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HB 6091

AN ACT CONCERNING AN EQUITABLE MEDICAID AUDIT, BILLING AND REIMBURSEMENT POLICY FOR PHARMACIES.

2025 Regular Session Introduced by Tom Delnicki and 3 co-sponsors

Bill establishes equitable Medicaid audit, billing, and reimbursement standards for Connecticut pharmacies to improve access and reduce administrative burden on providers.

REF. BY HOUSE TO COMMITTEE ON Appropriations
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Bill Summary · HB 6091

Legislative bill overview

HB 6091 seeks to establish more equitable audit, billing, and reimbursement policies for pharmacies operating under Connecticut's Medicaid program. The bill addresses concerns about how the state audits pharmacy claims and reimburses them for services rendered to Medicaid beneficiaries. This legislation aims to create standardized, fair procedures that protect pharmacies from excessive or arbitrary audit practices and ensure timely, adequate reimbursement.

Why is this important

Pharmacies are critical healthcare infrastructure, particularly for low-income Medicaid beneficiaries, but many struggle with Medicaid's complex audit and reimbursement processes that can create cash flow problems and administrative burden. Unfair audit practices or delayed reimbursement can threaten pharmacy viability, potentially reducing access to medications in underserved communities. Establishing equitable policies could improve pharmacy participation in Medicaid and ensure more reliable medication access for vulnerable populations.

Potential points of contention

  • Cost to the state: More generous reimbursement rates or stricter audit limitations could increase Connecticut's Medicaid expenditures, creating pressure on an already-strained state budget
  • Fraud prevention vs. fairness: Pharmacies may argue current audits are overly rigorous, while Medicaid administrators may contend strict audits are necessary to prevent fraud and waste of public funds
  • Scope of "equitable" policies: Disagreement over what specific audit and billing standards constitute fairness, including timeline protections, appeal processes, and reimbursement adequacy thresholds

Compiled from official sources — confirm details with the bill’s official record.

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