Connecticut 2021 Regular Session Status: In Committee Bipartisan · 7 D · 3 R cosponsors

SB 1007 — AN ACT REQUIRING HEALTH INSURANCE AND MEDICAID COVERAGE FOR THE TREATMENT OF SEVERE OBESITY.

Last action — FAV. RPT., TAB. FOR CAL., SEN.

  1. ✓
    Introduced
  2. 2
    In Committee
  3. 3
    Passed Senate
  4. 4
    Passed House
  5. 5
    To Executive
  6. 6
    Enacted

This bill died with 2021 Regular Session. It reached “In Committee” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.

This bill is no longer active — its legislative session has ended, so there is no live prognosis. It would have to be reintroduced in the current session to move again.

Bill Text

What changed in the latest version

22 added · 154 removed

Plain-language change summary

The updated version of Bill SB 1007 has been streamlined by removing extraneous references and details that were not essential to the bill’s main points. This simplifies the bill and highlights its key provisions more effectively. The changes make it easier for lawmakers and the public to understand what the bill aims to accomplish and why it is significant. Overall, this makes the legislative process more transparent and accessible.

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Senate General Assembly File No.
General Assembly Raised Bill No.
364 January Session, 2021 Senate Bill No.
1007 January Session, 2021 LCO No.
1007 Senate, April 8, 2021 The Committee on Insurance and Real Estate reported through SEN.
3318 ReferredtoCommitteeonINSURANCE ANDREAL ESTATE Introduced by:
LESSER of the 9th Dist., Chairperson of the Committee on the part of the Senate, that the bill ought to pass.
(INS) AN ACT REQUIRING HEALTH INSURANCE AND MEDICAID COVERAGE FOR THE TREATMENT OF SEVERE OBESITY.
AN ACT REQUIRING HEALTH INSURANCE AND MEDICAID COVERAGE FOR THE TREATMENT OF SEVERE OBESITY.
(b) Each individual health insurance policy providing coverage of the SB1007 / File No.
(b) Each individual health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 LCO 3318 \\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-01007-R01 of 5 SB.docx Raised Bill No.
364 1 SB1007 File No.
1007 ofthegeneralstatutesdelivered,issuedfor delivery,renewed,amended or continued in this state on or after January 1, 2022, shall provide coverage for:
364 type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 ofthegeneralstatutesdelivered,issuedfor delivery,renewed,amended or continued in this state on or after January 1, 2022, shall provide coverage for:
or (B) Thirty-five or more if an individual has been diagnosed with a comorbid disease or condition, including, but not limited to, a SB1007 / File No.
or (B) Thirty-five or more if an individual has been diagnosed with a comorbid disease or condition, including, but not limited to, a LCO 3318 {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-01002 of 5 R02-SB.docx } Raised Bill No.
364 2 SB1007 File No.
1007 cardiopulmonary condition, diabetes, hypertension or sleep apnea.
364 cardiopulmonary condition, diabetes, hypertension or sleep apnea.
(A) Greater than forty;
LCO 3318 {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-01003 of 5 R02-SB.docx } Raised Bill No.
or SB1007 / File No.
1007 (A) Greater than forty;
364 3 SB1007 File No.
or (B) Thirty-five or more if a Medicaid beneficiary has been diagnosed with a comorbid disease or condition, including, but not limited to, a cardiopulmonary condition, diabetes, hypertension or sleep apnea.
364 (B) Thirty-five or more if a Medicaid beneficiary has been diagnosed with a comorbid disease or condition, including, but not limited to, a cardiopulmonary condition, diabetes, hypertension or sleep apnea.
(B)RecognizedbytheNationalInstitutesofHealth,AmericanSociety for Metabolic and Bariatric Surgery and American College of Surgeons as providing long-term weight loss;
(B)RecognizedbytheNationalInstitutesof Health,AmericanSociety for Metabolic and Bariatric Surgery and American College of Surgeons as providing long-term weight loss;
The commissioner may adopt policies or procedures to implementtheprovisionsofthissectionwhileintheprocessofadopting regulations, provided such policies or procedures are posted on the Internet web site of the Department of Social Services and on the eRegulations System prior to the adoption of such policies or procedures.
The commissioner may adopt policies or procedures to implementtheprovisionsofthissectionwhileintheprocessofadopting regulations, provided such policies or procedures are posted on the Internet web site of the Department of Social Services and on the LCO 3318 {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-01004 of 5 R02-SB.docx } Raised Bill No.
SB1007 / File No.
1007 eRegulations System prior to the adoption of such policies or procedures.
364 4 SB1007 File No.
This act shall take effect as follows and shall amend the following sections:
364 This act shall take effect as follows and shall amend the following sections:
3 July 1, 2021 New section INS Joint Favorable SB1007 / File No.
3 July 1, 2021 New section INS Joint Favorable APP Joint Favorable LCO 3318 {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-01007- 5 of 5 R02-SB.docx }
364 5 SB1007 File No.
364 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 $ ACA – State Mandate GF - Cost Significant Significant Social Services, Dept.
GF - Potential See Below See Below Cost Note:
GF=General Fund Municipal Impact:
Municipalities Effect FY 22 $ FY 23 $ Various Municipalities STATE See Below See Below MANDATE 1 - Cost Explanation The bill does not result in a cost to the state employee and retiree health plan as the state health plan currently provides coverage in accordance with the provisions of the bill.
The bill will result in a cost to fully-insured municipal health plans that do not currently provide coverage for surgical procedures to treat severe obesity.
The cost to fully insured municipal plans will be reflected in premiums for policy years beginning on and after January 1, 2022 and be based on the risk profile of the covered members.
