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Legislation Signed into Law

2019

Primary Focus: Compliance: Reporting Requirement; Enforcement: Other; Medical Mangement Limitation; Mandated Benefit: MAT; Mandated Benefit: SUD
Title/Description: An act concerning parity for mental health and SUD benefits, NQTLs, MAT, and SUD services
Citation: Public Act 19-159
Summary: This bill amends the CT General Statutes by adding a new section that requires health carriers to submit an annual report to the Insurance Commissioner, Attorney General, Health Care Advocate and Executive Director of the Office of Health Strategy that details compliance with parity in terms of medical necessity determinations and NQTLs. The bill requires the Insurance Commissioner to submit to the joint standing committee (having cognizance of matters related to insurance) of the General Assembly each of the health carriers’ reports. Additionally, the bill requires the joint standing committee to hold an annual public hearing concerning the health carriers’ reports. Such hearing must be attended by the Insurance Commissioner, Attorney General, Health Care Advocate and Executive Director of the Office of Health Strategy (or their designees). These entities must inform the committee if they feel each report is satisfactory and indicates compliance with parity requirements.

Furthermore, the bill adds new sections to the CT General Statutes to prohibit individual and group health insurance policies from applying NQTLs on MH/SUD benefits that are not also equally applied to med/surgical benefits. Additionally, the bill prohibits plans from excluding coverage of SUD services and prescriptions solely because the drug or services were prescribed pursuant to a court order.
Effective Date: Reporting requirements beginning  Oct. 1, 2019 and rest after January 2020
Notes: Enacted through HB 7125

Primary Focus: Essential Health Benefits
Title/Description: Mandating individual and employer provided insurance coverage of essential health benefits
Citation: Public Act No. 18-10
Summary: Public Act No. 18-10 requires individual and group health insurance policies to cover essential health benefits, which the statute defines to include mental health and substance use disorders including, but not limited to, behavioral health treatment.
Effective Date: January 1, 2019
Notes: Public Act No. 18-10 §§ 1-2 pertain to coverage of essential mental health benefits.

2018

Primary Focus: Reimbursement for Out-of-Network Providers
Title/Description: Mandatory coverage for the diagnosis and treatment of mental or nervous conditions. Benefits payable re: type of provider or facility. State’s claim against proceeds.
Citation: Public Act No. 17-157
Summary: Public Act No. 17-157 requires reimbursement for behavioral health treatment covered under the insured’s policy but provided by an out-of-network provider to be paid directly to the provider if the provider is otherwise eligible for reimbursement. Providers cannot bill, charge, collect a deposit from, seek compensation, remuneration or reimbursement from or have any recourse against the insured for such services, except that such provider may collect any copayments, deductibles or other out-of-pocket expenses that the insured is required to pay under the policy. The insured who received behavioral health services shall be deemed to have made an assignment to such provider of such insured’s coverage reimbursement benefits.
Effective Date: October 1, 2018
Notes: Public Act No. 17-157 adopted the provisions set out in HB 5140 which amended CONN. GEN. STAT. §§ 38a-488a, 38a-514

Primary Focus: Parity: General (Group Health Plans)
Title/Description: Mandatory coverage for the diagnosis and treatment of mental or nervous conditions. Exceptions. Benefits payable re type of provider or facility. State’s claims against proceeds. Direct reimbursement for certain covered services rendered by certain out-of-network providers.
Citation: Conn. Gen. Stat. § 38a-514
Summary: Section 38a-514 defines “mental or nervous conditions” as those provided for in the most recent edition of the American Psychiatric Association’s “Diagnostic and Statistical Manual of Mental Disorders.” The statute requires group health insurance policies to provide benefits for the diagnosis and treatment of mental or nervous conditions, and such benefits must include, but are not limited to, the following:

