Sec. 38a-478e. Medical protocols. Procedure prior to change. Physician input. Notification of change.
Sec. 38a-478e. Medical protocols. Procedure prior to change. Physician input.
Notification of change. (a) Each managed care organization shall, prior to implementing new medical protocols or substantially or materially altering existing medical protocols, obtain input from physicians actively practicing in Connecticut and practicing in
the relevant specialty areas. The managed care organization shall also seek input from
physicians who are not employees of or consultants, other than to the extent a person
is an employee or consultant solely for the purposes of this subsection, to the managed
care organization provided the input is not unreasonably withheld. The managed care
organization shall obtain the input in a manner permitting verification by the commissioner and shall document the process by which it obtained the input. For the purpose
of this section, "medical protocols" shall include, but not be limited to, drug formularies
or lists of covered drugs.
(b) Each managed care organization shall (1) make available, upon the request of
a participating provider, its medical protocols for examination during regular business
hours at the principal Connecticut headquarters of the managed care organization, and
(2) if a managed care organization denies a treatment, service or procedure, the organization shall furnish, upon the request of a participating provider, a copy of the relevant
medical protocol to the participating provider, along with an explanation of the denial
at the time the denial is made.
(P.A. 97-99, S. 6; P.A. 00-216, S. 7, 28.)
History: P.A. 00-216 amended Subsec. (a) by making a technical change and adding provision defining "medical
protocols" to include drug formularies or lists of covered drugs, effective July 1, 2000.