summary
Introduced
02/26/2026
02/26/2026
In Committee
03/30/2026
03/30/2026
Crossed Over
Passed
Dead
Introduced Session
2026 General Assembly
Bill Summary
To: (1) require certain health insurers, preferred provider networks and other entities to include certain provisions in contracts with health care providers regarding reimbursement for certain covered health benefits, (2) clarify the definition of "anti-steering clause" under section 38a-477i of the general statutes, (3) require the Insurance Commissioner to conduct a study concerning various revisions to the insurance statutes, (4) change the time period that a health carrier and participating provider shall continue to abide by the terms of a contract under section 38a-472f of the general statutes, (5) prohibit a health carrier from using a software tool to downcode or deny certain health insurance claims, (6) establish a rebuttable presumption for purposes of the review of an adverse determination under section 38a-591e of the general statutes, and (7) prohibit certain health carriers from requiring step therapy for prescription drugs used to treat a chronic, disabling or life-threatening condition.
AI Summary
This bill mandates that health insurers and similar entities must include specific provisions in their contracts with healthcare providers, requiring equal reimbursement rates for covered outpatient benefits regardless of the facility or provider's affiliation, and prohibits varying reimbursement based on the facility. It also clarifies the definition of "anti-steering clause," which are contract provisions that limit a health carrier's ability to encourage enrollees to use competitor providers or specific centers of excellence. The bill requires the Insurance Commissioner to study potential revisions to insurance laws, including those related to outpatient services, and prohibits health carriers from using automated software tools to downcode or deny claims without review by a qualified medical professional, establishing a "rebuttable presumption" that a service ordered by a top-tier provider is medically necessary. Furthermore, it extends the contract continuation period for hospitals and their parent entities after termination or non-renewal to the earlier of dispute resolution or the policyholder's renewal date, and prohibits health carriers from requiring step therapy, a protocol for sequential prescription drug use, for drugs treating chronic, disabling, or life-threatening conditions.
Committee Categories
Business and Industry
Sponsors (4)
Other Sponsors (1)
Insurance and Real Estate Committee (Joint)
Last Action
File Number 223 (on 03/30/2026)
bill text
bill summary
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bill summary
| Document Type | Source Location |
|---|---|
| State Bill Page | https://www.cga.ct.gov/asp/cgabillstatus/cgabillstatus.asp?selBillType=Bill&bill_num=SB00342&which_year=2026 |
| Bill Analysis For File Copy 223 | https://www.cga.ct.gov/2026/BA/PDF/2026SB-00342-R000223-BA.PDF |
| Fiscal Note For File Copy 223 | https://www.cga.ct.gov/2026/FN/PDF/2026SB-00342-R000223-FN.PDF |
| BillText | https://www.cga.ct.gov/2026/TOB/S/PDF/2026SB-00342-R01-SB.PDF |
| BillText | https://www.cga.ct.gov/2026/TOB/S/PDF/2026SB-00342-R00-SB.PDF |
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