(1) General inpatient hospitalization, including in state-operated facilities;
(2) Medically necessary acute treatment services and medically necessary clinical stabilization services;
(3) General hospital outpatient services, including at state-operated facilities;
(4) Psychiatric inpatient hospitalization, including in state-operated facilities;
(5) Psychiatric outpatient hospital services, including at state-operated facilities;
(6) Intensive outpatient services, including at state-operated facilities;
(7) Partial hospitalization, including at state-operated facilities;
(8) Intensive, home-based services designed to address specific mental or nervous conditions in a child;
(9) Evidence-based family-focused therapy that specializes in the treatment of juvenile substance use disorders;
(10) Short-term family therapy intervention;
(11) Nonhospital inpatient detoxification;
(12) Medically monitored detoxification;
(13) Ambulatory detoxification;
(14) Inpatient services at psychiatric residential treatment facilities;
(15) Rehabilitation services provided in residential treatment facilities, general hospitals, psychiatric hospitals or psychiatric facilities;
(16) Observation beds in acute hospital settings;
(17) Psychological and neuropsychological testing conducted by an appropriately licensed health care provider;
(18) Trauma screening conducted by a licensed behavioral health professional;
(19) Depression screening, including maternal depression screening, conducted by a licensed behavioral health professional; and
(20) Substance use screening conducted by a licensed behavioral health professional.

Policies may not place a greater financial burden on an insured for access to diagnosis or treatment of mental or nervous conditions than that for diagnosis or treatment of medical, surgical, or other physical health conditions, or prohibit and insured from obtaining or a health care provider from being reimbursed for multiple screening services as part of a single-day visit. The statute also provides that benefits payable for services of a licensed physician or psychologist should be payable for the same services when rendered by licensed psychologists, social workers, family and marital therapists, drug or alcohol counselors, professional counselors, and advanced practice registered nurses. The statute provides additional specific examples of how certain benefits payable for certain services must be the payable in the same way when provided for mental or nervous conditions.
Effective Date: January 1, 2018
Notes: Enacted through S.B. 1502 (Session Year 2017)

Primary Focus: Parity: General (Individual Health Plans)
Title/Description: Mandatory coverage for the diagnosis and treatment of mental or nervous conditions. Exceptions. Benefits payable re type of provider or facility. State’s claims against proceeds. Direct reimbursement for certain covered services rendered by certain out-of-network providers.
Citation: Conn. Gen. Stat. § 38a-488a
Summary: Section 38a-488a defines “mental or nervous conditions” as those provided for in the most recent edition of the American Psychiatric Association’s “Diagnostic and Statistical Manual of Mental Disorders.” The statute requires individual health insurance policies to provide benefits for the diagnosis and treatment of mental or nervous conditions, and such benefits must include, but are not limited to, the following:

(1) General inpatient hospitalization, including in state-operated facilities;
(2) Medically necessary acute treatment services and medically necessary clinical stabilization services;
(3) General hospital outpatient services, including at state-operated facilities;
(4) Psychiatric inpatient hospitalization, including in state-operated facilities;
(5) Psychiatric outpatient hospital services, including at state-operated facilities;
(6) Intensive outpatient services, including at state-operated facilities;
(7) Partial hospitalization, including at state-operated facilities;
(8) Intensive, home-based services designed to address specific mental or nervous conditions in a child;
(9) Evidence-based family-focused therapy that specializes in the treatment of juvenile substance use disorders;
(10) Short-term family therapy intervention;
(11) Nonhospital inpatient detoxification;
(12) Medically monitored detoxification;
(13) Ambulatory detoxification;
(14) Inpatient services at psychiatric residential treatment facilities;
(15) Rehabilitation services provided in residential treatment facilities, general hospitals, psychiatric hospitals or psychiatric facilities;
(16) Observation beds in acute hospital settings;
(17) Psychological and neuropsychological testing conducted by an appropriately licensed health care provider;
(18) Trauma screening conducted by a licensed behavioral health professional;
(19) Depression screening, including maternal depression screening, conducted by a licensed behavioral health professional; and
(20) Substance use screening conducted by a licensed behavioral health professional.

