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General Assembly Raised Bill No. 5256
February Session, 2020
LCO No. 1153
Referred to Committee on INSURANCE AND REAL ESTATE
Introduced by:
(INS)
AN ACT CONCERNING RE QUIRED HEALTH INSURA NCE
COVERAGE FOR DETOXIF ICATION AND SUBSTANCE 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 Section 38a-492p of the general statutes is repealed and the 1
following is substituted in lieu thereof (Effective January 1, 2021): 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 Raised Bill No. 5256
LCO No. 1153 2 of 4
detoxification" have the same meanings as described in the most recent 15
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; 22
(3) Not fewer than four admissions for inpatient hospital or 23
nonhospital detoxification services for the insured or enrollee during 24
such insured's or enrollee's lifetime; 25
(4) Not fewer than thirty days of substance abuse services rendered 26
to the insured or enrollee at a residential treatment facility during any 27
year and a total of not fewer than ninety days of such services during 28
such insured's or enrollee's lifetime; 29
(5) Not fewer than thirty sessions of outpatient or partial 30
hospitalization substance abuse services for the insured or enrollee 31
during any year and a total of not fewer than one hundred twenty 32
sessions of such services during such insured's or enrollee's lifetime; and 33
(6) Not fewer than thirty additional sessions of outpatient or partial 34
hospitalization substance abuse services for the insured or enrollee 35
during such insured's or enrollee's lifetime, which such insured or 36
enrollee may exchange on a two-to-one basis to obtain fifteen additional 37
days of nonhospital substance abuse services rendered to such insured 38
or enrollee at a residential treatment facility during such insured's or 39
enrollee's lifetime. 40
Sec. 2. Section 38a-518p of the general statutes is repealed and the 41
following is substituted in lieu thereof (Effective January 1, 2021): 42
Each insurance company, hospital service corporation, medical 43
service corporation, health care center, fraternal benefit society or other 44 Raised Bill No. 5256
LCO No. 1153 3 of 4
entity that delivers, issues for delivery, renews, amends or continues in 45
this state a group health insurance policy providing coverage of the type 46
specified in subdivision (1), (2), (4), (11) or (12) of section 38a-469 that 47
provides coverage to an insured or enrollee who has been diagnosed 48
with a substance use disorder, as described in section 17a-458, shall 49
cover: [medically necessary, medically monitored inpatient 50
detoxification services and medically necessary, medically managed 51
intensive inpatient detoxification services provided to the insured or 52
enrollee. For purposes of this section, "medically monitored inpatient 53
detoxification" and "medically managed intensive inpatient 54
detoxification" have the same meanings as described in the most recent 55
edition of the American Society of Addiction Medicine Treatment 56
Criteria for Addictive, Substance-Related and Co-Occurring 57
Conditions.] 58
(1) Family counseling and intervention services for the insured or 59
enrollee; 60
(2) Not more than seven days of inpatient hospital or nonhospital 61
detoxification services per admission for the insured or enrollee; 62
(3) Not fewer than four admissions for inpatient hospital or 63
nonhospital detoxification services for the insured or enrollee during 64
such insured's or enrollee's lifetime; 65
(4) Not fewer than thirty days of substance abuse services rendered 66
to the insured or enrollee at a residential treatment facility during any 67
year and a total of not fewer than ninety days of such services during 68
such insured's or enrollee's lifetime; 69
(5) Not fewer than thirty sessions of outpatient or partial 70
hospitalization substance abuse services for the insured or enrollee 71
during any year and a total of not fewer than one hundred twenty 72
sessions of such services during such insured's or enrollee's lifetime; and 73
(6) Not fewer than thirty additional sessions of outpatient or partial 74
hospitalization substance abuse services for the insured or enrollee 75 Raised Bill No. 5256
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during such insured's or enrollee's lifetime, which such insured or 76
enrollee may exchange on a two-to-one basis to obtain fifteen additional 77
days of nonhospital substance abuse services rendered to such insured 78
or enrollee at a residential treatment facility during such insured's or 79
enrollee's lifetime. 80
This act shall take effect as follows and shall amend the following
sections:
Section 1 January 1, 2021 38a-492p
Sec. 2 January 1, 2021 38a-518p
Statement of Purpose:
To modify required health insurance coverage for detoxification and
substance abuse services.
[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.]