Connecticut 2016 Regular Session

Connecticut Senate Bill SB00099 Compare Versions

OldNewDifferences
11 General Assembly Raised Bill No. 99
22 February Session, 2016 LCO No. 1052
3- *_____SB00099INS___031616____*
3+ *01052_______INS*
44 Referred to Committee on INSURANCE AND REAL ESTATE
55 Introduced by:
66 (INS)
77
88 General Assembly
99
1010 Raised Bill No. 99
1111
1212 February Session, 2016
1313
1414 LCO No. 1052
1515
16-*_____SB00099INS___031616____*
16+*01052_______INS*
1717
1818 Referred to Committee on INSURANCE AND REAL ESTATE
1919
2020 Introduced by:
2121
2222 (INS)
2323
2424 AN ACT CONCERNING BENEFITS PAYABLE FOR ASSESSMENTS TO DETERMINE A DIAGNOSIS OF A CONDITION AND RELATED CONSULTATIONS.
2525
2626 Be it enacted by the Senate and House of Representatives in General Assembly convened:
2727
2828 Section 1. Section 38a-488a of the 2016 supplement to the general statutes, as amended by section 44 of public act 15-5 of the June special session, is repealed and the following is substituted in lieu thereof (Effective January 1, 2017):
2929
3030 (a) For the purposes of this section: (1) "Mental or nervous conditions" means mental disorders, as defined in the most recent edition of the American Psychiatric Association's "Diagnostic and Statistical Manual of Mental Disorders". "Mental or nervous conditions" does not include (A) intellectual disabilities, (B) specific learning disorders, (C) motor disorders, (D) communication disorders, (E) caffeine-related disorders, (F) relational problems, and (G) other conditions that may be a focus of clinical attention, that are not otherwise defined as mental disorders in the most recent edition of the American Psychiatric Association's "Diagnostic and Statistical Manual of Mental Disorders"; (2) "benefits payable" means the usual, customary and reasonable charges for treatment deemed necessary under generally accepted medical standards, except that in the case of a managed care plan, as defined in section 38a-478, "benefits payable" means the payments agreed upon in the contract between a managed care organization, as defined in section 38a-478, and a provider, as defined in section 38a-478; (3) "acute treatment services" means twenty-four-hour medically supervised treatment for a substance use disorder, that is provided in a medically managed or medically monitored inpatient facility; and (4) "clinical stabilization services" means twenty-four-hour clinically managed postdetoxification treatment, including, but not limited to, relapse prevention, family outreach, aftercare planning and addiction education and counseling.
3131
3232 (b) Each individual health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 delivered, issued for delivery, renewed, amended or continued in this state shall provide benefits for the diagnosis and treatment of mental or nervous conditions. Benefits payable include, but need not be limited to:
3333
3434 (1) General inpatient hospitalization, including in state-operated facilities;
3535
3636 (2) Medically necessary acute treatment services and medically necessary clinical stabilization services;
3737
3838 (3) General hospital outpatient services, including at state-operated facilities;
3939
4040 (4) Psychiatric inpatient hospitalization, including in state-operated facilities;
4141
4242 (5) Psychiatric outpatient hospital services, including at state-operated facilities;
4343
4444 (6) Intensive outpatient services, including at state-operated facilities;
4545
4646 (7) Partial hospitalization, including at state-operated facilities;
4747
4848 (8) Evidence-based maternal, infant and early childhood home visitation services, as described in Section 2951 of the Patient Protection and Affordable Care Act, P.L. 111-148, as amended from time to time, that are designed to improve health outcomes for pregnant women, postpartum mothers and newborns and children, including, but not limited to, for maternal substance use disorders or depression and relationship-focused interventions for children with mental or nervous conditions or substance use disorders;
4949
5050 (9) Intensive, home-based services designed to address specific mental or nervous conditions in a child;
5151
5252 (10) Evidence-based family-focused therapy that specializes in the treatment of juvenile substance use disorders;
5353
5454 (11) Short-term family therapy intervention;
5555
5656 (12) Nonhospital inpatient detoxification;
5757
5858 (13) Medically monitored detoxification;
5959
6060 (14) Ambulatory detoxification;
6161
6262 (15) Inpatient services at psychiatric residential treatment facilities;
6363
6464 (16) Rehabilitation services provided in residential treatment facilities, general hospitals, psychiatric hospitals or psychiatric facilities;
6565
6666 (17) Observation beds in acute hospital settings;
6767
6868 (18) Psychological and neuropsychological testing conducted by an appropriately licensed health care provider;
6969
7070 (19) Trauma screening conducted by a licensed behavioral health professional;
7171
7272 (20) Depression screening, including maternal depression screening, conducted by a licensed behavioral health professional;
7373
7474 (21) Substance use screening conducted by a licensed behavioral health professional;
7575
7676 (22) Intensive, family-based and community-based treatment programs that focus on addressing environmental systems that impact chronic and violent juvenile offenders;
7777
7878 (23) Other home-based therapeutic interventions for children;
7979
8080 (24) Chemical maintenance treatment, as defined in section 19a-495-570 of the regulations of Connecticut state agencies; and
8181
8282 (25) Extended day treatment programs, as described in section 17a-22.
