Treatment of Substance Abuse and Opioid Addiction

On June 30, 2017, Gov. Malloy signed HB 7052 into law, creating Public Act. No. 17-131. The new law requires plans that provide coverage to plan participants who are diagnosed with substance use disorders (which includes opioid addiction) to provide coverage for medically necessary and monitored detoxification services and for medically necessary and medically managed intensive inpatient detoxification services. The law defines “medically monitored detoxification services” and “medically managed intensive detoxification services” by the most recent edition of the American Society of Addiction Medicine (ASAM) Treatment Criteria for Addictive, Substance-Related and Co-Occurring Conditions. More information on ASAM can be found here.

In addition, plans may not establish terms, conditions or benefits that place a greater financial burden on plan participants for diagnosis or treatment of mental or nervous conditions than that which they provide for medical, surgical or other physical health conditions. Finally, plans must provide direct reimbursement for diagnosis and treatment of substance use disorders for covered services provided in Connecticut by out-of-network health care providers. Reimbursements must be allowed for multiple screenings as part of a single-day visit and to health care providers or multi-care institutions.

The new law contains no new employer obligations. But employers should acquaint themselves with the new rules for health plans and carriers. Generally speaking, employers should treat mental health conditions the same as physical health conditions. Not only does that help avoid potential discrimination problems, but also helps address the general countrywide trend of mental health awareness.

The new law is effective Jan. 1, 2018.

Public Act No. 17-131 »