Pursuant to federal law, self-insured plans are exempt from state health 1State mandate is defined in Sec.
2-32b(2) of the Connecticut General Statutes, "state mandate" means any state initiated constitutional, statutory or executive action that requires a local government to establish, expand or modify its activities in such a way as to necessitate additional expenditures from local revenues.
SB1007 / File No.
364 6 SB1007 File No.
364 insurance mandates.
In addition, many municipal health plans are recognized as “grandfathered” health plans under the Affordable Care Act (ACA).
It 2 is unclear what effect the adoption of certain health mandates will have on the grandfathered status of certain municipal plans under the ACA.
Lastly, the bill will result in a cost to the state pursuant to the ACA, as the coverage requirements in the bill are not currently provided under the state exchange’s benchmark plan.
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The cost will depend on the utilization and cost of services for exchange plans.
Based on the experience of the state employee health plan, the cost to the state for exchange plansisapproximately $4.4 million.
Basedonthemost recent data available, the active state employee health plan covers approximately 90,500 members between the ages of 18-65.
Exchange5 plans provide coverage for approximately 106,000 members in the same age range.
For context, $4.4 million reflects 0.5% of total annualized premiums for exchange members.
Assuming median average procedure cost of approximately $20,000 – the impact assumes approximately 220 Exchange memberswould undergo theprocedure or 0.2% of enrollees in the applicable age cohort.
While states are allowed to mandate benefits in excess of the essential health benefit (EHB), federal law requires the state to defray the cost of any such additional mandated benefits for all plans sold in the Exchange, by reimbursing the carrier or the insured for the excess coverage.
Absent further federal guidance, state mandated benefits enacted after December 31, 2011 cannot be considered part of the EHB Grandfathered plans include most group insurance plans and some individual health plans created or purchased on or before March 23, 2010.
The Exchange benchmark plan is the Connecticare Flex POS Plan.
(Source:
https://www.cms.gov/CCIIO/Resources/Data-Resources/Downloads/Updated- Connecticut-Benchmark-Summary.pdf) Estimate based on state employee health plan expenditures for applicable services for calendar year 2018.
5Source:
Office of the State Comptroller, 2017.
Source:
Access HealthCT 2020 Open Enrollment Summary (February 20, 2020, Presentation to the Board of Directors).
SB1007 / File No.
364 7 SB1007 File No.
364 unless they are already part of the benchmark plan.
Section 3 could result in increased costs to the Department of Social Services (DSS) associated with requiring Medicaid reimbursement for all outpatient prescription drugs approved by the federal Food and Drug Administrationto treat severe obesity.Theimpact to DSSdepends ontheextentto whichsuchdrugs wouldbe utilizedandtheir associated net cost.
The Out Years The annualized ongoing fiscal impact identified above would continue into the future subject to an increase in premiums.
SB1007 / File No.
364 8 SB1007 File No.
364 OLR Bill Analysis SB 1007 AN ACT REQUIRING HEALTH INSURANCE AND MEDICAID COVERAGE FOR THE TREATMENT OF SEVERE OBESITY.
SUMMARY This bill requires certain commercial health insurance policies to cover surgical procedures performed to treat severe obesity, including gastric bypass, sleeve gastrectomy, and duodenal switch.
The procedures must be (1) recognized by the National Institutes of Health (NIH), American Society for Metabolic and Bariatric Surgery, and American College of Surgeons as providing long-term weight loss and (2) consistent with NIH treatment guidelines.
The bill requires that if the policies cover outpatient prescription drugs, they must also cover outpatient prescription drugs approved by the federal Food and Drug Administration to treat severe obesity.
Under the bill, coverage is subject to the same terms and conditions that apply to all other benefits covered under the policy.
The bill also requires the Department of Social Services (DSS) commissioner to provide Medicaid coverage reimbursement for the surgical procedures and outpatient prescription drugs described above to treat severe obesity.
The bill requires the DSS commissioner to (1) seek federal approval of a Medicaid state plan amendment or waiver for this, if necessary, in accordance with state law and (2) adopt implementing regulations.
It authorizes her to adopt policies and procedures to implement these provisions while in the process of adopting regulations, as long as the policies and procedures are posted on the DSS website and the state eRegulations system.
SB1007 / File No.
364 9 SB1007 File No.
364 EFFECTIVE DATE:
January 1, 2022, except the Medicaid provisions are effective July 1, 2021.
SEVERE OBESITY DEFINED Under the bill, a person with severe obesity has a body mass index (BMI) that is (1) over 40 or (2) at least 35 if he or she is also diagnosed with a comorbidity such as a cardiopulmonary condition, diabetes, hypertension, or sleep apnea.
BMI is calculated by dividing a person’s weight in kilograms by the square of their height in meters.
COMMERCIAL INSURANCE POLICY APPLICABILITY For commercialinsurance purposes,the billappliesto individualand group health insurance policies delivered, issued, renewed, amended, or continued in Connecticut on or after January 1, 2022, that cover (1) basic hospital expenses;
(2) basic medical-surgical expenses;
(3) major medical expenses;
or (4) hospital or medical services, including those provided under an HMO plan.
Because of the federal Employee Retirement Income Security Act (ERISA), state insurance benefit mandates do not apply to self-insured benefit plans.
COMMITTEE ACTION Insurance and Real Estate Committee Joint Favorable Yea 18 Nay 0 (03/22/2021) SB1007 / File No.
364 10
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Action History

