Bill Text: CT SB00543 | 2017 | General Assembly | Comm Sub
Bill Title: An Act Concerning Health Insurance Coverage Of Inpatient Substance Abuse Services.
Spectrum: Committee Bill
Status: (Introduced - Dead) 2017-05-03 - Referred by Senate to Committee on Appropriations [SB00543 Detail]
Download: Connecticut-2017-SB00543-Comm_Sub.html
General Assembly |
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January Session, 2017 |
*_____SB00543INS___031617____* |
AN ACT CONCERNING HEALTH INSURANCE COVERAGE OF INPATIENT SUBSTANCE ABUSE SERVICES.
Be it enacted by the Senate and House of Representatives in General Assembly convened:
Section 1. (NEW) (Effective January 1, 2018) (a) Each insurance company, hospital service corporation, medical service corporation, health care center, fraternal benefit society or other entity that delivers, issues for delivery, renews, amends or continues in this state an individual health insurance policy providing coverage of the type specified in subdivision (1), (2), (4), (11) or (12) of section 38a-469 of the general statutes that provides coverage to an insured or enrollee who has been diagnosed with a substance use disorder, as described in section 17a-458 of the general statutes, shall cover inpatient substance abuse services provided to the insured or enrollee until such time as the health condition of the insured or enrollee has been stabilized. For the purposes of this section, "stabilized" means, with respect to an insured or enrollee receiving substance abuse services described in this subsection, that no material deterioration in the health condition of the insured or enrollee is likely, within reasonable medical probability, to result from or occur during the transfer of the insured or enrollee from an inpatient facility.
(b) Nothing in this section shall be construed to prohibit utilization review.
(c) Any insurance company, hospital service corporation, medical service corporation, health care center, fraternal benefit society or other entity providing coverage for the substance abuse services described in subsection (a) of this section may seek recovery from an insured or enrollee for the cost of such services if such services are not medically necessary, provided the amount of such recovery shall not exceed the Medicare reimbursement rate for such services. For the purposes of this subsection, "medically necessary" has the same meaning as provided in section 38a-482a of the general statutes.
Sec. 2. (NEW) (Effective January 1, 2018) (a) Each insurance company, hospital service corporation, medical service corporation, health care center, fraternal benefit society or other entity that delivers, issues for delivery, renews, amends or continues in this state a group health insurance policy providing coverage of the type specified in subdivision (1), (2), (4), (11) or (12) of section 38a-469 of the general statutes that provides coverage to an insured or enrollee who has been diagnosed with a substance use disorder, as described in section 17a-458 of the general statutes, shall cover inpatient substance abuse services provided to the insured or enrollee until such time as the health condition of the insured or enrollee has been stabilized. For the purposes of this section, "stabilized" means, with respect to an insured or enrollee receiving substance abuse services described in this subsection, that no material deterioration in the health condition of the insured or enrollee is likely, within reasonable medical probability, to result from or occur during the transfer of the insured or enrollee from an inpatient facility.
(b) Nothing in this section shall be construed to prohibit utilization review.
(c) Any insurance company, hospital service corporation, medical service corporation, health care center, fraternal benefit society or other entity providing coverage for the substance abuse services described in subsection (a) of this section may seek recovery from an insured or enrollee for the cost of such services if such services are not medically necessary, provided the amount of such recovery shall not exceed the Medicare reimbursement rate for such services. For the purposes of this subsection, "medically necessary" has the same meaning as provided in section 38a-513c of the general statutes.
This act shall take effect as follows and shall amend the following sections: | ||
Section 1 |
January 1, 2018 |
New section |
Sec. 2 |
January 1, 2018 |
New section |
INS |
Joint Favorable Subst. |