2023 Connecticut General Statutes › Title 19a - Public Health and Well-Being › Chapter 368dd - Office of Health Strategy › Section 19a-754i. - Meetings between payer or provider and executive director. Criteria for identification of entities exceeding health care cost growth benchmark.

(a)(1) For each calendar year, beginning on January 1, 2023, the executive director shall, if the payer or provider entity subject to the cost growth benchmark or primary care spending target so requests, meet with such payer or provider entity to review and validate the total medical expenses data collected pursuant to section 19a-754h for such payer or provider entity. The executive director shall review information provided by the payer or provider entity and, if deemed necessary, amend findings for such payer or provider prior to the identification of payer or provider entities that exceeded the health care cost growth benchmark or failed to meet the primary care spending target for the performance year as set forth in section 19a-754h. The executive director shall identify, not later than May first of such calendar year, each payer or provider entity that exceeded the health care cost growth benchmark or failed to meet the primary care spending target for the performance year.
(2) For each calendar year beginning on or after January 1, 2024, the executive director shall, if the payer or provider entity subject to the health care quality benchmarks for the performance year so requests, meet with such payer or provider entity to review and validate the quality data collected pursuant to section 19a-754h for such payer or provider entity. The executive director shall review information provided by the payer or provider entity and, if deemed necessary, amend findings for such payer or provider prior to the identification of payer or provider entities that exceeded the health care quality benchmark as set forth in section 19a-754h. The executive director shall identify, not later than May first of such calendar year, each payer or provider entity that exceeded the health care quality benchmark for the performance year.
(3) Not later than thirty days after the executive director identifies each payer or provider entity pursuant to subdivisions (1) and (2) of this subsection, the executive director shall send a notice to each such payer or provider entity. Such notice shall be in a form and manner prescribed by the executive director, and shall disclose to each such payer or provider entity:
(A) That the executive director has identified such payer or provider entity pursuant to subdivision (1) or (2) of this subsection; and
(B) The factual basis for the executive director's identification of such payer or provider entity pursuant to subdivision (1) or (2) of this subsection.
(b) (1) For each calendar year beginning on and after January 1, 2023, if the executive director determines that the annual percentage change in total health care expenditures for the performance year exceeded the health care cost growth benchmark for such year, the executive director shall identify, not later than May first of such calendar year, any other entity that significantly contributed to exceeding such benchmark. Each identification shall be based on:
(A) The report prepared by the executive director pursuant to subsection (b) of section 19a-754h for such calendar year;
(B) The report filed pursuant to section 38a-479ppp for such calendar year;
(C) The information and data reported to the office pursuant to subsection (d) of section 19a-754b for such calendar year;
(D) Information obtained from the all-payer claims database established under section 19a-755a; and
(E) Any other information that the executive director, in the executive director's discretion, deems relevant for the purposes of this section.
(2) The executive director shall account for costs, net of rebates and discounts, when identifying other entities pursuant to this section.
(P.A. 22-118, S. 221.)
History: P.A. 22-118 effective May 7, 2022.