Committee Bill No. 10 proposes significant reforms to health insurance regulations, particularly focusing on mental health and substance use disorder benefits. Effective October 1, 2025, health carriers will be required to file an annual certification with the Insurance Commissioner, confirming compliance with state and federal reporting requirements. This certification must be signed by the health carrier's chief executive officer and chief medical officer. The bill establishes a "parity advancement account" to support mental health parity enforcement and consumer education, while also introducing penalties for non-compliance, including civil penalties of up to $100 per participant and late fees for missed filings. Additionally, it repeals certain existing provisions, including the requirement for the Insurance Commissioner to submit reports identifying health carriers, thereby enhancing confidentiality.

The bill also introduces changes to the utilization review process, requiring that any review company demonstrate that a health care service is not medically necessary, and mandates alignment of clinical review criteria with established guidelines. It prohibits the use of artificial intelligence in adverse determinations and ensures that reviews are conducted impartially. Furthermore, the bill addresses prescription drug coverage by prohibiting exclusive mail order pharmacy requirements and limiting step therapy protocols. It establishes a more accessible override process for healthcare providers and mandates standardized reimbursement practices for outpatient benefits. Overall, Committee Bill No. 10 aims to enhance patient access to necessary medications, improve transparency in insurance practices, and ensure fair pricing and reimbursement in the health insurance market.

Statutes affected:
Committee Bill: