Raised Bill No. 405, introduced in the February Session, 2024, addresses the issue of downcoding in health insurance claims. Downcoding is defined as the practice of adjusting a health benefit claim to a less complex or lower cost billing code, resulting in a lower reimbursement to a health care provider than what is required for the actual service performed. The bill mandates that any contract entered into, renewed, or amended on or after July 1, 2025, between a health care provider and an insurer or related entity in Connecticut must include a clause prohibiting downcoding. This applies to insurers, health care centers, hospital service corporations, medical service corporations, preferred provider networks, or other entities providing health benefits.

The bill also instructs the Insurance Commissioner to adopt regulations to implement these provisions, in accordance with chapter 54 of the general statutes. The act is set to be effective starting July 1, 2025, and introduces a new section to the law. The purpose of the bill is to prevent health insurance carriers from downcoding health benefit claims, ensuring that health care providers are reimbursed for the actual services performed. The bill includes insertions that indicate new legal language being added to the current law, while deletions, which would be enclosed in brackets or indicated by underline, are not present in this bill as the entire text is new and not underlined.