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General Assembly Substitute Bill No. 7115
January Session, 2025
AN ACT CONCERNING REVISIONS TO THE HEALTH CARE COST
GROWTH BENCHMARK PROGRAM.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. Section 19a-754h of the general statutes is repealed and the 1
following is substituted in lieu thereof (Effective October 1, 2025): 2
(a) (1) Not later than August 15, 2022, and annually thereafter, each 3
payer shall report to the commissioner, in a form and manner prescribed 4
by the commissioner, for the preceding or prior years, if the 5
commissioner so requests based on material changes to data previously 6
submitted, aggregated data, including aggregated self-funded data as 7
applicable, necessary for the commissioner to calculate total health care 8
expenditures, primary care spending as a percentage of total medical 9
expenses and net cost of private health insurance. Each payer shall also 10
disclose, as requested by the commissioner, payer data required for 11
adjusting total medical expense calculations to reflect changes in the 12
patient population. 13
(2) Except as provided in subdivision (3) of this subsection, each 14
payer required to report data pursuant to the provisions of subdivision 15
(1) of this subsection shall provide to each employer of a self-funded 16
employee health plan a form, in a form and manner prescribed by the 17
commissioner and made available on the Office of Health Strategy's 18 Substitute Bill No. 7115
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Internet web site, that such employer may complete to opt in to the 19
submission of such employer's self-funded employee health plan data 20
to such payer. 21
(3) Notwithstanding the provisions of subdivision (2) of this 22
subsection, any payer may provide to each employer of a self-funded 23
employee health plan a form developed by the insurer for multistate 24
use, provided the commissioner determines that such form is 25
substantially similar to the form prescribed by the commissioner 26
pursuant to the provisions of subdivision (2) of this subsection. 27
(4) Each form provided by such payer to any such employer of a self-28
funded employee health plan pursuant to the provisions of subdivision 29
(2) or (3) of this subsection shall be provided not later than fifteen days 30
after claim administration services are retained and after such payer 31
determines that such employer satisfies the requirements of this section. 32
(5) (A) Except as provided in subdivision (4) of this subsection, each 33
form completed by an employer of a self-funded employee health plan 34
pursuant to the provisions of this subsection shall be effective for the 35
current data reporting period and shall remain effective for all future 36
data reporting periods pursuant to the requirements of this section. 37
(B) No such employer of a self-funded employee health plan may 38
complete such form to opt in for a partial data reporting period. 39
(C) Any such employer of a self-funded employee health plan who 40
completes such form to opt in for a data reporting period may opt out 41
of all subsequent data reporting periods by providing written notice to 42
such payer not less than thirty days before the start of the next data 43
reporting period. 44
(6) For any self-funded employee health plan whose employer 45
completes a form to opt in for the submission of such employer's self-46
funded health plan data to such payer, such payer shall include such 47
self-funded health plan data as part of such payer's data submission 48
required pursuant to the provisions of this section. 49 Substitute Bill No. 7115
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(7) Not later than January 31, 2026, and annually thereafter, each 50
payer shall report to the commissioner, in a form and manner prescribed 51
by the commissioner, for the preceding year: 52
(A) A list of self-funded employee health plans whose employer 53
opted in for the submission of such employer's self-funded employee 54
health plan data in accordance with the provisions of this subsection; 55
(B) A list of employers who previously opted in for the submission of 56
such employer's self-funded employee health plan data who 57
subsequently elected to opt out of all subsequent data reporting periods 58
in accordance with the provisions of subparagraph (C) of subdivision 59
(5) of this subsection; 60
(C) A certification signed by an officer of such payer certifying that 61
such payer has taken reasonable efforts to provide the form required 62
pursuant to subdivision (2) or (3) of this subsection to each employer of 63
a self-funded employee health plan to complete to opt in to the 64
submission of such employer's self-funded health plan data; and 65
(D) A list identifying each employer, by name and mailing address, 66
to which such payer provided such form. 67
(8) Such opt-in form required pursuant to the provisions of this 68
subsection shall only be provided to employers of self-funded employee 69
health plans and shall not affect mandatory reporting requirements 70
otherwise required pursuant to this section. 71
(9) Except for the actual cost incurred to each payer for the 72
submission of an employer's self-funded data to the commissioner 73
pursuant to the provisions of this section, no payer shall impose any cost 74
or fee on any such employer whose self-funded data is included in such 75
payer's reporting of aggregate data submitted to the commissioner. 76
(b) Not later than March 31, 2023, and annually thereafter, the 77
commissioner shall prepare and post on the office's Internet web site, a 78
report concerning the total health care expenditures utilizing the total 79 Substitute Bill No. 7115
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aggregate medical expenses reported by payers pursuant to subsection 80
(a) of this section, including, but not limited to, a breakdown of such 81
population-adjusted total medical expenses by payer and provider 82
entities. The report may include, but shall not be limited to, information 83
regarding the following: 84
(1) Trends in major service category spending; 85
(2) Primary care spending as a percentage of total medical expenses; 86
(3) The net cost of private health insurance by payer by market 87
segment, including individual, small group, large group, self-insured, 88
student and Medicare Advantage markets; and 89
