| 4 | 23 | | |
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| 5 | 24 | | AN ACT CONCERNING THE WORKING GROUP ON BEHAVIORAL HEALTH UTILIZATION. |
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| 6 | 25 | | |
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| 7 | 26 | | Be it enacted by the Senate and House of Representatives in General Assembly convened: |
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| 8 | 27 | | |
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| 9 | 28 | | Section 1. Section 353 of public act 15-5 of the June special session is repealed and the following is substituted in lieu thereof (Effective from passage): |
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| 10 | 29 | | |
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| 11 | 30 | | (a) Not later than October 1, 2015, the Insurance Commissioner shall convene a working group to develop recommendations for behavioral health utilization and quality measures data that should be collected uniformly from state agencies that pay health care claims, group hospitalization and medical and surgical insurance plans established pursuant to section 5-259 of the general statutes, the state medical assistance program and health insurance companies and health care centers that write health insurance policies and health care contracts in this state. The purposes of such recommendations include, but are not limited to, protecting behavioral health parity for youths and other populations. |
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| 12 | 31 | | |
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| 13 | 32 | | (b) The working group shall consist of the Insurance Commissioner, the Healthcare Advocate, the Commissioners of Social Services, Public Health, Mental Health and Addiction Services, Children and Families and Developmental Services and the Comptroller, or their designees, and may include representatives from health insurance companies or health care centers or any other members the Insurance Commissioner deems necessary and relevant to carry out the working group's duties under this section. |
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| 14 | 33 | | |
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| 15 | 34 | | (c) (1) The working group shall determine the data that should be collected to inform analysis on (A) coverage for behavioral health services, (B) the adequacy of coverage for behavioral health conditions, including, but not limited to, autism spectrum disorders and substance use disorders, (C) the alignment of medical necessity criteria and utilization management procedures across such agencies, plans, program, companies and centers, (D) the adequacy of health care provider networks, (E) the overall availability of behavioral health care providers in this state, (F) the percentage of behavioral health care providers in this state that are participating providers under a group hospitalization and medical and surgical insurance plan established pursuant to section 5-259 of the general statutes, the state medical assistance program, or a health insurance policy or health care contract delivered, issued for delivery, renewed, amended or continued in this state, and (G) the adequacy of services available for behavioral health conditions, including, but not limited to, autism spectrum disorders and substance use disorders. |
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| 16 | 35 | | |
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| 17 | 36 | | (2) The recommendations developed by the working group may include data such as (A) per member, per month claim expenses, (B) the median length of a covered treatment for an entire course of treatment by levels of care, (C) utilization review outcome data grouped by levels of care, age categories and levels of review as set forth in part VII of chapter 700c of the general statutes, (D) the number of in-network and out-of-network health care providers by location and provider type, (E) health care provider network management data by location and provider type, [and] (F) health care provider network fluctuations, the causes of such fluctuations and the decisions made by health insurance companies, health care centers and state agencies regarding the approval of health care providers to join a health care provider network, (G) the number of prior authorization requests for behavioral health services and the number of denials for such requests compared with the number of prior authorization requests for other health care services and the number of denials for such requests, and (H) the percentage of paid claims for out-of-network behavioral health services compared with the percentage of paid claims for other types of out-of-network health care and surgical services. |
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| 18 | 37 | | |
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| 19 | 38 | | (d) Not later than January 1, [2016] 2017, the Insurance Commissioner shall submit a report of the recommendations of the working group as set forth in subsection (a) of this section, in accordance with the provisions of section 11-4a of the general statutes, to the Governor and the joint standing committees of the General Assembly having cognizance of matters relating to insurance, human services, public health and children. |
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