Connecticut 2026 Session Status: Enacted Bipartisan · 16 D · 6 R cosponsors

HB 5377 — AN ACT CONCERNING RETURN OF HEALTH CARE PROVIDER PAYMENTS.

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 May 27, 2026.

Odds of enactment

High chance

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

Upgrade to see the exact probability and what's driving it.

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

Prognosis

Likely to advance 78% · moderate confidence

  • Enacted

    Current position in the legislative process.

  • 22 sponsors

    22 primary, 0 co-sponsors signed on.

  • Bipartisan support

    Sponsored across 2 parties (16 D · 6 R) — 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 outlines the process for returning payments made to healthcare providers.

This bill establishes guidelines for how healthcare payments should be returned. It provides a structured approach to ensure payments are handled properly.

What this means for you
  • Healthcare: This means that healthcare providers will have a clear set of rules for returning payments.

Bill Text

What changed in the latest version

143 added · 296 removed

Plain-language change summary

The recent changes to Bill HB 5377 made adjustments to the time frame during which health organizations can cancel or deny payment for claims due to administrative errors. Specifically, the limit has been shortened from eighteen months to twelve months after a clean claim is received. This change is important because it provides greater financial security for healthcare providers, ensuring that they have more certainty about payments they receive for services rendered, while still allowing organizations to recover funds if there are legitimate reasons for canceling a claim.

