SB 360 — AN ACT CONCERNING VARIOUS CHANGES TO UTILIZATION REVIEW COMPANIES LICENSURE STATUTE.

Senate GeneralBill Assembly File No.

188360 FebruaryPublic Session,Act 2022 Senate Bill No.

36022-84 Senate,AN MarchACT 29,CONCERNING 2022VARIOUS TheCHANGES CommitteeTO onUTILIZATION InsuranceREVIEW andCOMPANIES RealLICENSURE EstateSTATUTE. reported through SEN.

LESSER of the 9th Dist., Chairperson of the Committee on the part of the Senate, that the bill ought to pass.

AN ACT CONCERNING VARIOUS CHANGES TO UTILIZATION REVIEW COMPANIES LICENSURE STATUTE.

(b) The [annual] license fee shall be [three thousand dollars] six thousand dollars and shall be dedicated to the regulation of utilization review, except that the commissioner shall be authorized to use such funds as is necessary to (1) implement the provisions of sections 38a- 91aa to 38a-91tt, inclusive, and (2) contract with The University of Connecticut School of Medicine to provide any medical consultations necessary to carry out the commissioner's responsibilities under this SB360title /with Filerespect No.to consumer and market conduct matters.

188(c) 1The SB360request Filefor licensure or renewal shall include the name, address, telephone number and normal business hours of the utilization review company, and the name and telephone number of a person for Senate Bill No.

188360 titlethe withcommissioner respect to consumercontact. and market conduct matters.

(c) The request for licensure or renewal shall include the name, address, telephone number and normal business hours of the utilization review company, and the name and telephone number of a person for the commissioner to contact.

ThisApproved actMay shall24, take2022 effectPublic asAct followsNo. and shall amend the following sections:

Section22-84 12 Januaryof 1,2 2023 38a-591j INS Joint Favorable SB360 / File No.

188 2 SB360 File No.

188 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 23 $ FY 24 $ Insurance Dept.

Utilization 177,000 (177,000) Review - Revenue Impact Municipal Impact:

None Explanation The bill changes the utilization review licensing fee paid by utilization review companies from an annual fee of $3,000 to a biannual fee of $6,000.

This change will result in a revenue gain of approximately $177,000 in FY 23 and a corresponding revenue loss of $177,000 in FY 24 to the Utilization Review Fund, a separate, non-lapsing account.

1 Overall, the amount of revenue collected over a two period will remain unchanged since the fee has been adjusted to reflect the change in the frequency of license renewals.

The Out Years The annualized ongoing fiscal impact identified above would continue into thefuture, withtheamountsvarying basedonthenumber of utilization review companies licensed by the Insurance Department.

1According to the Insurance Department, there are 59 utilization review companies licensed in Connecticut as of March 24, 2022.

SB360 / File No.

188 3 SB360 File No.

188 OLR Bill Analysis SB 360 AN ACT CONCERNING VARIOUS CHANGES TO UTILIZATION REVIEW COMPANIES LICENSURE STATUTE.

SUMMARY By law, a utilization review company must obtain a license from the insurance commissioner to operate in the state.

This bill requires a utilization review company to renew its license every two years, rather than annually as under current law.

It correspondingly increases the license fee from $3,000 to $6,000.

Additionally, the bill requires a licensed utilization review company to file with the insurance commissioner any material change to approved policies, procedures, sample letters, or behavioral health clinical criteria.

It must do this within 30 days after the change.

Bylaw,autilizationreviewcompanyconductsareviewofhealthcare services, procedures, or settings to monitor or evaluate their medical necessity, appropriateness, efficacy, or efficiency.

Through utilization review, a company may make prospective, concurrent, or retrospective review benefit determinations on behalf of a health carrier (e.g., insurer or HMO) (CGS § 38a-591a (39) & (40)).

EFFECTIVE DATE:

January 1, 2023 COMMITTEE ACTION Insurance and Real Estate Committee Joint Favorable Yea 16 Nay 0 (03/17/2022) SB360 / File No.

188 4