SB 10, An Act Concerning Health Insurance And Patient Protection

TESTIMONY OF THE CONNECTICUT HOSPITAL ASSOCIATION
SUBMITTED TO THE INSURANCE AND REAL ESTATE COMMITTEE

Thursday, March 6, 2025

The Connecticut Hospital Association (CHA) appreciates this opportunity to submit testimony concerning SB 10, An Act Concerning Health Insurance And Patient Protection. CHA supports Sections 1-8 and Sections 18-19, requests expansion of the bill in some areas, and opposes Section 9 of the bill.

Connecticut hospitals and health systems care for patients, strengthen the state’s economy, and support vulnerable communities across the state. Every day, they work to improve healthcare access, affordability, and health equity. Even as they face ongoing challenges, hospitals provide world-class care to everyone who walks through their doors, regardless of their ability to pay. Hospitals also support an exemplary workforce as the largest collective employer in the state, contribute significantly to the state’s economy, and invest in their communities addressing social drivers of health.

CHA finds alignment in Sections 1-8 of SB 10. We support ensuring that mental health and substance use benefits are treated equally to all other benefits offered by health plans and these sections will strengthen existing mental health parity laws in Connecticut. We also support meaningful improvements to the prior authorization processes used by health insurers to delay and deny patient care. We are especially supportive of the legislation’s provisions to create a presumption that care called for by a provider is medically necessary. The burden should rightfully be on the insurer to demonstrate otherwise. Additionally, we support the bill’s recognition of the importance of clinical peer review in the adverse determination process rather than a sole reliance on artificial intelligence (AI) or an algorithm.

CHA also supports Sections 18-19 of the bill, which prohibit a health insurance carrier from imposing arbitrary time limits for general anesthesia and denying, reducing, or terminating reimbursement based on predetermined time limits. We believe this provision is critical, and we further emphasize the importance of not restricting critical care to patients.

CHA appreciates the legislative attention to prior authorization and urges the legislature to expand on a few aspects not mentioned in this bill.

For example, we urge the legislature to broaden its focus on transparency and timeliness in the prior authorization process. A recurring challenge to healthcare delivery is the lack of clarity providers can face when navigating insurer policy changes and difficulty reaching insurance company representatives or clinical peers for timely decisions. CHA recommends the inclusion of language that requires health carriers to make transparent a list of services that may require prior authorization or medically necessary review, outline a process by which providers can obtain information on both urgent and nonurgent requests, and establish more definitive timeframes for peer-to-peer scheduling and decision-making.

Furthermore, we advocate for the availability of real-time status updates for prior authorization requests, protections against retrospective denials for previously authorized services, and automatic authorization of services when the health carrier or utilization review entity fails to meet the appropriate deadlines for review. We believe these improvements would help streamline the process and enhance care delivery for patients.

CHA opposes Section 9 of the bill, which requires “site-neutral” payment policies that would have devasting consequences for patients in underserved communities and Connecticut hospitals. These policies would require providers and health insurers to use equal reimbursement rates for all contracting healthcare providers in the same geographic region and to reimburse providers for outpatient services using specific medical codes at the same rate, regardless of where the service is provided. We believe this section of the bill is unnecessary and will have unintended consequences on hospitals’ and health systems’ ability to provide life-saving, around-the-clock care to all patients, especially in underserved communities.

Given their unique role, while treating sicker and lower-income patients, hospitals are held to higher licensing, accreditation, and regulatory standards than independent physician offices and ambulatory surgical centers. Hospitals must be prepared and equipped to provide emergency care 24/7, serve as a safety net provider for vulnerable populations, respond to natural and man-made disasters, and more — and they must cover the costs of complying with these requirements through their direct patient care revenue. Provisions for site-neutral payments, such as the one outlined in Section 9 of this bill, disregard the economic headwinds that Connecticut hospitals are currently facing and fail to recognize the fundamental differences between hospital outpatient departments (HOPD) and other sites of care.

Now more than ever, hospitals need stable and adequate reimbursements for what is a highly challenging environment. Connecticut hospitals cannot withstand policies intended to erode the ability to care for patients and undermine the financial health of the sector.

Thank you for your consideration of our position. For additional information, contact CHA Government Relations at (203) 294-7301.