The proposed General Assembly Raised Bill No. 342 seeks to improve health coverage regulations in Connecticut, set to take effect on July 1, 2026. It requires all insurers and health care entities to include provisions in their contracts with health care providers that ensure equal reimbursement rates for covered outpatient benefits across geographic regions, regardless of the provider's employer or affiliation. Additionally, contracts must include a statement confirming adherence to these reimbursement standards. The bill also prohibits health carriers from automatically downcoding insurance claims without a clinical peer review, ensuring fair evaluation of claims. Other significant changes include establishing a rebuttable presumption of medical necessity for services ordered by top-tier providers, extending contract terms post-termination until disputes are resolved, and requiring the Insurance Commissioner to study various insurance statutes with a report due by January 1, 2027.

Moreover, the bill amends existing laws concerning health insurance policies, particularly the review process for adverse determinations and step therapy for prescription drugs. It mandates that health carriers appoint clinical peers, uninvolved in the initial adverse determination, to review such cases. The legislation also prohibits insurance companies from mandating that individuals obtain prescription drugs from mail order pharmacies as a condition for benefits and limits the duration of step therapy protocols, especially for serious conditions like cancer. Treating health care providers are granted the authority to override step therapy if deemed clinically ineffective. These amendments aim to enhance patient rights and streamline access to necessary medical treatments, with specific provisions taking effect in 2026 and 2027.