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This page lists some of the action toward parity compliance undertaken by Connecticut regulatory agencies since 2008.

Are we missing any actions taken by state regulatory agencies? Let us know at info@paritytrack.org.

Action in the Regulatory Arena

2018

Primary Focus: Reasonable Access to Mental Health Care
Agency: Connecticut Insurance Department
Title/Description: Network Adequacy
Citation: CONN. AGENCIES REGS. §§38a-472f-2 through 38a-472f-5
Summary: CONN. AGENCIES REGS. §§38a-472f-2 through 38a-472f-5 defines the term “specialist” to mean a health care provider who (i) focuses on a specific area of physical, mental or behavioral health or a specific group of patients, and (ii) has successfully completed required training and is recognized by this state to provide specialty care. The regulations further establish reasonable wait times for access mental health care. Providers under these regulations must serve individual with mental health disabilities. The regulations mandate that each health carrier shall contract with the providers to ensure that each person covered by such health carrier under such a plan or certificate has reasonable access to participating providers located near such covered person’s place of residence or employment. Reasonable access to mental health care includes maintaining a sufficient number and appropriate types of participating providers that predominately serve, without unreasonable travel or delay.
Effective Date: July 2, 2018
Notes: N/A

8/2016

Primary Focus: Compliance: Reporting Requirement, Certification
Agency: Connecticut Insurance Department
Title/Description: Additional Rate Filing Requirements
Citation: Conn. Agencies Regs. § 38a-481-9 (2016)
Summary: This statute requires insurers to submit filings including an annual certification of compliance with mental health parity.
Effective Date: August 2, 2016
Notes: N/A

 

8/2015

The Market Conduct Division of the Connecticut Insurance Department examined (pdf | Get Adobe® Reader®) the utilization review practices of United Behavioral Health. The examination reviewed 204 sample complaints and appeal certifications from January 1, 2013 through December 31, 2013. Among other things, the examination found that 2 appeal determinations were not reviewed by an “appropriate clinical peer for the service requested”.

The Connecticut Insurance Department fined United Behavioral Health $8,500 for the violations. United Behavioral Health also agreed to provide a full report of the actions taken to comply with the legislative and regulatory requirements impacting utilization review within 90 days of the release of this document.

4/2014

The Connecticut Insurance Department issued a bulletin (pdf | Get Adobe® Reader®) clarifying changes in mandated coverage of autism spectrum disorders and early intervention services resulting from the ACA. The bulletin announces an amendment that extends group health insurance coverage for ASD to a yearly benefit of $50,000 for a child less than nine, $35,000 for a child between nine and 13, and $25,000 for a child between 13 and 14. The amendment requires individual and group policies to cover early intervention services in individualized family service plans to a maximum of $6,400 per child per year from birth until age 3 or an aggregate benefit of $19,200 per child over a three-year period.

3/2014

The Connecticut Insurance Department issued a bulletin (pdf | Get Adobe® Reader®) that was not primarily about parity, but reminded insurance plans that they had to abide by an earlier department bulletin regarding copayments (summarized below from 8/2011).

1/2014

The Connecticut Insurance Department issued a bulletin (pdf | Get Adobe® Reader®) announcing a new element of the market conduct examination process dealing with mental health parity compliance. The bulletin requires any entity delivering individual and group health insurance to complete an annual mental health parity compliance survey. If the entity is not in full compliance, they must attach an action plan to their survey response. Entities will pay a late filing fee of one hundred dollars per day for each day passed the survey due date.

12/2013

The Connecticut Insurance Department released a report (pdf | Get Adobe® Reader®) on what it is doing to ensure that insurance plans under its jurisdiction are complying with the state parity law and the Federal Parity Law. This report had been mandated by the Connecticut General Assembly earlier in the year. Here are some of the activities the Insurance Department listed in the report:

  • Issued a bulletin (pdf | Get Adobe® Reader®) to insurance plans about new requirements regarding external review appeals and grievance appeals. This informed insurance plans that state law now required new criteria for behavioral health appeals and that reviewers were now required to be of the same background as the patient’s treating provider. It also informed plans that state law now required plans to process urgent requests for behavioral health services in less than 24 hours.
  • Created a short consumer guide (pdf | Get Adobe® Reader®) about how to navigate the appeals process.
  • Recovered $1.3 million for consumers from insurance plans after investigating complaints about health insurance coverage. Some of these complaints were about behavioral health coverage.
  • Created an awareness program about parity and behavioral health coverage.
  • Created a behavioral health consumer toolkit (pdf | Get Adobe® Reader®) to help consumers better understand how to get quality behavioral healthcare through their insurance plans.
  • Mentioned that the Insurance Department investigates all complaints that could be possible parity violations and checks to see if there are any violations of the state laws or the Federal Parity Law.
  • Listed how many complaints that were not under Insurance Department jurisdiction that were referred to the Office of the Healthcare Advocate.
  • Urged state legislators to tell their constituents to contact the Insurance Department’s Consumer Affairs Unit so the Department can spot trends of possible non-compliance with parity laws.
  • Issued the Department’s annual Consumer Report Card on Health Insurance Carriers (pdf | Get Adobe® Reader®) that can help locate trends of possible non-compliance within its section on behavioral health.
  • Issued a bulletin (pdf | Get Adobe® Reader®) that requires insurance plans to submit information that demonstrates their compliance with parity laws.
  • Responded to complaints about a major health insurance plan’s behavioral health reimbursement practices and required the insurance plan to reprocess nearly 40,000 claims. This led to over $472,000 of additional reimbursement that had originally been denied.
  • Met with members of Connecticut’s federal delegation to push for the appropriate federal agencies to release the final regulation (pdf | Get Adobe® Reader®) for the Federal Parity Law.
  • “Strongly requested” that insurance plans change the tone and content of their behavioral health coverage denial letters.
  • Wrote to the Sandy Hook Commission clarifying examples of non-quantitative treatment limitations.
  • Launched a parity page on the Insurance Department’s website.

12/2013

The Connecticut Insurance Department issued a bulletin that informed insurance plans that they are not allowed to exclude any medically necessary services for gender dysphoria. This bulletin informs plans that excluding these services would violate the state parity laws, state anti-discrimination laws, and state unfair trade practices laws. The bulletin also clearly states that gender reassignment services cannot be excluded. However, plans are still allowed to conduct medical necessity reviews for gender dysphoria services.

9/2013

The Connecticut Insurance Department issued a press release asking for public comments about the methods the Department uses to enforce compliance with state parity laws and the Federal Parity Law.

8/2011

The Connecticut Insurance Department issued a bulletin (pdf | Get Adobe® Reader®) clarifying requirements for how insurance plans use copayments under the state parity laws and the Federal Parity Law. The final determination was that large employer plans had to follow the formulas in place for determining copayments as dictated by the interim final regulation (pdf | Get Adobe® Reader®) for the Federal Parity Law.

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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:

Get Support

Connecticut Insurance Division

Common Violations

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

Common Violations

Definition

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