STATE OF CONNECTICUT INSURANCE DEPARTMENT Bulletin HC .. 53 June 9, 1997 TO: All insurance companies and health care centers licensed to write health insurance in Connecticut RE: Public Act 97-99, An Act Concerning Managed Care Public Act 97-99, recently signed into law by the Governor, establishes a system for the regulation ofmanaged care organizations and managed care plans. The bill affects managed care plans delivered, issued for delivery, renewed or continued in Connecticut on or after October 1, 1997. A "managed care organization", as defined in the act means "an insurer, health care center, hospital or medical service corporation or other organization delivering, issuing for delivery, renewing or amending any individual or group health managed care plan in this state". A "managed care plan" as defined means "a product offered by a managed care organization that provides for the financing or delivery ofhealth care services to persons enrolled in the plan through:(A) Arrangements with selected providers to furnish health care services; (B) explicit standards for the selection ofparticipating providers; · (C) financial incentives for enrollees to use the participating providers and procedures provided for by the plan; or (D) arrangements that share risk with providers, provided the organization ,q~ering a plan described under subparagraph (A), (B), (C) of(D) ofthis subdivision is licensed by the Insurance Department pursuant to chapter 698, 698a or 700 of the general statutes and that the plan includes utilization review pursuant to sections 38a-226 to 38a-226d, inclusive, of the general statutes, as amended by this act". The first step needed to implement certain provisions ofthis act is to determine which carriers offer managed care plans. Please complete the enclosed certification·form indicating whether your company offers managed care plans (as defined above) in Connecticut. The certification must be signed by an officer of the company and returned to the Department no later than June 27, 1997~ A copy of Public Act 97-99 may be obtained by contacting th·e Insurance Department web site at http://www.state.ct.us/cid or by calling (860) 297-3862. 1-L ....... ~.~.~­ ~:~M. Reider, Jr. 1 \J" Insurance Commissioner Phone: P. 0. Box 816 Hartford, cr 06142-0816 An Equal Opportunity Employer