Overview
Connecticut is a state to watch on healthcare cost, transparency, and competition. Connecticut’s legislature passed a statute in 2012 establishing an All-Payer Claims Database Program in the state. Connecticut’s APCD, Healthscore CT, contains information about the quality, price and cost of health services in the state to allow healthcare consumers to compare cost and quality information among different coverage options. Healthcare consumers in Connecticut have statutory protection from surprise and balance medical bills for both emergency and non-emergency services. In 2019, the Connecticut legislature passed a shared savings pilot incentive program for nonprofit providers that allows providers who otherwise meet contractual requirements to retain a percentage of any savings realized from the contracted cost for services. The program then requires providers to use at least 50% of such savings to expand the provider’s services.
In other price transparency efforts, Connecticut law limits gag clauses in healthcare contracts to promote competition and price transparency. Contracts entered between a healthcare provider and a health carrier are prohibited from containing a provision restricting disclosure of billed or allowed amounts, or reimbursement rates or out-of-pocket costs. Contracts between a managed care organization and a participating provider are also prohibited from containing gag clauses that prevent the provider from discussing with enrollees any treatment options and services available in and out-of-network.
On the prescription drug price transparency front, the Connecticut legislature passed legislation that requires pharmaceutical companies to disclose and explain prescription drug price hikes. Drug makers must justify any pharmaceutical price that jumps 20 percent or more during a calendar year, insurers must report large drug cost increases when filing rate requests, and PBMs must report how much they collect in rebates and how much they keep.
Besides price transparency, Connecticut has a combination of strong statutory mandate and strong enforcement in healthcare market competition. The Connecticut Antitrust Act contains provisions under which (often in addition to federal statutes) the state or private persons may bring claims. State law also restricts most favored nation clauses in provider contracts and limits covenants not to compete in physician contracts. In provider market regulation, Connecticut has one of the nation’s most robust merger review statutes, granting the state strong review and approval authority over all hospital transactions. Prior notice must be provided to the state’s certificate of need agency for any provider and provider organization transaction, while notice to the state attorney general is required for any group practice and hospital transaction. In addition to pre-merger notice, the state requires review and approval of all hospital transactions based on factors that take into consideration competition and antitrust implications. As a result, Connecticut’s attorney general has been active in promoting greater enforcement and review of provider consolidation. Notably, many of the cases were independently brought by the state AG without enforcement action from federal agencies. For example, the AG challenged and imposed conditions on a pair of acquisitions by Prospect Medical Holdings. The proposed merger of Waterbury Hospital and Vanguard (Tenet) was also abandoned after state entities including the AG imposed a total of 68 conditions on the for-profit joint venture.
In the insurance market, Connecticut runs a state-based exchange called Access Health CT. Connecticut statute provides coverage parity for telehealth services, requiring that individual and group health insurance policies provide coverage for medical advice, diagnosis, care or treatment through telehealth to the same extent that coverage is provided in-person. The Connecticut legislature has also attempted to introduce single payer and public option initiatives as broader health system reform efforts.
For 2024, Connecticut considered legislation on healthcare affordability, noncompete agreements, private equity investment in healthcare, downcoding, and certificate of need, but none of these bills passed into law.
See below for an overview of Connecticut state mandates. Click on citation tab for detailed information of specific statutes (click link to download statute text).
State Action
Latest Legislative Session: 1/4/2023 - 6/7/2023 (2023 term). *Current session bill updates are ongoing. Check back weekly for updates.
B 7278 – Connecticut
Introduced: 2019 Status: Inactive / Dead
AN ACT CONCERNING MOBILE INTEGRATED HEALTH CARE. Includes modified statutory defintion of “telehealth provider”
Conn. Gen. Stat. § 38a-477i – Connecticut
Introduced: 2024 Status: Enacted
§ 38a-477i. Contract provisions containing all-or-nothing clauses, anti-steering clauses, anti-tiering clauses or gag clauses prohibited.
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HB 5001 – Connecticut
Introduced: 2022 Status: Enacted
Broadly expands health insurance and emergency access to DCF-licensed urgent crisis centers services, including by prohibiting balance billing, higher out-of-network billing, and prior authorization. The bill makes it a Connecticut Unfair Trade Practices Act (CUTPA) […]
HB 5039 – Connecticut
Introduced: 2018 Status: Inactive / Dead
PROTECTING HEALTH CARE FAIRNESS AND AFFORDABILITY: Each individual health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general statutes delivered, issued for […]
HB 5045 – Connecticut
Introduced: 2021 Status: Inactive / Dead
To ensure adequate access to medical specialists in southeastern Connecticut.
Conn. Gen. Stat. § 19a-486a. Sale of nonprofit hospitals: Certificate of need determination letter. Hearing. Application for approval: Health Care Institutions – Connecticut
Introduced: Status: Enacted
Requires Certificate of Need determination for sale of non-profit hospitals.
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Conn. Gen. Stat. § 17b-238. State payments to hospitals: Medical Assistance – Connecticut
Introduced: Status: Enacted
States that the commissioner of social services establish annually the cost of services for which payment is to be made, requiring hospitals receiving state aid to submit cost data under oath by forms approved by […]
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Conn. Gen. Stat. § 17b-239. Payments to hospitals, emergency department physicians. Regulations: Medical Assistance – Connecticut
Introduced: Status: Enacted
States that Medicaid rates paid to acute care hospitals, including children’s hospitals, shall be based on diagnosis-related groups established and periodically rebased by the Commissioner of Social Services. Within available appropriations, the commissioner shall annually […]
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Conn. Gen. Stat. § 17b-239a. Payments to short-term general hospitals located in certain distressed municipalities and targeted investment communities with enterprise zones: Medical Assistance – Connecticut
Introduced: Status: Enacted
The Department of Social Services may, within available funds, make payments to all short-term general hospitals located in distressed municipalities. The payment amount for each hospital shall be determined by the Commissioner of Social Services […]
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Conn. Gen. Stat. § 17b-239b. Chronic disease hospitals. Prior authorization procedures. Regulations: Medical Assistance – Connecticut
Introduced: Status: Enacted
States that the Commissioner of Social Services shall establish prior authorization procedures under the Medicaid program for admissions and lengths of stay in chronic disease hospitals.
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In Re: Generic Pharmaceuticals Pricing Antitrust Litigation – Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin
District Court: Eastern District of Pennsylvania Status: Pending
Plaintiffs are attorney generals from 48 states, Puerto Rico, and the District of Columbia, as well as classes of private plaintiffs that filed an antitrust […]
Negron v. Cigna and OptumRx – Connecticut
District Court: District of Connecticut Status: Pending
Cigna faces a class-action lawsuit alleging the insurance giant overcharged its members by more than 10 times the amount the insurer paid for certain prescription […]
Additional Resources
STATE BUDGET
The state operates on a biennial budget cycle, with the fiscal year beginning July 1. State agencies submit their budget requests to the governor in September, and the Governor submits the proposed budget to the state legislature in February. The legislature adopts a budget in May or June. A simple majority is required to pass a budget. The Governor is required to submit a balanced budget and the legislature must adopt a balanced budget.
STATE LEGISLATURE
The 36 members of the Senate serve two-year terms, and the 151 members of the House of Representatives also have two-year terms. During even-numbered years, the General Assembly is in session from February to May. In odd-numbered years, the session lasts from January to June. Bills do not carry over from year to year.