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General Assembly Raised Bill No. 6588
January Session, 2021
LCO No. 3806
Referred to Committee on INSURANCE AND REAL ESTATE
Introduced by:
(INS)
AN ACT CONCERNING ME NTAL HEALTH CARE AND SUBSTANCE
ABUSE SERVICES.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. (NEW) (Effective January 1, 2022) Notwithstanding any 1
provision of the general statutes, no individual health insurance policy 2
providing coverage of the type specified in subdivisions (1), (2), (4), (11), 3
(12) and (16) of section 38a-469 of the general statutes delivered, issued 4
for delivery, renewed, amended or continued in this state on or after 5
January 1, 2022, that provides coverage for outpatient prescription 6
drugs shall: (1) Require a prescribing health care provider to prescribe a 7
supply of a covered outpatient psychotropic drug that is larger than the 8
supply of such drug that such provider deems clinically appropriate; or 9
(2) if a prescribing health care provider deems a ninety-day supply of a 10
covered outpatient psychotropic drug to be clinically inappropriate and 11
prescribes less than a ninety-day supply of such drug, impose a 12
coinsurance, copayment, deductible or other out-of-pocket expense for 13
the prescribed supply of such drug in an amount that exceeds the 14
amount of the coinsurance, copayment, deductible or other out-of-15
pocket expense for a ninety-day supply of such drug reduced pro rata 16 Raised Bill No. 6588
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in proportion to such prescribed supply of such drug. 17
Sec. 2. (NEW) (Effective January 1, 2022) Notwithstanding any 18
provision of the general statutes, no group health insurance policy 19
providing coverage of the type specified in subdivisions (1), (2), (4), (11), 20
(12) and (16) of section 38a-469 of the general statutes delivered, issued 21
for delivery, renewed, amended or continued in this state on or after 22
January 1, 2022, that provides coverage for outpatient prescription 23
drugs shall: (1) Require a prescribing health care provider to prescribe a 24
supply of a covered outpatient psychotropic drug that is larger than the 25
supply of such drug that such provider deems clinically appropriate; or 26
(2) if a prescribing health care provider deems a ninety-day supply of a 27
covered outpatient psychotropic drug to be clinically inappropriate and 28
prescribes less than a ninety-day supply of such drug, impose a 29
coinsurance, copayment, deductible or other out-of-pocket expense for 30
the prescribed supply of such drug in an amount that exceeds the 31
amount of the coinsurance, copayment, deductible or other out-of-32
pocket expense for a ninety-day supply of such drug reduced pro rata 33
in proportion to such prescribed supply of such drug. 34
Sec. 3. Section 38a-476b of the general statutes is repealed and the 35
following is substituted in lieu thereof (Effective January 1, 2022): 36
Notwithstanding any provision of the general statutes or the 37
regulations of Connecticut state agencies, no mental health care benefit 38
provided under state law, or with state funds or to state employees may, 39
through the use of a drug formulary, list of covered drugs or any other 40
means: (1) Limit the availability of psychotropic drugs that are the most 41
effective therapeutically indicated pharmaceutical treatment with the 42
least probability of adverse side effects; [or] (2) require utilization of 43
psychotropic drugs that are not the most effective therapeutically 44
indicated pharmaceutical treatment with the least probability of adverse 45
side effects; or (3) require a prescribing health care provider to prescribe 46
a supply of an outpatient psychotropic drug that is larger than the 47
supply of such drug that such provider deems clinically appropriate. 48
Nothing in this section shall be construed to limit the authority of a 49 Raised Bill No. 6588
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physician to prescribe a drug that is not the most recent pharmaceutical 50
treatment. Nothing in this section shall be construed to prohibit 51
differential copays among pharmaceutical treatments or to prohibit 52
utilization review. 53
Sec. 4. (Effective from passage) (a) There is established a task force to 54
study methods available to this state, and health carriers doing business 55
in this state, to encourage health care providers providing mental health 56
services to participate in provider networks. 57
(b) The task force shall consist of the following members: 58
(1) Two appointed by the speaker of the House of Representatives; 59
(2) Two appointed by the president pro tempore of the Senate; 60
(3) One appointed by the majority leader of the House of 61
Representatives; 62
(4) One appointed by the majority leader of the Senate; 63
(5) One appointed by the minority leader of the House of 64
Representatives; 65
(6) One appointed by the minority leader of the Senate; 66
(7) The Insurance Commissioner, or the commissioner's designee; 67
and 68
(8) Two appointed by the Governor. 69
(c) Any member of the task force appointed under subdivision (1), 70
(2), (3), (4), (5) or (6) of subsection (b) of this section may be a member 71
of the General Assembly. 72
(d) All initial appointments to the task force shall be made not later 73
than thirty days after the effective date of this section. Any vacancy shall 74
be filled by the appointing authority. 75 Raised Bill No. 6588
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(e) The speaker of the House of Representatives and the president pro 76
tempore of the Senate shall select the chairpersons of the task force from 77
among the members of the task force. Such chairpersons shall schedule 78
