Connecticut 2026 Session Status: Enacted Bipartisan · 3 R · 2 D cosponsors

HB 5354 — AN ACT CONCERNING MEDICAID PROVIDER AUDITS.

Last action — SIGNED BY GOVERNOR

  1. ✓
    Introduced
  2. ✓
    In Committee
  3. ✓
    Passed House
  4. ✓
    Passed Senate
  5. ✓
    To Executive
  6. 6
    Enacted

This bill has been enacted into law. Introduced February 26, 2026. Enacted.

Signed by Governor Ned Lamont (Democratic) on June 02, 2026.

Odds of enactment

High chance

Based on the sponsor, cosponsors, and committee posture, this bill has a high chance of becoming law.

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A statistical estimate from our own model of past outcomes — an insight, not a guarantee. Policymaking is volatile.

Prognosis

Likely to advance 76% · moderate confidence

  • Enacted

    Current position in the legislative process.

  • 5 sponsors

    5 primary, 0 co-sponsors signed on.

  • Bipartisan support

    Sponsored across 2 parties (3 R · 2 D) — cross-party backing.

Based on stage, sponsorship breadth, committee status, recorded votes, and cross-state momentum — a description of the observable signals, not a prediction.

In plain language

The bill addresses the process of auditing Medicaid providers.

This bill establishes provisions for auditing Medicaid providers to ensure compliance and proper use of funds. It aims to clarify the auditing process and enhance the oversight of Medicaid services delivered to beneficiaries.

What this means for you
  • Healthcare: This means more rigorous oversight of healthcare providers participating in Medicaid, ensuring compliance with funding guidelines.

Bill Text

What changed in the latest version

19 added · 32 removed

Plain-language change summary

The amendment to HB 5354 changes the threshold for when overpayments to Medicaid providers can be based on extrapolation, increasing it from 1.75% to 2.75% of total claims. This means that providers will face fewer extrapolated overpayment findings unless the errors are larger, which could help reduce unnecessary financial penalties for smaller mistakes. Additionally, starting in 2027, providers will receive updated educational materials to help them with proper billing before any extrapolation occurs, which aims to support providers and improve compliance.

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General Assembly Substitute Bill No.
Substitute House Bill No.
5354 February Session, 2026 AN ACT CONCERNING MEDICAID PROVIDER AUDITS.
5354 Public Act No.
26-143 AN ACT CONCERNING MEDICAID PROVIDER AUDITS.
Subdivision (4) of subsection (d) of section 17b-99 of the general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2026):
Subdivision (4) of subsection (d) of section 17b-99 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2026):
(4) A finding of overpayment or underpayment to a provider in a program operated or administered by the department pursuant to this chapter or chapter 319t, 319v, 319y or 319ff, except a provider for which rates are established pursuant to section 17b-340, shall not be based on extrapolation unless (A) there is a determination of a sustained or high level of payment error involving the provider, (B) the commissioner makes a good faith determination that the provider is engaging in vendor fraud, or (C) if documented educational intervention has failed to correct the level of payment error and the total net amount of extrapolated overpayment calculated from a statistically valid sampling and extrapolation methodology exceeds oneand three-quarters per cent of total claims paid to the provider for the audit period.
(4) A finding of overpayment or underpayment to a provider in a program operated or administered by the department pursuant to this chapter or chapter 319t, 319v, 319y or 319ff, except a provider for which rates are established pursuant to section 17b-340, shall not be based on extrapolation unless the total net amount of extrapolated overpayment calculated from a statistically valid sampling and extrapolation methodology exceeds [one] two and three-quarters per cent of total claims paid to the provider for the audit period.
To the extent permissible under federal law, unless the commissioner makes a good faith determination that the provider is engaging in vendor fraud, recoupment ofanextrapolatedoverpayment fromacoveredpharmacist or pharmacy, as defined in section 20-571, shall be limited to the sum of LCO 1 of 2 Substitute Bill No.
Beginning with audit review periods commencing January 1, 2027, the commissioner shall make available up-to-date education materials and technical assistance documents to assist providers with proper Medicaid billing prior to extrapolation.
5354 any professional dispensing fees, paid by the commissioner pursuant to section 17b-280, that are associated with such extrapolated overpayment.
Governor's Action:
This act shall take effect as follows and shall amend the following sections:
Approved June 2, 2026
Section 1 July 1, 2026 17b-99(d)(4) HS Joint Favorable Subst.
FIN Joint Favorable LCO 2 of 2
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Action History

  1. SIGNED BY GOVERNOR

  2. TRANSMITTED BY SECRETARY OF THE STATE TO GOVERNOR

  3. TRANSMITTED TO SECRETARY OF THE STATE

  4. PUBLIC ACT 26-143

  5. IN CONCURRENCE

  6. HOUSE PASSED, SEN. AMEND. SCH. A

  7. HOUSE PASSED, HOUSE AMEND. SCH. A

  8. HOUSE ADOPTED SEN. AMEND. SCH. A

  9. POTENTIAL DISAGREEING ACTION, TABLED CAL. HO.

  10. TRANSMITTED PURSUANT TO JOINT RULE 17

  11. SEN. PASSED, SEN. AMEND. SCH. A

  12. SEN. PASSED, HO. AMEND. SCH. A

  13. SEN. ADOPTED SEN. AMEND. SCH. A

  14. SEN. ADOPTED HO. AMEND. SCH. A

  15. SENATE CALENDAR NUMBER 519

  16. FAV. RPT., TAB. FOR CAL., SEN.

  17. IMMEDIATE TRANSMITTAL TO THE SENATE

  18. HOUSE PASSED, HOUSE AMEND. SCH. A

  19. HOUSE ADOPTED HOUSE AMEND. SCH. A

  20. TABLED FOR HOUSE CALENDAR

  21. NO NEW FILE BY COMM. ON Finance, Revenue and Bonding

  22. RPTD. OUT OF LCO

  23. FILED WITH LCO

  24. Joint Favorable

  25. REF. BY HOUSE TO COMMITTEE ON Finance, Revenue and Bonding

  26. FILE NO. 413

  27. HOUSE CALENDAR NUMBER 297

  28. FAV. RPT., TABLED FOR HOUSE CALENDAR

  29. RPTD. OUT OF LCO

  30. REFERRED TO Office of Legislative Research AND Office of Fiscal Analysis 04/07/26

  31. FILED WITH LCO

  32. Joint Favorable Substitute

  33. PUBLIC HEARING 0303

  34. REF. TO JOINT COMM. ON Human Services

Sponsors

Sponsorship breakdown

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5 sponsors · 0 co-sponsors · 182 not signed on

Sponsors (5)

Co-sponsors (0)

None.

Not signed on (182)

182 members have not signed on to this bill.

Show all 182 →

"Not signed on" means a member has not sponsored or co-sponsored this bill — it does not imply opposition. Members flagged Voted No have a recorded No vote on this bill.

Whip count is in markup. Polling the chamber and every recorded vote this session. Only the first open is slow. It’s instant for you after this. Calling the roll · Tallying · Engrossing

Subjects

healthcare health-insurance
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Frequently asked questions

Who sponsors HB 5354?
HB 5354 is sponsored by Nicole Klarides-Ditria (Republican), Saud Anwar (Democratic), Kenneth Gucker (Democratic), Tom Delnicki (Republican), and Tracy Marra (Republican).
What is the current status of HB 5354?
This bill has been enacted into law. Introduced February 26, 2026. Enacted.
Where can I track HB 5354?
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