OLR Bill Analysis

HB 7042

AN ACT CONTROLLING CONSUMER HEALTH CARE COSTS.

SUMMARY

This bill modifies the Insurance Department's mandated health benefit review program. It prohibits the General Assembly, beginning February 1, 2018, from enacting any legislation mandating insurers to cover a new health benefit unless the benefit has been the subject of (1) a health benefit review report by the department and (2) an informational hearing before the Insurance and Real Estate and Public Health committees at which the commissioner is present and available for questions.

The bill authorizes the Insurance and Real Estate Committee, during a regular legislative session and by a majority vote of the committee members, to require the insurance commissioner to review and report on up to five proposed mandated health benefits. Under current law, the committee may request a review from the commissioner by August 1 of each year.

As under current law, the bill requires the commissioner to submit the report by the next January 1. Under the bill, the report must be submitted to the Insurance and Real Estate and Public Health committees. Under current law, she submits it only to the Insurance and Real Estate Committee.

The bill allows, rather than requires, the commissioner to contract with the UConn Center for Public Health and Health Policy to conduct the reviews. Under the bill, she may also contract with an actuarial accounting firm for the reviews.

The bill reduces the amount of information that each report must contain. Under current law, a report must review specified social and financial impacts of mandating the benefit. The bill instead requires the report to evaluate specified quality and cost impacts of mandating it.

By law, unchanged by the bill, the commissioner may assess health carriers (e.g., insurers and HMOs) for the costs of the health benefit review program. Assessments are deposited in the Insurance Fund.

EFFECTIVE DATE: July 1, 2017

MANDATED HEALTH BENEFIT DEFINITION

The bill narrows the definition of “mandated health benefit.” Under the bill, the term means proposed legislation that requires a health carrier offering health insurance policies or benefit plans in Connecticut to offer or provide coverage for (1) a particular health care treatment or service or (2) medical equipment, supplies, or drugs used in connection with a treatment or service.

Current law defines the term to also include (1) an existing statutory obligation of the carrier; (2) a provision allowing enrollees to obtain treatment or services from a particular type of health care provider; and (3) a provision to offer or provide coverage for the screening, diagnosis, or treatment of a particular disease or condition.

QUALITY AND COST IMPACTS MUST BE EVALUATED

Under the bill, a mandated benefit review report must evaluate the quality and cost impacts of mandating the benefit, and, as under existing law, must include:

1. the extent to which a significant portion of the population uses the treatment, service, equipment, supplies, or drugs;

2. the extent to which the treatment, service, or equipment is, or supplies and drugs are, available under Medicare or through public programs that charities, public schools, the Department of Public Health, municipal health departments or districts, or the Department of Social Services administer;

3. the extent to which insurance policies already cover the treatment, service, equipment, supplies, or drugs;

4. the impact of applying the benefit to the state employees' health benefits plan;

5. the extent to which credible scientific evidence published in peer-reviewed medical literature that the relevant medical community generally recognizes determines the treatment, service, equipment, supplies, or drugs are safe and effective;

6. the extent to which the benefit may increase or decrease, over the next five years, (a) the cost of the treatment, service, equipment, supplies, or drugs and (b) the appropriate or inappropriate use of the benefit;

7. the extent to which the treatment, service, or equipment is, or supplies or drugs are, more or less expensive than an existing one determined to be equally safe and effective by credible scientific evidence published in peer-reviewed medical literature that the relevant medical community generally recognizes;

8. the extent to which the treatment, service, equipment, supplies, or drugs could be an alternative for a more or less expensive one;

9. the reasonably expected increase or decrease of a policyholder's insurance premiums and administrative expenses;

10. methods that will be implemented to manage the benefit's utilization and costs;

11. the impact on the (a) total cost of health care, including potential savings to insurers and employers resulting from prevention or early detection of disease or illness, and (b) cost of health care for small employers and other employers; and

12. the impact on (a) cost-shifting between private and public payors of health care coverage and (b) the overall cost of the state's health care delivery system.

ELEMENTS NO LONGER REQUIRED

The bill eliminates the following elements from a mandated benefit review report:

1. if coverage of the benefit is not generally available, the extent to which this results in (a) people being unable to obtain necessary treatment and (b) unreasonable financial hardships on those needing treatment;

2. the level of demand from the public and health care providers for (a) the treatment, service, equipment, supplies, or drugs and (b) insurance coverage for these;

3. the likelihood of meeting a consumer need based on other states' experiences;

4. relevant findings of state agencies or other appropriate public organizations relating to the benefit's social impact;

5. alternatives to meeting the identified need, including other treatments, methods, or procedures;

6. whether the benefit is (a) a medical or broader social need and (b) consistent with the role of health insurance and managed care concepts;

7. potential social implications regarding the direct or specific creation of a comparable mandated benefit for similar diseases, illnesses, or conditions;

8. the benefit's impact (a) on the availability of other benefits already offered and (b) on employers shifting to self-insured plans; and

9. the extent to which employers with self-insured plans offer the benefit.

COMMITTEE ACTION

Insurance and Real Estate Committee

Joint Favorable

Yea

18

Nay

2

(03/09/2017)