SB 282 — AN ACT CONCERNING MEDICAL ASSISTANCE FOR SURGICAL AND PRESCRIPTION DRUG TREATMENT OF SEVERE OBESITY.

Senate General Assembly RaisedFile Bill No.

282164 February Session, 2022 LCOSubstitute Senate Bill No.

2478282 ReferredSenate, toMarch 29, 2022 The Committee on HUMANHuman SERVICESServices Introducedreported by:through SEN.

(HS)MOORE ANof ACTthe CONCERNING22nd MEDICALDist., ASSISTANCEChairperson FORof BARIATRICthe SURGERYCommittee ANDon PRESCRIPTIONthe DRUGpart TREATMENTof OFthe OBESITY.Senate, that the substitute bill ought to pass.

AN ACT CONCERNING MEDICAL ASSISTANCE FOR SURGICAL AND PRESCRIPTION DRUG TREATMENT OF SEVERE OBESITY.

(NEW) (Effective JulyOctober 1, 2022) (a) As used in this section:

(1) "Bariatric"Body surgery"mass index" means surgicalthe changesnumber tocalculated theby digestivedividing systeman toindividual's helpweight anin obesekilograms patientby losethe weight;individual's height in meters squared;

(2) "Body"Severe massobesity" index" means thea numberbody calculatedmass byindex dividingthat anis: individual's weight in kilograms by the individual's height in meters squared;

(3) "Severe obesity" means a body mass index that is:

and (4)(3) "Obese""Medically meansnecessary" ahas bodythe masssame indexmeaning as provided in section 17b-259b of thirtythe orgeneral higher.statutes.

LCOsSB282 / File No.

2478164 1 ofsSB282 2File (b)No. The Commissioner of Social Services shall provide medical assistance for (1) bariatric surgery for Medicaid and HUSKY B beneficiaries with severe obesity, and (2) prescription drug treatment of obese Medicaid and HUSKY B beneficiaries with a body mass index greater than thirty-five, provided such beneficiaries otherwise meet conditions set by the Centers for Medicare and Medicaid Services for such surgery and prescription drug treatment.

If164 necessary,(b) theOn commissionerand mayafter amendApril 1, 2023, the MedicaidCommissioner stateof planSocial Services, subject to federal approval and thecompliance statewith planapplicable forfederal requirements, may provide reimbursement under the Medicaid program and Children's Health Insurance Program tofor implement(1) themedically provisionsnecessary, covered surgical treatment of thissevere section.obesity, including, but not limited to, related hospital services, and (2) medically necessary, covered outpatient prescription drugs to treat severe obesity.

Section 1 JulyOctober 1, 2022 New section StatementHS ofJoint Purpose:Favorable Subst.

TosSB282 require/ theFile CommissionerNo. of Social Services to provide medical assistance for bariatric surgery and prescription drug treatment of obesity.

[Proposed164 deletions2 aresSB282 enclosedFile inNo. brackets.

Proposed164 additionsThe following Fiscal Impact Statement and Bill Analysis are indicatedprepared byfor underline,the exceptbenefit thatof whenthe members of the entireGeneral textAssembly, solely for purposes of ainformation, billsummarization orand resolutionexplanation orand ado sectionnot ofrepresent athe billintent orof resolutionthe isGeneral new,Assembly itor iseither notchamber underlined.]thereof LCOfor No.any purpose.

2478In 2general, fiscal impacts are based upon a variety of 2informational 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 23 $ FY 24 $ Social Services, Dept.

GF - Potential See Below See Below Cost Note:

GF=General Fund Municipal Impact:

None Explanation The bill could result in a cost to the state by allowing the Department of Social Service (DSS) to provide Medicaid and HUSKY B coverage of surgical treatments for severe obesity and associated outpatient prescription drugs, as medically necessary.

The cost is dependent on the extent to which the agency provides additional coverage and experiences increased utilization of such reimbursable services, on and after 4/1/23.

The Out Years The annualized ongoing fiscal impact identified above would continue into the future subject to inflation.

sSB282 / File No.

164 3 sSB282 File No.

164 OLR Bill Analysis sSB 282 AN ACT CONCERNING MEDICAL ASSISTANCE FOR SURGICAL AND PRESCRIPTION DRUG TREATMENT OF SEVERE OBESITY.

SUMMARY Beginning April 1, 2023, and subject to federal approval and compliance, this bill authorizes the social services commissioner to reimburse, under the Medicaid program and the Children’s Health Insurance Program (CHIP, also known as HUSKY B, see BACKGROUND), for medically necessary covered treatment of severe obesity, specifically (1) surgery, including related hospital services and (2) outpatient prescription drugs.

In practice, covered treatment of obesity under the state’s Medicaid program and HUSKY B is currently limited to surgical treatments, with required prior authorization.

However, these surgical treatments are only covered when obesity is caused by an illness or is making an illness worse.

So, subject to federal approval, the bill adds outpatient prescription drugs as a covered obesity treatment option under both programs and eliminates their requirements that a comorbidity exist.

The bill defines “severe obesity” as a body mass index (BMI, calculated by dividing an individual’s weight in kilograms by their height in meters squared) greater than 40 or greater than 35 with comorbidities (e.g., cardiopulmonary condition, diabetes, hypertension, or sleep apnea).

EFFECTIVE DATE:

October 1, 2022 BACKGROUND HUSKY B HUSKY B provides medically necessary health care coverage for sSB282 / File No.

164 4 sSB282 File No.

164 uninsured children under age 19 in families with household incomes between 196% and 318% of the federal poverty limit who do not qualify for HUSKY A (Medicaid).

Unlike Medicaid, it is a capped program (i.e., a block grant), and, as such, the federal government annually determines the share of program funding it will pay to the state.

Families receiving HUSKY B services must contribute towards the care cost, and these contributions rise as family income rises.