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General Assembly Committee Bill No. 6095
January Session, 2019
LCO No. 5488
Referred to Committee on INSURANCE AND REAL ESTATE
Introduced by:
(INS)
AN ACT CONCERNING RE QUIRED HEALTH INSURA NCE
COVERAGE FOR DETOXIF ICATION AND SUBSTANC E ABUSE
SERVICES.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. Section 38a-492p of the general statutes is repealed and 1
the following is substituted in lieu thereof (Effective January 1, 2020): 2
Each insurance company, hospital service corporation, medical 3
service corporation, health care center, fraternal benefit society or other 4
entity that delivers, issues for delivery, renews, amends or continues in 5
this state an individual health insurance policy providing coverage of 6
the type specified in subdivision (1), (2), (4), (11) or (12) of section 38a-7
469 that provides coverage to an insured or enrollee who has been 8
diagnosed with a substance use disorder, as described in section 17a-9
458, shall cover: [medically necessary, medically monitored inpatient 10
detoxification services and medically necessary, medically managed 11
intensive inpatient detoxification services provided to the insured or 12
enrollee. For purposes of this section, "medically monitored inpatient 13
detoxification" and "medically managed intensive inpatient 14
detoxification" have the same meanings as described in the most recent 15 Committee Bill No. 6095
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edition of the American Society of Addiction Medicine Treatment 16
Criteria for Addictive, Substance-Related and Co-Occurring 17
Conditions] 18
(1) Family counseling and intervention services for the insured or 19
enrollee; 20
(2) Not more than seven days of inpatient hospital or nonhospital 21
detoxification services per admission for the insured or enrollee; and 22
(3) Not fewer than: 23
(A) Four admissions for inpatient hospital or nonhospital 24
detoxification services for the insured or enrollee during such insured's 25
or enrollee's lifetime; 26
(B) Thirty days of substance abuse services rendered to the insured 27
or enrollee at a residential treatment facility during any year; 28
(C) Ninety days of substance abuse services rendered to the insured 29
or enrollee at a residential treatment facility during such insured's or 30
enrollee's lifetime; 31
(D) Thirty sessions of outpatient or partial hospitalization substance 32
abuse services for the insured or enrollee during any year; 33
(E) One hundred twenty sessions of outpatient or partial 34
hospitalization substance abuse services for the insured or enrollee 35
during such insured's or enrollee's lifetime; and 36
(F) Thirty additional sessions of outpatient or partial hospitalization 37
substance abuse services for the insured or enrollee during such 38
insured's or enrollee's lifetime, which such insured or enrollee may 39
exchange on a two-to-one basis to obtain fifteen additional days of 40
nonhospital substance abuse services rendered to such insured or 41
enrollee at a residential treatment facility during such insured's or 42
enrollee's lifetime. 43 Committee Bill No. 6095
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Sec. 2. Section 38a-518p of the general statutes is repealed and the 44
following is substituted in lieu thereof (Effective January 1, 2020): 45
Each insurance company, hospital service corporation, medical 46
service corporation, health care center, fraternal benefit society or other 47
entity that delivers, issues for delivery, renews, amends or continues in 48
this state a group health insurance policy providing coverage of the 49
type specified in subdivision (1), (2), (4), (11) or (12) of section 38a-469 50
that provides coverage to an insured or enrollee who has been 51
diagnosed with a substance use disorder, as described in section 17a-52
458, shall cover: [medically necessary, medically monitored inpatient 53
detoxification services and medically necessary, medically managed 54
intensive inpatient detoxification services provided to the insured or 55
enrollee. For purposes of this section, "medically monitored inpatient 56
detoxification" and "medically managed intensive inpatient 57
detoxification" have the same meanings as described in the most recent 58
edition of the American Society of Addiction Medicine Treatment 59
Criteria for Addictive, Substance-Related and Co-Occurring 60
Conditions] 61
(1) Family counseling and intervention services for the insured or 62
enrollee; 63
(2) Not more than seven days of inpatient hospital or nonhospital 64
detoxification services per admission for the insured or enrollee; and 65
(3) Not fewer than: 66
(A) Four admissions for inpatient hospital or nonhospital 67
detoxification services for the insured or enrollee during such insured's 68
or enrollee's lifetime; 69
(B) Thirty days of substance abuse services rendered to the insured 70
or enrollee at a residential treatment facility during any year; 71
(C) Ninety days of substance abuse services rendered to the insured 72
or enrollee at a residential treatment facility during such insured's or 73 Committee Bill No. 6095
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enrollee's lifetime; 74
(D) Thirty sessions of outpatient or partial hospitalization substance 75
abuse services for the insured or enrollee during any year; 76
(E) One hundred twenty sessions of outpatient or partial 77
hospitalization substance abuse services for the insured or enrollee 78
during such insured's or enrollee's lifetime; and 79
(F) Thirty additional sessions of outpatient or partial hospitalization 80
substance abuse services for the insured or enrollee during such 81
insured's or enrollee's lifetime, which such insured or enrollee may 82
exchange on a two-to-one basis to obtain fifteen additional days of 83
nonhospital substance abuse services rendered to such insured or 84
enrollee at a residential treatment facility during such insured's or 85
enrollee's lifetime. 86
This act shall take effect as follows and shall amend the following
sections:
Section 1 January 1, 2020 38a-492p
Sec. 2 January 1, 2020 38a-518p
INS Joint Favorable