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