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Read. Follow. Verify.Connecticut bill bans automated claim downcoding, limits step therapy, and regulates health insurance provider contracts
Last action · May 6, 2026: House Calendar Number 575Sponsors: Martin Looney and 9 others
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What This Bill Proposed
Connecticut legislation prohibits health carriers from using automated software or artificial intelligence to or deny insurance claims without review, restricts protocols for specific chronic and mental health conditions, and standardizes health care provider reimbursement rates beginning in 2026 and 2027.
- The Connecticut General Assembly operates in annual sessions, with even-numbered years traditionally reserved for shorter sessions focusing on specific budgetary and policy adjustments. context
- Step therapy and claim downcoding practices by health insurance carriers have been subjects of ongoing legislative debate regarding patient access to timely care and provider reimbursement fairness. context
Who It Would Have Affected
Groups the bill's text would have affected, as described in the record. Being affected is not a position for or against it.
Health insurance enrollees
Enrollees gain protections against automated claim downcoding, limits on mail-order pharmacy mandates, and restrictions on prescription drug step therapy.
Health care providers
Providers receive standardized regional reimbursement rates for outpatient services and protection against unilateral claim downcoding by insurers.
Health carriers and insurers
Insurers must adjust provider contracts, eliminate automated claim downcoding without clinical review, and alter step therapy and contract continuation practices.
Key Facts
- Beginning July 1, 2026, health insurers and preferred provider networks must reimburse contracting health care providers for outpatient CPT E/M, A/M, telehealth, and drug infusion codes at rates that do not vary based on the facility location.
- Health insurers must use equal reimbursement rates for all contracting providers in the same geographic region as determined by the Insurance Commissioner.
- The Insurance Commissioner must conduct a study on insurance statute revisions regarding excess insurance, the Health Care Cabinet, and off-site hospital-based outpatient services, reporting by January 1, 2027.
- Effective October 1, 2026, health carriers are prohibited from using software tools, including artificial intelligence or algorithms, to automatically downcode or deny health insurance claims without review by a clinical peer.
Show all 8 facts
- If a contract between a health carrier and a hospital is not renewed or is terminated, both parties must continue abiding by contract terms until the earlier of the date the dispute is resolved or the policyholder's renewal date.
- Effective January 1, 2027, utilization reviews for health care services ordered by providers in the highest tier of a tiered network carry a rebuttable presumption of medical necessity, placing the burden of proof on the health carrier.
- Effective October 1, 2026, health insurance policies covering prescription drugs cannot require patients to use mail-order pharmacies as a condition of obtaining benefits.
- Step therapy protocols for prescription drugs are restricted to a maximum of thirty days and cannot be required for cancer treatments, disabling or life-threatening chronic diseases, or specified mental health conditions.
Frequently Asked Questions
Can my health insurance company force me to use a mail-order pharmacy?
How long can an insurance company make me try step therapy for a prescription drug?
What happens to my insurance claim if an automated system tries to downcode it?
What else do you want to know?
News Coverage
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Votes, people, money & the original sourceWhere This Stands
This bill did not become law - Died at adjournment · passed the Senate · on the House floor.
Procedural history
29 actions- May 6, 2026HouseHouse Calendar Number 575
- May 6, 2026HouseFavorable Report, Tabled for the Calendar, House
- May 5, 2026Connecticut General AssemblyTransmitted Pursuant To Joint Rule 17
- May 5, 2026SenateFloorSenate Passed as Amended by Senate Amendment Schedule A,B
- May 5, 2026SenateFloorSenate Adopted Senate Amendment Schedule B 6132
- Apr 27, 2026SenateFavorable Report, Tabled for the Calendar, Senate
Show 23 earlier actions
- Apr 27, 2026Connecticut General AssemblyNo New File by Committee on Judiciary
- Apr 27, 2026Connecticut General AssemblyReported Out of Legislative Commissioners' Office
- Apr 24, 2026Connecticut General AssemblyFiled with Legislative Commissioners' Office
- Apr 24, 2026Connecticut General AssemblyJoint Favorable
- Apr 22, 2026Connecticut General AssemblyImmediate Transmittal
- Apr 22, 2026SenateReferred by Senate to Committee on Judiciary
- Apr 20, 2026SenateFavorable Report, Tabled for the Calendar, Senate
- Apr 20, 2026Connecticut General AssemblyNo New File by Committee on Appropriations
- Apr 20, 2026Connecticut General AssemblyReported Out of Legislative Commissioners' Office
- Apr 20, 2026Connecticut General AssemblyFiled with Legislative Commissioners' Office
- Apr 17, 2026Connecticut General AssemblyJoint Favorable
- Apr 15, 2026Connecticut General AssemblyImmediate Transmittal
- Apr 15, 2026SenateReferred by Senate to Committee on Appropriations
- Apr 15, 2026SenateFloorSenate Adopted Senate Amendment Schedule A 4096
- Mar 30, 2026Connecticut General AssemblyFile Number 223
- Mar 30, 2026SenateSenate Calendar Number 178
- Mar 30, 2026SenateFavorable Report, Tabled for the Calendar, Senate
- Mar 30, 2026Connecticut General AssemblyReported Out of Legislative Commissioners' Office
- Mar 23, 2026Connecticut General AssemblyReferred to Office of Legislative Research and Office of Fiscal Analysis 03/30/26 12:00 PM
- Mar 12, 2026Connecticut General AssemblyFiled with Legislative Commissioners' Office
- Mar 12, 2026Connecticut General AssemblyJoint Favorable
- Feb 27, 2026Connecticut General AssemblyPublic Hearing 03/03
- Feb 26, 2026Connecticut General AssemblyCommitteeReferred to Joint Committee on Insurance and Real Estate
Version history
Only one version on file - nothing to compare yet. As later stages (committee substitute, engrossed, enrolled) are captured, the redline appears here.
View official text →Lobbying Activity
No state lobbying filings in our records match this bill. Federal lobbying reports (LDA) cover Congress, so they are not listed on state bills.
Full breakdown
Who this bill affects and the strongest case for and against it, written only from the bill’s own text.
Sponsors
Discoveries
Patterns POLISCOPE noticed across the record. These are observations to investigate, not conclusions.
Comprehensive Restructuring of Insurer Utilization Controls
The bill simultaneously restricts multiple utilization management tools, targeting automated claim downcoding, step therapy durations, mail-order mandates, and network tier adverse determinations.
Connected Entities
Sources
cga.ct.gov
Analysis Score
0–100- Significance20Lowered because this bill did not pass (its text scored 85)
- Controversy65Intensity of disagreement among stakeholders
- Entertainment10Compellingness for a non-policy-wonk reader
- Buzz50Current news / social attention level
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