Researcher: JKL Page 1 4/8/21
OLR Bill Analysis
SB 1007
AN ACT REQUIRING HEALTH INSURANCE AND MEDICAID
COVERAGE FOR THE TREATMENT OF SEVERE OBESITY.
SUMMARY
This bill requires certain commercial health insurance policies to
cover surgical procedures performed to treat severe obesity, including
gastric bypass, sleeve gastrectomy, and duodenal switch. The
procedures must be (1) recognized by the National Institutes of Health
(NIH), American Society for Metabolic and Bariatric Surgery, and
American College of Surgeons as providing long-term weight loss and
(2) consistent with NIH treatment guidelines.
The bill requires that if the policies cover outpatient prescription
drugs, they must also cover outpatient prescription drugs approved by
the federal Food and Drug Administration to treat severe obesity.
Under the bill, coverage is subject to the same terms and conditions
that apply to all other benefits covered under the policy.
The bill also requires the Department of Social Services (DSS)
commissioner to provide Medicaid coverage reimbursement for the
surgical procedures and outpatient prescription drugs described above
to treat severe obesity.
The bill requires the DSS commissioner to (1) seek federal approval
of a Medicaid state plan amendment or waiver for this, if necessary, in
accordance with state law and (2) adopt implementing regulations. It
authorizes her to adopt policies and procedures to implement these
provisions while in the process of adopting regulations, as long as the
policies and procedures are posted on the DSS website and the state
eRegulations system.
EFFECTIVE DATE: January 1, 2022, except the Medicaid provisions 2021SB-01007-R000364-BA.DOCX
Researcher: JKL Page 2 4/8/21
are effective July 1, 2021.
SEVERE OBESITY DEFINED
Under the bill, a person with severe obesity has a body mass index
(BMI) that is (1) over 40 or (2) at least 35 if he or she is also diagnosed
with a comorbidity such as a cardiopulmonary condition, diabetes,
hypertension, or sleep apnea. BMI is calculated by dividing a person’s
weight in kilograms by the square of their height in meters.
COMMERCIAL INSURANCE POLICY APPLICABILITY
For commercial insurance purposes, the bill applies to individual
and group health insurance policies delivered, issued, renewed,
amended, or continued in Connecticut on or after January 1, 2022, that
cover (1) basic hospital expenses; (2) basic medical-surgical expenses;
(3) major medical expenses; or (4) hospital or medical services,
including those provided under an HMO plan. Because of the federal
Employee Retirement Income Security Act (ERISA), state insurance
benefit mandates do not apply to self-insured benefit plans.
COMMITTEE ACTION
Insurance and Real Estate Committee
Joint Favorable
Yea 18 Nay 0 (03/22/2021)