The proposed Substitute Bill No. 10 seeks to strengthen health insurance regulations in Connecticut, particularly focusing on mental health and substance use disorder benefits, utilization review processes, and reimbursement practices. Effective October 1, 2025, health carriers will be required to file an annual certification with the Insurance Commissioner to confirm compliance with mental health parity laws, signed by their chief executive and medical officers. The bill establishes a "parity advancement account" to support enforcement and consumer education initiatives. It also repeals certain reporting requirements for the Insurance Commissioner while maintaining confidentiality for health carriers. Additionally, penalties for non-compliance are introduced, allowing civil penalties and late fees for those failing to meet certification requirements.

Further amendments include changes to the utilization review process, such as requiring health carriers to use documented clinical review criteria and establishing a rebuttable presumption of medical necessity for services ordered by healthcare professionals. The bill modifies step therapy protocols, reducing the maximum duration for such requirements and expanding conditions for bypassing them. It mandates equal reimbursement rates for outpatient benefits and requires that all group health insurance policies be approved by the commissioner before issuance. The bill also enhances transparency in rate filings, requiring detailed actuarial information and public hearings for rate approvals. Overall, these changes aim to improve access to necessary healthcare services, ensure fair insurance practices, and enhance consumer protection.

Statutes affected:
Committee Bill:
INS Joint Favorable Substitute:
File No. 419:
JUD Joint Favorable:
APP Joint Favorable: