Healthcare (Medicare)

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 requires the Department of Social Services to increase Medicaid reimbursement rates for healthcare providers starting July 1, 2026, with the goal of reaching at least 75% of Medicare rates by June 30, 2029. The law establishes a five-state benchmark using average rates from Maine, Massachusetts, New Jersey, New York, and Oregon to determine increases for services without corresponding Medicare rates. Additionally, the bill mandates annual rate adjustments after 2029 based on Medicare rate comparisons, the five-state benchmark, or changes in the Medicare Economic Index to account for inflation. A separate oversight council must review provider reimbursement rates annually and report to the legislature with recommendations on necessary funding to maintain adequate compensation for healthcare providers.

SB 88 requires health insurance policies covering chemotherapy to also cover scalp cooling systems, which prevent hair loss during cancer treatment. It applies to individual and group health insurance plans issued in the state on or after January 1, 2027, directly affecting cancer patients receiving chemotherapy and insurers. The bill mandates that coverage for scalp cooling must be at least as comprehensive as Medicare’s coverage, prohibiting stricter copayments, deductibles, or coinsurance than for other covered benefits. Insurers may still require prior authorization for scalp cooling, but only under the same conditions applied to other covered treatments.

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.

SB 42 creates a tax credit that allows taxpayers to reduce their personal income tax bill by the amount paid for Medicare and Medicare Advantage plan premiums. This directly affects individuals who pay Medicare premiums and file personal income tax returns. The credit applies to premiums paid during a taxable year and lowers the taxpayer's overall income tax liability. The bill does not change Medicare eligibility or premium amounts but provides a direct tax benefit for those already paying for Medicare coverage.

SB 209 requires Connecticut's Medicaid program to increase reimbursement rates for nephrology services (kidney care) to at least 80% of Medicare rates for the same services. This directly affects kidney specialists and clinics that treat Medicaid patients. The bill mandates the state to file a report on how these rate changes impact provider participation, patient access to care, and state budget costs. It does not alter eligibility or coverage but adjusts payment rates for existing Medicaid services. The bill focuses on improving financial incentives for providers to participate in Medicaid.