Policies may not place a greater financial burden on an insured for access to diagnosis or treatment of mental or nervous conditions than that for diagnosis or treatment of medical, surgical, or other physical health conditions, or prohibit and insured from obtaining or a health care provider from being reimbursed for multiple screening services as part of a single-day visit. The statute also provides that benefits payable for services of a licensed physician or psychologist should be payable for the same services when rendered by licensed psychologists, social workers, family and marital therapists, drug or alcohol counselors, professional counselors, and advanced practice registered nurses. The statute provides additional specific examples of how certain benefits payable for certain services must be the payable in the same way when provided for mental or nervous conditions.
Effective Date: January 1, 2018
Notes: Enacted through S.B. 1502 (Session Year 2017)

2017

HB 5140
Introduced: 1/2017
Sponsor: Joint Insurance and Real Estate
Status: Signed into law 7/2017
Summary: This bill amends state insurance laws about behavioral health coverage by requiring group and individual plans to directly reimburse out of network providers for substance use disorder services if the provider is otherwise eligible for reimbursement and prohibits the providers from directly billing consumers for out of network services.

2016

Introduced: 3/2016
Sponsor: Joint Insurance and Real Estate
Status: Signed into law 6/2016
Summary: Among other things, this bill amends state insurance law about utilization review by allowing insurers to develop and have approved by the commissioner their own clinical review criteria in order to adjust for advancements in technology and types of care for substance use disorder that are not covered in current criteria.
HB 5620
Introduced: 3/2016
Sponsor: Joint Insurance and Real Estate
Status: Signed into law 6/2016
Summary: This bill requires the Insurance Commissioner to study the impediments to substance use disorder treatment for individuals receiving care through their health insurance policies. The study must include the following areas –
  • Availability of coverage
  • Types of treatments
  • The requirements that an enrollee must meet to qualify for treatment to be covered
  • Cost-sharing requirements
SB 131
Introduced: 2/2016
Sponsor: Sen. Kennedy and Sen. Kelly
Status: Signed into law 6/2016
Summary: This bill amends the language in SB 1502 (listed below) to expand the data that could be requested by the working group convened by the Insurance Commissioner to ensure proper implementation of parity laws. The expanded data includes the number of prior authorization requests for behavioral health services approved and denied, as well as the same information for other medical services. It also specifies that information about the percentage of claims paid for out-of-network behavioral health services as compared to claims paid for other out-of-network medical services should be considered as well.
SB 372
Introduced: 3/2016
Sponsor: Sen. Looney, Sen. Crisco, and Sen. Moore
Status: Signed into law 6/2016
Summary: This bill changed the sections of the state insurance law about utilization review. It specifies the following:

2015

SB 1502
Introduced: 6/2015
Sponsor: Sen. Looney, Sen. Duff, Rep. Sharkey and Rep. Aresimowicz
Status: Signed into law 7/2015
Summary: Among many other things, this bill slightly amends some of the changes to the parity section of the state insurance law made by SB 1085 (listed directly below this) and changes some of the sections of the state insurance law about autism coverage, starting on 1/1/2016 (all of these looming changes are summarized at the bottom of the page under “Connecticut Parity Law”).
SB 1085
Introduced: 3/2015
Sponsor: Insurance and Real Estate Committee
Status: Signed into law 6/2015
Summary: This bill will dramatically change the parity section of the state insurance law when it takes effect in January 2016 (several provisions in this bill do not take effect until January 2017). It specifically lists 25 forms of treatment that insurance plans must cover that are not listed in the current version of the law. For a summary of the current parity law and the future parity law, scroll to the “Connecticut Parity Law” section near the bottom of this page.

