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General Assembly Substitute Bill No. 6895
January Session, 2025
AN ACT CONCERNING HEALTH BENEFIT REVIEW AND REQUIRING
HEALTH INSURANCE COVERAGE FOR BIOMARKER TESTING.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. Section 38a-21 of the general statutes is repealed and the 1
following is substituted in lieu thereof (Effective January 1, 2026): 2
(a) As used in this section: 3
(1) "Commissioner" means the Insurance Commissioner. 4
(2) "Exchange" has the same meaning as provided in section 38a-1080. 5
(3) "Health carrier" has the same meaning as provided in section 38a-6
1080. 7
[(2)] (4) "Mandated health benefit" means [an existing] any statutory 8
obligation [of, or proposed legislation] that would require [,] an insurer, 9
health care center, hospital service corporation, medical service 10
corporation, fraternal benefit society or other entity that offers 11
individual or group health insurance or medical or health care benefits 12
plan in this state or a health carrier that offers a qualified health plan 13
through the exchange or the state employee plan to [: (A) Permit an 14
insured or enrollee to obtain health care treatment or services from a 15
particular type of health care provider; (B) offer or provide coverage for 16 Substitute Bill No. 6895
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the screening, diagnosis or treatment of a particular disease or 17
condition; or (C)] offer or provide coverage for a particular type of 18
health care treatment or service, or for medical equipment, medical 19
supplies or drugs used in connection with a health care treatment or 20
service. ["Mandated health benefit" includes any proposed legislation to 21
expand or repeal an existing statutory obligation relating to health 22
insurance coverage or medical benefits.] 23
(5) "Qualified health plan" has the same meaning as provided in 24
section 38a-1080. 25
(6) "State employee plan" has the same meaning as provided in 26
section 3-123rrr. 27
(b) (1) There is established within the Insurance Department a health 28
benefit review program for the review and evaluation of any mandated 29
health benefit that is [requested by the joint standing committee of] 30
passed by the General Assembly [having cognizance of matters relating 31
to insurance] on or after January 1, 2026. Such program shall be funded 32
by the Insurance Fund established under section 38a-52a. The 33
commissioner shall be authorized to make assessments in a manner 34
consistent with the provisions of chapter 698 for the costs of carrying 35
out the requirements of this section. Such assessments shall be in 36
addition to any other taxes, fees and moneys otherwise payable to the 37
state. The commissioner shall deposit all payments made under this 38
section with the State Treasurer. The moneys deposited shall be credited 39
to the Insurance Fund and shall be accounted for as expenses recovered 40
from insurance companies. Such moneys shall be expended by the 41
commissioner to carry out the provisions of this section and section 2 of 42
public act 09-179. 43
(2) The commissioner shall [contract with The University of 44
Connecticut Center for Public Health and Health Policy to conduct] 45
engage the services of any actuary, actuarial firm, quality improvement 46
clearinghouse, health policy research organization or any other 47
independent expert as the commissioner deems necessary to assist said 48 Substitute Bill No. 6895
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commissioner in the review and evaluation of any mandated health 49
benefit review [requested pursuant to subsection (c) of] required 50
pursuant to this section. [The director of said center may engage the 51
services of an actuary, quality improvement clearinghouse, health 52
policy research organization or any other independent expert, and may 53
engage or consult with any dean, faculty or other personnel said director 54
deems appropriate within The University of Connecticut schools and 55
colleges, including, but not limited to, The University of Connecticut (A) 56
School of Business, (B) School of Dental Medicine, (C) School of Law, 57
(D) School of Medicine, and (E) School of Pharmacy. 58
(c) Not later than August first of each year, the joint standing 59
committee of the General Assembly having cognizance of matters 60
relating to insurance shall submit to the commissioner a list of any 61
mandated health benefits for which said committee is requesting a 62
review. Not later than January first of the succeeding year, the 63
commissioner shall submit a report, in accordance with section 11-4a, of 64
the findings of such review and the information set forth in subsection 65
(d) of this section. 66
(d) The review report shall include at least the following, to the extent 67
information is available: 68
(1) The social impact of mandating the benefit, including:] 69
(c) Any mandated health benefit passed by the General Assembly on 70
or after January 1, 2026, shall be terminated for all individual and group 71
health insurance policies delivered, issued for delivery, renewed, 72
amended or continued in this state four years after the effective date of 73
such mandated health benefit, unless, prior to such termination and 74
