Raised S.B. No. 1045
Session Year 2021


AN ACT CONCERNING STEP THERAPY, ADVERSE DETERMINATION AND UTILIZATION REVIEWS, AND HEALTH INSURANCE COVERAGE FOR CHILDREN, STEPCHILDREN AND OTHER DEPENDENT CHILDREN.

To: (1) Allow a child, stepchild or other dependent child to retain health insurance coverage under a parent's individual or group health insurance policy until the policy anniversary date after the date on which the child, stepchild or other dependent child attains the age of twenty-six; (2) prohibit certain health carriers from requiring the use of step therapy for drugs prescribed to treat behavioral health conditions or chronic, disabling or life-threatening conditions or diseases; (3) redefine "clinical peer" for the purposes of adverse determination and utilization reviews; (4) require health carriers to bear the burden of proving that certain health care services under adverse determination or utilization review are not medically necessary; and (5) require health carriers to provide certain clinical peers with the authority to reverse initial adverse determinations.