8383
8484 (c) No such policy shall establish any terms, conditions or benefits that (1) place a greater financial burden on an insured for access to diagnosis or treatment of mental or nervous conditions than for diagnosis or treatment of medical, surgical or other physical health conditions, [or] (2) prohibit an insured from obtaining or a health care provider from being reimbursed for multiple screening services as part of a single-day visit to a health care provider or a multicare institution, as defined in section 19a-490, or (3) limit the number of visits to a health care provider or a multicare institution to assess an insured for a diagnosis of a condition.
8585
8686 (d) In the case of benefits payable for the services of a licensed physician, such benefits shall be payable for the same services when such services are lawfully rendered by a psychologist licensed under the provisions of chapter 383 or by such a licensed psychologist in a licensed hospital or clinic.
8787
8888 (e) In the case of benefits payable for the services of a licensed physician or psychologist, such benefits shall be payable for the same services when such services are rendered by:
8989
9090 (1) A clinical social worker who is licensed under the provisions of chapter 383b and who has passed the clinical examination of the American Association of State Social Work Boards and has completed at least two thousand hours of post-master's social work experience in a nonprofit agency qualifying as a tax-exempt organization under Section 501(c) of the Internal Revenue Code of 1986 or any subsequent corresponding internal revenue code of the United States, as from time to time amended, in a municipal, state or federal agency or in an institution licensed by the Department of Public Health under section 19a-490;
9191
9292 (2) A social worker who was certified as an independent social worker under the provisions of chapter 383b prior to October 1, 1990;
9393
9494 (3) A licensed marital and family therapist who has completed at least two thousand hours of post-master's marriage and family therapy work experience in a nonprofit agency qualifying as a tax-exempt organization under Section 501(c) of the Internal Revenue Code of 1986 or any subsequent corresponding internal revenue code of the United States, as from time to time amended, in a municipal, state or federal agency or in an institution licensed by the Department of Public Health under section 19a-490;
9595
9696 (4) A marital and family therapist who was certified under the provisions of chapter 383a prior to October 1, 1992;
9797
9898 (5) A licensed alcohol and drug counselor, as defined in section 20-74s, or a certified alcohol and drug counselor, as defined in section 20-74s;
9999
100100 (6) A licensed professional counselor; or
101101
102102 (7) An advanced practice registered nurse licensed under the provisions of chapter 378.
103103
104104 (f) (1) In the case of benefits payable for the services of a licensed physician, such benefits shall be payable for (A) services rendered in a child guidance clinic or residential treatment facility by a person with a master's degree in social work or by a person with a master's degree in marriage and family therapy under the supervision of a psychiatrist, physician, licensed marital and family therapist, or licensed clinical social worker who is eligible for reimbursement under subdivisions (1) to (4), inclusive, of subsection (e) of this section; (B) services rendered in a residential treatment facility by a licensed or certified alcohol and drug counselor who is eligible for reimbursement under subdivision (5) of subsection (e) of this section; or (C) services rendered in a residential treatment facility by a licensed professional counselor who is eligible for reimbursement under subdivision (6) of subsection (e) of this section.
105105
106106 (2) In the case of benefits payable for the services of a licensed psychologist under subsection (e) of this section, such benefits shall be payable for (A) services rendered in a child guidance clinic or residential treatment facility by a person with a master's degree in social work or by a person with a master's degree in marriage and family therapy under the supervision of such licensed psychologist, licensed marital and family therapist, or licensed clinical social worker who is eligible for reimbursement under subdivisions (1) to (4), inclusive, of subsection (e) of this section; (B) services rendered in a residential treatment facility by a licensed or certified alcohol and drug counselor who is eligible for reimbursement under subdivision (5) of subsection (e) of this section; or (C) services rendered in a residential treatment facility by a licensed professional counselor who is eligible for reimbursement under subdivision (6) of subsection (e) of this section.
