OFFICE OF FISCAL ANALYSIS

Legislative Office Building, Room 5200

Hartford, CT 06106 (860) 240-0200

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

sHB-5208

AN ACT CONCERNING MAMMOGRAMS, BREAST ULTRASOUNDS AND MAGNETIC RESONANCE IMAGING OF BREASTS.

As Amended by House "A" (LCO 4900)

House Calendar No.: 74

Senate Calendar No.: 516


OFA Fiscal Note

State Impact: None

Municipal Impact:

Municipalities

Effect

FY 19 $

FY 20 $

Various Municipalities

STATE MANDATE - Cost

See Below

See Below

Explanation

The bill does not result in a fiscal impact to the state health plan as the state does not currently impose cost sharing in-network for mammograms, including tomosynthesis.

The bill's expanded definition of mammogram, to include coverage codes for tomosynthesis will result in a cost to certain fully-insured municipal plans, to the extent the expanded coverage definition precludes municipal plans from imposing cost sharing for tomosynthesis. Pursuant to federal law cost sharing for in network mammograms is prohibited.1 The coverage requirements may result in increased premium costs for the municipality when they enter into new health insurance contracts after January 1, 2019. 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”2 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.

House “A” struck the underlying bill and its associated fiscal impact and results in the fiscal impact described herein.

The Out Years

The fiscal impact will continue into the future and will be reflected in future premiums.

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 https://www.healthcare.gov/preventive-care-women/

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