SB 1048 — AN ACT CONCERNING REIMBURSEMENTS FOR CERTAIN COVERED HEALTH BENEFITS.

Senate General Assembly RaisedFile Bill No.

1048373 January Session, 2021 LCOSenate Bill No.

36601048 ReferredtoCommitteeonINSURANCESenate, ANDREALApril ESTATE8, Introduced2021 by:The Committee on Insurance and Real Estate reported through SEN.

(INS)LESSER ANof ACTthe CONCERNING9th REIMBURSEMENTSDist., FORChairperson CERTAINof COVEREDthe HEALTHCommittee BENEFITS.on the part of the Senate, that the bill ought to pass.

AN ACT CONCERNING REIMBURSEMENTS FOR CERTAIN COVERED HEALTH BENEFITS.

(A) Reimburse the contracting health care provider for a covered outpatient benefit that uses a current procedural terminology evaluation and management (CPT E/M) code, current procedural terminology assessment and management (CPT A/M) code or drug infusionSB1048 code/ inFile an amount that does not vary based on the facility LCO 3660 \\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-01048-R01 of 2 SB.docx Raised Bill No.

1048373 where1 theSB1048 contractingFile healthNo. care provider provides such benefit;

373 infusion code in an amount that does not vary based on the facility where the contracting health care provider provides such benefit;

Section 1 July 1, 2022 New section INS Joint Favorable LCOSB1048 3660/ {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-01048-2File ofNo. 2 R01-SB.docx }

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373 The following Fiscal Impact Statement and Bill Analysis are prepared for the benefit of the members of the General Assembly, solely for purposes of information, summarization and explanation and do 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.

OFA Fiscal Note State Impact:

Agency Affected Fund-Effect FY 22 $ FY 23 $ UConn Health Ctr.

Other - See Below None See Below Municipal Impact:

None Explanation The bill requires contracts between insurers and providers to entail equal reimbursement for certain outpatient services, regardless of the type of facility in which the service was provided, for contracts that are new, renewed, or amended beginning July 1, 2022 (FY 23).

The bill also requires equal reimbursement rates for the same services, for all of an insurer's contracting providers in the same region, in certain circumstances.

The bill is anticipated to decrease reimbursements for hospital settings and hospital-based facilities, and to increase reimbursements for outpatient facilities for the treatments outlined in the bill.

It is uncertain if the net costs to insurers will increase based on negotiated rates and changes in utilization by setting, as reflected in premiums for plan years starting after July 1, 2022.

The UConn Health Center may be impacted by the bill.

The health center offers outpatient services in both regular outpatient and hospital- based outpatient facilities.

The reimbursement rates could be affected for the services specified in the bill, particularly in the hospital-based facilities.

Hospital-based facilities must comply with numerous requirements not imposed on other outpatient facilities, such as Joint SB1048 / File No.

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373 Commission accreditation, staffing requirements, and availability of emergency equipment, and consequently, total reimbursement rates may be higher for hospital-based outpatient care.

The impact of the regional reimbursement equity provision depends on how UConn Health's contractual reimbursements currently compare to the same insurers' reimbursements to other providers in the same geographical area, which is unknown.

The Out Years The annualized ongoing fiscal impact identified above would continue into the future subject to inflation in health care costs and reimbursements.

SB1048 / File No.

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373 OLR Bill Analysis SB 1048 AN ACT CONCERNING REIMBURSEMENTS FOR CERTAIN COVERED HEALTH BENEFITS.

SUMMARY Starting July 1, 2022, this bill requires health carriers (e.g., health insurers and HMOs) and preferred provider networks that enter into, renew, or amend a contract with a health care provider to include in the contract a provision requiring equal reimbursement rates for covered outpatient services:

1.

for all providers in the same geographic region (as determined by the insurance commissioner), regardless of the provider’s employer or affiliation, if the services are reimbursed on a fee- for-servicesbasisorasastandardizedbundleofbenefits(e.g.,per diagnosis, condition, or procedure) and 2.

regardless of the facility where the services are provided.

The bill applies to covered outpatient services that use a current procedural terminology evaluation and management (CPT E/M) code, current procedural terminology assessment and management (CPT A/M) code, or drug infusion code.

Additionally, the bill requires the (1) contracts to include a conspicuous statement that they comply with the bill’s requirement and (2) insurance commissioner to adopt implementing regulations.

EFFECTIVE DATE:

July 1, 2022 COMMITTEE ACTION Insurance and Real Estate Committee SB1048 / File No.

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