107107
108108 (g) In the case of benefits payable for the service of a licensed physician practicing as a psychiatrist or a licensed psychologist, under subsection (e) of this section, such benefits shall be payable for outpatient services rendered (1) in a nonprofit community mental health center, as defined by the Department of Mental Health and Addiction Services, in a nonprofit licensed adult psychiatric clinic operated by an accredited hospital or in a residential treatment facility; (2) under the supervision of a licensed physician practicing as a psychiatrist, a licensed psychologist, a licensed marital and family therapist, a licensed clinical social worker, a licensed or certified alcohol and drug counselor or a licensed professional counselor who is eligible for reimbursement under subdivisions (1) to (6), inclusive, of subsection (e) of this section; and (3) within the scope of the license issued to the center or clinic by the Department of Public Health or to the residential treatment facility by the Department of Children and Families.
109109
110110 (h) Except in the case of emergency services or in the case of services for which an individual has been referred by a physician affiliated with a health care center, nothing in this section shall be construed to require a health care center to provide benefits under this section through facilities that are not affiliated with the health care center.
111111
112112 (i) In the case of any person admitted to a state institution or facility administered by the Department of Mental Health and Addiction Services, Department of Public Health, Department of Children and Families or the Department of Developmental Services, the state shall have a lien upon the proceeds of any coverage available to such person or a legally liable relative of such person under the terms of this section, to the extent of the per capita cost of such person's care. Except in the case of emergency services, the provisions of this subsection shall not apply to coverage provided under a managed care plan, as defined in section 38a-478.
113113
114114 (j) In addition to the benefits payable under subsections (b) to (g), inclusive, of this section, each such policy shall provide benefits for the services of a provider specified in subsection (d) or (e) of this section for any consultation with such provider that includes the insured or a family member of the insured (1) during an assessment for a diagnosis of a condition, and (2) after a diagnosis of a mental or nervous condition has been made.
115115
116116 Sec. 2. Section 38a-514 of the 2016 supplement to the general statutes, as amended by section 46 of public act 15-5 of the June special session, is repealed and the following is substituted in lieu thereof (Effective January 1, 2017):
117117
118118 (a) For the purposes of this section: (1) "Mental or nervous conditions" means mental disorders, as defined in the most recent edition of the American Psychiatric Association's "Diagnostic and Statistical Manual of Mental Disorders". "Mental or nervous conditions" does not include (A) intellectual disabilities, (B) specific learning disorders, (C) motor disorders, (D) communication disorders, (E) caffeine-related disorders, (F) relational problems, and (G) other conditions that may be a focus of clinical attention, that are not otherwise defined as mental disorders in the most recent edition of the American Psychiatric Association's "Diagnostic and Statistical Manual of Mental Disorders"; (2) "benefits payable" means the usual, customary and reasonable charges for treatment deemed necessary under generally accepted medical standards, except that in the case of a managed care plan, as defined in section 38a-478, "benefits payable" means the payments agreed upon in the contract between a managed care organization, as defined in section 38a-478, and a provider, as defined in section 38a-478; (3) "acute treatment services" means twenty-four-hour medically supervised treatment for a substance use disorder, that is provided in a medically managed or medically monitored inpatient facility; and (4) "clinical stabilization services" means twenty-four-hour clinically managed postdetoxification treatment, including, but not limited to, relapse prevention, family outreach, aftercare planning and addiction education and counseling.
