SB 341 — AN ACT CONCERNING RETURN OF HEALTH CARE PROVIDER PAYMENTS.

Senate General Assembly RaisedFile Bill No.

341209 February Session, 2026 LCOSenate Bill No.

2246341 ReferredtoCommitteeonINSURANCEANDREALSenate, ESTATEMarch Introduced26, by:2026 The Committee on Insurance and Real Estate reported through SEN.

(INS)CABRERA ANof ACTthe CONCERNING17th RETURNDist., OFChairperson HEALTHof CAREthe PROVIDERCommittee PAYMENTS.on the part of the Senate, that the bill ought to pass.

AN ACT CONCERNING RETURN OF HEALTH CARE PROVIDER PAYMENTS.

(C)SB341 Such/ organizationFile has paid the provider for such claim more than LCO 2246 1 of 3 Raised Bill No.

341209 once;1 SB341 File No.

209 (C) Such organization has paid the provider for such claim more than once;

LCOSB341 2246/ 2File of 3 Raised Bill No.

341209 (D)2 IfSB341 thereFile isNo. no appeal or an appeal is denied, such provider may resubmit an adjusted claim, if applicable, to such organization, not later than thirty days after the receipt of the notice required under subparagraph (A) of this subdivision or the denial of the appeal, whichever is applicable, except that if a return of payment was demanded pursuant to subparagraph (C) of subdivision (1) of this subsection, such claim shall not be resubmitted.

209 (D) If there is no appeal or an appeal is denied, such provider may resubmit an adjusted claim, if applicable, to such organization, not later than thirty days after the receipt of the notice required under subparagraph (A) of this subdivision or the denial of the appeal, whichever is applicable, except that if a return of payment was demanded pursuant to subparagraph (C) of subdivision (1) of this subsection, such claim shall not be resubmitted.

Section 1 January 1, 2027 Section 1 38a-479b(c) INS Joint Favorable LCOSB341 2246/ 3File ofNo. 3

209 3 SB341 File No.

209 The following Fiscal Impact Statement and Bill Analysis are prepared for the benefit of the members of the General Assembly, solely for purposes of information, summarization and explanation and do not represent the intent of the General Assembly or either chamber thereof for any purpose.

In general, fiscal impacts are based upon a variety of informational sources, including the analyst’s professional knowledge.

Whenever applicable, agency data is consulted as part of the analysis, however final products do not necessarily reflect an assessment from any specific department.

OFA Fiscal Note State Impact:

None Municipal Impact:

None Explanation The bill shortens the period in which a health carrier can demand return of payment from a health care provider due to error and results in no fiscal impact to the state.

SB341 / File No.

209 4 SB341 File No.

209 OLR Bill Analysis SB 341 AN ACT CONCERNING RETURN OF HEALTH CARE PROVIDER PAYMENTS.

SUMMARY This bill makes various changes to laws on claim payments and appeals between contracting health organizations (managed care organizations and preferred provider networks) and health care providers (for example, physicians).

Specifically, the bill:

1.

reduces, from 18 months to 12 months, the time period after receiving a clean (complete and error-free) claim by which a contracting health organization may generally cancel, deny, or demand full or partial return of payment from a health care provider for an administrative or eligibility error;

2.

specifies that for the existing requirement to give providers 30 days minimum advance notice of a payment cancellation, denial, or demand, notice must be sent (a) by certified mail, return receipt requested, if sent by mail or (b) to an email address the provider designates, if sent by email;

and 3.

requires the organization to notify the provider of its appeal determination within 15 business days after receiving the provider’s appeal, or else the appeal must be construed in the provider’s favor.

EFFECTIVE DATE:

January 1, 2027 SB341 / File No.

209 5 SB341 File No.

209 PAYMENT CANCELLATION, DENIAL, OR RETURN Time Limit Current law generally prohibits a contracting health organization from canceling, denying, or demanding the return of full or partial payment for an authorized covered service due to administrative or eligibility error, more than 18 months after receiving the claim.

The bill reduces this to 12 months after receiving the clean claim.

Under existing law, unchanged by the bill, the time limit does not apply if the:

1.

organization (a) has a documented basis to believe that the provider fraudulently submitted the claim, (b) already paid the provider for the claim, or (c) paid a claim that should have been or was paid by a federal or state program;

or 2.

provider (a) did not bill the claim appropriately based on documentation or evidence of what medical service was provided or (b)receivedpayment fromadifferent insurer, payor, or administrator through coordination of benefits, subrogation, or coverage under an automobile insurance or workers’ compensation policy.