Connecticut SB00342 modifies health insurance contracts, reimbursement, and step therapy protocols.

Connecticut SB00342 mandates that insurers, health care centers, and other entities include specific provisions in contracts with health care providers regarding reimbursement for certain covered benefits. It prohibits health carriers from using software tools to automatically downcode or deny health insurance claims without clinical peer review. The bill also establishes a rebuttable presumption that a drug prescribed by a treating health care provider is medically necessary if ordered by a provider in the highest tier of a health carrier's tiered network.

Connecticut SB00342 modifies health insurance contracts, reimbursement, and step therapy protocols.

Connecticut SB00342 mandates that insurers, health care centers, and other entities include specific provisions in contracts with health care providers regarding reimbursement for certain covered benefits. It prohibits health carriers from using software tools to automatically downcode or deny health insurance claims without clinical peer review. The bill also establishes a rebuttable presumption that a drug prescribed by a treating health care provider is medically necessary if ordered by a provider in the highest tier of a health carrier's tiered network.