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 Section 38a-21 of the general statutes is repealed and the 1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