Connecticut hearing on SB 10 spotlights mental‑health parity, prior authorization and stop‑loss debate

Lawmakers and advocates spent most of a long Insurance and Real Estate Committee hearing debating Senate Bill 10, an omnibus measure that would strengthen enforcement of behavioral‑health parity and reshape insurer rules on prior authorization, step therapy, site‑neutral payments and stop‑loss coverage for employer plans.

Supporters said SB 10 gives Connecticut regulators the tools to enforce the state’s 2019 parity law and to curb denials and delays that they say block timely care. Comptroller Sean Scanlon told the committee he supported SB 10’s parity provisions because they would force greater transparency from carriers and give regulators stronger remedies when carriers break parity rules: “The public needs data specifically about their insurance carriers,” Scanlon said, arguing that naming insurers in reports and giving regulators discretion to impose fines would strengthen enforcement.

The Office of Health Strategy’s commissioner, Deidre Gifford, told the panel the bill’s reporting and affordability provisions would help reduce unexplained price variation and give the state more leverage to measure and, when necessary, compel participation in the cost‑growth benchmark process. “We have evidence that entities decline to participate in our hearings,” Gifford said, describing OHS’s efforts to collect complete claims data and its limited ability to require attendance by drug manufacturers and other contributors to cost growth.

Clinical witnesses framed SB 10 as a patient‑safety and access measure. Andrew Gerber, president and medical director of Silver Hill Hospital, said low reimbursement and administrative burdens push clinicians out of insurer networks and that better parity enforcement could help get more mental‑health providers back into networks: “If we can incentivize the payers to pay fairly…that then incentivizes psychiatrists and other mental‑health professionals to take insurance,” Gerber said. Anesthesiologist John Satterfield warned against insurer proposals to cap anesthesia payment by arbitrary time limits and backed language in SB 10 that would prohibit such caps. “Any policy establishing arbitrary anesthesia time limits…would represent an unprecedented break in the trust between a health insurer and their policyholders,” he said.

Insurer and business groups voiced strong cautions. Susan Halpin of the Connecticut Association of Health Plans said carriers have participated in parity work but warned the bill’s reporting, presumption and penalty provisions risk unfairly exposing insurers and could raise costs if implemented without careful drafting. The Connecticut Business & Industry Association, the Connecticut Association of Health Plans and a coalition of brokers and employers opposed parts of SB 10 that would change stop‑loss rules for self‑funded plans, saying those provisions (section 10 in the current draft) would sharply increase costs for small and medium employers and might be preempted by ERISA.

Employers and brokers explained the practical impact. Brokers and small‑employer representatives said raising attachment points or requiring stop‑loss coverall would push many small employers out of the level‑funded/self‑funded market or force them to give up offering benefits. “If the stop‑loss requirement were put in place…a small group could be required to pay as much as $200,000 of additional health claims if they had a bad year,” actuary Keith Passwater told the committee. CBIA witnesses called the stop‑loss language a “nonstarter” that would “decimate” the small‑group market.

Committee members and witnesses repeatedly returned to prior authorization and step therapy. Medical and specialty societies urged shifting the burden of proof so insurers must justify denials, and limiting step‑therapy rules that force patients to “fail first” on less‑effective drugs before accessing recommended therapies. “Prior authorization has ballooned into a routine barrier for even basic treatments,” Dr. David Haas of the Connecticut State Medical Society said, urging changes to prevent automatic denials driven by opaque algorithms.

Several witnesses urged tighter parity transparency. Mental‑health advocates and the attorney general’s office earlier concluded that certain reporting gaps made it impossible for the public to judge whether carriers complied with parity. The bill would require carriers to file more detailed parity reports, unblinded by insurer name, and would allow the insurance commissioner civil‑penalty authority tied to noncompliance or failure to report.

What’s next: the bill remains under committee review. Supporters said SB 10 would bring badly needed enforcement powers and data into a system where advocates and clinicians say denials, network inadequacy and administrative burdens hinder access to behavioral health care. Opponents said sections of the draft—most prominently the stop‑loss provisions—would raise costs, disrupt the self‑funded market and might violate federal ERISA rules. The committee did not record any vote during the public hearing.

Key points of discussion • Parity enforcement: Advocates pushed for public, carriernamed parity reporting and civil penalties so regulators can detect and remedy noncompliance; insurers warned about safety and security concerns and urged oversight that preserves proprietary review criteria. • Prior authorization and AI: Physicians urged a rebuttable presumption of medical necessity and human clinical review; providers described prior authorization as a major administrative burden and raised concerns that some automated AI‑driven denials lack transparency. • Step therapy: Supporters asked the committee to broaden prohibitions on “fail‑first” protocols for chronic, disabling or life‑threatening conditions; some insurers said reform should be balanced against cost─containment tools. • Stop‑loss/ERISA: Business groups and brokers said the bill’s changes to the minimum individual and aggregate stop‑loss attachment points would materially increase employer risk and plan costs, potentially driving employers from the self‑funded market; they urged the committee to evaluate ERISA preemption and economic impacts before advancing that language.

Quotes “Today we can and must do better with new and stronger legislation to enforce mental health parity.” — Comptroller Sean Scanlon “We invited the pharmaceutical companies to participate in our June hearing; some declined to participate. Strengthened subpoena power would give OHS more ability to compel participation.” — Deidre Gifford, Commissioner, Office of Health Strategy “Prior authorization has ballooned into a routine barrier for even basic treatments.” — Dr. David Haas, Connecticut State Medical Society “It’s not just an insurer problem. If this language were enacted it would kill level‑funded and self‑funded options that many small employers rely on.” — Grace Brangwyn, Connecticut Business & Industry Association (opposition to stop‑loss language)

Ending The committee’s long public hearing underscored a rare alignment—across clinicians, patient advocates and business groups—on the need to fix parts of the health‑insurance system, even while the parties sharply disagreed on the fixes. SB 10 would give regulators new reporting and enforcement options on parity and lift some restrictions that clinicians say prevent timely care. The bill’s revisions to stop‑loss and rate review — and the ways they are drafted — remain the most politically and economically contentious elements going forward.