This bill establishes new Medicaid payment rates and service limits for adult dental care and cognitive assessments in Connecticut. Starting July 1, 2026, it requires prior authorization for nonemergency dental services while exempting basic preventive care and medically necessary procedures from a $1,000 annual spending cap. The legislation also directs the state to update Medicaid reimbursement rates to match Medicare standards for cognitive assessments and care planning for patients under 65 showing signs of cognitive impairment. Additionally, it creates a structured advisory council with representatives from various healthcare sectors to oversee Medicaid service modifications and ensure balanced oversight of dental benefit limitations.
This bill updates the definition of intellectual disability used by the Department of Developmental Services to align with the fifth edition of the American Psychiatric Association's diagnostic manual, which will affect eligibility for state-administered services starting July 1, 2026. It includes a protection clause ensuring that people currently receiving services will not lose benefits or face reduced services due to changes in eligibility criteria resulting from this definition update. The bill also requires the Commissioner of Developmental Services to review and potentially adjust eligibility criteria by December 1, 2026, after consulting with stakeholders and studying best practices from other states. A report detailing recommendations, expected impacts on eligible populations, and associated costs must be submitted to the General Assembly committees overseeing human services and appropriations.
HB 5354 limits how Connecticut can audit Medicaid pharmacies by prohibiting the use of data extrapolation for minor clerical errors in audits. It requires the state to confirm notices to pharmacies about billing and maintain a real-time database of approved drugs on the preferred drug list. Pharmacies can challenge disputed reimbursements through a new grievance process starting October 2026, allowing them to present cost evidence. The bill directly affects pharmacies participating in Connecticut's Medicaid program and takes effect July 1, 2026.
HB 5374 requires individual health insurance policies in Connecticut that cover chemotherapy to also provide coverage for scalp cooling systems used to prevent hair loss during treatment. This applies to policies delivered, renewed, or continued on or after January 1, 2027, and mandates coverage "at least equivalent to such coverage provided under Medicare." The bill specifically targets policies covering certain chemotherapy-related treatments, directly affecting patients receiving chemotherapy who may use scalp cooling systems. It does not apply to group plans or other insurance types, focusing solely on individual health insurance policies meeting the specified coverage criteria.
This bill updates motor vehicle and medical licensing laws to improve accessibility and professional training. It requires disability parking placards to display expiration dates prominently in boldface and establishes an advisory council to prevent fraud while protecting disabled individuals. The council will develop educational materials and review best practices for placard use and parking access. Additionally, the bill mandates that physicians include specific training topics like cultural competency and risk management in their continuing medical education requirements. These changes aim to enhance system integrity and improve healthcare standards without altering existing rights for qualified individuals.
This bill updates Connecticut school health regulations to allow trained school personnel to administer opioid overdose reversal medication to students experiencing an opioid-related overdose without prior written authorization. The legislation requires the State Board of Education to establish specific conditions and procedures for storing and administering these medications, similar to existing rules for epinephrine in allergic reaction emergencies. School staff must complete annual training to administer the medication, and the rules apply to both intramural and interscholastic athletics settings. The changes take effect on July 1, 2026, and aim to ensure students have access to life-saving treatment during opioid overdoses at school.
This bill restricts most Connecticut hospitals from selling and leasing back their main campus property (a "sale-leaseback") after October 1, 2026, except for hospitals in financial distress that obtain board approval and notify the state health commissioner and attorney general. It requires all hospitals to annually submit a written attestation confirming no private equity firm controls the hospital or interferes with clinical decisions, such as patient care timing, discharge policies, or medical diagnoses. The attestation must cover specific areas like emergency department triage, patient discharge decisions, and medical record entries. Hospitals must use a standard form developed by the state health commissioner to comply.
HB 5375 transfers public health program funding from the Insurance Fund to the General Fund over five years (starting July 1, 2026), replacing the previous fee structure. It requires domestic insurers and health care centers providing specific health insurance types to pay an annual public health fee based on their enrolled lives in Connecticut, calculated to fund designated programs. These programs include syringe services, AIDS services, breast/cervical cancer detection, tuberculosis care, and children's health initiatives. The fee amount is determined annually by the Insurance Commissioner using a formula based on the total funding needed and the reported number of covered lives. The bill repeals the existing fee statute (Section 19a-7p) and establishes new reporting and payment requirements for insurers.
HB 5377 modifies health insurance billing rules to protect providers and improve transparency. It shortens the timeframe insurers can demand repayment for claims from 18 to 15 months after a clean claim is submitted (except for fraud, billing errors, duplicate payments, or federal program overlaps), requires insurers to provide 30 days' notice and an electronic appeal process for repayment demands, and mandates off-site hospital facilities to submit their unique national provider identifier (NPI) and tax ID on all claims. These changes directly affect health insurers, healthcare providers, and off-site hospital facilities, ensuring clearer billing requirements and reducing disputes over claim payments. The bill takes effect October 1, 2026, for the NPI requirement and January 1, 2027, for the repayment timeline changes.
SB 123 requires assisted living facilities to hold public informational hearings when increasing resident fees by more than 10% of the previous fee. Facilities must provide at least 30 days' notice before the hearing and allow residents, families, and the public to comment. This applies to all fee increases exceeding 10% (effective October 1, 2026), while exempting adjustments tied to immediate care changes or safety needs. The bill also mandates 60-day advance disclosure of all fee increases and provides residents with three years of fee history upon request. It directly affects assisted living agencies and their residents by adding transparency to significant cost changes.