2014

HB 5578
Introduced: 3/2014
Sponsor: Rep. Conroy, Rep. Tercyak, & Sen. Crisco
Status: Signed into law 5/2014
Summary: This bill changed the sections of the state insurance law about the utilization review process. It changed the definition of “clinical peer” so that a clinical peer in behavioral health must have a national board certification in psychiatry or a doctoral level psychology degree AND clinical experience treating behavioral health conditions. Previously the law had not required a doctoral level psychology degree, and actual clinical experience treating behavioral health conditions was not required; it was optional.
HB 5378
Introduced: 2/2014
Sponsor: Program Review and Investigations Committee
Status: Signed into Law 5/2014
Summary: This bill changed sections of state law about Medicaid. The bill requires increased the use of case management for “frequent users” of the emergency room (10 or more visits per year), including those with behavioral health conditions. Some parts of the bill are somewhat related to parity:
  • It requires insurance plans that cover state Medicaid behavioral health care to cover intensive case management
  • It requires the Department of Social Services to change any change any procedures related to utilization management of behavioral health services, if necessary

2013

SB 1160
Introduced: 4/2013
Sponsor: Sen. Williams & Rep. Sharkey
Status: Signed into Law 4/2013
Summary: This comprehensive bill about gun violence prevention and children’s safety also had several sections about parity.

It required the Insurance Commissioner to get stakeholder input from the Office of the Healthcare Advocate, insurance companies, behavioral health providers, and behavioral health advocacy groups about the methods the Insurance Department should use to check for insurance plan compliance with the state parity law and the Federal Parity Law.

The bill then required the Insurance Commissioner to file a report and give a presentation to the General Assembly about the following:

  • The methods the Insurance Department is using to comply with the Federal Parity Law
  • The methods the Insurance Department is using to comply with the state parity law
  • The regulatory and educational approaches the Insurance Department is using related to financing mental health services in Connecticut

It also changed the state insurance law about utilization review and required that:

  • Inpatient care, partial hospitalization services, residential treatment, and intensive outpatient services for behavioral health could be part of an “urgent care request.”
  • A clinical peer reviewer of child and adolescent behavioral health services must have national board certification in child and adolescent psychiatry or psychology and have training or experience in treating children and adolescents with behavioral health conditions.
  • A clinical peer reviewer of adult behavioral health services must have national board certification in adult psychiatry or psychology and have training or experience in treating adults with behavioral health conditions.
  • All utilization reviews for substance use disorders to use the Patient Placement Criteria from the American Society of Addiction Medicine (ASAM) or criteria that are consistent with the ASAM criteria.
  • Each plan that uses utilization review for substance use disorder services must have a document that compares its review criteria with ASAM criteria and explains any deviation from ASAM criteria.
  • Utilization reviews for child mental health services must use guidelines from the American Academy of Child and Adolescent Psychiatry’s (AACAP) Child and Adolescent Service Intensity Instrument or criteria that are consistent with these guidelines.
  • Each plan that uses utilization review for child mental health services must have a document that compares its review criteria with guidelines from the AACAP’s Child and Adolescent Service Intensity Instrument and explains any deviation from those guidelines.
  • Utilization reviews for adult mental health services must use either the most recent guidelines from the American Psychiatric Association (APA) or criteria that are consistent with these guidelines; or the most recent Standards and Guidelines of the Association for Ambulatory Behavioral Healthcare (AABH) or criteria that are consistent with these.
  • Each plan that uses utilization review for adult mental health services must have a document that compares its review criteria for adult mental health reviews with guidelines those of the APA and AABH and explains any deviation from those guidelines.
SB 1029
Introduced: 2/2013
Sponsor: Insurance and Real Estate Committee
Status: Signed into law 6/2013
Summary: This bill changed the sections of the state insurance law about autism coverage (A more detailed summary of these sections of the law can be found near the bottom of the page). The bill forbids insurance plans from changing their coverage levels for certain people diagnosed with autism spectrum disorder after the release of the most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM).

2011

SB 314
Introduced: 1/2011
Sponsor: Committee on Insurance and Real Estate
Status: Signed into law 7/2011
Summary: This bill changed the state insurance law so that it is now an unfair business practice for insurance plans to refuse to cover people because they have a behavioral health condition.