after the joint standing committee of the General Assembly having 75
cognizance of matters relating to insurance receives a mandated health 76
benefit review report pursuant to the provisions of subsection (d) of this 77
section, the General Assembly approves such mandated health benefit 78
by a majority vote of both houses. 79
(d) Not later than three years after the effective date of any mandated 80 Substitute Bill No. 6895
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health benefit, the commissioner shall submit a mandated health benefit 81
review report, in accordance with the provisions of section 11-4a, to the 82
joint standing committee of the General Assembly having cognizance of 83
matters relating to insurance. Such report shall provide an assessment 84
of each mandated health benefit passed by the General Assembly on or 85
after January 1, 2026. Such report shall include an evaluation of the 86
quality and cost impacts of mandating each such health benefit, 87
including: 88
[(A)] (1) The extent to which the treatment, service or equipment, 89
supplies or drugs, as applicable, is utilized by a significant portion of 90
the population; 91
[(B)] (2) The extent to which the treatment, service or equipment, 92
supplies or drugs, as applicable, is currently available to the population, 93
including, but not limited to, coverage under Medicare, or through 94
public programs administered by charities, public schools, the 95
Department of Public Health, municipal health departments or health 96
districts or the Department of Social Services; 97
[(C)] (3) The extent to which insurance coverage is already available 98
for the treatment, service or equipment, supplies or drugs, as applicable; 99
[(D) If the coverage is not generally available, the extent to which 100
such lack of coverage results in persons being unable to obtain necessary 101
health care treatment; 102
(E) If the coverage is not generally available, the extent to which such 103
lack of coverage results in unreasonable financial hardships on those 104
persons needing treatment; 105
(F) The level of public demand and the level of demand from 106
providers for the treatment, service or equipment, supplies or drugs, as 107
applicable; 108
(G) The level of public demand and the level of demand from 109
providers for insurance coverage for the treatment, service or 110 Substitute Bill No. 6895
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equipment, supplies or drugs, as applicable; 111
(H) The likelihood of achieving the objectives of meeting a consumer 112
need as evidenced by the experience of other states; 113
(I) The relevant findings of state agencies or other appropriate public 114
organizations relating to the social impact of the mandated health 115
benefit; 116
(J) The alternatives to meeting the identified need, including, but not 117
limited to, other treatments, methods or procedures; 118
(K) Whether the benefit is a medical or a broader social need and 119
whether it is consistent with the role of health insurance and the concept 120
of managed care; 121
(L) The potential social implications of the coverage with respect to 122
the direct or specific creation of a comparable mandated benefit for 123
similar diseases, illnesses or conditions; 124
(M) The impact of the benefit on the availability of other benefits 125
currently offered; 126
(N) The impact of the benefit as it relates to employers shifting to self-127
insured plans and the extent to which the benefit is currently being 128
offered by employers with self-insured plans;] 129
[(O)] (4) The impact of making the mandated health benefit 130
applicable to the state employee [health insurance or health benefits] 131
plan; [and] 132
[(P)] (5) The extent to which credible scientific evidence published in 133
peer-reviewed medical literature generally recognized by the relevant 134
medical community determines the treatment, service or equipment, 135
supplies or drugs, as applicable, to be safe and effective; [and 136
(2) The financial impact of mandating the benefit, including:] 137
[(A)] (6) The extent to which the mandated health benefit may 138 Substitute Bill No. 6895
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increase or decrease the cost of the treatment, service or equipment, 139
supplies or drugs, as applicable, over the next five years; 140
[(B)] (7) The extent to which the mandated health benefit may 141
increase the appropriate or inappropriate use of the treatment, service 142
or equipment, supplies or drugs, as applicable, over the next five years; 143
[(C)] (8) The extent to which the mandated health benefit may serve 144
as an alternative for more expensive or less expensive treatment, service 145
or equipment, supplies or drugs, as applicable; 146
[(D)] (9) The methods that will be implemented to manage the 147
utilization and costs of the mandated health benefit; 148
[(E)] (10) The extent to which insurance coverage for the treatment, 149
service or equipment, supplies or drugs, as applicable, may be 150
reasonably expected to increase or decrease the insurance premiums 151
and administrative expenses for policyholders; 152
[(F)] (11) The extent to which the treatment, service or equipment, 153
supplies or drugs, as applicable, is more or less expensive than an 154
