Connecticut 2021 Regular Session

Connecticut House Bill HB05013 Compare Versions

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7	7		General Assembly Committee Bill No. 5013
8	8		January Session, 2021
9	9		LCO No. 2684
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12	12		Referred to Committee on INSURANCE AND REAL ESTATE
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14	14
15	15		Introduced by:
16	16		(INS)
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19	19
20	20		AN ACT CONCERNING MA NDATED HEALTH INSURA NCE BENEFIT
21	21		REVIEW.
22	22		Be it enacted by the Senate and House of Representatives in General
23	23		Assembly convened:
24	24
25	25		Section 1. Section 38a-21 of the general statutes is repealed and the 1
26	26		following is substituted in lieu thereof (Effective July 1, 2021): 2
27	27		(a) As used in this section: 3
28	28		(1) "Commissioner" means the Insurance Commissioner. 4
29	29		(2) "Mandated health benefit" means [an existing statutory obligation 5
30	30		of, or] proposed legislation that would require [,] an insurer, health care 6
31	31		center, hospital service corporation, medical service corporation, 7
32	32		fraternal benefit society or other entity that offers individual or group 8
33	33		health insurance or a medical or health care benefits plan in this state to 9
34	34		[: (A) Permit an insured or enrollee to obtain health care treatment or 10
35	35		services from a particular type of health care provider; (B) offer or 11
36	36		provide coverage for the screening, diagnosis or treatment of a 12
37		-	particular disease or condition; or (C)] offer or provide coverage for a 13 Committee Bill No. 5013
	37	+	particular disease or condition; or (C)] offer or provide coverage for a 13
	38	+	particular type of health care treatment or service, or for medical 14
	39	+	equipment, medical supplies or drugs used in connection with a health 15
	40	+	Committee Bill No. 5013
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44		-	particular type of health care treatment or service, or for medical 14
45		-	equipment, medical supplies or drugs used in connection with a health 15
46	45		care treatment or service. ["Mandated health benefit" includes any 16
47	46		proposed legislation to expand or repeal an existing statutory obligation 17
48	47		relating to health insurance coverage or medical benefits.] 18
49	48		(b) (1) There is established within the Insurance Department a health 19
50	49		benefit review program for the review and evaluation of any mandated 20
51	50		health benefit that is requested by the joint standing committee of the 21
52	51		General Assembly having cognizance of matters relating to insurance. 22
53	52		Such program shall be funded by the Insurance Fund established under 23
54	53		section 38a-52a. The commissioner shall be authorized to make 24
55	54		assessments in a manner consistent with the provisions of chapter 698 25
56	55		for the costs of carrying out the requirements of this section. Such 26
57	56		assessments shall be in addition to any other taxes, fees and moneys 27
58	57		otherwise payable to the state. The commissioner shall deposit all 28
59	58		payments made under this section with the State Treasurer. The moneys 29
60	59		deposited shall be credited to the Insurance Fund and shall be accounted 30
61	60		for as expenses recovered from insurance companies. Such moneys shall 31
62	61		be expended by the commissioner to carry out the provisions of this 32
63	62		section and section 2 of public act 09-179. 33
64	63		(2) The commissioner [shall] may contract with The University of 34
65	64		Connecticut Center for Public Health and Health Policy or an actuarial 35
66	65		accounting firm to conduct any mandated health benefit review 36
67	66		requested pursuant to subsection (c) of this section. The director of said 37
68	67		center may engage the services of an actuary, quality improvement 38
69	68		clearinghouse, health policy research organization or any other 39
70	69		independent expert, and may engage or consult with any dean, faculty 40
71	70		or other personnel said director deems appropriate within The 41
72	71		University of Connecticut schools and colleges, including, but not 42
73	72		limited to, The University of Connecticut (A) School of Business, (B) 43
74	73		School of Dental Medicine, (C) School of Law, (D) School of Medicine, 44
75	74		and (E) School of Pharmacy. 45
76		-	[(c) Not later than August first of each year, the joint standing 46 Committee Bill No. 5013
	75	+	[(c) Not later than August first of each year, the joint standing 46
	76	+	committee of the General Assembly having cognizance of matters 47
	77	+	Committee Bill No. 5013
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83		-	committee of the General Assembly having cognizance of matters 47
84	82		relating to insurance shall submit to the commissioner a list of any 48
85	83		mandated health benefits for which said committee is requesting a 49
86	84		review. Not later than January first of the succeeding year, the 50
87	85		commissioner shall submit a report, in accordance with section 11-4a, of 51
88	86		the findings of such review and the information set forth in subsection 52
89	87		(d) of this section. 53
90	88		(d) The review report shall include at least the following, to the extent 54
91	89		information is available: 55
92	90		(1) The social impact of mandating the benefit, including:] 56
93	91		(c) During a regular session of the General Assembly, the joint 57
94	92		standing committee of the General Assembly having cognizance of 58
95	93		matters relating to insurance may, upon a majority vote of its members, 59
96	94		require the commissioner to conduct one review of not more than five 60
97	95		mandated health benefits. The committee shall submit to the 61
98	96		commissioner a list of the mandated health benefits to be reviewed. 62
99	97		(d) Not later than January first of the first calendar year following a 63
100	98		request for review made under subsection (c) of this section, the 64
101	99		commissioner shall submit a mandated health benefit review report, in 65
102	100		accordance with section 11-4a, to the joint standing committees of the 66
103	101		General Assembly having cognizance of matters relating to insurance 67
104	102		and public health. Such report shall include an evaluation of the quality 68
105	103		and cost impacts of mandating the benefit, including: 69
106	104		[(A)] (1) The extent to which the treatment, service or equipment, 70
107	105		supplies or drugs, as applicable, is utilized by a significant portion of 71
108	106		the population; 72
109	107		[(B)] (2) The extent to which the treatment, service or equipment, 73
110	108		supplies or drugs, as applicable, is currently available to the population, 74
111	109		including, but not limited to, coverage under Medicare, or through 75
112	110		public programs administered by charities, public schools, the 76
113		-	Department of Public Health, municipal health departments or health 77 Committee Bill No. 5013
	111	+	Department of Public Health, municipal health departments or health 77
	112	+	Committee Bill No. 5013
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120	117		districts or the Department of Social Services; 78
121	118		[(C)] (3) The extent to which insurance coverage is already available 79
122	119		for the treatment, service or equipment, supplies or drugs, as applicable; 80
123	120		[(D) If the coverage is not generally available, the extent to which 81
124	121		such lack of coverage results in persons being unable to obtain necessary 82
125	122		health care treatment; 83
126	123		(E) If the coverage is not generally available, the extent to which such 84
127	124		lack of coverage results in unreasonable financial hardships on those 85
128	125		persons needing treatment; 86
129	126		(F) The level of public demand and the level of demand from 87
130	127		providers for the treatment, service or equipment, supplies or drugs, as 88
131	128		applicable; 89
132	129		(G) The level of public demand and the level of demand from 90
133	130		providers for insurance coverage for the treatment, service or 91
134	131		equipment, supplies or drugs, as applicable; 92
135	132		(H) The likelihood of achieving the objectives of meeting a consumer 93
136	133		need as evidenced by the experience of other states; 94
137	134		(I) The relevant findings of state agencies or other appropriate public 95
138	135		organizations relating to the social impact of the mandated health 96
139	136		benefit; 97
140	137		(J) The alternatives to meeting the identified need, including, but not 98
141	138		limited to, other treatments, methods or procedures; 99
142	139		(K) Whether the benefit is a medical or a broader social need and 100
143	140		whether it is consistent with the role of health insurance and the concept 101
144	141		of managed care; 102
145	142		(L) The potential social implications of the coverage with respect to 103
146	143		the direct or specific creation of a comparable mandated benefit for 104
147		-	similar diseases, illnesses or conditions; 105 Committee Bill No. 5013
	144	+	similar diseases, illnesses or conditions; 105
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154	150		(M) The impact of the benefit on the availability of other benefits 106
155	151		currently offered; 107
156	152		(N) The impact of the benefit as it relates to employers shifting to self-108
157	153		insured plans and the extent to which the benefit is currently being 109
158	154		offered by employers with self-insured plans;] 110
159	155		[(O)] (4) The impact of making the benefit applicable to the state 111
