SENATOR CABRERA LEADS APPROVAL OF NEW INSURANCE COVERAGE MANDATES FOR CHEMOTHERAPY, INFERTILITY, PROSTHETIC LIMBS, AND MORE

HARTFORD – State Senator Jorge Cabrera (D-Hamden), who is Senate Chair of the Insurance and Real Estate Committee, today led final approval in the state Senate of a bill that requires insurance companies operating in Connecticut to cover the cost of a host of new medical treatments, from prosthetic devices designed exclusively for athletic purposes and scalp cooling systems used in connection with chemotherapy, to an expanded definition of “infertility” and certain pediatric autoimmune disorders associated with streptococcal infections.

House Bill 5374, “AN ACT CONCERNING HEALTH COVERAGE MANDATES FOR CERTAIN HEALTH CONDITIONS,” passed the Senate on a unanimous and bipartisan 36-0 vote and now heads to Governor Ned Lamont for his signature into law.

“The bill seeks to ensure that people requiring critical care can get it without incurring financial hardship,” Sen. Cabrera told the Senate chamber. “I learned a lot about the pain and suffering that many people in Connecticut are undergoing because of these conditions. A whole host of people came to the public hearing to advocate for this bill, a very large array of advocates and impacted people who had endured a variety of struggles. Their stories were heart-wrenching. This bill goes a long way to alleviate their pain and suffering.”

• Cover scalp cooling systems used in connection with chemotherapy. Under the bill, a “scalp cooling system” is any device designed and intended for repeated medical use to cool the human scalp to prevent or reduce hair loss due to chemotherapy. Hair loss is one of the most visible and emotionally distressing side effects of chemotherapy. FDA-approved scalp cooling systems have been shown to significantly reduce, or even prevent, hair loss for individuals undergoing chemotherapy. Despite their proven effectiveness, these treatments are often not covered by health insurance plans. Patients can pay between $1,500 and $3,000 out of pocket per round of chemotherapy, placing an additional financial burden on patients who are already dealing with the high costs of cancer treatments.
• Cover infertility diagnosis and treatment that, among other things, establishes various ways in which infertility can be determined. Under current law, “infertility” means being unable to conceive or produce conception, or sustain a successful pregnancy during a one-year period, or the treatment is medically necessary. The bill expands this definition by establishing various conditions upon which infertility diagnosis and treatment can be based, including a shorter time period (six months) under specific circumstances.
• Cover “athletic” prosthetic devices so individuals with limb loss and limb difference can participate in physical activities and remain healthy and fit. Under existing law, a “prosthetic device” is an artificial device to replace all or part of an arm or leg; current law expressly excludes a device that is designed exclusively for athletic purposes. This bill removes this exclusion and in so doing expands the mandate to include coverage for prosthetic devices designed exclusively for athletic purposes. If signed into law, Connecticut would join 12 other states — including New Hampshire and Maine — that have already passed similar laws since 2023.
• Cover treatments for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) and Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS). PANS and PANDAS are conditions that are characterized by a sudden and severe onset of obsessive-compulsive disorder or restrictive eating disorder in children before puberty. They are often associated with noticeable changes in mood, behavior, and sensory and motor function in children; moderate to severe cases may render children unable to leave their homes, result in psychiatric hospitalization, self-harm, or cause profound functional impairment. These medical conditions are treatable, and ensuring access to treatment can shorten flares and change the course of a child’s life. Treatment may include antibiotics, anti-inflammatories, symptom management, or – in moderate and severe cases – IV therapy.