Insurers would pay equal outpatient rates under the raised bill

Insurers would include equal-payment requirements in contracts with health care providers. The requirements cover specified outpatient visits, assessments, telehealth services, and drug infusions for people insured in Connecticut. Equal rates across providers would apply to payments for individual services or standard bundles of services, regardless of providers' employers or affiliations. The Insurance Commissioner would define the regions and write rules to carry out these requirements. The requirements would apply to provider contracts entered into, renewed, or amended on or after July 1, 2026.

Insurers would require a clinical peer's review before software denies claims or lowers billing codes to reduce payment. The medical-need rule covers care ordered by providers in the highest level of an insurer's ranked provider network. Care ordered within a top-tier provider's allowed practice would be presumed medically necessary during reviews and appeals. Insurers could challenge that presumption but would have to support their finding that the care is not medically necessary. The software rule would take effect October 1, 2026. The medical-need rules would take effect January 1, 2027.

Insurers and hospitals would keep following their contract terms after termination or nonrenewal. The rule covers contracts with hospitals, their parent companies, or their intermediaries entered into, renewed, amended, or continued on or after July 1, 2023. The requirement would apply when either side ends the contract or does not renew it. Both sides would continue following all contract terms, including payment terms. This provision would take effect October 1, 2026.

Insurers would not require patients to try other medicines first for cancer or disabling or life-threatening chronic diseases. The treatment categories are cancer and chronic diseases that are disabling or life-threatening. These provisions would apply to individual and group health policies that cover prescription drugs. When the treating provider finds the required drug sequence ineffective, the insurer would authorize the prescribed medicine if the policy covers it. These provisions would take effect October 1, 2026.

The Insurance Commissioner would study possible revisions to insurance laws and report recommendations to lawmakers. The study would include excess insurance, the Health Care Cabinet, and outpatient care at hospital facilities away from the main campus, including injections and infusions. The study requirement would start upon passage. The report to the legislature's insurance committee would be due no later than January 1, 2027.