OFFICE OF FISCAL ANALYSIS
Legislative Office Building, Room 5200
Hartford, CT 06106 (860) 240-0200
http://www.cga.ct.gov/ofa
SB-364
AN ACT CONCERNING HEALTH INSURANCE.
AMENDMENT
LCO No.: 4730
File Copy No.: 315
Senate Calendar No.: 234
Primary Analyst: MP 4/19/22
Contributing Analyst(s): (FN)
OFA Fiscal Note
See Fiscal Note Details
The amendment strikes the underlying bill and its associated fiscal
impact.
The amendment may result in a cost to the state employee and retiree
health plan, as well as municipalities that participate in the Partnership
Plan, and is anticipated to 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 amendment 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 amendment results in
services being rendered that otherwise would have been denied, there
is a cost 1) to the state for the state employee and retiree health plan and
2) to fully insured municipalities in the form of higher premiums. It is
unclear how the amendment 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 governed by the federal Employee Retirement
Income Security Act of 1974 (ERISA). The cost to fully insured
municipalities would be reflected in premiums for plan years adopted 2022SB-00364-R00LCO04730-FNA.DOCX Page 2 of 2
after January 1, 2023.
The amendment also results in a cost for certain fully insured
municipal plans that currently require step therapy for conditions
specified in the amendment, to the extent the amendment results in
higher prescription drug costs that are passed on in the form of higher
premiums. The amendment’s provisions prohibiting step therapy in
certain cases do not result in a fiscal impact to the state employee and
retiree health plan or municipalities that participate in the Partnership
Plan, as step therapy is not required by the plans.
The preceding Fiscal Impact statement is prepared for the benefit of the members of the General Assembly, solely
for the purposes of information, summarization and explanation and does not represent the intent of the General
Assembly or either chamber thereof for any purpose. In general, fiscal impacts are based upon a variety of
informational sources, including the analyst’s professional knowledge. Whenever applicable, agency data is
consulted as part of the analysis, however final products do not necessarily reflect an assessment from any
specific department.