CT HB06557

Expands definition of "urgent care request" to include substance use disorder treatment and co-occurring disorders, effective September 1, 2013, with accelerated 12-hour determination deadline for inpatient substance use disorder or detoxification treatment.

Requires health carriers to conduct internal grievance reviews for adverse determinations by "clinical peers" (licensed health care professionals with appropriate credentials and board certification) rather than generic reviewers, effective at staggered dates from September 1, 2013 through January 1, 2015.

Mandates specific clinical review criteria for substance use disorder treatment based on American Society of Addiction Medicine's Patient Placement Criteria or state-approved alternatives, with documented comparisons to ASAM standards.

Strengthens notice requirements for adverse determinations and grievance decisions, including statements about free assistance from Office of the Healthcare Advocate, right to submit supporting documentation, and procedures for external review.

Deems internal grievance process exhausted if health carriers fail to strictly adhere to procedural requirements, allowing covered persons to immediately pursue external review and other available remedies regardless of claimed substantial compliance.