OFFICE OF FISCAL ANALYSIS
Legislative Office Building, Room 5200
Hartford, CT 06106 (860) 240-0200
http://www.cga.ct.gov/ofa
April 11, 2021
ADDENDUM
To Fiscal Note on
SB-1045, File No. 370
AN ACT CONCERNING STEP THERAPY, ADVERSE
DETERMINATION AND UTILIZATION REVIEWS, AND HEALTH
INSURANCE COVERAGE FOR CHILDREN, STEPCHILDREN AND
OTHER DEPENDENT CHILDREN.
Primary Analyst: AN 4/11/21
Contributing Analyst(s):
The bill may result in a cost to the state employee and retiree health
plan and will result in a cost to fully-insured municipalities by creating
a rebuttal presumption under the adverse determination and
utilization review processes that a service ordered by a physician is
medically necessary.
The bill places the burden of proof upon a carrier that a service
ordered by a physician is not medically necessary, which contrasts
with current practice. To the extent the bill results in services being
rendered that otherwise would have been denied, there is a cost. The
cost to fully-insured municipalities will be reflected in premiums for
plan years adopted after January 1, 2022.
It is unclear how the bill may affect the state employee and retiree
health plan, as a utilization standard was established pursuant to the
2017 State Employees Bargaining Agent Coalition (SEBAC) agreement
and the state plan is exempt from state health mandates pursuant to
federal law.