Sec. 38a-542d. Cancer clinical trials: Routine patient care costs.
Sec. 38a-542d. Cancer clinical trials: Routine patient care costs. (a) For purposes of sections 38a-542a to 38a-542g, inclusive, "routine patient care costs" means:
(1) Coverage for medically necessary health care services that are incurred as a result
of the treatment being provided to the insured person for purposes of the cancer clinical
trial that would otherwise be covered if such services were not rendered pursuant to a
cancer clinical trial. Such services shall include those rendered by a physician, diagnostic
or laboratory tests, hospitalization or other services provided to the patient during the
course of treatment in the cancer clinical trial for a condition, or one of its complications,
that is consistent with the usual and customary standard of care and would be covered
if the insured person were not enrolled in a cancer clinical trial. Such hospitalization
shall include treatment at an out-of-network facility if such treatment is not available
in-network and not eligible for reimbursement by the sponsors of such clinical trial; and
(2) coverage for routine patient care costs incurred for drugs provided to the insured
person, in accordance with section 38a-518b, provided such drugs have been approved
for sale by the federal Food and Drug Administration.
(b) Routine patient care costs shall be subject to the terms, conditions, restrictions,
exclusions and limitations of the contract or certificate of insurance between the subscriber and the insurer or health plan, including limitations on out-of-network care,
except that treatment at an out-of-network hospital as provided in subdivision (1) of
subsection (a) of this section shall be made available by the out-of-network hospital and
the insurer or health care center at no greater cost to the insured person than if such
treatment was available in-network. The insurer or health care center may require that
any routine tests or services required under the cancer clinical trial protocol be performed
by providers or institutions under contract with the insurer or health care center.
(c) Notwithstanding the provisions of subsection (a) of this section, routine patient
care costs shall not include: (1) The cost of an investigational new drug or device that
has not been approved for market for any indication by the federal Food and Drug
Administration; (2) the cost of a non-health-care service that an insured person may be
required to receive as a result of the treatment being provided for the purposes of the
cancer clinical trial; (3) facility, ancillary, professional services and drug costs that are
paid for by grants or funding for the cancer clinical trial; (4) costs of services that (A)
are inconsistent with widely accepted and established regional or national standards of
care for a particular diagnosis, or (B) are performed specifically to meet the requirements
of the cancer clinical trial; (5) costs that would not be covered under the insured person's
policy for noninvestigational treatments, including, but not limited to, items excluded
from coverage under the insured person's contract with the insurer or health plan; and
(6) transportation, lodging, food or any other expenses associated with travel to or from
a facility providing the cancer clinical trial, for the insured person or any family member
or companion.
(P.A. 01-171, S. 4, 25; P.A. 07-67, S. 2.)
History: P.A. 01-171 effective January 1, 2002; P.A. 07-67 amended Subsec. (a)(1) to require that hospitalization
include treatment at out-of-network facility if treatment is not available in-network and not eligible for reimbursement by
sponsors of clinical trial, and amended Subsec. (b) to require out-of-network hospitalization to be made available at the
in-network level of benefits under the policy or contract, effective May 30, 2007.
See Sec. 38a-504d for similar provisions re individual policies.