General Assembly Substitute Bill No. 5411
February Session, 2010 *_____HB05411HS____032310____*
General Assembly
Substitute Bill No. 5411
February Session, 2010
*_____HB05411HS____032310____*
AN ACT CONCERNING MEDICAID.
Be it enacted by the Senate and House of Representatives in General Assembly convened:
Section 1. Section 17b-28e of the 2010 supplement to the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):
(a) The Commissioner of Social Services shall amend the Medicaid state plan to include, on and after January 1, 2009, hospice services as [optional services] a covered service under the Medicaid program. Said state plan amendment shall supersede any regulations of Connecticut state agencies concerning such optional services.
(b) The Commissioner of Social Services shall amend the Medicaid state plan to include, on and after January 1, 2011, podiatry services as a covered service under the Medicaid program. Said state plan amendment shall supersede any regulations of Connecticut state agencies concerning such optional services.
[(b)] (c) Not later than February 1, 2011, the Commissioner of Social Services shall amend the Medicaid state plan to include foreign language interpreter services provided to any beneficiary with limited English proficiency as a covered service under the Medicaid program. Not later than February 1, 2011, the commissioner shall develop and implement the use of medical billing codes for foreign language interpreter services for the HUSKY Plan, Part A and Part B, and for the fee-for-services Medicaid programs.
[(c)] (d) Each managed care organization that enters into a contract with the Department of Social Services to provide foreign language interpreter services under the HUSKY Plan, Part A shall report, semi-annually, to the department on the interpreter services provided to recipients of benefits under the program. Such written reports shall be submitted to the department not later than June first and December thirty-first each year. Not later than thirty days after receipt of such report, the department shall submit a copy of the report, in accordance with the provisions of section 11-4a, to the Medicaid Managed Care Council.
Sec. 2. Section 17b-278a of the general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2010):
[The] Not later than January 1, 2011, the Commissioner of Social Services shall amend the Medicaid state plan to provide coverage for treatment for smoking cessation ordered by a licensed health care professional who possesses valid and current state licensure to prescribe such drugs. [in accordance with a plan developed by the commissioner to provide smoking cessation services. The commissioner shall present such plan to the joint standing committees of the General Assembly having cognizance of matters relating to human services and appropriations by January 1, 2003, and, if such plan is approved by said committees and funding is provided in the budget for the fiscal year ending June 30, 2004, such plan shall be implemented on July 1, 2003. If the initial treatment provided to the patient for smoking cessation, as allowed by the plan, is not successful as determined by a licensed health care professional, all prescriptive options for smoking cessation shall be available to the patient.]
Sec. 3. Section 17b-28 of the 2010 supplement to the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):
(a) There is established a council on Medicaid care management oversight which shall advise the Commissioner of Social Services on the planning and implementation of a system of Medicaid [managed] care management and shall monitor such planning and implementation [and shall advise the Waiver Application Development Council, established pursuant to section 17b-28a,] on matters including, but not limited to, eligibility standards, benefits, access and quality assurance. The council shall be composed of the chairpersons and ranking members of the joint standing committees of the General Assembly having cognizance of matters relating to human services, public health and appropriations and the budgets of state agencies, or their designees; two members of the General Assembly, one to be appointed by the president pro tempore of the Senate and one to be appointed by the speaker of the House of Representatives; the director of the Commission on Aging, or a designee; the director of the Commission on Children, or a designee; the Healthcare Advocate, or a designee; a representative of each organization that has been selected by the state to provide managed care and a representative of a primary care case management provider, to be appointed by the president pro tempore of the Senate; two representatives of the insurance industry, to be appointed by the speaker of the House of Representatives; two advocates for persons receiving Medicaid, one to be appointed by the majority leader of the Senate and one to be appointed by the minority leader of the Senate; one advocate for persons with substance use disorders, to be appointed by the majority leader of the House of Representatives; one advocate for persons with psychiatric disabilities, to be appointed by the minority leader of the House of Representatives; two advocates for the Department of Children and Families foster families, one to be appointed by the president pro tempore of the Senate and one to be appointed by the speaker of the House of Representatives; two members of the public who are currently recipients of Medicaid, one to be appointed by the majority leader of the House of Representatives and one to be appointed by the minority leader of the House of Representatives; two representatives of the Department of Social Services, to be appointed by the Commissioner of Social Services; two representatives of the Department of Public Health, to be appointed by the Commissioner of Public Health; two representatives of the Department of Mental Health and Addiction Services, to be appointed by the Commissioner of Mental Health and Addiction Services; two representatives of the Department of Children and Families, to be appointed by the Commissioner of Children and Families; two representatives of the Office of Policy and Management, to be appointed by the Secretary of the Office of Policy and Management; and one representative of the office of the State Comptroller, to be appointed by the State Comptroller. [and the members of the Health Care Access Board who shall be ex-officio members and who may not designate persons to serve in their place.] The council shall choose a chair from among its members. The Joint Committee on Legislative Management shall provide administrative support to such chair. The council shall convene its first meeting no later than June 1, 1994.
(b) The council shall make recommendations concerning (1) guaranteed access to enrollees and effective outreach and client education; (2) available services comparable to those already in the Medicaid state plan, including those guaranteed under the federal Early and Periodic Screening, Diagnostic and Treatment Services Program under 42 USC 1396d; (3) the sufficiency of provider networks; (4) the sufficiency of capitated rates provider payments, financing and staff resources to guarantee timely access to services; (5) participation in [managed] care management programs by existing community Medicaid providers; (6) the linguistic and cultural competency of providers and other program facilitators; (7) quality assurance; (8) timely, accessible and effective client grievance procedures; (9) coordination of the Medicaid [managed care plan] care management programs with state and federal health care reforms; (10) eligibility levels for inclusion in the [program] programs; (11) cost-sharing provisions; (12) a benefit package; (13) coordination [with] of coverage under the HUSKY Plan, Part A, the HUSKY Plan, Part B and other health care programs administered by the Department of Social Services; (14) the need for program quality studies within the areas identified in this section and the department's application for available grant funds for such studies; (15) the [managed care portion of] HUSKY Plan, Part A, the HUSKY Plan, Part B, HUSKY Primary Care, the state-administered general assistance program, the Medicaid care management programs and the Charter Oak Health Plan; (16) other issues pertaining to the development of a Medicaid Research and Demonstration Waiver under Section 1115 of the Social Security Act; and (17) the primary care case management pilot program, established pursuant to section 17b-307.
