OHA Lunch & Learn
Office of the Healthcare Advocate in Connecticut provides free assistance to consumers with healthcare and health insurance issues. Learn about the new laws for 2023 that may impact your healthcare rights, including federal law changes and Connecticut mandates for fully insured plans.
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Presentation Transcript
OHA Lunch & Learn New Laws for 2023 Ted Doolittle, Healthcare Advocate, and Adam Prizio, OHA Staff Attorney
Introduction What is the Office of the Healthcare Advocate? Created in 1999 as the Office of the Managed Care Ombudsman Name changed in 2005 to Office of the Healthcare Advocate Staff of Nurse Consultants, Attorneys, Paralegals, and other professionals Assist Connecticut consumers with healthcare and health insurance issues e.g., Doctor orders a procedure but insurance doesn t think it s necessary Free of charge to the consumer
New Laws for 2023 Changes that may affect you this year Every year, Congress, the Connecticut General Assembly, and the regulatory agencies make changes to the law that may impact your rights as a healthcare consumer Some healthcare benefits are only subject to Federal law: ERISA plans (a.k.a. self-funded employer health benefits) Medicaid Veteran s Benefits
Federal Law Premium Subsidies and Prescription Drug Cost Caps Ten years of ACA plans Enhanced Advanced Premium Tax Credit subsidies in effect in 2023 Open Enrollment ended on January 15. Inflation Reduction Act of 2022 Medicare Part D $35 cap on Insulin copays Medicare drug price rebate Reduction in costs for adult vaccines in Part D, Medicaid, and CHIP
Connecticut Law Notices and Mandates for Fully Insured Plans P.A. 22-47 An Act Concerning Children s Mental Health Enhanced notification of OHA services in adverse determinations & denials 2 mental health wellness examinations without cost sharing Revise surprise billing, provider collection, & mental health coverage statutes to afford OON urgent crisis center services the same protections as OON emergency services Revise network adequacy to require equivalent access to urgent crisis center services as emergency services No prior authorization for urgent crisis center or acute inpatient psychiatric services following ED admission or referral from treating clinician
Connecticut Law (contd) Notices and Mandates for Fully Insured Plans P.A. 22-90 An Act Concerning Breast and Ovarian Cancer Susceptibility Screening Coverage without cost sharing for: Baseline mammogram/tomography for insureds ages 35-39, younger if at increased risk; Annual mammogram/tomography for insureds >40, younger if at increased risk; Diagnostic & screening ultrasounds if DBT or if at risk. Diagnostic & screening MRIs per ACS guidelines for insureds over 35 or younger if at risk Biopsy of tissue Prophylactic mastectomy and reconstruction
Connecticut Law (contd) Notices and Mandates for Fully Insured Plans P.A. 22-90 (cont d) Coverage without cost sharing for: Genetic testing for insureds with a family history of breast or ovarian cancer Routine screening & surveillance tests for insureds at risk, if ordered by physician CA-125 monitoring of ovarian cancer subsequent to treatment Other genetic testing per USPSTF
Connecticut Law (contd) Notices and Mandates for Fully Insured Plans P.A. 22-118 Extends through age 12 HUSKY eligibility for undocumented immigrant children Allows undocumented immigrant children age 13-19 to remain on HUSKY if income-eligible and ineligible for other coverage Establishes a community ombudsman program at the Long-Term Care Ombudsman, focusing on home care services
Connecticut Law (contd) Notices and Mandates for Fully Insured Plans P.A. 22-146 Narrow exception to copay accumulator ban for HSA-qualified HDHPs
Thank You Questions? The Office of the Healthcare Advocate is here for YOU Office of the Healthcare Advocate P.O. Box 1543 Hartford, CT 06144 Toll-Free: 866-466-4446 Email: healthcare.advocate@ct.gov
