CONNECTICUT

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The Connecticut SBL became effective July 1, 2016. The relevant provisions include: reimbursement for OON ER services at UCR rates, and reimbursement for inadvertent OON services at INN rates. See Connecticut General Statutes Section 38a-477aa.

Regarding bifurcation, according to CMS,

Connecticut does not have an applicable All-Payer Model Agreement that would determine the out-of-network rate. Based on the survey response, CMS research, and CMS communications with the Connecticut Insurance Department and the Department of Public Health staff, CMS understands that CGS Sec. 38a-477aa, is a specified state law that will apply for purposes of determining the out-of-network rate with respect to certain health care services by out-of-network health care providers at an in-network facility or an out-of-network clinical laboratory upon referral of an in-network provider and emergency services furnished to individuals with coverage from health carriers in Connecticut. The federal independent dispute resolution process under section 2799A-1(c) of the PHS Act and 45 CFR 149.510 will apply for purposes of determining the out-of-network rate with respect to any items and services furnished to individuals in an insured group health plan, or group or individual health insurance coverage in Connecticut by nonparticipating providers and nonparticipating emergency facilities to which CGS Sec. 38a-477aa does not apply. The federal independent dispute resolution process under section 2799A-2(b) of the PHS Act and 45 CFR 149.520 will apply for purposes of determining the out-of-network rate with respect to services furnished to individuals in an insured group health plan, or group or individual health insurance coverage in Connecticut by nonparticipating providers of air ambulance services. Connecticut will enforce the outcome of the federal independent dispute resolution process for such cases in Connecticut under section 2799A-1(c) of the PHS Act. CMS will enforce the outcome of the federal independent dispute resolution process for such cases in Connecticut under section 2799A-2(b) of the PHS Act.

Letter from CMS to Governor of Connecticut, dated December 21, 2021.