OLR Bill Analysis

sSB 290

AN ACT CONCERNING HEALTH INSURANCE COVERAGE FOR BONE MARROW TESTING.

SUMMARY:

This bill requires certain health insurance policies to provide specified coverage for human leukocyte antigen testing, which determines compatibility for bone marrow transplants.

EFFECTIVE DATE: January 1, 2010

COVERAGE REQUIREMENTS

The bill requires coverage for human leukocyte antigen testing, also referred to as histocompatibility locus antigen testing, for A, B, and DR antigens for bone marrow transplant purposes. It permits a policy to limit coverage to one covered test in a person's lifetime.

It prohibits a policy, except for a high-deductible policy, from imposing a coinsurance, copayment, deductible, or other out-of-pocket expense for the testing that exceeds 20% of the cost for testing per year.

The bill requires a policy to (1) require bone marrow testing be done at a facility certified under the federal Clinical Laboratory Improvement Act and accredited by the American Society for Histocompatibility and Immunogenetics, or its successor, and (2) limit coverage to people who sign up for the National Marrow Donor Program when being tested.

APPLICABILITY

The bill applies to individual and group health insurance policies delivered, issued, renewed, amended, or continued in Connecticut on and after January 1, 2010 that cover (1) basic hospital expenses; (2) basic medical-surgical expenses; (3) major medical expenses; and (4) hospital or medical services, including coverage under an HMO plan.

Due to federal law (ERISA), state insurance benefit mandates do not apply to self-insured benefit plans.

BACKGROUND

Clinical Laboratory Improvement Act

The federal Centers for Medicare and Medicaid Services regulate all laboratory testing (except research) performed on people in the United States under the Clinical Laboratory Improvement Act.

American Society for Histocompatibility and Immunogenetics

This society is a nonprofit association of clinical and research professionals, including immunologists, geneticists, transplant physicians and surgeons, and pathologists. It is a member of the United Network for Organ Sharing and works with numerous scientific and medical organizations, including the National Marrow Donor Program. It develops and maintains accreditation standards for laboratories.

COMMITTEE ACTION

Insurance and Real Estate Committee

Joint Favorable