2009

SB 301
Introduced: 1/2009
Sponsor: Committee on Insurance and Real Estate
Status: Signed into law 6/2009
Summary: This bill changed the section of the state insurance law about autism coverage for small employer fully-insured plans and large employer fully-insured plans. This bill created most of what is currently in the law. A summary of this section of the law is at the bottom of this page.

Connecticut Parity Law

The sections of the state insurance law related to parity will change on January 1, 2016. Here is what you will find below, in separate parts:

  • A summary of the current sections of the law
  • A summary of how the law will be different on January 1, 2016
  • A summary of the current sections of the insurance law about autism coverage
  • A summary of how the sections of the insurance law about autism coverage will change on January 1, 2016

Current Law

There are two sections of the insurance law related to parity. One section is for individual plans, and another section is for small employer fully-insured plans and large employer fully-insured plans. Both sections are identical except for the wording about to which kind of insurance plan they apply.

These sections of the law require insurance plans to cover all behavioral health conditions that are in the Diagnostic and Statistical Manual of Mental Disorders (DSM) except for the following:

(1) Intellectual disabilities

(2) Specific learning disorders

(3) Motor disorders

(4) Communication disorders

(5) Caffeine-related disorders

(6) Relational problems

(7) Other conditions that may be a focus of clinical attention, but are not in the DSM

These sections of the law also state that they do not apply to autism and that insurance plans are required to comply with the sections of the law about autism coverage (summarized below).

Insurance plans are forbidden from using “any terms, conditions or benefits that place a greater financial burden” on plan enrollees for behavioral health coverage than they do for other medical coverage.

Insurance plans are required to cover services from the following list of providers:

  1. Psychologists
  2. Licensed clinical social workers
  3. Independent social workers
  4. Licensed marital and family therapists
  5. Licensed or certified alcohol and drug counselors
  6. Licensed professional counselor

Insurance plans are required to cover services in the following treatment facilities:

  1. Child guidance clinics
  2. Residential treatment facilities
  3. Non-profit community mental health center
  4. Adult psychiatric clinic

Insurance plans are required to cover residential treatment if a provider does not think the patient can be treated safely by a lesser form of treatment.

Changes to the Law Starting 1/2016

The parity sections of the insurance law will change beginning in January 2016 because of SB 1085 (pdf | Get Adobe® Reader®) that was signed by the Governor on 6/30, 2015. (However, SB 1502 slightly amended some of the provisions of SB 1085; the relevant sections are sections 43-46) Here is how the law will be different:

  • There is no longer any language stating that these sections do not apply to people diagnosed with autism spectrum disorders.
  • There is language that further defines “benefits payable” as “usual, customary, and reasonable charges for treatment deemed medically necessary under generally accepted medical standards.”
  • It defines “acute treatment services” as “twenty-four-hour medically supervised treatment for a substance use disorder , that is provided in a medically managed or medically monitored inpatient facility”
  • It defines “clinical stabilization services” as “twenty-four-hour clinically managed post-detoxification treatment, including, but not limited to, relapse prevention, family outreach, aftercare planning and addiction education and counseling.”
  • It updates the wording to reflect the appropriate title of the treatment criteria from the American Society of Addiction Medicine
  • It specifically mentions 25 forms of treatment that now must be covered by insurance plans:

(1) General inpatient hospitalization, including at state-operated facilities

(2) Medically necessary acute treatment services and medically necessary clinical stabilization services

(3) General hospital outpatient services , including at state-operated facilities

(4) Psychiatric inpatient hospitalization, including in state-operated facilities

(5) Psychiatric outpatient hospital services, including at state-operated facilities

(6) Intensive outpatient services, including at state-operated facilities

(7) Partial hospitalization , including at state-operated facilities

(8) Evidence-based maternal, infant and early childhood home visitation services, as described in Section 2951 of the Affordable Care Act

(9) Intensive, home-based services designed to address specific mental health conditions in a child

(10) Evidence-based family-focused therapy that specializes in the treatment of juvenile substance use disorders

