Connecticut 2025 Regular Session

Connecticut House Bill HB07207 Compare Versions

Version 1 (Old)

Version 2 (New)

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3		-	LCO 1 of 5
	3	+	LCO No. 6057 1 of 5
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5		-	General Assembly ~~Substitute~~ Bill No. 7207
	5	+	General Assembly Raised Bill No. 7207
6	6		January Session, 2025
	7	+	LCO No. 6057
	8	+
	9	+
	10	+	Referred to Committee on GOVERNMENT ADMINISTRATION
	11	+	AND ELECTIONS
	12	+
	13	+
	14	+	Introduced by:
	15	+	(GAE)
	16	+
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10	20		AN ACT CONCERNING THE DISCLOSURE OF INSURER REPORTS
11		-	CONCERNING TREATMENT LIMITATIONS ON MENTAL HEALTH AND
12		-	SUBSTANCE USE DISORDER AND OTHER BENEFITS AS A PUBLIC
13		-	RECORD.
	21	+	CONCERNING MENTAL HEALTH PARITY AS A PUBLIC RECORD.
14	22		Be it enacted by the Senate and House of Representatives in General
15	23		Assembly convened:
16	24
17	25		Section 1. Section 38a-477ee of the general statutes is repealed and the 1
18	26		following is substituted in lieu thereof (Effective October 1, 2025): 2
19	27		(a) For the purposes of this section: 3
20	28		(1) "Health carrier" has the same meaning as provided in section 38a-4
21	29		1080; 5
22	30		(2) "Mental health and substance use disorder benefits" means all 6
23	31		benefits for the treatment of a mental health condition or a substance 7
24	32		use disorder that (A) falls under one or more of the diagnostic categories 8
25	33		listed in the chapter concerning mental disorders in the most recent 9
26	34		edition of the International Classification of Diseases, or (B) is a mental 10
27	35		disorder, as that term is defined in the most recent edition of the 11
28	36		American Psychiatric Association's "Diagnostic and Statistical Manual 12
29	37		of Mental Disorders"; and 13
	38	+	Raised Bill No. 7207
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	40	+
	41	+
	42	+	LCO No. 6057 2 of 5
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30	44		(3) "Nonquantitative treatment limitation" means a limitation that 14
31	45		cannot be expressed numerically but otherwise limits the scope or 15
32		-	duration of a covered benefit. 16 Substitute Bill No. 7207
33		-
34		-
35		-	LCO 2 of 5
36		-
	46	+	duration of a covered benefit. 16
37	47		(b) Not later than March 1, 2021, and annually thereafter, each health 17
38	48		carrier shall submit a report to the Insurance Commissioner, in a form 18
39	49		and manner prescribed by the commissioner, containing the following 19
40	50		information for the calendar year immediately preceding: 20
41	51		(1) A description of the processes that such health carrier used to 21
42	52		develop and select criteria to assess the medical necessity of (A) mental 22
43	53		health and substance use disorder benefits, and (B) medical and surgical 23
44	54		benefits; 24
45	55		(2) A description of all nonquantitative treatment limitations that 25
46	56		such health carrier applied to (A) mental health and substance use 26
47	57		disorder benefits, and (B) medical and surgical benefits; and 27
48	58		(3) The results of an analysis concerning the processes, strategies, 28
49	59		evidentiary standards and other factors that such health carrier used in 29
50	60		developing and applying the criteria described in subdivision (1) of this 30
51	61		subsection and each nonquantitative treatment limitation described in 31
52	62		subdivision (2) of this subsection, provided the commissioner shall not 32
53	63		disclose such results in a manner that is likely to compromise the 33
54	64		financial, competitive or proprietary nature of such results. The results 34
55	65		of such analysis shall, at a minimum: 35
56	66		(A) Disclose each factor that such health carrier considered, 36
57	67		regardless of whether such health carrier rejected such factor, in (i) 37
58	68		designing each nonquantitative treatment limitation described in 38
59	69		subdivision (2) of this subsection, and (ii) determining whether to apply 39
60	70		such nonquantitative treatment limitation; 40
61	71		(B) Disclose any and all evidentiary standards, which standards may 41
62	72		be qualitative or quantitative in nature, applied under a factor described 42
63	73		in subparagraph (A) of this subdivision, and, if no evidentiary standard 43
	74	+	Raised Bill No. 7207
	75	+
	76	+
	77	+
	78	+	LCO No. 6057 3 of 5
	79	+
64	80		is applied under such a factor, a clear description of such factor; 44
65	81		(C) Provide the comparative analyses, including the results of such 45
66	82		analyses, performed to determine that the processes and strategies used 46
67		-	to design each nonquantitative treatment limitation, as written, and the 47 Substitute Bill No. 7207
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69		-
70		-	LCO 3 of 5
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	83	+	to design each nonquantitative treatment limitation, as written, and the 47
72	84		processes and strategies used to apply such nonquantitative treatment 48
73	85		limitation, as written, to mental health and substance use disorder 49
74	86		benefits are comparable to, and applied no more stringently than, the 50
75	87		processes and strategies used to design each nonquantitative treatment 51
76	88		limitation, as written, and the processes and strategies used to apply 52
77	89		such nonquantitative treatment limitation, as written, to medical and 53
78	90		surgical benefits; 54
79	91		(D) Provide the comparative analyses, including the results of such 55
80	92		analyses, performed to determine that the processes and strategies used 56
