OFFICE OF FISCAL ANALYSIS
Legislative Office Building, Room 5200
Hartford, CT 06106 (860) 240-0200
http://www.cga.ct.gov/ofa
SB-6
AN ACT CONCERNING UTILIZATION REVIEW AND HEALTH
CARE CONTRACTS, HEALTH INSURANCE COVERAGE FOR
NEWBORNS AND STEP THERAPY.
Primary Analyst: NN 3/29/23
Contributing Analyst(s): SB, MP
OFA Fiscal Note
State Impact:
Agency Affected Fund-Effect FY 24 $ FY 25 $
State Comptroller - Fringe
Benefits
GF - Potential
Cost
See Below See Below
UConn Health Ctr. GF - Potential
Cost
At Least
100,000
At Least
100,000
Note: GF=General Fund
Municipal Impact:
Municipalities Effect FY 24 $ FY 25 $
Various Municipalities Potential
Cost
See Below See Below
Explanation
Sections 1 and 3 pertain to: (1) exemptions, under certain
circumstances, for health care providers from certain utilization review
processes used by health insurers and HMOs (also known as “gold-
carding”) and (2) shortening several of the maximum timeframes for
insurers or independent review organizations (IRO) to notify insureds
of their utilization review decisions.
These sections do not result in a fiscal impact to the Insurance
Department because: (1) the agency has the capacity and expertise to
develop the regulations required by the bill and enforce its provisions,
and (2) the bill specifies that the fees for IROs to conduct reviews of 2023SB-00006-R000337-FN.DOCX Page 2 of 2
adverse determinations for such exemptions must be paid by the health
insurer or HMO.
Section 2 could result in a potential cost to the UConn Health Center
beginning in FY 24, associated with establishing a secure system to
electronically receive and respond to prospective and concurrent review
requests. It is anticipated that the potential costs would exceed $100,000
annually.
Sections 4 and 5 extend the timeframe insurers must provide for
notice of the birth of a newborn. This may result in a fiscal impact to the
state and municipal plans to the extent that the number of claims
increases.
Sections 6 and 7 eliminate step therapy for certain behavioral health,
or chronic, disabling, or life-threatening conditions or diseases resulting
in no fiscal impact to the state employee and retiree health plan because
step therapy is not frequently used within the plans. This may impact
certain municipal plans that require step therapy.
Section 8 of the bill prohibits the repeated use of utilization review
for recurring health care services or prescription drugs. This decreases
health carriers' ability to lower costs and in turn may impact state and
municipal health plans through increased premiums.
The Out Years
The annualized ongoing fiscal impact identified above would
continue into the future subject to inflation.