OFFICE OF FISCAL ANALYSIS
Legislative Office Building, Room 5200
Hartford, CT 06106 (860) 240-0200
http://www.cga.ct.gov/ofa
SB-180
AN ACT CONCERNING ADVERSE DETERMINATION AND
UTILIZATION REVIEWS.
Primary Analyst: NN 3/12/24
Contributing Analyst(s): SB
OFA Fiscal Note
State Impact:
Agency Affected Fund-Effect FY 25 $ FY 26 $
State Comptroller - Fringe
Benefits
GF - Potential
Cost
Potential Potential
UConn Health Ctr. GF - Potential
Clinical Revenue
Gain
Potential Potential
Note: GF=General Fund
Municipal Impact:
Municipalities Effect FY 25 $ FY 26 $
Various Municipalities Potential
Cost
See Below See Below
Explanation
The bill results in a potential cost to the State Comptroller – Fringe
Benefits account for the state employee health plan from the anticipated
increase in administrative costs and utilization of medical services.
Administrative costs are expected to increase from the redefinition of
"clinical peer," which would require carriers to contract specialists at a
rate of approximately $700 per adverse determination. Claims costs are
also expected to increase as more medical services are deemed,
"medically necessary" resulting from the change in utilization review
methodology.
Self and fully insured municipalities as well as those enrolled in the 2024SB-00180-R000018-FN.DOCX Page 2 of 2
Partnership plan are likely to see an increase in premiums to the extent
carriers expect to see higher utilization of services and face higher costs
for evaluating adverse determination appeals. Due to federal law, self-
insured health plans are exempt from state health insurance benefit
mandates, so potential costs are contingent on the plan electing to adopt
the mandate.
To the extent that the bill results in additional medical services
provided by the University of Connecticut Health Center, there could
be a clinical revenue increase beginning in FY 25. The scope of the
revenue increase would be dependent upon the type and number of
additional services.
The Out Years
The annualized ongoing fiscal impact identified above would
continue into the future subject to inflation.
Sources: State Employee Health Plan Provider