(11) Short-term family therapy intervention

(12) Non-hospital inpatient detoxification

(13) Medically monitored detoxification

(14) Ambulatory detoxification

(15) Inpatient services at psychiatric residential treatment facilities

(16) Rehabilitation services provided in residential treatment facilities, general hospitals, psychiatric hospitals or psychiatric facilities

(17) Observation beds in acute hospital settings

(18) Psychological and neuropsychological testing conducted by an appropriately licensed health care provider

(19) Trauma screening conducted by a licensed behavioral health professional

(20) Depression screening, including maternal depression screening, conducted by a licensed behavioral health professional

(21) Substance use screening conducted by a licensed behavioral health professional

(22) Intensive, family-based and community-based treatment programs that focus on addressing environmental systems that impact chronic and violent juvenile offenders (not in effect until 1/2017)

(23) Other home-based therapeutic interventions for children (not in effect until 1/2017)

(24) Chemical maintenance treatment (not in effect until 1/2017)

(25) Extended day treatment programs (not in effect until 1/2017)

  • Requires insurance plans to cover multiple screening tests as part of one visit
  • Requires insurance plans to cover services performed by an advance practice registered nurse
  • Requires the Insurance Commissioner and the Office of the Healthcare Advocate to create a working group comprised of insurance company representatives, behavioral health providers, and consumers of behavioral health services. This group will give recommendations to the Insurance Commissioner and the Office of the Healthcare Advocate to improve the utilization review process
  • Requires the Insurance Commissioner to convene a working group to develop recommendations for collecting behavioral health data from state agencies and insurers for the purposes of “protecting behavioral health parity for youths and other populations”. The recommendations were to address:
  1. Coverage for behavioral health services
  2. The adequacy of coverage for behavioral health conditions, including, but not limited to, autism spectrum disorders and substance use disorders
  3. The alignment of medical necessity criteria and utilization management
  4. The adequacy of health care provider networks
  5. The overall availability of behavioral health care providers in this state
  6. The percentage of behavioral health care providers in this state that are participating providers in various plans
  7. The adequacy of services available for behavioral health conditions, including, but not limited to, autism spectrum disorders and substance use disorders

Current Autism Law

There are two sections of the insurance law about coverage for autism. One section is for individual plans and another section is for small employer fully-insured plans and large employer fully-insured plans.

The one for individual plans is very brief. It only requires insurance plans to cover physical therapy, speech therapy and occupational therapy “to the extent such services are a covered benefit for other diseases and conditions.”

The section for small employer plans and large employer plans is much more detailed.

It requires plans to cover autism and defines autism spectrum disorder as pervasive developmental disorders as defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM), including but not limited to:

  1. Autistic disorder
  2. Asperger’s disorder
  3. Rhett’s disorder
  4. Childhood disintegrative disorder
  5. Pervasive developmental disorder not otherwise specified

It requires plans to cover the following treatments:

  1. Behavioral therapy (includes applied behavior analysis)
  2. Prescription drugs
  3. Psychiatric therapy
  4. Psychological therapy
  5. Physical therapy
  6. Occupational therapy
  7. Speech and language pathology services

It requires plans to cover these treatments from the following providers:

  1. Physician (psychiatrist)
  2. Psychologist
  3. Licensed clinical social worker

It requires insurance plans to have annual maximums that are at least the following:

  1. $50,000 for children under 9
  2. $36,000 for children 9-12
  3. $25,000 for children 13 and 14

Financial requirements must be the same as what they are for other medical services.

Insurance plans are not allowed to limit outpatient visits unless it is because a medical necessity review determines that visits may be limited.

Insurance plans can only use utilization review once every 6 months.

Changes to the Autism Law Starting 1/2016

The autism sections of the insurance law will change beginning in January 2016 because of SB 1502 Here is how the law will be different:

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Common Violations

In seeking care or services, be aware of the common ways parity rights can be violated.

Common Violations

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