Latest Executive Order Repeals Certain Changes Made to Provider Reimbursement Rates

Pullman & Comley - Connecticut Health Law
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Pullman & Comley - Connecticut Health Law

This week, Governor Lamont issued Executive Order No. 7CC, which repeals two of the temporary changes to health care provider reimbursement rates that were made in Executive Order No. 7U. Specifically, Section 9 of Executive Order No. 7CC repeals Sections 2(a) and 2(b) of Executive Order No. 7U, which had:

  • Required that emergency services rendered to an insured patient by an out-of-network health care provider be reimbursed in the amount that the insured’s health care plan would pay for the services if rendered by an in-network health care provider as payment in full; and
  • Suspended the application of the state statute (C.G.S. §38a-477aa(b)(3)(B)) that permits a health carrier and out-of-network health care provider to agree to a greater reimbursement amount than those provided in subsection (b)(3)(A) of that statute (i.e., (i) the amount the insured’s health care plan would pay for such services if rendered by an in-network health care provider; (ii) the usual, customary and reasonable rate for such services; or (iii) the amount Medicare would reimburse for such services).

These provisions have been repealed and the effective date of these repeals is retroactive to April 5. See our prior Alert for a summary of Executive Order No. 7U, including the changes to provider reimbursement rates that were not repealed by Executive Order No. 7CC.

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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