AN ACT CONCERNING THE RETURN OF HEALTH CARE PROVIDER PAYMENTS, ESTABLISHING A WORKING GROUP TO STUDY PHARMACIST COMPENSATION FOR ADMINISTERING CERTAIN SERVICES, REVISING THE DEFINITION OF CLINICAL PEER AND CONCERNING THE CONNECTICUT UNFAIR INSURANCE PRACTICES ACT.
What changed between versions
The retroactive denial provision was replaced with new rules limiting when health organizations can cancel, deny, or demand return of payments for claims, primarily restricting this to fraud, billing errors, or overpayment scenarios.
New requirements were added mandating coverage for medical foods for individuals with phenylketonuria and coverage for motorized wheelchairs, repairs, and replacement batteries.
A new working group was established to study pharmacist compensation for administering certain services like vaccines and HIV/influenza tests.
The original provision requiring centralized locations to collect used motorized wheelchairs was removed from the individual and group health insurance policy requirements.
The original study on telehealth coverage requirements for out-of-state students was removed and replaced with the pharmacist compensation working group.
The original provision prohibiting recovery of lobbying costs through health insurance premiums was removed.
The effective date for the new payment return rules was set to January 1, 2026, with a 12-month lookback period replacing the previous 2-year period for retroactive denials.
New appeal procedures were added requiring insurers to provide at least 30 days' notice before demanding payment returns, with a 10-day window for insurers to respond to appeals.
