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HB 7039

AN ACT CONCERNING THE RETURN OF HEALTH CARE PROVIDER PAYMENTS, ESTABLISHING A WORKING GROUP TO STUDY PHARMACIST COMPENSATION FOR ADMINISTERING CERTAIN SERVICES, REVISING THE DEFINITION OF CLINICAL PEER AND CONCERNING THE CONNECTICUT UNFAIR INSURANCE PRACTICES ACT.

2025 Regular Session Introduced by Tom Delnicki and 1 co-sponsor

HB 7039 clarifies how incorrect provider payments are returned, studies pharmacist compensation for certain services, and updates standards for clinical peer definitions and unfair

FILE NO. 363
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Bill Summary · HB 7039

Summary — HB 7039 (File No. 363)

Title: AN ACT CONCERNING THE RETURN OF HEALTH CARE PROVIDER PAYMENTS, ESTABLISHING A WORKING GROUP TO STUDY PHARMACIST COMPENSATION FOR ADMINISTERING CERTAIN SERVICES, REVISING THE DEFINITION OF CLINICAL PEER AND CONCERNING THE CONNECTICUT UNFAIR INSURANCE PRACTICES ACT

Note: This summary is based on the bill title, subject tags, and available legislative actions. The full bill text was not provided; where specifics are not available in the public metadata, the summary indicates likely content or the provision’s purpose rather than quoting exact statutory language.

Main purpose and intent

HB 7039 appears intended to (1) provide statutory rules around returning incorrect or excess payments made to health care providers, (2) create a multi-stakeholder working group to study how pharmacists are compensated for delivering certain clinical services, (3) revise the statutory definition of “clinical peer” (a term used in insurer utilization review and appeals), and (4) make related changes to Connecticut’s Unfair Insurance Practices Act. The overall aim is to clarify payment/appeal processes, evaluate pharmacist reimbursement, and address certain insurance practice standards.

Key provisions (as indicated by title and subjects)

  • Return of provider payments
    • Establishes requirements or procedures for returning payments made to health care providers that are incorrect, duplicative, or otherwise improperly paid (exact triggers, timelines and return methods would be specified in the bill text).
  • Pharmacist compensation working group
    • Creates a working group to study pharmacist compensation for administering “certain services” (likely examples include immunizations, point-of-care testing, medication administration, or other pharmacist-provided clinical services).
    • The working group likely will include representatives from insurers, pharmacy professional boards, providers, patient advocates, and relevant state agencies and be charged with producing recommendations or a report.
  • Revision to “clinical peer”
    • Changes the statutory definition of “clinical peer,” which is commonly used to determine who can review clinical decisions in utilization review, external review, or appeals—potentially affecting which clinicians can render adverse determination reviews.
  • Amendments to the Connecticut Unfair Insurance Practices Act
    • Adds, clarifies, or modifies prohibited insurance practices—possibly in areas tied to provider payments, refunds, appeals, or insurer communications.

Who is affected

  • Health insurers and managed care organizations (policy and operational changes; compliance costs)
  • Health care providers (physicians, dentists, behavioral health, developmental disability providers, durable medical equipment suppliers such as wheelchair providers)
  • Pharmacists and pharmacy organizations (subject of the working group study; potential future changes to reimbursement)
  • Patients/consumers (effects via network stability, access to pharmacist services, or insurer practices)
  • State agencies and boards (Insurance Department, Department of Public Health, professional licensing bodies) — potential reporting or participation duties

Procedural / timeline information

  • Introduced: February 20, 2025
  • Public hearing: February 27, 2025
  • Joint Favorable Substitute reported: March 13, 2025
  • Filed with LCO: March 14, 2025
  • Referred to OLR and OFA: March 24, 2025; reports completed by March 31, 2025
  • Reported out of committee and tabled for House calendar: March 31, 2025 (House Calendar No. 245; File No. 363)

Implementation and next steps

  • The bill was favorably reported and placed on the House calendar; final enactment would require passage by both chambers and the governor’s signature.
  • The working group provision, if enacted, would likely have a statutory deadline for a report with recommendations; the exact timing and membership will appear in the bill text.
  • Stakeholders (insurers, provider groups, pharmacy organizations, disability and children’s advocates) should monitor any further amendments and the final bill text to understand precise compliance obligations and timelines.

If you would like, I can produce a redline-style list of likely statutory sections affected or draft a plain-language explainer for providers and insurers once the bill text is available.

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

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