With less than a week left in the 2014 legislative session, an amendment to HB 5529 greatly expands the definition of medical necessity—healthcare services that insurance policies must cover, and thus employers and employees must pay for. It’s a change that will significantly impact both healthcare quality and cost in Connecticut.

The proposed amendment (4614) presumes that any healthcare service or procedure provided to a patient is "medically necessary."

As pointed out by the Office of Fiscal Analysis (OFA), a nonpartisan office charged with analyzing the fiscal impact of proposed bills, this will increase the scope of services covered under a health insurance policy and therefore their associated costs.

Here is yet another proposal certain to drive up the cost of healthcare in Connecticut at a time when costs are already too high.

But more important, this measure could impact healthcare quality by changing the type of services and procedures physicians may be reimbursed for in providing to their patients.

The current definition was reached after significant discussions with all stakeholders and the change means that any type of treatment–including services/procedures that have not been tested or verified–would be reimbursable. 

Connecticut employers are concerned with ensuring their workforce receives high quality healthcare at an affordable price. Lawmakers should reject this amendment because it will negatively impact both of those goals. 

For more information, contact CBIA’s Jennifer Herz at 860.244.1921 | jennifer.herz@cbia.com | @CBIAjherz