Attorney General's Opinion
Attorney General, Richard Blumenthal
September 22, 2008
Honorable Thomas R. Sullivan
State of Connecticut
P.O. Box 816
Hartford, CT 06142-0816
Dear Commissioner Sullivan:
You have asked for our opinion on whether the provisions of Conn. Gen. Stat. § 38a -816(15) apply to out-of-state health care providers who provide health care to Connecticut residents. That statute requires health insurance companies to make timely payment to health care providers and imposes a fifteen per cent late charge on bills that are not timely paid. It is my opinion that you should seek legislative clarification of this issue because past legislative amendments to Section 38a-816(15) can be interpreted to both expand and limit the scope of that statute's protection.
According to the information supplied by your Department, the Insurance Department has interpreted Conn. Gen. Stat. § 38a-816(15) to require insurance companies to make timely payment to Connecticut and out-of-state health care providers who provide health services to Connecticut residents. Any insurance company that fails to make timely payment as set forth in the statute is required to pay interest "at the rate of fifteen per cent per annum."
Prior to 2001, there was no definition of "health care provider" contained in Section 38a-816(15). In 2001, the General Assembly enacted Public Act 01-111 amending Conn. Gen. Stat. § 38a-816(15) to define the term "health care provider" to include those categories of health care services contained in "chapter 368v, chapters 370 to 373, inclusive, 375 to 383c, inclusive, or chapter 400j." Public Act 01-111. That definition was codified as Conn. Gen. Stat. § 38a-816(15)(C). The new definition of "health care provider" substantially expanded the categories of health care providers who would be covered by the timely payment and interest provisions of Section 38a-816(15). According to its legislative history, Public Act 01-111 was intended "to expand the definition of medical providers so it is no longer just physicians but a number of medical providers…." H. Rep., at 4680(May 29,2001)(remarks of Rep. Cleary); see also S. Rep., at 1754 (remarks of Sen. Harp)("We haven't defined health care provider and this bill defines health care provider and specifies which providers are (sic), for the purposes of prompt payment claims, will be included.")
Although Public Act 01-111 expanded the categories of health care providers covered by Section 38a-816(15), the Public Act included within the definition of health care provider the words "person licensed to provide health care services" under the cited Connecticut licensing statutes. The question has now been raised whether Conn. Gen. Stat. § 38a-816(15) only applies to health care providers who are licensed in Connecticut or whether it also applies to health care providers within the categories of health care providers set forth in Section 38a-816(15)(C) who are licensed in other states .
Your Department had construed Section 38a-816(15) as applying to in-state and out-of-state health care providers. Because the legislature through Public Act 01-111 intended to expand the categories of health care providers protected by Section 38a-816(15), it is reasonable to believe that the legislature did not intend Public Act 01-111 to limit the provisions of that statute to health care providers licensed in Connecticut. Nevertheless, Section 381-816(15)(C) can be read to provide such a limitation.
I recommend that you seek legislative clarification of whether Public Act 01-111 intended the protections afforded by Section 38a-816(15) to apply to health care providers licensed in Connecticut and other states who provide Connecticut residents the types of health care services set forth in Section 38a-816(15)(C).
Clearly, there are strong public policy reasons for ensuring that all health care providers who provide health care services to Connecticut residents receive timely payment for their services. I would be pleased to work with you on this matter.