General Assembly Raised Bill No. 342 seeks to improve health coverage regulations in Connecticut, set to take effect on July 1, 2026. The bill mandates that insurers and health care entities include specific provisions in their contracts with health care providers, ensuring equal reimbursement rates for outpatient benefits based on geographic region, regardless of provider affiliation. It also prohibits the automatic downcoding or denial of health insurance claims without clinical peer review, thereby ensuring fair compensation for health care providers. Key amendments include a new definition for "anti-steering clauses," a rebuttable presumption of medical necessity for services ordered by top-tier providers, and a requirement for the Insurance Commissioner to conduct a study on insurance statutes by January 1, 2027.

Additionally, the bill addresses the review process for adverse determinations made by health carriers, ensuring the independence of clinical peers involved in reviews and requiring that all relevant information be considered. It introduces a new definition for "step therapy" and limits the duration of such protocols to no more than thirty days for prescribed drugs, including those for chronic or life-threatening conditions. The previous language specifying certain conditions has been removed, broadening the scope to include disabling or life-threatening chronic diseases. Overall, the bill aims to enhance transparency, fairness, and accountability in health care reimbursement practices while improving patient access to necessary treatments.