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Previous
Latest
House of Representatives File No.
Substitute House Bill No.
722 General Assembly February Session, 2026Reprint of File No.
5377 Public Act No.
245) Substitute House Bill No.
26-56 AN ACT CONCERNING RETURN OF HEALTH CARE PROVIDER PAYMENTS.
5377 As Amended by House Amendment Schedule "A" Approved by the Legislative Commissioner April 27, 2026 AN ACT CONCERNING RETURN OF HEALTH CARE PROVIDER PAYMENTS.
sHB5377 / File No.
(C) Such organization has paid the provider for such claim more than once;
722 sHB5377 File No.
(D) Such organizationpaid a claim that should have beenor was paid Substitute House Bill No.
722 (C) Such organization has paid the provider for such claim more than once;
5377 by a federal or state program;
(D) Such organizationpaid a claim that should have beenor was paid by a federal or state program;
If any such organization fails to notify the provider of such organization's determination of such appeal not later than thirty business days after receipt of such appeal from such sHB5377 / File No.
If any such organization fails to notify the provider of such organization's determination of such appeal not later than thirty business days after receipt of such appeal from such provider, such appeal shall be construed in favor of such provider.
722 sHB5377 File No.
Any Public Act No.
722 provider, such appeal shall be construed in favor of such provider.
26-56 2 of 6 Substitute House Bill No.
Any demand for the return of full or partial payment shall be stayed during the pendency of such appeal.
5377 demand for the return of full or partial payment shall be stayed during the pendency of such appeal.
(A) Such insurer, center, society, corporation or other entity has a documentedbasistobelievethatsuchclaimwassubmittedfraudulently by such health care provider;
(A) Such insurer, center, society, corporation or other entity has a Public Act No.
sHB5377 / File No.
26-56 3 of 6 Substitute House Bill No.
722 sHB5377 File No.
5377 documentedbasistobelievethatsuchclaimwassubmittedfraudulently by such health care provider;
722 (B) The health care provider did not bill appropriately for such claim based on the documentation or evidence of what medical service was actually provided;
(B) The health care provider did not bill appropriately for such claim based on the documentation or evidence of what medical service was actually provided;
(2) (A) Such insurer, center, society, corporation or other entity shall give at least thirty days' advance notice to a health care provider by certifiedmail,return receipt requested, electronicmailto suchelectronic mail address designated by such health care provider or facsimile, or through a secure electronic health care provider portal or electronic clearinghouse used for claims or remittance communications, of the insurer's, center's, society's, corporation's or other entity's cancellation, denial or demand for the return of full or partial payment pursuant to subdivision (1) of this subsection.
(2) (A) Such insurer, center, society, corporation or other entity shall give at least thirty days' advance notice to a health care provider by certifiedmail,return receipt requested,electronicmailto suchelectronic mail address designated by such health care provider or facsimile, or through a secure electronic health care provider portal or electronic clearinghouse used for claims or remittance communications, of the insurer's, center's, society's, corporation's or other entity's cancellation, denial or demand for the return of full or partial payment pursuant to subdivision (1) of this subsection.
(B) If such insurer, center, society, corporation or other entity demands the return of full or partial payment from a health care provider, the notice required under subparagraph (A) of this subdivision shall disclose to the health care provider (i) the amount that is demanded to be returned, (ii) the claim that is the subject of such demand, and (iii) the basis on which such return is being demanded.
(B) If such insurer, center, society, corporation or other entity Public Act No.
sHB5377 / File No.
26-56 4 of 6 Substitute House Bill No.
722 sHB5377 File No.
5377 demands the return of full or partial payment from a health care provider, the notice required under subparagraph (A) of this subdivision shall disclose to the health care provider (i) the amount that is demanded to be returned, (ii) the claim that is the subject of such demand, and (iii) the basis on which such return is being demanded.
722 (C) Not later than thirty days after the receipt of the notice required under subparagraph (A) of this subdivision, a health care provider may appeal such cancellation, denial or demand in accordance with the procedures provided by such insurer, center, society, corporation or other entity, which shall include, but need not be limited to, an electronic appeal process.
(C) Not later than thirty days after the receipt of the notice required under subparagraph (A) of this subdivision, a health care provider may appeal such cancellation, denial or demand in accordance with the procedures provided by such insurer, center, society, corporation or other entity, which shall include, but need not be limited to, an electronic appeal process.
(E) A health care provider shall have one year after the date of the written notice set forth in subparagraph (A) of this subdivision to identify any other appropriate insurance coverage applicable on the date of service and to file a claim with such insurer, center, society, corporation or other issuing entity, regardless of such insurer's, center's, society's, corporation's or other issuing entity's timely filing requirements.
(E) A health care provider shall have one year after the date of the written notice set forth in subparagraph (A) of this subdivision to identify any other appropriate insurance coverage applicable on the date of service and to file a claim with such insurer, center, society, corporation or other issuing entity, regardless of such insurer's, center's, society's, corporation's or other issuing entity's timely filing Public Act No.
This act shall take effect as follows and shall amend the following sections:
26-56 5 of 6 Substitute House Bill No.
Section 1 January 1, 2027 38a-479b(c) Sec.
5377 requirements.
2 January 1, 2027 New section sHB5377 / File No.
Governor's Action:
722 sHB5377 File No.
Approved May 27, 2026 Public Act No.
722 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.
26-56 6 of 6
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 has no fiscal impact to the state or municipalities.
It makes changes to laws regarding claim payments and appeals between health insurers and health care providers.
These changes do not impact state and municipal health care plans.
House "A" alters the original bill by making technical changes regarding repayment from health care providers to insurers due to administrative or eligibility errors resulting in no fiscal impact.
sHB5377 / File No.
722 sHB5377 File No.
722 OLR Bill Analysis sHB 5377 (as amended by House "A")* AN ACT CONCERNING RETURN OF HEALTH CARE PROVIDER PAYMENTS AND SITE OF SERVICE BILLING REQUIREMENTS.
SUMMARY This bill makes changes to laws regarding claim payments and appeals between health care providers (for example, physicians) and (1) contracting health organizations (managed care organizations and preferred provider networks) or (2) health insurance carriers (for example, insurance companies, hospital or medical service corporations, HMOs, or fraternal benefit societies).
For contracting health organizations’ provider claim payment and appeals processes, the bill:
Show all 86 changed rows (46 more)
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Latest
1.
reduces, from 18 months to 12 months, the time period after receiving a clean (complete and error-free) claim during which a contracting health organization may generally cancel, deny, or demand full or partial return of payment from a health care provider due to an administrative or eligibility error;
2.
allows organizations to use a secure electronic provider portal or electronic clearinghouse used for claims or remittance communications to give providers the 30-day minimum advance notice of a payment cancellation, denial, or demand, notice required by law;
3.
specifies that if the above notice is sent by (a) mail, it must be sent by certified mail, return receipt requested, or (b) email, it must be sent to an email address the provider designates;
and sHB5377 / File No.
722 7 sHB5377 File No.
722 4.
requires the organization to notify the provider of its appeal determination within 30 business days after receiving the provider’s appeal, otherwise the appeal must be construed in the provider’s favor.
It also applies the provider claim payment and appeals provisions that apply to contracting health organizations, under existing law and the bill, to health insurance carriers that deliver, issue, renew, amend, or continue certain individual or group health insurance policies in Connecticut on or after January 1, 2027.
*House Amendment “A” (1) reduces, from 15 months to 12 months, the time limit in the underlying bill by which a health organization may take an adverse action on a full or partial payment of an authorized service;
(2)increases, from12businessdaysto30businessdays,the time limit in the underlying bill by which health organizations must notify providers of an appeal determination;
(3) deletes the provision in the underlying bill on off-site facility billing requirements;
and (4) applies the claim payment and appeals provisions that apply to contracting health organizations under existing law and the bill to certain health insurance carriers.
EFFECTIVE DATE:
January 1, 2027, and applicable to individual and group health insurance policies delivered, issued for delivery, renewed, amended, or continued in Connecticut on or after that date.
PROVIDER CLAIM PAYMENT AND APPEALS PROCESSES Contracting Health Organizations 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 clean 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 sHB5377 / File No.
722 8 sHB5377 File No.
722 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 providedor (b)receivedpayment fromadifferent insurer, payor, or administrator through coordination of benefits, subrogation, or coverage under an automobile insurance or workers’ compensation policy.
Advance Notice.
Under existing law, an organization must give a provider at least 30 days’ advance notice of a payment cancellation, denial, or return demand by mail, email, or fax.
The bill specifies that if the notice is sent by mail, it must be sent by certified mail, return receipt requested;
and if it is sent by email, it must be sent to the provider’s designated email.
The bill also gives organizations the option of providing this notice through a secure electronic provider portal or electronic clearinghouse used for claims or remittance communications.
Appeal.
By law, a provider may appeal, in accordance with the organization’s procedures, a payment cancellation, denial, or return demand within 30 days after receiving notice of it.
Current law does not specify a mode for the appeal process.
The bill explicitly requires organizations to have an electronic appeal process available to providers but allows them to have additionalmeans to appeal available.
Further, thebillrequirestheorganizationto notify theprovider ofthe appeal determination within 30 days after receiving the appeal.
Under the bill, if the organization fails to do so, then the appeal must be construed in the provider’s favor.
Existing law, unchanged by the bill, requires a payment return demand to be stayed (postponed) during the appeal.
sHB5377 / File No.
722 9 sHB5377 File No.
722 Health Insurance Carriers The bill applies the provider claim payment and appeals provisions that apply to contracting health organizations, under existing law and the bill (as described above), to health insurance carriers that deliver, issue, renew, amend, or continue individual or group health insurance policies in Connecticut on or after January 1, 2027, that cover (1) basic hospitalexpenses;(2)basicmedical-surgicalexpenses;(3)majormedical expenses;
or (4) hospital or medical services, including those provided under an HMO plan.
(Because of the federal Employee Retirement Income Security Act (ERISA), state insurance benefit mandates do not apply to self-insured benefit plans.) BACKGROUND Related Bill SB 341 (File 209), favorably reported by the Insurance and Real Estate Committee, has similar provisions on (1) provider payment, cancellation, denial, and return and (2) the appeal determination notice.
COMMITTEE ACTION Insurance and Real Estate Committee Joint Favorable Substitute Yea 13 Nay 0 (03/12/2026) sHB5377 / File No.
722 10
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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 26-56

