Substitute House Bill No. 7039 proposes significant amendments to health care provider payment processes and pharmacist compensation in Connecticut. Key changes include reducing the time frame for health organizations to cancel or demand the return of payments for authorized services from eighteen months to twelve months, with exceptions for fraud or billing errors. The bill also requires health organizations to notify providers at least thirty days in advance of any payment cancellations and introduces an electronic appeal process for providers to contest such demands. Additionally, the definition of "clinical peer" is revised to ensure that only qualified professionals with relevant expertise can review medical conditions or treatments.

The bill establishes a working group tasked with studying pharmacist compensation for administering specific healthcare services, including vaccines and HIV-related tests, with a report due by February 1, 2026. It also outlines new unfair insurance practices, such as failing to act in good faith in network decisions and not adhering to written agreements. Furthermore, the bill mandates that health carriers provide written notice to patients when a participating provider exits the network, ensuring continuity of care, and requires adherence to existing contract terms for 60 days during contract disputes. Overall, these changes aim to enhance transparency, fairness, and patient care continuity in the health insurance landscape.

Statutes affected:
INS Joint Favorable Substitute:
File No. 363: