Connecticut 2021 Regular Session

Connecticut Senate Bill SB01007 Compare Versions

Version 1 (Old)

Version 2 (New)

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4	4		SB.docx
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7	7		General Assembly Raised Bill No. 1007
8	8		January Session, 2021
9	9		LCO No. 3318
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12	12		Referred to Committee on INSURANCE AND REAL ESTATE
13	13
14	14
15	15		Introduced by:
16	16		(INS)
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20	20		AN ACT REQUIRING HEA LTH INSURANCE AND MEDICAID
21	21		COVERAGE FOR THE TRE ATMENT OF SEVERE OBE SITY.
22	22		Be it enacted by the Senate and House of Representatives in General
23	23		Assembly convened:
24	24
25	25		Section 1. (NEW) (Effective January 1, 2022) (a) For the purposes of this 1
26	26		section: 2
27	27		(1) "Body mass index" means the number calculated by dividing an 3
28	28		individual's weight in kilograms by the individual's height in meters 4
29	29		squared; and 5
30	30		(2) "Severe obesity" means a body mass index that is: 6
31	31		(A) Greater than forty; or 7
32	32		(B) Thirty-five or more if an individual has been diagnosed with a 8
33	33		comorbid disease or condition, including, but not limited to, a 9
34	34		cardiopulmonary condition, diabetes, hypertension or sleep apnea. 10
35	35		(b) Each individual health insurance policy providing coverage of the 11
36	36		type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 12 Raised Bill No. 1007
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38	38
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43	43		of the general statutes delivered, issued for delivery, renewed, amended 13
44	44		or continued in this state on or after January 1, 2022, shall provide 14
45	45		coverage for: 15
46	46		(1) Each surgical procedure that is: 16
47	47		(A) Performed to treat severe obesity, including, but not limited to, 17
48	48		gastric bypass surgery, sleeve gastrectomy and duodenal switch 18
49	49		surgery; 19
50	50		(B) Recognized by the National Institutes of Health, American Society 20
51	51		for Metabolic and Bariatric Surgery and American College of Surgeons 21
52	52		as providing long-term weight loss; and 22
53	53		(C) Consistent with treatment guidelines issued by the National 23
54	54		Institutes of Health as applied to the insured; and 24
55	55		(2) Each outpatient prescription drug that is approved by the federal 25
56	56		Food and Drug Administration to treat severe obesity if such policy 26
57	57		includes coverage for outpatient prescription drugs. 27
58	58		(c) The benefits required by subsection (b) of this section shall be 28
59	59		subject to the same terms and conditions that apply to all other benefits 29
60	60		covered under a policy that is subject to this section. 30
61	61		Sec. 2. (NEW) (Effective January 1, 2022) (a) For the purposes of this 31
62	62		section: 32
63	63		(1) "Body mass index" means the number calculated by dividing an 33
64	64		individual's weight in kilograms by the individual's height in meters 34
65	65		squared; and 35
66	66		(2) "Severe obesity" means a body mass index that is: 36
67	67		(A) Greater than forty; or 37
68	68		(B) Thirty-five or more if an individual has been diagnosed with a 38
69	69		comorbid disease or condition, including, but not limited to, a 39 Raised Bill No. 1007
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76	76		cardiopulmonary condition, diabetes, hypertension or sleep apnea. 40
77	77		(b) Each group health insurance policy providing coverage of the 41
78	78		type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 42
79	79		of the general statutes delivered, issued for delivery, renewed, amended 43
80	80		or continued in this state on or after January 1, 2022, shall provide 44
81	81		coverage for: 45
82	82		(1) Each surgical procedure that is: 46
83	83		(A) Performed to treat severe obesity, including, but not limited to, 47
84	84		gastric bypass surgery, sleeve gastrectomy and duodenal switch 48
85	85		surgery; 49
86	86		(B) Recognized by the National Institutes of Health, American Society 50
87	87		for Metabolic and Bariatric Surgery and American College of Surgeons 51
88	88		as providing long-term weight loss; and 52
89	89		(C) Consistent with treatment guidelines issued by the National 53
90	90		Institutes of Health as applied to the insured; and 54
91	91		(2) Each outpatient prescription drug that is approved by the federal 55
92	92		Food and Drug Administration to treat severe obesity if such policy 56
93	93		includes coverage for outpatient prescription drugs. 57
94	94		(c) The benefits required by subsection (b) of this section shall be 58
95	95		subject to the same terms and conditions that apply to all other benefits 59
96	96		covered under a policy that is subject to this section. 60
97	97		Sec. 3. (NEW) (Effective July 1, 2021) (a) For the purposes of this 61
98	98		section: 62
99	99		(1) "Body mass index" means the number calculated by dividing a 63
100	100		Medicaid beneficiary's weight in kilograms by the Medicaid 64
101	101		beneficiary's height in meters squared; and 65
102	102		(2) "Severe obesity" means a body mass index that is: 66 Raised Bill No. 1007
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109	109		(A) Greater than forty; or 67
110	110		(B) Thirty-five or more if a Medicaid beneficiary has been diagnosed 68
111	111		with a comorbid disease or condition, including, but not limited to, a 69
112	112		cardiopulmonary condition, diabetes, hypertension or sleep apnea. 70
113	113		(b) The Commissioner of Social Services shall provide Medicaid 71
114	114		reimbursement for: 72
115	115		(1) Each surgical procedure that is: 73
116	116		(A) Performed to treat severe obesity, including, but not limited to, 74
117	117		gastric bypass surgery, sleeve gastrectomy and duodenal switch 75
118	118		surgery; 76
119	119		(B) Recognized by the National Institutes of Health, American Society 77
120	120		for Metabolic and Bariatric Surgery and American College of Surgeons 78
121	121		as providing long-term weight loss; and 79
122	122		(C) Consistent with treatment guidelines issued by the National 80
123	123		Institutes of Health as applied to the Medicaid beneficiary; and 81
124	124		(2) Each outpatient prescription drug that is approved by the federal 82
125	125		Food and Drug Administration to treat severe obesity. 83
126	126		(c) The commissioner shall seek federal approval of a Medicaid state 84
127	127		plan amendment or Medicaid waiver, if necessary, to implement the 85
128	128		provisions of this section. Any submission of a Medicaid state plan 86
129	129		amendment or Medicaid waiver shall be in accordance with the 87
130	130		provisions of section 17b-8 of the general statutes. 88
131	131		(d) The commissioner shall adopt regulations, in accordance with 89
132	132		chapter 54 of the general statutes, to implement the provisions of this 90
133	133		section. The commissioner may adopt policies or procedures to 91
134	134		implement the provisions of this section while in the process of adopting 92
135	135		regulations, provided such policies or procedures are posted on the 93
136	136		Internet web site of the Department of Social Services and on the 94 Raised Bill No. 1007
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143	143		eRegulations System prior to the adoption of such policies or 95
144	144		procedures. 96
145	145		This act shall take effect as follows and shall amend the following
146	146		sections:
147	147
148	148		Section 1 January 1, 2022 New section
149	149		Sec. 2 January 1, 2022 New section
150	150		Sec. 3 July 1, 2021 New section
151	151
152	152		INS Joint Favorable
153		-	APP Joint Favorable
154	153