An Act Concerning Revisions To The Health Care Cost Growth Benchmark Program.
HB 7115 revises Connecticut’s Health Care Cost Growth Benchmark Program, which is administered by the Office of Health Strategy. The bill updates reporting requirements for payers so the commissioner can continue calculating total health care expenditures, primary care spending as a share of total medical expenses, and the net cost of private health insurance. A major change is a new opt-in process for self-funded employee health plans: payers must give employers a standardized form to allow their self-funded plan data to be included in aggregate reporting, and employers may later opt out for future reporting periods. The bill also requires annual reporting on which employers opted in or out, which employers were offered the form, and whether the payer made reasonable efforts to provide it.
The bill also expands and clarifies the state’s public reporting and oversight functions. The commissioner must continue publishing annual reports on total health care expenditures and quality benchmarks, and may include additional context such as inflation, access to care, and public health emergencies. It also requires annual requests to CMS for unadjusted Connecticut resident medical expense data and authorizes the commissioner to contract with experts and consultants to support the program. In addition, the bill preserves and reinforces the state’s public hearing process for examining whether spending growth exceeds the benchmark and whether providers, payers, or other entities are contributing significantly to cost growth.
In terms of state law impact, the bill amends sections 19a-754h and 19a-754j, effective October 1, 2025. It strengthens the data collection framework used to monitor health care spending trends and primary care investment, while adding explicit procedures and limits around self-funded plan data submission. It also authorizes a penalty of up to $10 per covered individual enrolled in a self-funded plan if a payer fails to provide the required opt-in form, which gives the commissioner a new enforcement tool.
The general sentiment reflected in the available record appears strongly favorable. The bill received a unanimous 13-0 Joint Favorable Substitute vote in the Insurance and Real Estate Committee, and there is no recorded opposition in the provided materials. That suggests broad committee support for continuing and refining the benchmark program rather than changing its overall purpose.
The main point of potential contention is the treatment of self-funded employee health plans and the administrative burden on payers and employers. The bill requires payers to solicit opt-in participation, track opt-ins and opt-outs, and report detailed compliance information, while also limiting fees charged to employers to actual submission costs. Another possible area of concern is the commissioner’s expanded authority to require testimony from payers, provider entities, and even drug manufacturers at public hearings, which could be viewed as increasing regulatory scrutiny on the health care industry.
The bill amends Connecticut’s health care cost growth benchmark statutes by expanding reporting, hearing, and enforcement requirements for payers, provider entities, and certain other health care stakeholders. It creates a formal opt-in mechanism for self-funded employee health plan data to be included in aggregate reporting, adds annual compliance reporting by payers, and authorizes civil penalties for failure to provide the required forms. It also reinforces the Office of Health Strategy’s authority to publish annual spending and quality reports, request federal data, and convene hearings on cost growth and primary care spending targets.
The available voting history indicates clear support for the bill, with a 13-0 unanimous Joint Favorable Substitute vote in the Insurance and Real Estate Committee. No committee transcript opposition is provided, and the bill’s structure suggests it is framed as a technical and oversight-focused update to an existing cost-control program. Overall, the sentiment in the record is favorable and noncontroversial at the committee stage.
The most notable tension is between the state’s desire for more complete health care cost data and the administrative burden placed on payers and self-funded employers. Payers must distribute opt-in forms, track employer elections, and report detailed compliance information, while employers may be concerned about privacy, reporting obligations, or participation in state data collection. Another possible point of contention is the commissioner’s authority to require testimony from entities identified as significant contributors to cost growth, including drug manufacturers, which could draw resistance from the health care and pharmaceutical sectors.