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 COPAYMENTS FOR BREAST ULTRASOUND SCREENINGS.

As Amended by Senate "A" (LCO 4678)

Senate Calendar No.: 43


OFA Fiscal Note

State Impact:

Agency Affected

Fund-Effect

FY 15 $

FY 16 $

State Comptroller - Fringe Benefits (State Employee and Retiree Health Plan)

GF, TF - Cost

Less than $5,000

Less than $10,000

Municipal Impact:

Municipalities

Effect

FY 15 $

FY 16 $

Various Municipalities

STATE MANDATE - Cost

Potential

Potential

Explanation

There may be a potential cost of less than $5,000 in FY 15 and less than $10,000 in FY 16 to the state employee and retiree health plan1 from capping copayments for breast ultrasound screenings at $20.2 The potential cost is attributable to out-of-network ultrasound screenings for members enrolled in the state Point of Service (POS) plans3 and those not currently enrolled in the Health Enhancement Program (HEP)4, who fit the screening parameter of the bill. The state plan does not currently impose a copayment for in-network screenings. The vast majority of members use in-network services. There is no cost to the state from capping in-network occupational therapy services as the state plan does not currently impose a copayment.

The bill's cap on copayments for ultrasound screenings and in-network occupational therapy services may increase costs for certain fully insured municipalities which require member cost sharing in excess of $20 and $30 respectively. The coverage requirements may result in increased premium costs for the municipality when they enter into new health insurance contracts after January 1, 2015. Due to federal law, municipalities with self-insured plans are exempt from state health insurance mandates.

Lastly, many municipal plans may be recognized as “grandfathered”5 plans under the federal Affordable Care Act (ACA). It is uncertain what the effect of this mandate will have on the grandfathered status of those municipal plans.

For the purposes of the ACA the provisions of this bill are not considered additional mandates and therefore will not result in an additional state cost related to reimbursement for the mandates for those individuals covered through the exchange plans.

Senate “A” added the $30 cap on copays for in-network occupational therapy services to the underlying bill and resulted in the fiscal impact above.

The Out Years

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

Sources:

Office of the State Comptroller

 

Office of the State Comptroller State Health Plan, Plan Benefit Document as of July 2013

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 The state employee and retiree health plan is a self-insured health plan. Pursuant to federal law, self-insured health plans are exempt from state health mandates. However, the state has traditionally adopted all state health mandates.

2 The potential cost assumes the average ultrasound screening is approximately $252. (Source: University of Connecticut, Review and Evaluation of Certain Health Benefit Mandates in Connecticut, 2012, p. 198) Adjusted by medical inflation.

3 Members enrolled in a POS plan are required to pay 20% of allowable costs after satisfying the plan deductible and 100% of costs charged by the provider in excess of the allowable cost.

4 Members not enrolled in the HEP plan must satisfy the plan's deductible for services where there is no cost sharing.

5 Grandfathered plans include most group health insurance plans and some individual plans created or purchased on or before March 23, 2010.