CT SB00342

Requires insurers to reimburse health care providers at equal rates within the same geographic region for outpatient services using CPT E/M, CPT A/M, telehealth, or drug infusion codes, regardless of the facility where services are provided, effective July 1, 2026.

Prohibits health carriers from using artificial intelligence, algorithms, or other software tools to automatically downcode or deny health insurance claims without review by a clinical peer, effective October 1, 2026.

Creates a rebuttable presumption that health care services ordered by providers in the highest tier of a carrier's network are medically necessary, shifting the burden to insurers to prove otherwise during utilization review, effective January 1, 2027.

Expands step therapy restrictions to prohibit insurers from requiring step therapy for cancer treatment, disabling or life-threatening chronic diseases, schizophrenia, major depressive disorder, or bipolar disorder, and limits step therapy to 30 days for all other prescribed drugs.

Extends contract continuation requirements when hospital contracts are terminated or not renewed, requiring both parties to honor contract terms until the earlier of dispute resolution or the policyholder's renewal date.