  1. FAV. RPT., TAB. FOR CAL., SEN.

  2. NO NEW FILE BY COMM. ON Appropriations

  3. RPTD. OUT OF LCO

  4. FILED WITH LCO

  5. Joint Favorable

  6. REF. BY SEN. TO COMM. ON Appropriations

  7. FILE NO. 364

  8. SENATE CALENDAR NUMBER 231

  9. FAV. RPT., TAB. FOR CAL., SEN.

  10. RPTD. OUT OF LCO

  11. REFERRED TO Office of Legislative Research AND Office of Fiscal Analysis 04/07/21

  12. FILED WITH LCO

  13. Joint Favorable

  14. PUBLIC HEARING 0318

  15. REF. TO JOINT COMM. ON Insurance and Real Estate

Sponsors

Sponsorship breakdown

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15 sponsors · 0 co-sponsors · 172 not signed on

Sponsors (15)

Co-sponsors (0)

None.

Not signed on (172)

172 members have not signed on to this bill.

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"Not signed on" means a member has not sponsored or co-sponsored this bill — it does not imply opposition. Members flagged Voted No have a recorded No vote on this bill.

Whip count is in markup. Polling the chamber and every recorded vote this session. Only the first open is slow. It’s instant for you after this. Calling the roll · Tallying · Engrossing

Subjects

healthcare health-insurance
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Frequently asked questions

Who sponsors SB 1007?
SB 1007 is sponsored by Bobby G. Gibson (Democratic), Mitch Bolinsky (Republican), Eric C. Berthel (Republican), Haskell, Will, Petit, William A., Borer, Dorinda, John-Michael Parker (Democratic), Saud Anwar (Democratic), Julie Kushner (Democratic), Winkler, Michael A., Jill Barry (Democratic), Tom Delnicki (Republican), Josh Elliott (Democratic), Joshua M. Hall (Democratic), and Marilyn Moore.
What is the current status of SB 1007?
This bill died with 2021 Regular Session. It reached “In Committee” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.
Where can I track SB 1007?
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