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 mandates that health organizations provide at least thirty days' notice to providers before any payment cancellation and introduces an electronic appeal process for providers to contest such demands. Additionally, the definition of "clinical peer" is revised to require that individuals conducting adverse determination reviews have a nonrestricted license in the same specialty as the treating physician or substantial experience in managing the relevant condition.

The bill establishes a working group tasked with studying pharmacist compensation for administering health care services, such as vaccine administration and HIV-related tests, and requires the group to report its findings by February 1, 2026. It also introduces new requirements for health carriers, including providing written notice to patients when a participating provider exits the network and ensuring continuity of care for patients in active treatment. Furthermore, health carriers and hospitals must adhere to existing contract terms for 60 days following contract expiration or termination to protect patients from sudden changes in care. Overall, the bill aims to enhance transparency, fairness, and continuity in the health insurance landscape while improving compensation frameworks for healthcare providers and pharmacists.

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