(4) Any other factors the commissioner deems relevant to providing 90
context on such data, which shall include, but not be limited to, the 91
following factors: (A) The impact of the rate of inflation and rate of 92
medical inflation; (B) impacts, if any, on access to care; and (C) responses 93
to public health crises or similar emergencies. 94
(c) The commissioner shall annually submit a request to the federal 95
Centers for Medicare and Medicaid Services for the unadjusted total 96
medical expenses of Connecticut residents. 97
(d) Not later than August 15, 2023, and annually thereafter, each 98
payer or provider entity shall report to the commissioner in a form and 99
manner prescribed by the commissioner, for the preceding year, and for 100
prior years if the commissioner so requests based on material changes 101
to data previously submitted, on the health care quality benchmarks 102
adopted pursuant to section 19a-754g. 103
(e) Not later than March 31, 2024, and annually thereafter, the 104
commissioner shall prepare and post on the office's Internet web site, a 105
report concerning health care quality benchmarks reported by payers 106
and provider entities pursuant to subsection (d) of this section. 107
(f) The commissioner may enter into such contractual agreements as 108
may be necessary to carry out the purposes of this section, including, 109 Substitute Bill No. 7115
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but not limited to, contractual agreements with actuarial, economic and 110
other experts and consultants. 111
(g) The commissioner may impose a penalty of not more than ten 112
dollars per covered individual enrolled in a self-funded employee 113
health plan on any payer that fails to provide any employer of a self-114
funded employee health plan the opt-in form required pursuant to the 115
provisions of subdivision (2) or (3) of subsection (a) of this section. 116
Sec. 2. Subsection (a) of section 19a-754j of the general statutes is 117
repealed and the following is substituted in lieu thereof (Effective October 118
1, 2025): 119
(a) (1) Not later than June 30, 2023, and annually thereafter, the 120
commissioner shall hold an informational public hearing to compare the 121
growth in total health care expenditures in the performance year to the 122
health care cost growth benchmark established pursuant to section 19a-123
754g for such year. Such hearing shall involve an examination of: 124
(A) The report most recently prepared by the commissioner pursuant 125
to subsection (b) of section 19a-754h; 126
(B) The expenditures of provider entities and payers, including, but 127
not limited to, health care cost trends, primary care spending as a 128
percentage of total medical expenses and the factors contributing to 129
such costs and expenditures; and 130
(C) Any other matters that the commissioner, in the commissioner's 131
discretion, deems relevant for the purposes of this section. 132
(2) The commissioner may require any payer or provider entity that, 133
for the performance year, is found to be a significant contributor to 134
health care cost growth in the state or has failed to meet the primary care 135
spending target, to participate in such hearing in a form and manner 136
specified by the commissioner. Each such payer or provider entity that 137
is required to participate in such hearing shall provide testimony on 138
issues identified by the commissioner and provide additional 139 Substitute Bill No. 7115
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information on actions taken to reduce such payer's or entity's 140
contribution to future state-wide health care costs and expenditures or 141
to increase such payer's or provider entity's primary care spending as a 142
percentage of total medical expenses. 143
(3) The commissioner may require that any other entity that is found 144
to be a significant contributor to health care cost growth in this state 145
during the performance year participate in such hearing in a form and 146
manner specified by the commissioner. Any other entity that is required 147
to participate in such hearing shall provide written and oral testimony, 148
as requested by the commissioner, on issues identified by the 149
commissioner and provide additional information on actions taken to 150
reduce such other entity's contribution to future state-wide health care 151
costs. If such other entity is a drug manufacturer, and the commissioner 152
requires that such drug manufacturer participate in such hearing with 153
respect to a specific drug or class of drugs, such hearing may, to the 154
extent possible, include representatives from at least one brand-name 155
manufacturer, one generic manufacturer and one innovator company 156
that is less than ten years old. 157
(4) Not later than October 15, 2023, and annually thereafter, the 158
commissioner shall prepare and submit a report, in accordance with 159
section 11-4a, to the joint standing committees of the General Assembly 160
having cognizance of matters relating to insurance and public health. 161
Such report shall be based on the commissioner's analysis of the 162
information submitted during the most recent informational public 163
hearing conducted pursuant to this subsection and any other 164
information that the commissioner, in the commissioner's discretion, 165
deems relevant for the purposes of this section, and shall: 166
(A) Describe health care spending trends in this state, including, but 167
not limited to, trends in primary care spending as a percentage of total 168
medical expense, and the factors underlying such trends; 169
(B) Include the findings from the report prepared pursuant to 170
subsection (b) of section 19a-754h; 171 Substitute Bill No. 7115
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(C) Describe a plan for monitoring any unintended adverse 172
consequences resulting from the adoption of cost growth benchmarks 173
and primary care spending targets and the results of any findings from 174
the implementation of such plan; and 175
(D) Disclose the commissioner's recommendations, if any, concerning 176
strategies to increase the efficiency of the state's health care system, 177
including, but not limited to, any recommended legislation concerning 178
the state's health care system. 179
This act shall take effect as follows and shall amend the following
sections:
Section 1 October 1, 2025 19a-754h
Sec. 2 October 1, 2025 19a-754j(a)
INS Joint Favorable Subst.