119119
120120 (b) Except as provided in subsection (j) of this section, each group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 delivered, issued for delivery, renewed, amended or continued in this state shall provide benefits for the diagnosis and treatment of mental or nervous conditions. Benefits payable include, but need not be limited to:
121121
122122 (1) General inpatient hospitalization, including in state-operated facilities;
123123
124124 (2) Medically necessary acute treatment services and medically necessary clinical stabilization services;
125125
126126 (3) General hospital outpatient services, including at state-operated facilities;
127127
128128 (4) Psychiatric inpatient hospitalization, including in state-operated facilities;
129129
130130 (5) Psychiatric outpatient hospital services, including at state-operated facilities;
131131
132132 (6) Intensive outpatient services, including at state-operated facilities;
133133
134134 (7) Partial hospitalization, including at state-operated facilities;
135135
136136 (8) Evidence-based maternal, infant and early childhood home visitation services, as described in Section 2951 of the Patient Protection and Affordable Care Act, P.L. 111-148, as amended from time to time, that are designed to improve health outcomes for pregnant women, postpartum mothers and newborns and children, including, but not limited to, for maternal substance use disorders or depression and relationship-focused interventions for children with mental or nervous conditions or substance use disorders;
137137
138138 (9) Intensive, home-based services designed to address specific mental or nervous conditions in a child;
139139
140140 (10) Evidence-based family-focused therapy that specializes in the treatment of juvenile substance use disorders;
141141
142142 (11) Short-term family therapy intervention;
143143
144144 (12) Nonhospital inpatient detoxification;
145145
146146 (13) Medically monitored detoxification;
147147
148148 (14) Ambulatory detoxification;
149149
150150 (15) Inpatient services at psychiatric residential treatment facilities;
151151
152152 (16) Rehabilitation services provided in residential treatment facilities, general hospitals, psychiatric hospitals or psychiatric facilities;
153153
154154 (17) Observation beds in acute hospital settings;
155155
156156 (18) Psychological and neuropsychological testing conducted by an appropriately licensed health care provider;
157157
158158 (19) Trauma screening conducted by a licensed behavioral health professional;
159159
160160 (20) Depression screening, including maternal depression screening, conducted by a licensed behavioral health professional;
161161
162162 (21) Substance use screening conducted by a licensed behavioral health professional;
163163
164164 (22) Intensive, family-based and community-based treatment programs that focus on addressing environmental systems that impact chronic and violent juvenile offenders;
165165
166166 (23) Other home-based therapeutic interventions for children;
167167
168168 (24) Chemical maintenance treatment, as defined in section 19a-495-570 of the regulations of Connecticut state agencies; and
169169
170170 (25) Extended day treatment programs, as described in section 17a-22.
171171
172172 (c) No such group policy shall establish any terms, conditions or benefits that (1) place a greater financial burden on an insured for access to diagnosis or treatment of mental or nervous conditions than for diagnosis or treatment of medical, surgical or other physical health conditions, [or] (2) prohibit an insured from obtaining or a health care provider from being reimbursed for multiple screening services as part of a single-day visit to a health care provider or a multicare institution, as defined in section 19a-490, or (3) limit the number of visits to a health care provider or a multicare institution to assess an insured for a diagnosis of a condition.
173173
174174 (d) In the case of benefits payable for the services of a licensed physician, such benefits shall be payable for the same services when such services are lawfully rendered by a psychologist licensed under the provisions of chapter 383 or by such a licensed psychologist in a licensed hospital or clinic.
175175
176176 (e) In the case of benefits payable for the services of a licensed physician or psychologist, such benefits shall be payable for the same services when such services are rendered by:
177177
178178 (1) A clinical social worker who is licensed under the provisions of chapter 383b and who has passed the clinical examination of the American Association of State Social Work Boards and has completed at least two thousand hours of post-master's social work experience in a nonprofit agency qualifying as a tax-exempt organization under Section 501(c) of the Internal Revenue Code of 1986 or any subsequent corresponding internal revenue code of the United States, as from time to time amended, in a municipal, state or federal agency or in an institution licensed by the Department of Public Health under section 19a-490;
179179
180180 (2) A social worker who was certified as an independent social worker under the provisions of chapter 383b prior to October 1, 1990;
181181
182182 (3) A licensed marital and family therapist who has completed at least two thousand hours of post-master's marriage and family therapy work experience in a nonprofit agency qualifying as a tax-exempt organization under Section 501(c) of the Internal Revenue Code of 1986 or any subsequent corresponding internal revenue code of the United States, as from time to time amended, in a municipal, state or federal agency or in an institution licensed by the Department of Public Health under section 19a-490;
183183
184184 (4) A marital and family therapist who was certified under the provisions of chapter 383a prior to October 1, 1992;
185185
186186 (5) A licensed alcohol and drug counselor, as defined in section 20-74s, or a certified alcohol and drug counselor, as defined in section 20-74s;
187187
188188 (6) A licensed professional counselor; or
189189
190190 (7) An advanced practice registered nurse licensed under the provisions of chapter 378.
191191
192192 (f) (1) In the case of benefits payable for the services of a licensed physician, such benefits shall be payable for (A) services rendered in a child guidance clinic or residential treatment facility by a person with a master's degree in social work or by a person with a master's degree in marriage and family therapy under the supervision of a psychiatrist, physician, licensed marital and family therapist or licensed clinical social worker who is eligible for reimbursement under subdivisions (1) to (4), inclusive, of subsection (e) of this section; (B) services rendered in a residential treatment facility by a licensed or certified alcohol and drug counselor who is eligible for reimbursement under subdivision (5) of subsection (e) of this section; or (C) services rendered in a residential treatment facility by a licensed professional counselor who is eligible for reimbursement under subdivision (6) of subsection (e) of this section.