(c) The Commissioner of Social Services shall seek a federal waiver for the Medicaid [managed care plan. Implementation of the Medicaid managed care plan shall not occur before July 1, 1995] care management program.
(d) The Commissioner of Social Services may, in consultation with an educational institution, apply for any available funding, including federal funding, to support Medicaid [managed] care management programs.
(e) The Commissioner of Social Services shall provide monthly reports on the plans and implementation of the Medicaid [managed care system] care management program to the council.
(f) The council shall report its activities and progress once each quarter to the General Assembly.
Sec. 4. Subsection (b) of section 17b-28a of the general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2010):
(b) There is established a Medicaid waiver unit within the Department of Social Services for the purposes of developing the waiver under subsection (a) of this section. The Medicaid waiver unit's responsibilities shall include but not be limited to the following: (1) Administrating the Medicaid [managed] care management program, established pursuant to section 17b-28, as amended by this act; (2) contracting with and evaluating prepaid health plans providing Medicaid services, including negotiation and establishment of capitated rates; (3) assessing quality assurance information compiled by the federally required independent quality assurance contractor; (4) monitoring contractual compliance; (5) evaluating enrollment broker performance; (6) providing assistance to the Insurance Department for the regulation of Medicaid managed care health plans; and (7) developing a system to compare performance levels among prepaid health plans providing Medicaid services.
Sec. 5. Subsection (b) of section 12-202a of the general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2010):
(b) Notwithstanding the provisions of subsection (a) of this section, the tax shall not apply to:
(1) Any new or renewal contract or policy entered into with the state on or after July 1, 1997, to provide health care coverage to state employees, retirees and their dependents;
(2) Any subscriber charges received from the federal government to provide coverage for Medicare patients;
(3) Any subscriber charges received under a contract or policy entered into with the state to provide health care coverage to Medicaid recipients under the Medicaid [managed] care management program established pursuant to section 17b-28, as amended by this act, which charges are attributable to a period on or after January 1, 1998;
(4) Any new or renewal contract or policy entered into with the state on or after April 1, 1998, to provide health care coverage to eligible beneficiaries under the HUSKY Medicaid Plan Part A, HUSKY Part B, or the HUSKY Plus programs, each as defined in section 17b-290;
(5) Any new or renewal contract or policy entered into with the state on or after April 1, 1998, to provide health care coverage to recipients of state-administered general assistance pursuant to section 17b-192;
(6) Any new or renewal contract or policy entered into with the state on or after February 1, 2000, to provide health care coverage to retired teachers, spouses or surviving spouses covered by plans offered by the state teachers' retirement system;
(7) Any new or renewal contract or policy entered into on or after July 1, 2001, to provide health care coverage to employees of a municipality and their dependents under a plan procured pursuant to section 5-259;
(8) Any new or renewal contract or policy entered into on or after July 1, 2001, to provide health care coverage to employees of nonprofit organizations and their dependents under a plan procured pursuant to section 5-259;
(9) Any new or renewal contract or policy entered into on or after July 1, 2003, to provide health care coverage to individuals eligible for a health coverage tax credit and their dependents under a plan procured pursuant to section 5-259;
(10) Any new or renewal contract or policy entered into on or after July 1, 2005, to provide health care coverage to employees of community action agencies and their dependents under a plan procured pursuant to section 5-259; or
(11) Any new or renewal contract or policy entered into on or after July 1, 2005, to provide health care coverage to retired members and their dependents under a plan procured pursuant to section 5-259.
Sec. 6. (NEW) (Effective from passage) The Commissioner of Social Services shall apply for a Medicaid Research and Demonstration Waiver under Section 1115 of the Social Security Act for the purpose of converting part or all of the state-funded portion of the Connecticut home care program for the elderly, established pursuant to section 17b-342 of the general statutes, to a Medicaid funded program. In the event that the state-funded portion of the Connecticut home care program is successfully converted to a Medicaid funded program, the commissioner shall deposit federal funds received pursuant to this section in the Long-Term Care Reinvestment Account, established pursuant to section 17b-371 of the general statutes, and shall expend such funds to increase rates for providers under the Connecticut home care program for the elderly.
This act shall take effect as follows and shall amend the following sections:
Section 1 from passage 17b-28e
Sec. 2 July 1, 2010 17b-278a
Sec. 3 from passage 17b-28
Sec. 4 July 1, 2010 17b-28a(b)
Sec. 5 July 1, 2010 12-202a(b)
Sec. 6 from passage New section
This act shall take effect as follows and shall amend the following sections:
Section 1
from passage
17b-28e
Sec. 2
July 1, 2010
17b-278a
Sec. 3
from passage
17b-28
Sec. 4
July 1, 2010
17b-28a(b)
Sec. 5
July 1, 2010
12-202a(b)
Sec. 6
from passage
New section
Statement of Legislative Commissioners:
In the last sentence of section 6, "the commissioner shall deposit funds received" was changed to "the commissioner shall deposit federal funds received" for clarity.
HS Joint Favorable Subst.
HS
Joint Favorable Subst.