the first meeting of the task force, which shall be held not later than sixty 79
days after the effective date of this section. 80
(f) The administrative staff of the joint standing committee of the 81
General Assembly having cognizance of matters relating to insurance 82
shall serve as administrative staff of the task force. 83
(g) Not later than January 1, 2022, the task force shall submit a report 84
on its findings and recommendations to the joint standing committee of 85
the General Assembly having cognizance of matters relating to 86
insurance, in accordance with the provisions of section 11-4a of the 87
general statutes. The task force shall terminate on the date that it 88
submits such report or January 1, 2022, whichever is later. 89
Sec. 5. (Effective from passage) (a) There is established a task force to 90
study health insurance coverage for peer support services in this state. 91
Such study shall include, but need not be limited to, an examination of 92
any means available to increase health insurance coverage for peer 93
support services provided to individuals in this state. 94
(b) The task force shall consist of the following members: 95
(1) Two appointed by the speaker of the House of Representatives, 96
one of whom is a recovery support specialist and one of whom is a 97
member of the Connecticut Certification Board; 98
(2) Two appointed by the president pro tempore of the Senate, one of 99
whom is a recovery coach and one of whom is a representative of the 100
Connecticut Hospital Association; 101
(3) One appointed by the majority leader of the House of 102
Representatives, who is a representative of a program overseen by the 103
Department of Children and Families; 104
(4) One appointed by the majority leader of the Senate, who is a 105 Raised Bill No. 6588
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representative of an organization that trains recovery coaches or 106
recovery support specialists; 107
(5) One appointed by the minority leader of the House of 108
Representatives, who is a supervisor of peers from a provider agency 109
that employs peers; 110
(6) One appointed by the minority leader of the Senate, who is a 111
representative of an organization that provides services to Medicaid 112
beneficiaries; 113
(7) One appointed by the Insurance Commissioner, who is a 114
representative of a health carrier; and 115
(8) Two appointed by the Governor, one of whom is a young adult 116
with experience in various forms of peer support and one of whom has 117
perspective concerning community reentry. 118
(c) Any member of the task force appointed under subdivision (1), 119
(2), (3), (4), (5) or (6) of subsection (b) of this section may be a member 120
of the General Assembly. 121
(d) All initial appointments to the task force shall be made not later 122
than thirty days after the effective date of this section. Any vacancy shall 123
be filled by the appointing authority. 124
(e) The speaker of the House of Representatives and the president pro 125
tempore of the Senate shall select the chairpersons of the task force from 126
among the members of the task force. Such chairpersons shall schedule 127
the first meeting of the task force, which shall be held not later than sixty 128
days after the effective date of this section. 129
(f) The administrative staff of the joint standing committee of the 130
General Assembly having cognizance of matters relating to insurance 131
shall serve as administrative staff of the task force. 132
(g) Not later than December 31, 2021, the task force shall submit a 133
report on its findings and recommendations to the joint standing 134 Raised Bill No. 6588
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committee of the General Assembly having cognizance of matters 135
relating to insurance, in accordance with the provisions of section 11-4a 136
of the general statutes. The task force shall terminate on the date that it 137
submits such report or December 31, 2021, whichever is later. 138
This act shall take effect as follows and shall amend the following
sections:
Section 1 January 1, 2022 New section
Sec. 2 January 1, 2022 New section
Sec. 3 January 1, 2022 38a-476b
Sec. 4 from passage New section
Sec. 5 from passage New section
Statement of Purpose:
To: (1) Provide that no individual or group health insurance policy
providing coverage for outpatient prescription drugs shall (A) require a
prescribing health care provider to prescribe a supply of a covered
outpatient psychotropic drug that is larger than the supply of such drug
that such provider deems clinically appropriate, or (B) if a prescribing
health care provider deems a ninety-day supply of a covered outpatient
psychotropic drug to be clinically inappropriate and prescribes less than
a ninety-day supply of such drug, impose a coinsurance, copayment,
deductible or other out-of-pocket expense for the prescribed supply of
such drug in an amount that exceeds the amount of the coinsurance,
copayment, deductible or other out-of-pocket expense for a ninety-day
supply of such drug reduced pro rata in proportion to such prescribed
supply of such drug; (2) provide that no mental health care benefits
provided under state law, with state funds or to state employees shall
require a prescribing health care provider to prescribe a supply of an
outpatient psychotropic drug that is larger than the supply of such drug
that such provider deems clinically appropriate; (3) establish a task force
to study methods available to this state, and health carriers doing
business in this state, to encourage health care providers providing
mental health services to participate in provider networks; and (4)
establish a task force to study health insurance coverage for peer
support 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.]