  5. ON CONSENT CALENDAR /IN CONCURRENCE

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

  7. SEN. ADOPTED HO. AMEND. SCH. A

  8. FILE NO. 722

  9. SENATE CALENDAR NUMBER 458

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

  11. HOUSE PASSED, HOUSE AMEND. SCH. A

  12. HOUSE ADOPTED HOUSE AMEND. SCH. A

  13. FILE NO. 245

  14. HOUSE CALENDAR NUMBER 201

  15. FAV. RPT., TABLED FOR HOUSE CALENDAR

  16. RPTD. OUT OF LCO

  17. REFERRED TO Office of Legislative Research AND Office of Fiscal Analysis 03/30/26

  18. FILED WITH LCO

  19. Joint Favorable Substitute

  20. PUBLIC HEARING 0303

  21. REF. TO JOINT COMM. ON Insurance and Real Estate

Sponsors

Sponsorship breakdown

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22 sponsors · 0 co-sponsors · 165 not signed on

Sponsors (22)

Co-sponsors (0)

None.

Not signed on (165)

165 members have not signed on to this bill.

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"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.

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Frequently asked questions

Who sponsors HB 5377?
HB 5377 is sponsored by Tammy Nuccio (Republican), Saud Anwar (Democratic), Hector Arzeno (Democratic), Steven Winter (Democratic), Gary A. Turco (Democratic), Devin R. Carney (Republican), John-Michael Parker (Democratic), Mitch Bolinsky (Republican), Lucy Dathan (Democratic), Anne M. Hughes (Democratic), Jill Barry (Democratic), Renee LaMark Muir (Democratic), Michael DiGiovancarlo (Democratic), Christopher Poulos (Democratic), Julie Kushner (Democratic), William Heffernan (Democratic), Michael D. Quinn (Democratic), Tom Delnicki (Republican), Raghib Allie-Brennan (Democratic), Tony Hwang (Republican), Patrick E. Callahan (Republican), and Eilish Collins Main (Democratic).
What is the current status of HB 5377?
This bill has been enacted into law. Introduced February 26, 2026. Enacted.
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