OFFICE OF FISCAL ANALYSIS

Legislative Office Building, Room 5200

Hartford, CT 06106 (860) 240-0200

http: //www.cga.ct.gov/ofa

sSB-10

AN ACT CONCERNING INSURANCE COVERAGE FOR BREAST MAGNETIC RESONANCE IMAGING.

AMENDMENT

LCO No.: 7260

File Copy No.: 55

House Calendar No.: 537

Senate Calendar No.: 71

OFA Fiscal Note

State Impact: None, See Below for Out Years

Municipal Impact:

Municipalities

Effect

FY 12 $

FY 13 $

Various Municipalities

STATE MANDATE - Cost

Potential

Potential

Explanation

The amendment strikes the underlying bill in its entirety. The amendment results in no fiscal impact to the state in FY 12 and FY 13. The state employee health plan currently provides coverage for magnetic resonance imaging (MRI) and ultrasounds of the breast in accordance with the guidelines set forth by the associations named in the amendment.

The amendment's provisions may increase costs to certain fully insured municipal plans that do not currently provide the coverage mandated. The coverage requirements may result in increased premium costs when municipalities enter into new health insurance contracts on or after January 1, 2012. Due to federal law, municipalities with self-insured plans are exempt from state health insurance benefit mandates.

Many municipal health plans are recognized as “grandfathered” health plans under the Patient Protection and Affordable Care Act (PPACA) 1. It is unclear what effect the adoption of certain health mandates will have on the grandfathered status municipal plans PPACA2.

The Out Years

The annualized ongoing fiscal impact identified above would continue into the future subject to inflation.

There may be a potential impact to the state's self-insured plan if the guidelines put forth by the associations change the scope or course of treatment currently covered by the state employee health plan, and if the revised course of treatment were voluntarily adopted by the state's self-insured employee health plan.

In addition, the federal health care reform act requires that, effective January 1, 2014; all states must establish a health benefit exchange, which will offer qualified plans that must include a federally defined essential benefits package.  While states are allowed to mandate benefits in excess of the basic package, the federal law appears to require the state to pay the cost of any such additional mandated benefits.  The extent of these costs will depend on the mandates included in the federal essential benefit package, which have not yet been determined.  Neither the agency nor mechanism for the state to pay these costs has been established.

The preceding Fiscal Impact statement is prepared for the benefit of the members of the General Assembly, solely for the purposes of information, summarization and explanation and does not represent the intent of the General Assembly or either chamber thereof for any purpose. In general, fiscal impacts are based upon a variety of informational sources, including the analyst's professional knowledge. Whenever applicable, agency data is consulted as part of the analysis, however final products do not necessarily reflect an assessment from any specific department.

1 Grandfathered plans include most group insurance plans and some individual health plans created or purchased on or before March 23, 2010. Pursuant to the PPACA, all health plans, including those with grandfathered status are required to provide the following as of September 23, 2010: 1) No lifetime limits on coverage, 2) No rescissions of coverage when individual gets sick or has previously made an unintentional error on an application, and 3) Extension of parents' coverage to young adults until age 26. (www.healthcare.gov)

2 According to the PPACA, compared to the plans' policies as of March 23, 2010, grandfathered plans who make any of the following changes within a certain margin may lose their grandfathered status: 1) Significantly cut or reduce benefits, 2) Raise co-insurance charges, 3) Significantly raise co-payment charges, 4) Significantly raise deductibles, 5) Significantly lower employer contributions, and 5) Add or tighten annual limits on what insurer pays. (www.healthcare.gov)