State Codes and Statutes

Statutes > Connecticut > Title38a > Chap700c > Sec38a-542f

      Sec. 38a-542f. Cancer clinical trials: Standardized forms. Time frames for coverage determinations. Appeals. Regulations. (a) For purposes of cancer clinical trials, the Insurance Department, in cooperation with the Connecticut Oncology Association, the American Cancer Society, the Connecticut Association of Health Plans and Anthem Blue Cross of Connecticut, shall develop a standardized form that all providers, hospitals and institutions shall submit to the insurer or health care center when seeking to enroll an insured person in a cancer clinical trial. An insurer or health care center may not substitute any other approval request form for the form developed by the department, except that any insurer or health care center that has entered into an agreement to provide coverage for cancer clinical trials approved pursuant to section 38a-542g may use the form or process established by such agreement.

      (b) Any insurer or health care center that receives the department form from a provider, hospital or institution seeking coverage for the routine patient care costs of an insured person in a cancer clinical trial shall approve or deny coverage for such services within five business days of receiving such request and any other reasonable supporting materials requested by the insurer or health plan pursuant to section 38a-542c, except that an insurer or health care center that utilizes independent experts to review such requests shall respond within ten business days. Requests for coverage of phase III clinical trials for the prevention of cancer pursuant to section 38a-542a shall be approved or denied within fourteen business days.

      (c) The insured, or the provider with the insured's written consent, may appeal any denial of coverage for medical necessity to an external, independent review pursuant to section 38a-478n. Such external review shall be conducted by a properly qualified review agent whom the department has determined does not have a conflict of interest regarding the cancer clinical trial.

      (d) The Insurance Commissioner shall adopt regulations, in accordance with chapter 54, to implement the provisions of this section.

      (P.A. 01-171, S. 6, 25.)

      History: P.A. 01-171 effective January 1, 2002.

      See Sec. 38a-504f for similar provisions re individual policies.