As March begins, public hearings are in full swing, covering a wide range of issues impacting the physician community, such as the budget/Medicaid, drug affordability, out-of-network costs, and private equity. HCMA physicians have been outstanding in advocating for their peers’ needs. These hearings are essential for gathering input from stakeholders and experts, providing valuable perspectives on the key issues. In the coming weeks, committees will prepare to vote on bills to move them forward for floor votes. It’s crucial that we, as a community, continue advocating for the issues that will impact our practices and patients.
Medicaid/Budget
House Bill 6864 An Act Concerning the State Budget for the Biennium Ending June 30, 2027, and Making Appropriations Therefor
Status: Public Hearing on 2/28
Following Governor Ned Lamont’s budget proposal, the Appropriations Committee heard thousands of hours of testimony as they prepare to form their own version of the budget.
Governor Ned Lamont’s budget proposal included increased Medicaid reimbursement rates, a cap on generic drug price hikes, and expanded prescription drug discounts. While these provisions aim to improve access to care, there are concerns about their effects on out-of-network costs and private equity involvement in healthcare. Proper funding for Medicaid rate increases is crucial to ensuring physicians can continue serving Medicaid patients and providing care to low-income populations.
Both Democratic leadership and Governor Lamont have put forward plans to raise Medicaid reimbursement rates. Democratic leaders propose a $250 million, four-year plan to increase provider rates to 75%-80% of Medicare rates over four years, starting with $75 million in 2026. Governor Lamont’s proposal, however, includes a $70 million increase across FY 2026 and 2027, with $20 million in 2026 and over $50 million in 2027.
During the Human Services section of the Appropriations public hearing on the budget, physicians from across the state testified in support of additional funding to increase reimbursement rates. These proposals are crucial for physicians, as higher Medicaid reimbursement rates are essential for financial stability and ensuring continued access to care for vulnerable populations. The final budget will determine how well these adjustments can support both physicians and patients, making your advocacy for fair reimbursement especially important.
Key stakeholders including the Governor, leadership and members of the Appropriations Committee will enter negotiations as they prepare to form their version of a budget with the hopes of seeing additional funding aimed at increasing reimbursement rates for physicians.
Prior Authorization
Senate Bill 10: AAC Health Insurance and Patient Protection
Status: Public Hearing Scheduled for 3/10
Prior authorization has become a significant burden for physicians, causing delays in care, administrative inefficiencies, and increased costs. Physicians must obtain insurance approval before providing treatments, which can delay necessary care, especially for patients with urgent or complex needs. The complex and frequently changing requirements of prior authorization take time away from patient care, contributing to inefficiencies, particularly in smaller practices. When approvals are denied or delayed, treatment plans may need to be altered, affecting care quality and causing frustration for both physicians and patients.
Senate Bill 10, An Act Concerning Health Insurance and Patient Protection, seeks to address some of these issues by:
- Enforcing penalties on health carriers that fail to meet legal requirements for mental health and substance use disorder benefit parity
- Prohibiting automatic “downcoding”
- Limiting the use of step therapies.
These provisions aim to reduce administrative obstacles and ensure that patients receive the appropriate care they need, making it easier for physicians to practice medicine without unnecessary interference.
Prescription Drug Costs
Senate Bill 11: AAC Prescription Drug Access and Affordability
House Bill 6870: AA Addressing Patients Prescription Drug Costs
Status: Had a Public Hearing on 2/18
High prescription drug costs create a significant a financial burden for patients, often leading to non-compliance with prescribed treatments or delays in care. This worsens health outcomes and may require more complex treatments by physicians.
Senate Bill 11, aimed at pharmacy benefit managers (PBMs), which they believe drive up costs for insurers, pharmacies, and patients. Their proposal would mandate PBMs to act with fiduciary responsibility, ensuring that savings are passed on to plan sponsors. In addition, House Bill 6870 seeks to make prescription drugs more affordable by allowing low-cost drug purchases to count toward deductibles, capping annual increases in generic drug prices, and exploring the importation of drugs from Canada. These efforts are designed to make medications more affordable and accessible for Connecticut residents.
Out of Network
House Bill 6871: An Act Limiting Out-of-Network Healthcare costs
Status: Public Hearing on 2/18
Governor Lamont’s budget proposed capping out-of-network hospital charges at 240% of Medicare rates to protect patients from high medical bills and promote fair pricing. However, this poses to significantly impact physicians by reducing reimbursements, particularly in emergencies or high-overhead specialties. Lower rates may not cover the full cost of care, shifting financial burdens onto physicians and threatening the sustainability of their practices. This could lead to reduced services or physicians leaving areas with low reimbursement rates, ultimately limiting patient access to care. Ensuring fair reimbursement is crucial to maintaining physician stability and high-quality healthcare access.
During the public hearing, HCMA President Atique Mirza, MD, submitted testimony highlighting the severe impact this legislation would have on Connecticut’s healthcare system and patients. HCMA is collaborating with the Connecticut Hospital Association and other specialty groups in a coalition to oppose the bill.
Private Equity
HB 6873: An Act Strengthening the Review of Healthcare Entity Transactions
Status: There was a public hearing on 3/3
Connecticut, responding to Prospect Medical Holdings’ bankruptcy, introduced legislation to strengthen oversight of healthcare mergers, acquisitions, and asset transfers. Supported by Governor Ned Lamont, it expands Attorney General review, establishes a joint review process, and allows conditions to safeguard healthcare. Operators must notify the state 60 days before major changes. The law enhances transparency, prevents profit-driven disruptions, and preserves the “certificate of need” process to ensure care quality. Physicians benefit from greater oversight of private equity in healthcare, ensuring stability and prioritizing patient care.
Support for the legislation was mixed, with some specialty groups emphasizing private equity’s role in healthcare arguing that independent practices and surgery centers, unlike hospitals, should not be unfairly penalized and that a balance is needed to uphold best practices and patient care.