Connecticut Mental Health Parity Law: 5 Essential Changes
The Connecticut mental health parity law requires health plans to cover mental health and substance use disorder care no less favorably than medical and surgical care. Connecticut strengthened its enforcement in 2025 with Public Act 25-94, and the state’s Insurance Department followed with a report in April 2026. This guide explains what changed and what it means for your claims, contracts and denial log.
What the Connecticut mental health parity law now requires
The Connecticut mental health parity law now makes carriers prove compliance every year and puts the results in public view. The Office of Legislative Research summary of Public Act 25-94 lists five changes that matter to a practice.
| Change | What the summary says |
|---|---|
| 1. Yearly certification | Carriers certify to the insurance commissioner, starting by March 1, 2026, that they reviewed their administrative practices for the prior year. |
| 2. Public results | A carrier’s reported compliance or noncompliance becomes public. Earlier law kept carrier names confidential. |
| 3. Bigger penalties | Up to $100 per covered member, capped at $625,000 a year. The old general cap was $15,000. Late filings add $100 a day, also capped at $625,000. |
| 4. Outside experts | The commissioner may hire an independent expert to help review parity violations. |
| 5. Step therapy ban stays | The ban on step therapy for drugs that treat schizophrenia, major depressive disorder and bipolar disorder is permanent. It would have expired January 1, 2027. |
The parity sections took effect October 1, 2025. Most of the rest of the act took effect January 1, 2026. The summary also says the commissioner can waive a penalty for reasonable cause or when a carrier fixes the problem within 30 days of reporting it.
What did Connecticut find in April 2026?
On April 22, 2026, the Connecticut Insurance Department published its 2026 report on nonquantitative treatment limitations (NQTLs). NQTLs are plan rules that are not dollar limits, such as prior authorization, medical necessity review and network standards. The department’s release reports documentation gaps in coverage decisions, differences in behavioral health network access, and reimbursement methods that did not meet comparability standards.
The department says it started enforcement actions against Aetna, Anthem, ConnectiCare, Cigna and UnitedHealthcare. It lists no dollar amounts and no deadline. It says it will require corrective action plans, which means the effect on any one practice is not yet known.
Which plans the Connecticut mental health parity law reaches
The Connecticut mental health parity law applies to fully insured plans, not to every plan your patients carry. Keep the three buckets separate when you plan your work.
Private payers
The Connecticut Insurance Department’s mental health benefits page says state mental health laws apply to individual policies and fully insured group policies. Self-insured employer plans fall under federal rules instead, overseen by the U.S. Department of Labor. Ask during insurance verification whether the plan is fully insured or self-insured. The federal Mental Health Parity and Addiction Equity Act (MHPAEA) is explained on the CMS parity page.
Medicare and Medicaid
CMS says Medicare, Medicaid and the Children’s Health Insurance Program (CHIP) are not group health plans, so MHPAEA does not apply to them directly. Certain federal provisions do require parts of Medicaid and CHIP to meet parity rules. Connecticut’s Medicaid rules are separate from the commercial law described here.
State rules
This post covers Connecticut only. Other states set their own parity rules and penalties, so do not carry these figures to another state. On the federal side, the Departments of Labor, Health and Human Services and the Treasury said on May 15, 2025 that they will not enforce the new provisions of the September 2024 parity rule while they reconsider it. The statement says the underlying law still applies.
Does the Connecticut mental health parity law change what you get paid?
Not directly. The act as summarized gives carriers new duties and penalties but gives providers no new right to payment, and the department has not changed any contract rate. Any effect will come through your contracts, authorization rules and denials. A carrier correcting its practices may change prior authorization or network terms, so read payer notices closely and keep your contract file current.
What to do Monday morning
- Start a simple log of behavioral health denials and authorization delays: date, payer, code and stated reason.
- Check that every note supports medical necessity, since that is the first thing a reviewer asks for.
- Mark each patient’s plan as fully insured or self-insured in the chart.
- Read new notices from the five named carriers for changes to authorization or network rules. The insurance companies contact directory helps you find the right provider line.
- Match each denial to its reason code. Our guide to CARC and RARC codes shows how, and the underpayments guide covers short pays.
- Talk to counsel before you act on any parity theory or filing.
The short version: Connecticut mental health parity law
The Connecticut mental health parity law now requires yearly carrier certification, makes results public and raises penalties. The April 2026 report led to enforcement action against five carriers. It reaches fully insured plans, so log your denials and verify plan type.
How MCM South helps
MCM South Medical Billing Service, LLC works exclusively in mental and behavioral health billing for psychotherapists and psychiatrists in solo and medium-size practices. We bill out-of-network claims for clients. If you want help tracking denials and payer changes, see how network status changes your options, or ask us about your practice.
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Related reading
Want help keeping up with payer changes? We can talk through your practice.
FAQ
What is Public Act 25-94?
It is a 2025 Connecticut law (Substitute Senate Bill 10) that strengthened parity enforcement, among other insurance changes. Its parity sections took effect October 1, 2025.
Which insurers did Connecticut name in April 2026?
The Insurance Department said it started enforcement actions against Aetna, Anthem, ConnectiCare, Cigna and UnitedHealthcare. The release gives no penalty amounts.
Do providers receive any of the penalty money?
The summary describes penalties on carriers payable under the insurance law. It does not describe any payment to providers, so do not plan around one.
Does the law cover self-insured employer plans?
No. The Insurance Department says state insurance laws do not apply to self-insured plans, which follow federal rules overseen by the U.S. Department of Labor.
Where MCM South works
MCM South Medical Billing Service, LLC works with psychotherapists and psychiatrists in our ten currently served states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois. We serve solo and medium-size practices that bill mental and behavioral health. Founder Michael Williams has worked with insurance payers in all 50 states. Browse the state and regional billing guides for rules that vary by state, or see our billing services.
This post is operational guidance for billing, not legal advice. Rules change, so confirm with the payer or your counsel.
