AN ACT CONCERNING MEDICAID PROVIDER AUDITS.
HB 5354 limits how Connecticut can audit Medicaid pharmacies by prohibiting the use of data extrapolation for minor clerical errors in audits. It requires the state to confirm notices to pharmacies about billing and maintain a real-time database of approved drugs on the preferred drug list. Pharmacies can challenge disputed reimbursements through a new grievance process starting October 2026, allowing them to present cost evidence. The bill directly affects pharmacies participating in Connecticut's Medicaid program and takes effect July 1, 2026.
Bill status
signed
all 5 stages cleared
Introduction
Feb 2026
Committee Review
Apr 2026
House Passage
May 2026
Senate Passage
May 2026
Signed into Law
Jun 2026
Introduced Feb 26, 2026
Signed Jun 2, 2026
Maddy AI version diff · 1 comparison
What changed between versions
Raised Bill
→
HS Joint Favorable Substitute
·
4 edits
MODERATE
The bill was renamed from a 'Raised Bill' to a 'Substitute Bill' and its title was broadened from 'Medicaid Pharmacy Audits' to 'Medicaid Provider Audits'. The core policy change redefines when the state can use statistical extrapolation to estimate overpayments, restricting this practice to cases involving sustained errors, suspected fraud, or significant financial discrepancies after educational interventions fail.
Scope change
The bill's scope expanded from applying only to pharmacies to applying to all providers (with specific exceptions for rate-set providers) across multiple Medicaid chapters.
SCOPE
The bill title and applicability were expanded from 'pharmacies' to 'providers' to include a broader range of healthcare entities.
ENFORCEMENT
The use of statistical extrapolation to determine overpayments is now restricted to specific conditions: sustained payment errors, suspected vendor fraud, or when errors exceed 1.75% of total claims after failed educational interventions.
REQUIREMENT
A new requirement limits the recoupment of extrapolated overpayments from pharmacists to only the amount of professional dispensing fees associated with the error.
TECHNICAL
The bill status changed from 'Raised Bill' to 'Substitute Bill' following a favorable joint committee vote.
Floor votes · Senate May 6, 2026 · House May 1, 2026
How they voted
36–0
Passed
Total votes 36
May 6, 2026
D
Democratic25
100% Yea
R
Republican11
100% Yea
Vote distribution
All Yea
All Nay
Mixed
No data
Full legislative history
Actions timeline
Total actions
34
Key actions
13
Committee
4
Amendments
4
Jun 2, 2026
Signed into law
SIGNED BY GOVERNOR
upper
May 6, 2026
Upper · Passed
HOUSE PASSED, SEN. AMEND. SCH. A
upper
May 6, 2026
Lower · Passed
HOUSE PASSED, HOUSE AMEND. SCH. A
lower
May 6, 2026
Lower · Passed
HOUSE ADOPTED SEN. AMEND. SCH. A
lower
May 6, 2026
Lower · Passed
SEN. PASSED, SEN. AMEND. SCH. A
lower
May 6, 2026
Upper · Passed
SEN. PASSED, HO. AMEND. SCH. A
upper
May 6, 2026
Upper · Passed
SEN. ADOPTED SEN. AMEND. SCH. A
upper
May 6, 2026
Upper · Passed
SEN. ADOPTED HO. AMEND. SCH. A
upper
May 1, 2026
Lower · Passed
HOUSE PASSED, HOUSE AMEND. SCH. A
lower
May 1, 2026
Lower · Passed
HOUSE ADOPTED HOUSE AMEND. SCH. A
lower
Apr 20, 2026
Lower · Passed
Joint Favorable
lower
Apr 14, 2026
Lower · Passed
REF. BY HOUSE TO COMMITTEE ON Finance, Revenue and Bonding
lower
Mar 19, 2026
Lower · Passed
Joint Favorable Substitute
lower
Feb 26, 2026
Committee
REF. TO JOINT COMM. ON Human Services
lower
5 primary · 0 co-sponsors
Sponsors
Ask Maddy
·
AI policy assistant
Ask Maddy about HB 5354
Scope: CT
Hi! I can help you understand HB 5354. What would you like to know?
Try one of these
i
Maddy answers using official bill text and legislative records. Always verify before sharing.
Sources cited inline