CT HB05578

Expands the definition of "clinical peer" for mental health and substance use disorder reviews to include individuals with doctoral-level psychology degrees and relevant clinical experience, in addition to those with national board certifications.

Requires health carriers to use specific clinical review criteria for substance use disorder treatment (American Society of Addiction Medicine's Patient Placement Criteria) and mental disorder treatment (American Academy of Child and Adolescent Psychiatry guidelines for children/adolescents; American Psychiatric Association or Association for Ambulatory Behavioral Healthcare guidelines for adults).

Mandates health carriers using alternative clinical review criteria to post comparison documents on their websites showing how their criteria align with the specified professional guidelines and justifying any deviations with peer-reviewed evidence.

Requires adverse determination notices to include detailed information about the specific reasons for denial, relevant clinical review criteria used, the grievance process, and prominent references to the Office of the Healthcare Advocate's free assistance for appeals.

Removes references to the Division of Consumer Affairs within the Insurance Department from grievance-related notices, focusing consumer assistance information on the Office of the Healthcare Advocate.