existing treatment, service or equipment, supplies or drugs, as 155
applicable, that is determined to be equally safe and effective by credible 156
scientific evidence published in peer-reviewed medical literature 157
generally recognized by the relevant medical community; 158
[(G)] (12) The impact of insurance coverage for the treatment, service 159
or equipment, supplies or drugs, as applicable, on the total cost of health 160
care, including potential benefits or savings to insurers and employers 161
resulting from prevention or early detection of disease or illness related 162
to such coverage; 163
[(H)] (13) The impact of the mandated health care benefit on the cost 164
of health care for small employers, as defined in section 38a-564, and for 165
employers other than small employers; [and] 166
[(I)] (14) The impact of the mandated health benefit on cost-shifting 167
between private and public payors of health care coverage and on the 168 Substitute Bill No. 6895
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overall cost of the health care delivery system in the state; and 169
(15) The impact of the mandated health benefit on the cost of qualified 170
health plans offered through the exchange. 171
(e) The joint standing committee of the General Assembly having 172
cognizance of matters relating to insurance may conduct an 173
informational public hearing following such committee's receipt of the 174
mandated health benefit review report provided pursuant to the 175
provisions of subsection (d) of this section. The commissioner and the 176
Commissioner of Health Strategy shall attend any such public hearing 177
and be available for questions from the members of such committee at 178
such public hearing. 179
Sec. 2. Section 2-24 of the general statutes is repealed and the 180
following is substituted in lieu thereof (Effective January 1, 2026): 181
The words "State of Connecticut" shall be printed at the head of each 182
bill and document printed by order of the General Assembly, or either 183
house thereof, and on its title page or cover, if any. Before printed, 184
electronic or photographic copies of an original bill are made, the bill 185
shall be endorsed with (1) the date of its introduction; (2) its number; (3) 186
the name of the member or committee introducing it; and (4) the name 187
of the committee to which it was referred. Copies of bills or resolutions 188
printed or produced electronically after favorable report by a committee 189
or reprinted or produced electronically after amendment on the third 190
reading, i.e., files, shall bear the file number of such bill or resolution, 191
placed conspicuously at the head of the same, which file number shall 192
be assigned by the Legislative Commissioners' Office in the order 193
printed or produced, the number and title of the bill, the name of the 194
committee to which it was referred, the date and nature of the 195
committee's report, in any case where the bill, if passed, would (A) 196
require the expenditure of state or municipal funds, [or] (B) affect state 197
or municipal revenue, or (C) impact the premiums paid by enrollees of 198
health benefit plans offered through the exchange, as provided in 199
section 38a-1080, a fiscal note, including an estimate of the cost or of the 200 Substitute Bill No. 6895
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revenue impact shall be appended thereto, [and,] in any case where the 201
bill, if passed, would have a financial impact on electric ratepayers, a 202
ratepayer impact statement, as described in subsection (b) of section 2-203
24a, as amended by this act, and, in any case where the bill, if passed, 204
would have a financial impact on the premiums paid by enrollees of 205
health benefit plans offered through the exchange, an enrollee impact 206
statement, as described in subsection (b) of section 2-24a, as amended 207
by this act. When a bill or resolution is accompanied with a report of a 208
committee, other than a recommendation that it ought or ought not to 209
pass, it shall then have an additional endorsement, as follows: 210
"Accompanied by special report, No.-". Bills shall be designated in the 211
calendar of each house by their file numbers, as well as by the titles and 212
numbers of the bills. 213
Sec. 3. Section 2-24a of the general statutes is repealed and the 214
following is substituted in lieu thereof (Effective January 1, 2026): 215
(a) No bill without a fiscal note appended thereto which, if passed, 216
would require the expenditure of state or municipal funds or affect state 217
or municipal revenue in the current fiscal year or any of the next ensuing 218
five fiscal years shall be acted upon by either house of the General 219
Assembly unless said requirement of a fiscal note is dispensed with by 220
a vote of at least two-thirds of such house. Such fiscal note shall clearly 221
identify the cost and revenue impact to the state and municipalities in 222
the current fiscal year and in each of the next ensuing five fiscal years. 223
(b) Beginning with the session of the General Assembly commencing 224
on January 9, 2019, no bill without a ratepayer impact statement 225
appended thereto which, if passed, would have a financial impact on 226
electric ratepayers, shall be acted upon by either house of the General 227
Assembly unless said requirement of a ratepayer impact statement is 228
dispensed with by a vote of at least two-thirds of such house. Such 229
statement shall (1) be prepared by the Office of Fiscal Analysis; and (2) 230
provide an assessment as to whether such bill will have a significant 231
direct financial impact on the cost of electricity to the majority of 232
Connecticut electric ratepayers. 233 Substitute Bill No. 6895
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(c) Beginning with the session of the General Assembly commencing 234
on February 4, 2026, no bill without an enrollee impact statement 235
appended thereto which, if passed, would have a financial impact on 236
the premiums paid by enrollees of health benefit plans offered through 237
the exchange, shall be acted upon by either house of the General 238
Assembly, unless said requirement of an enrollee impact statement is 239
dispensed with by a vote of at least two-thirds of such house. Such 240
statement shall (1) be prepared by the Office of Fiscal Analysis, and (2) 241
provide an assessment as to whether such bill will have a significant 242
direct financial impact on the cost of premiums paid by enrollees of 243
health benefit plans offered through the exchange. For the purposes of 244
this section, "health benefit plan" has the same meaning as provided in 245
section 38a-591a. 246
Sec. 4. (NEW) (Effective January 1, 2026) (a) As used in this section: 247
(1) "Biomarker" means a characteristic, including, but not limited to, 248
a gene mutation or protein expression that can be objectively measured 249
and evaluated as an indicator of normal biological processes, pathogenic 250
processes or pharmacologic responses to a specific therapeutic 251
intervention for a disease or condition. 252
(2) "Biomarker testing" means the analysis of a patient's tissue, blood 253
or other biospecimen for the presence of a biomarker, including, but not 254
limited to, tests for a single substance, tests for multiple substances and 255
diseases or conditions. "Biomarker testing" does not include an 256
evaluation of how a patient feels, functions or survives. 257
(3) "Clinical utility" means the test result provides information that is 258
used in the formulation of a treatment or monitoring strategy that 259
informs a patient's outcome and impacts the clinical decision. 260
(4) "Nationally recognized clinical practice guidelines" means 261
evidence-based clinical practice guidelines informed by a systematic 262
review of evidence and an assessment of the benefits and risks of 263
alternative care options intended to optimize patient care developed by 264
independent organizations or medical professional societies utilizing 265 Substitute Bill No. 6895
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transparent methodologies and reporting structures and conflict-of-266
interest policies. 267
(b) Each individual health insurance policy providing coverage of the 268
type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 269
of the general statutes delivered, issued for delivery, renewed, amended 270
or continued in this state on or after January 1, 2026, shall provide 271
coverage for biomarker testing for the purpose of diagnosis, treatment, 272
appropriate management or ongoing monitoring of an insured's disease 273
or condition, provided such biomarker testing provides clinical utility 274
as demonstrated by medical and scientific evidence, including, but not 275
limited to, one or more of the following: (1) Approval or clearance of 276
such test by the federal Food and Drug Administration or 277
recommendations on labels of drugs approved by the federal Food and 278
Drug Administration to conduct such test, (2) national coverage 279
determinations or local coverage determinations for Medicare 280
Administrative Contractors by the Centers for Medicare and Medicaid 281
Services, or (3) nationally recognized clinical practice guidelines. Such 282
policy shall provide such coverage in a manner that limits disruptions 283
in care, including, but not limited to, the need for multiple biopsies or 284
biospecimen samples. Such policy shall require that biomarker testing 285
be performed at an in-network clinical laboratory facility certified under 286
the Clinical Laboratory Improvement Act of 1967, 42 USC Section 263a, 287
as amended from time to time, or any such in-network clinical 288
laboratory facility that has been granted a Clinical Laboratory 289
Amendments of 1988 waiver by the federal Food and Drug 290
Administration to perform such biomarker testing. 291
(c) Each entity providing such coverage shall establish a clear, readily 292
accessible and convenient process through which an insured or an 293
insured's health care provider may (1) request an exception to a 294
coverage policy, or (2) dispute an adverse utilization review 295
determination relating to such coverage. Each such entity shall post 296
such process on the Internet web site maintained by such entity. 297
(d) If prior authorization is required before providing such coverage, 298 Substitute Bill No. 6895
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each entity providing such coverage or each utilization review entity or 299
other third party acting on behalf of such entity shall approve or deny 300
such prior authorization and notify the insured, the insured's health care 301
provider and any other entity requesting such prior authorization of 302
such approval or denial (1) if the prior authorization is not urgent, as 303
determined by the insured's health care provider, not later than seven 304
days after receiving a prior authorization request, or (2) if the prior 305
authorization is urgent, as determined by the insured's health care 306
provider, not later than seventy-two hours after receiving a prior 307
authorization request. 308
Sec. 5. (NEW) (Effective January 1, 2026) (a) As used in this section: 309
(1) "Biomarker" means a characteristic, including, but not limited to, 310
a gene mutation or protein expression that can be objectively measured 311
and evaluated as an indicator of normal biological processes, pathogenic 312
processes or pharmacologic responses to a specific therapeutic 313
intervention for a disease or condition. 314
(2) "Biomarker testing" means the analysis of a patient's tissue, blood 315
or other biospecimen for the presence of a biomarker, including, but not 316
limited to, tests for a single substance, tests for multiple substances and 317
diseases or conditions. "Biomarker testing" does not include an 318
evaluation of how a patient feels, functions or survives. 319
(3) "Clinical utility" means the test result provides information that is 320
used in the formulation of a treatment or monitoring strategy that 321
informs a patient's outcome and impacts the clinical decision. 322
(4) "Nationally recognized clinical practice guidelines" means 323
evidence-based clinical practice guidelines informed by a systematic 324
review of evidence and an assessment of the benefits and risks of 325
alternative care options intended to optimize patient care developed by 326
independent organizations or medical professional societies utilizing 327
transparent methodologies and reporting structures and conflict-of-328
interest policies. 329 Substitute Bill No. 6895
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(b) Each group health insurance policy providing coverage of the 330
type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 331
of the general statutes delivered, issued for delivery, renewed, amended 332
or continued in this state on or after January 1, 2026, shall provide 333
coverage for biomarker testing for the purpose of diagnosis, treatment, 334
appropriate management or ongoing monitoring of an insured's disease 335
or condition, provided such biomarker testing provides clinical utility 336
as demonstrated by medical and scientific evidence, including, but not 337
limited to, one or more of the following: (1) Approval or clearance of 338
such test by the federal Food and Drug Administration or 339
recommendations on labels of drugs approved by the federal Food and 340
Drug Administration to conduct such test, (2) national coverage 341
determinations or local coverage determinations for Medicare 342
Administrative Contractors by the Centers for Medicare and Medicaid 343
Services, or (3) nationally recognized clinical practice guidelines. Such 344
policy shall provide such coverage in a manner that limits disruptions 345
in care, including, but not limited to, the need for multiple biopsies or 346
biospecimen samples. Such policy shall require that biomarker testing 347
be performed at an in-network clinical laboratory facility certified under 348
the Clinical Laboratory Improvement Act of 1967, 42 USC Section 263a, 349
as amended from time to time, or any such in-network clinical 350
laboratory facility that has been granted a Clinical Laboratory 351
Amendments of 1988 waiver by the federal Food and Drug 352
Administration to perform such biomarker testing. 353
(c) Each entity providing such coverage shall establish a clear, readily 354
accessible and convenient process through which an insured or an 355
insured's health care provider may (1) request an exception to a 356
coverage policy, or (2) dispute an adverse utilization review 357
determination relating to such coverage. Each such entity shall post 358
such process on the Internet web site maintained by such entity. 359
(d) If prior authorization is required before providing such coverage, 360
each entity providing such coverage or each utilization review entity or 361
other third party acting on behalf of such entity shall approve or deny 362
such prior authorization and notify the insured, the insured's health care 363 Substitute Bill No. 6895
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provider and any other entity requesting such prior authorization of 364
such approval or denial (1) if the prior authorization is not urgent, as 365
determined by the insured's health care provider, not later than seven 366
days after receiving a prior authorization request, or (2) if the prior 367
authorization is urgent, as determined by the insured's health care 368
provider, not later than seventy-two hours after receiving a prior 369
authorization request. 370
This act shall take effect as follows and shall amend the following
sections:
Section 1 January 1, 2026 38a-21
Sec. 2 January 1, 2026 2-24
Sec. 3 January 1, 2026 2-24a
Sec. 4 January 1, 2026 New section
Sec. 5 January 1, 2026 New section
INS Joint Favorable Subst.