160	156		employee health insurance or health benefits plan; [and] 112
161	157		[(P)] (5) The extent to which credible scientific evidence published in 113
162	158		peer-reviewed medical literature generally recognized by the relevant 114
163	159		medical community determines the treatment, service or equipment, 115
164	160		supplies or drugs, as applicable, to be safe and effective; [and] 116
165	161		[(2) The financial impact of mandating the benefit, including:] 117
166	162		[(A)] (6) The extent to which the mandated health benefit may 118
167	163		increase or decrease the cost of the treatment, service or equipment, 119
168	164		supplies or drugs, as applicable, over the next five years; 120
169	165		[(B)] (7) The extent to which the mandated health benefit may 121
170	166		increase the appropriate or inappropriate use of the treatment, service 122
171	167		or equipment, supplies or drugs, as applicable, over the next five years; 123
172	168		[(C)] (8) The extent to which the mandated health benefit may serve 124
173	169		as an alternative for more expensive or less expensive treatment, service 125
174	170		or equipment, supplies or drugs, as applicable; 126
175	171		[(D)] (9) The methods that will be implemented to manage the 127
176	172		utilization and costs of the mandated health benefit; 128
177	173		[(E)] (10) The extent to which insurance coverage for the treatment, 129
178	174		service or equipment, supplies or drugs, as applicable, may be 130
179	175		reasonably expected to increase or decrease the insurance premiums 131
180	176		and administrative expenses for policyholders; 132
181		-	[(F)] (11) The extent to which the treatment, service or equipment, 133 Committee Bill No. 5013
	177	+	[(F)] (11) The extent to which the treatment, service or equipment, 133
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188	183		supplies or drugs, as applicable, is more or less expensive than an 134
189	184		existing treatment, service or equipment, supplies or drugs, as 135
190	185		applicable, that is determined to be equally safe and effective by credible 136
191	186		scientific evidence published in peer-reviewed medical literature 137
192	187		generally recognized by the relevant medical community; 138
193	188		[(G)] (12) The impact of insurance coverage for the treatment, service 139
194	189		or equipment, supplies or drugs, as applicable, on the total cost of health 140
195	190		care, including potential benefits or savings to insurers and employers 141
196	191		resulting from prevention or early detection of disease or illness related 142
197	192		to such coverage; 143
198	193		[(H)] (13) The impact of the mandated health care benefit on the cost 144
199	194		of health care for small employers, as defined in section 38a-564, and for 145
200	195		employers other than small employers; and 146
201	196		[(I)] (14) The impact of the mandated health benefit on cost-shifting 147
202	197		between private and public payors of health care coverage and on the 148
203	198		overall cost of the health care delivery system in the state. 149
204	199		(e) The joint standing committees of the General Assembly having 150
205	200		cognizance of matters relating to insurance and public health shall 151
206	201		conduct a joint informational hearing following their receipt of a 152
207	202		mandated health benefit review report submitted by the commissioner 153
208	203		pursuant to subsection (d) of this section. The commissioner shall attend 154
209	204		and be available for questions from the members of the committees at 155
210	205		such hearing. On and after January 1, 2022, the General Assembly shall 156
211	206		not enact legislation to establish a mandated health benefit unless (1) 157
212	207		such benefit has been the subject of a report and an informational 158
213	208		hearing as provided in this section, or (2) upon a two-thirds vote of the 159
214	209		members of the joint standing committee of the General Assembly 160
215	210		having cognizance of matters relating to insurance. 161
216	211		This act shall take effect as follows and shall amend the following
217	212		sections:
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219		-	~~Section 1 July 1, 2021 38a-21~~ Committee Bill No. 5013
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	219	+	Section 1 July 1, 2021 38a-21
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227		-	INS Joint Favorable
	221	+	Statement of Purpose:
	222	+	To alter the manner in which the General Assembly enacts new
	223	+	mandated health insurance benefits.
	224	+	[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except
	225	+	that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not
	226	+	underlined.]
	227	+
	228	+	Co-Sponsors: REP. PAVALOCK-D'AMATO, 77th Dist.
	229	+
	230	+	H.B. 5013
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