193193
194194 (2) In the case of benefits payable for the services of a licensed psychologist under subsection (e) of this section, such benefits shall be payable for (A) services rendered in a child guidance clinic or residential treatment facility by a person with a master's degree in social work or by a person with a master's degree in marriage and family therapy under the supervision of such licensed psychologist, licensed marital and family therapist or licensed clinical social worker who is eligible for reimbursement under subdivisions (1) to (4), inclusive, of subsection (e) of this section; (B) services rendered in a residential treatment facility by a licensed or certified alcohol and drug counselor who is eligible for reimbursement under subdivision (5) of subsection (e) of this section; or (C) services rendered in a residential treatment facility by a licensed professional counselor who is eligible for reimbursement under subdivision (6) of subsection (e) of this section.
195195
196196 (g) In the case of benefits payable for the service of a licensed physician practicing as a psychiatrist or a licensed psychologist, under subsection (e) of this section, such benefits shall be payable for outpatient services rendered (1) in a nonprofit community mental health center, as defined by the Department of Mental Health and Addiction Services, in a nonprofit licensed adult psychiatric clinic operated by an accredited hospital or in a residential treatment facility; (2) under the supervision of a licensed physician practicing as a psychiatrist, a licensed psychologist, a licensed marital and family therapist, a licensed clinical social worker, a licensed or certified alcohol and drug counselor, or a licensed professional counselor who is eligible for reimbursement under subdivisions (1) to (6), inclusive, of subsection (e) of this section; and (3) within the scope of the license issued to the center or clinic by the Department of Public Health or to the residential treatment facility by the Department of Children and Families.
197197
198198 (h) Except in the case of emergency services or in the case of services for which an individual has been referred by a physician affiliated with a health care center, nothing in this section shall be construed to require a health care center to provide benefits under this section through facilities that are not affiliated with the health care center.
199199
200200 (i) In the case of any person admitted to a state institution or facility administered by the Department of Mental Health and Addiction Services, Department of Public Health, Department of Children and Families or the Department of Developmental Services, the state shall have a lien upon the proceeds of any coverage available to such person or a legally liable relative of such person under the terms of this section, to the extent of the per capita cost of such person's care. Except in the case of emergency services the provisions of this subsection shall not apply to coverage provided under a managed care plan, as defined in section 38a-478.
201201
202202 (j) A group health insurance policy may exclude the benefits required by this section if such benefits are included in a separate policy issued to the same group by an insurance company, health care center, hospital service corporation, medical service corporation or fraternal benefit society. Such separate policy, which shall include the benefits required by this section and the benefits required by section 38a-533, shall not be required to include any other benefits mandated by this title.
203203
204204 (k) In the case of benefits based upon confinement in a residential treatment facility, such benefits shall be payable in situations in which the insured has a serious mental or nervous condition that substantially impairs the insured's thoughts, perception of reality, emotional process or judgment or grossly impairs the behavior of the insured, and, upon an assessment of the insured by a physician, psychiatrist, psychologist or clinical social worker, cannot appropriately, safely or effectively be treated in an acute care, partial hospitalization, intensive outpatient or outpatient setting.
205205
206206 (l) The services rendered for which benefits are to be paid for confinement in a residential treatment facility shall be based on an individual treatment plan. For purposes of this section, the term "individual treatment plan" means a treatment plan prescribed by a physician with specific attainable goals and objectives appropriate to both the patient and the treatment modality of the program.
207207
208208 (m) In addition to the benefits payable under subsections (b) to (g), inclusive, and subsections (k) and (l) of this section, each such policy shall provide benefits for the services of a provider specified in subsection (d) or (e) of this section for any consultation with such provider that includes the insured or a family member of the insured (1) during an assessment for a diagnosis of a condition, and (2) after a diagnosis of a mental or nervous condition has been made.
209209
210210
211211
212212
213213 This act shall take effect as follows and shall amend the following sections:
214214 Section 1 January 1, 2017 38a-488a
215215 Sec. 2 January 1, 2017 38a-514
216216
217217 This act shall take effect as follows and shall amend the following sections:
218218
219219 Section 1
220220
221221 January 1, 2017
222222
223223 38a-488a
224224
225225 Sec. 2
226226
227227 January 1, 2017
228228
229229 38a-514
230230
231+Statement of Purpose:
231232
233+To prohibit limits on the number of visits to assess an insured for a diagnosis of a condition and to require health insurance coverage for consultations with certain health care providers during the assessment for a diagnosis of a condition and after a diagnosis of a mental or nervous condition.
232234
233-INS Joint Favorable
234-
235-INS
236-
237-Joint Favorable
235+[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not underlined.]