Substitute House Bill No. 7039 proposes significant amendments to health care provider payment processes and pharmacist compensation in Connecticut. The bill reduces 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. It also requires health organizations to notify providers at least thirty days in advance of any payment cancellations and mandates a response to appeals within ten business days. Additionally, the bill establishes a working group to study pharmacist compensation for administering health care services, including vaccinations and HIV-related tests, with findings due by February 1, 2026.

Moreover, the bill revises the definition of "clinical peer" to ensure that only qualified professionals with relevant expertise can conduct reviews of medical conditions or treatments. It also introduces new practices deemed unfair under the Connecticut Unfair Insurance Practices Act, such as failing to act in good faith in network decisions and not adhering to written agreements with providers. The bill further requires health carriers to provide written notice to patients when a participating provider leaves the network and to maintain existing contract terms for 60 days during contract disputes, thereby enhancing transparency and fairness in health care practices.

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