Connecticut Legislation

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.

This bill amends Title 38a of the General Statutes to require health insurance coverage for long-term substance use disorder services.

SB 333 requires health insurance coverage for certain screenings for mental or nervous conditions. Additionally, the bill expands reporting requirements concerning the all-payer claims database and mental and behavioral health. Finally, the bill modifies the Consumer Report Card on Health Insurance Carriers in Connecticut and requires health carriers to comply with the Federal Parity Law.

HB 7033 requires that each health carrier doing health insurance business in the state must submit an annual report concerning parity for mental health and substance use disorder benefits. Furthermore, the committee of the General Assembly having cognizance of matters relating to insurance must conduct a public hearing concerning all such reports and compliance with the Federal Parity Law. Additionally, the bill expands coverage and prohibits the use of prior authorization and step therapy for certain prescription drugs.

HB 5212 expands mental health parity requirement and requires that health carriers report additional data to the Insurance Commissioner concerning mental health parity. The bill requires that the commissioner submit an annual report to the General Assembly regarding the commissioner’s efforts to ensure mental health parity and requires that the Office of Health Strategy must submit an annual report to the General Assembly regarding the all-payer claims database.

HB 5897 establishes reporting requirements for insurers to demonstrate parity between limits on benefits for mental health care services and limits on physical health care services. The bill specifies how the Insurance Department can implement such parity and requires said department to report on implementation. Additionally, the bill eliminates certain managed-care barriers to medication assisted treatment for substance use disorders.

HB 5120 expands mental health parity requirements and requires that health carriers report additional data to the Insurance Commissioner concerning mental health parity. The bill requires that the commissioner must submit an annual report to the General Assembly regarding the commissioner’s efforts to ensure mental health parity and requires that the Office of Health Strategy must submit an annual report to the General Assembly regarding the all-payer claims database

Section 2 amends the General Statutes of Connecticut by adding a new requirement that all group and individual insurers must comply with federal and state parity laws and regulations. Section 3 of the bill further supports this new section by requiring insurers to submit detailed comparative analysis and data to the Commissioner to demonstrate compliance with parity requirements. Section 4 also adds a new section to the General Statutes of Connecticut to require the Commissioner to submit a report to the General Assembly detailing enforcement, oversight, and educational activities taken to ensure insurer and HMO compliance with parity laws and regulations. Section 6 repeals and replaces Section 38a-478c to require MCOs to submit a report to the Commissioner that details SUD prevalence and service availability/accessibility by county while Section 7 amends § 38a-478l to require MCOs to submit detailed comparative analysis and data to the Commissioner to demonstrate compliance with parity requirements. Lastly, Section 8 repeals §38a-488a and substitutes new language, requiring insurers to provide coverage for screenings of mental and nervous conditions at annual physical exams.

• Separately for mental health benefits, physical health benefits, and substance use disorder benefit, the ratio of claims that required prior authorization to total number of claims received, ratio of claims denied to claims received, and reasons for claim denials.
• Separately for mental health benefits, physical health benefits, and substance use disorder benefit, services provided in-network on an inpatient basis, in-network on an outpatient basis, out of network on an inpatient basis, out of network for an outpatient basis, emergency medical services, and pharmaceutical services and products
• Information demonstrating how the insurer designs its medical necessity criteria for mental health treatment, substance use disorder treatment, and medical treatment along with an explanation that the criteria are consistent with “generally accepted standards of medical practice”
• Information demonstrating that nonquantitative treatment limitations for behavioral health services are applied no more stringently than those applied to other medical services
• A statement certifying that the insurer is in compliance with state law, the federal parity law, and the Affordable Care Act

Furthermore, the bill required commissioner to establish and maintain a complaint submission system that individuals could use to notify the commissioner of any potential parity violations. The commissioner must maintain reasonable procedure for the resolutions of complaints and public records and logs of complaints.

Moreover, the bill requires the commissioner to adopt regulations, to implement the above provisions, and submit to the General Assembly a report that includes the following:

• A description of processes and methods the department used to ensure insurers complied with the federal parity law and the state provisions listed above
• A description of any efforts made by the department to educate insurers and the public about the new parity provisions listed above
• A description of any enforcement actions made in regards to the above

This bill amends state insurance law about behavioral health by requiring all insurers to cover inpatient substance use disorder services until an individual has been “stabilized,” provided that insurers can recoup the cost of the services if they are deemed “not medically necessary” upon retrospective review.

• Psychologists
• Social workers
• Marital and family therapists
• Drug and alcohol counselors
• Professional counselors
• Advance practice nurses

Among other things, this bill tried to change the sections of the state insurance law relevant to parity so that licensed master professional counselors could be reimbursed for providing behavioral health services.

Among other things, this bill tried to change the sections of the state insurance law relevant to parity by removing the subsection that requires individual plans, small employer fully-insured plans, and large employer fully-insured plans to cover home visitation services for behavioral health treatment for pregnant and postpartum women and children with behavioral health conditions.

• The number and percentage of people who have received treatment for a substance use disorder; the average length of treatment covered for a substance use disorder; per month-per member expenses for for substance use disorder treatment; and number of in-network providers and the percentage of them taking new patients;
• The number of behavioral health providers and facilities that have applied for in-network status and the percentage who were accepted along with the number of providers who no longer participate in the network.
• Information about how often the organizations used utilization review for behavioral health treatment and how often they denied or restricted coverage for behavioral health treatment.
• Information about external reviews.

This is very similar to HB 5373 from the 2014 legislative session, which was Vetoed (pdf | Get Adobe® Reader®) by the governor. The difference is that this bill removed the sections requiring insurance plans to identify and explain factors that could be limiting patients’ access to substance use disorder treatment, and to explain how they would address these factors.

Read the responses to the Governor’s veto message from the Office of the Healthcare Advocate (pdf | Get Adobe® Reader®) and the Connecticut State Medical Society (pdf | Get Adobe® Reader®)

This bill tried to change the section of the state insurance law that requires managed care organizations to file reports with the Insurance Commissioner. This bill would have required managed care organizations to provide the following additional information:

• The number and percentage of people who have received treatment for a substance use disorder; the average length of treatment covered for a substance use disorder; per month-per member expenses for for substance use disorder treatment; and number of in-network providers and the percentage of them taking new patients;
• The number of behavioral health providers and facilities that have applied for in-network status and the percentage who were accepted along with the number of providers who no longer participate in the network.
• Identify and explain factors that could be limiting patients’ access to substance use disorder treatment. The organizations would also be required to explain their plans and activities to address these factors.
• Information about how often the organizations used utilization review for behavioral health treatment and how often they denied or restricted coverage for behavioral health treatment.
• Information about external reviews.

This bill tried to change state law so that the Commissioner of Social Services would have been required to change the state Medicaid plan to cover services of psychologists and licensed clinical social workers performed in private offices who are enrolled as Medicaid providers.

This bill tried to change the state insurance law so that the Insurance Commissioner would be required to file a report that would explain how the Insurance Department was checking insurance plans for compliance with the Federal Parity Law and the state parity law. The Insurance Department would have also been required to hold at least one public meeting involving relevant state agency employees, representatives from insurance companies, and members of the public (which would presumably include behavioral health advocacy organizations). This meeting would help the Insurance Commissioner develop the methods for checking parity compliance.

• Inpatient care, partial hospitalization services, 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.
• All utilization reviews for substance use disorders to use criteria from the American Society of Addiction Medicine (ASAM) or criteria approved by the state’s Department of Mental Health and Addiction Services and the Department of Children and Families.
• Each plan that uses utilization review must have a document that compares its review criteria with ASAM criteria and explains any deviation from ASAM criteria.
• Utilization reviews for mental health services must use criteria approved by the state’s Department of Mental Health and Addiction Services and the Department of Children and Families or guidelines from the American Academy of Child and Adolescent Psychiatry’s Child and Adolescent Service Intensity Instrument.
• Each plan that uses utilization review must have a document that compares its review criteria with guidelines from the American Academy of Child and Adolescent Psychiatry’s Child and Adolescent Service Intensity Instrument and explains any deviation from those guidelines.

• The Office of Early Childhood was required to implement a public information and education program that would address many things, but specifically educate parents about insurance coverage for child behavioral health services.
• The state would try to find ways to get insurance coverage for school-based behavioral health services offered in part because of the federal Early Periodic Screening and Diagnosis Treatment Program.

• Treatment requested for substance use disorder services could be considered an “urgent care request.”
• An insurance plan must make a decision on an urgent care request within 12 hours.
• 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. “Appropriate national board certification” is defined as a national addiction board.
• All reviews for substance use disorders to use criteria from the American Society of Addiction Medicine (ASAM) or criteria approved by the state’s Department of Mental Health and Addiction Services and the Department of Children and Families.
• Each plan that uses utilization review must have a document that compares its review criteria with ASAM criteria and explains any deviation from ASAM criteria.

This bill tried to change the state insurance law to require the state to develop a uniform mental health treatment authorization form for patients to sign before starting treatment. The form would have been required to comply with the Federal Parity Law and the state parity law.

 This was a comprehensive bill designed to bring Connecticut state law into compliance with the Affordable Care Act. One of the sections of the bill tried to change the state insurance law so that individual plans, small employer fully-insured plans, and large employer fully-insured plans would not longer be allowed make patients pay 50% of costs even after they have met the plan’s deductible.

1. $10,000 for year 1
2. $8,000 for year 2
3. $6,000 for year 3
4. $4,000 for year 4
5. $4,000 for year 5

 This bill tried to change the state insurance law to explicitly state that large employer fully-insured plans must comply with the Federal Parity Law.

This bill tried to change the section of the state social services law about the Charter Oak Health Plan. It would have required this plan to comply with the parity section of the state insurance law. It also would have required the plan to give patients a right to external reviews.

Among many other things, this bill tried to change the state insurance law so that it explicitly stated that plans had to cover residential treatment. The law eventually was changed to do what this section of the bill intended.

This bill tried to change the state insurance law so that insurance plans would no longer have to cover services performed by a licensed marital and family therapist.

This bill tried to change the section of the state insurance law about autism coverage. It was introduced at the same time as SB 301, which was signed into law. This bill was similar but did not go into as much detail as SB 301. The most significant difference between the two bills was that this bill did not set any annual maximums or age restrictions for behavioral therapy. A summary of the current sections of the state insurance law about autism coverage can be found at the bottom of the page.