§ 19a-754g — Development, publication and modification of health care cost growth benchmarks, primary care spending targets and health care quality benchmarks.

(a) Not later than July 1, 2022, the commissioner shall publish (1) the health care cost growth benchmarks and annual primary care spending targets as a percentage of total medical expenses for the calendar years 2021 to 2025, inclusive, and (2) the annual health care quality benchmarks for the calendar years 2022 to 2025, inclusive, on the office's Internet web site. (b) (1) (A) Not later than July 1, 2025, and every five years thereafter, the commissioner shall develop and adopt annual health care cost growth benchmarks and annual primary care spending targets for the succeeding five calendar years for provider entities and payers. (B) In developing the health care cost growth benchmarks and primary care spending targets pursuant to this subdivision, the commissioner shall consider (i) any historical and forecasted changes in median income for individuals in the state and the growth rate of potential gross state product, (ii) the rate of inflation, and (iii) the most recent report prepared by the commissioner pursuant to subsection (b) of section 19a-754h . (C) (i) The commissioner shall hold at least one informational public hearing prior to adopting the health care cost growth benchmarks and primary care spending targets for each succeeding five-year period described in this subdivision. The commissioner may hold informational public hearings concerning any annual health care cost growth benchmark and primary care spending target set pursuant to subsection (a) or subdivision (1) of subsection (b) of this section. Such informational public hearings shall be held at a time and place designated by the commissioner in a notice prominently posted by the commissioner on the office's Internet web site and in a form and manner prescribed by the commissioner. The commissioner shall make available on the office's Internet web site a summary of any such informational public hearing and include the commissioner's recommendations, if any, to modify or not to modify any such annual benchmark or target. (ii) If the commissioner determines, after any informational public hearing held pursuant to this subparagraph, that a modification to any health care cost growth benchmark or annual primary care spending target is, in the commissioner's discretion, reasonably warranted, the commissioner may modify such benchmark or target. (iii) The commissioner shall annually (I) review the current and projected rate of inflation, and (II) include on the office's Internet web site the commissioner's findings of such review, including the reasons for making or not making a modification to any applicable health care cost growth benchmark. If the commissioner determines that the rate of inflation requires modification of any health care cost growth benchmark adopted under this section, the commissioner may modify such benchmark. In such event, the commissioner shall not be required to hold an informational public hearing concerning such modified health care cost growth benchmark. (D) The commissioner shall post each adopted health care cost growth benchmark and annual primary care spending target on the office's Internet web site. (E) Notwithstanding the provisions of subparagraphs (A) to (D), inclusive, of this subdivision, if the average annual health care cost growth benchmark for a succeeding five-year period described in this subdivision differs from the average annual health care cost growth benchmark for the five-year period preceding such succeeding five-year period by more than one-half of one per cent, the commissioner shall submit the annual health care cost growth benchmarks developed for such succeeding five-year period to the joint standing committee of the General Assembly having cognizance of matters relating to insurance for the committee's review and approval. The committee shall be deemed to have approved such annual health care cost growth benchmarks for such succeeding five-year period, except upon a vote to reject such benchmarks by the majority of committee members at a meeting of such committee called for the purpose of reviewing such benchmarks and held not later than thirty days after the commissioner submitted such benchmarks to such committee. If the committee votes to reject such benchmarks, the commissioner may submit to the committee modified annual health care cost growth benchmarks for such succeeding five-year period for the committee's review and approval in accordance with the provisions of this subparagraph. The commissioner shall not be required to hold an informational public hearing concerning such modified benchmarks. Until the joint standing committee of the General Assembly having cognizance of matters relating to insurance approves annual health care cost growth benchmarks for the succeeding five-year period, such benchmarks shall be deemed to be equal to the average annual health care cost growth benchmark for the preceding five-year period. (2) (A) Not later than July 1, 2025, and every five years thereafter, the commissioner shall develop and adopt annual health care quality benchmarks for the succeeding five calendar years for provider entities and payers. (B) In developing annual health care quality benchmarks pursuant to this subdivision, the commissioner shall consider (i) quality measures endorsed by nationally recognized organizations, including, but not limited to, the National Quality Forum, the National Committee for Quality Assurance, the Centers for Medicare and Medicaid Services, the National Centers for Disease Control and Prevention, the Joint Commission and expert organizations that develop health equity measures, and (ii) measures that: (I) Concern health outcomes, overutilization, underutilization and patient safety, (II) meet standards of patient-centeredness and ensure consideration of differences in preferences and clinical characteristics within patient subpopulations, and (III) concern community health or population health. (C) (i) The commissioner shall hold at least one informational public hearing prior to adopting the health care quality benchmarks for each succeeding five-year period described in this subdivision. The commissioner may hold informational public hearings concerning the quality measures the commissioner proposes to adopt as health care quality benchmarks. Such informational public hearings shall be held at a time and place designated by the commissioner in a notice prominently posted by the commissioner on the office's Internet web site and in a form and manner prescribed by the commissioner. The commissioner shall make available on the office's Internet web site a summary of any such informational public hearing and include the recommendations, if any, to modify or not modify any such health care quality benchmark. (ii) If the commissioner determines, after any informational public hearing held pursuant to this subparagraph, that modifications to any health care quality benchmarks are, in the commissioner's discretion, reasonably warranted, the commissioner may modify such quality benchmarks. The commissioner shall not be required to hold an additional informational public hearing concerning such modified quality benchmarks. (D) The commissioner shall post each adopted health care quality benchmark on the office's Internet web site. (c) The commissioner may enter into such contractual agreements as may be necessary to carry out the purposes of this section, including, but not limited to, contractual agreements with actuarial, economic and other experts and consultants.

Legislative History

(P.A. 22-118, S. 219; P.A. 24-24, S. 28; 24-81, S. 221.) History: P.A. 22-118 effective May 7, 2022; P.A. 24-24 substituted “National Centers for Disease Control and Prevention” for “Centers for Disease Control”; P.A. 24-81 replaced references to executive director of the Office of Health Strategy with references to Commissioner of Health Strategy, effective May 30, 2024.