81	93		to apply each nonquantitative treatment limitation, in operation, to 57
82	94		mental health and substance use disorder benefits are comparable to, 58
83	95		and applied no more stringently than, the processes and strategies used 59
84	96		to apply each nonquantitative treatment limitation, in operation, to 60
85	97		medical and surgical benefits; and 61
86	98		(E) Disclose information that, in the opinion of the Insurance 62
87	99		Commissioner, is sufficient to demonstrate that such health carrier, 63
88	100		consistent with the Paul Wellstone and Pete Domenici Mental Health 64
89	101		Parity and Addiction Equity Act of 2008, P.L. 110-343, as amended from 65
90	102		time to time, and regulations adopted thereunder, (i) applied each 66
91	103		nonquantitative treatment limitation described in subdivision (2) of this 67
92	104		subsection comparably, and not more stringently, to (I) mental health 68
93	105		and substance use disorder benefits, and (II) medical and surgical 69
94	106		benefits, and (ii) complied with (I) sections 38a-488c and 38a-514c, (II) 70
95	107		sections 38a-488a and 38a-514, (III) sections 38a-510 and 38a-544, and 71
96	108		(IV) the Paul Wellstone and Pete Domenici Mental Health Parity and 72
97	109		Addiction Equity Act of 2008, P.L. 110-343, as amended from time to 73
98	110		time, and regulations adopted thereunder. 74
	111	+	Raised Bill No. 7207
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	115	+	LCO No. 6057 4 of 5
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99	117		(c) (1) Not later than April 15, 2021, and annually thereafter, the 75
100	118		Insurance Commissioner shall submit each report that the 76
101	119		commissioner received pursuant to subsection (b) of this section for the 77
102	120		calendar year immediately preceding to: 78
103		-	(A) The joint standing committee of the General Assembly having 79 Substitute Bill No. 7207
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106		-	LCO 4 of 5
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	121	+	(A) The joint standing committee of the General Assembly having 79
108	122		cognizance of matters relating to insurance, in accordance with section 80
109	123		11-4a; and 81
110	124		(B) The Attorney General, Healthcare Advocate and Commissioner 82
111	125		of Health Strategy. 83
112	126		(2) [Notwithstanding subdivision (1) of this subsection, the 84
113	127		commissioner shall not submit the name or identity of any health carrier 85
114	128		or entity that has contracted with such health carrier, and such name or 86
115	129		identity shall be given confidential treatment and not be made public by 87
116	130		the commissioner] Such report shall be a public record for purposes of 88
117	131		the Freedom of Information Act, as defined in section 1-200. 89
118	132		(d) Not later than May 15, 2021, and annually thereafter, the joint 90
119	133		standing committee of the General Assembly having cognizance of 91
120	134		matters relating to insurance may hold a public hearing concerning the 92
121	135		reports that such committee received pursuant to subsection (c) of this 93
122	136		section for the calendar year immediately preceding. The Insurance 94
123	137		Commissioner, or the commissioner's designee, shall attend the public 95
124	138		hearing and inform the committee whether, in the commissioner's 96
125	139		opinion, each health carrier, for the calendar year immediately 97
126	140		preceding, (1) submitted a report pursuant to subsection (b) of this 98
127	141		section that satisfies the requirements established in said subsection, 99
128	142		and (2) complied with (A) sections 38a-488c and 38a-514c, (B) sections 100
129	143		38a-488a and 38a-514, (C) sections 38a-510 and 38a-544, and (D) the Paul 101
130	144		Wellstone and Pete Domenici Mental Health Parity and Addiction 102
131	145		Equity Act of 2008, P.L. 110-343, as amended from time to time, and 103
132	146		regulations adopted thereunder. 104
133	147		(e) Nothing in this section shall be construed to require any disclosure 105
	148	+	Raised Bill No. 7207
	149	+
	150	+
	151	+
	152	+	LCO No. 6057 5 of 5
	153	+
134	154		in violation of (1) 42 USC 290dd-2, as amended from time to time, (2) 42 106
135	155		USC 1320d et seq., as amended from time to time, (3) 42 CFR 2, as 107
136	156		amended from time to time, and (4) 45 CFR 160.101 to 164.534, inclusive, 108
137	157		as amended from time to time. 109
138	158		(f) The Insurance Commissioner may adopt regulations, in 110
139		-	accordance with chapter 54, to implement the provisions of this section. 111 Substitute Bill No. 7207
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141		-
142		-	LCO 5 of 5
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	159	+	accordance with chapter 54, to implement the provisions of this section. 111
144	160		This act shall take effect as follows and shall amend the following
145	161		sections:
146	162
147	163		Section 1 October 1, 2025 38a-477ee
148	164
149		-	Statement of Legislative Commissioners:
150		-	The title was changed.
	165	+	Statement of Purpose:
	166	+	To make reports submitted by insurers to the Insurance Department
	167	+	concerning how the insurers assess the medical necessity of mental
	168	+	health and other benefits a public record for purposes of the Freedom of
	169	+	Information Act.
151	170
152		-	GAE Joint Favorable Subst. -LCO
	171	+	[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except
	172	+	that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not
	173	+	underlined.]
153	174