Connecticut 2020 Regular Session

Connecticut Senate Bill SB00194 Compare Versions

Only one version of the bill is available at this time.

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4	4	LCO No. 1565 1 of 10
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6	6	General Assembly Raised Bill No. 194
7	7	February Session, 2020
8	8	LCO No. 1565
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10	10
11	11	Referred to Committee on HUMAN SERVICES
12	12
13	13
14	14	Introduced by:
15	15	(HS)
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19	19
20	20	AN ACT CONCERNING OB SOLETE REFERENCES RE LATING TO
21	21	THE DEPARTMENT OF SO CIAL SERVICES IN THE GENERAL
22	22	STATUTES.
23	23	Be it enacted by the Senate and House of Representatives in General
24	24	Assembly convened:
25	25
26	26	Section 1. Subsection (c) of section 17a-485d of the general statutes is 1
27	27	repealed and the following is substituted in lieu thereof (Effective July 1, 2
28	28	2020): 3
29	29	(c) The Commissioner of Social Services [shall take such action as may 4
30	30	be necessary to] may amend the Medicaid state plan to provide for 5
31	31	coverage of optional adult rehabilitation services supplied by providers 6
32	32	of mental health services or substance abuse rehabilitation services for 7
33	33	adults with serious and persistent mental illness or who have 8
34	34	alcoholism or other substance use disorders, that are certified by the 9
35	35	Department of Mental Health and Addiction Services. The 10
36	36	Commissioner of Social Services [shall] may adopt regulations, in 11
37	37	accordance with the provisions of chapter 54, to implement optional 12
38	38	rehabilitation services under the Medicaid program. The commissioner 13
39	39	[shall] may implement policies and procedures to administer such 14 Raised Bill No. 194
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41	41
42	42
43	43	LCO No. 1565 2 of 10
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45	45	services while in the process of adopting such policies or procedures in 15
46	46	regulation form, provided [notice of intention to adopt the regulations 16
47	47	is printed in the Connecticut Law Journal within forty-five days of 17
48	48	implementation, and any] the commissioner posts such policies and 18
49	49	procedures on the eRegulations System prior to adopting the policies 19
50	50	and procedures. Any such policies or procedures shall be valid until the 20
51	51	time final regulations are effective. 21
52	52	Sec. 2. Subsection (b) of section 17b-59a of the general statutes is 22
53	53	repealed and the following is substituted in lieu thereof (Effective July 1, 23
54	54	2020): 24
55	55	(b) The Commissioner of Social Services, in consultation with the 25
56	56	executive director of the Office of Health Strategy, established under 26
57	57	section 19a-754a, shall (1) develop, throughout the Departments of 27
58	58	Developmental Services, Public Health, Correction, Children and 28
59	59	Families, Veterans Affairs and Mental Health and Addiction Services, 29
60	60	uniform management information, uniform statistical information, 30
61	61	uniform terminology for similar facilities [,] and uniform electronic 31
62	62	health information technology standards, [and uniform regulations for 32
63	63	the licensing of human services facilities,] (2) plan for increased 33
64	64	participation of the private sector in the delivery of human services, (3) 34
65	65	provide direction and coordination to federally funded programs in the 35
66	66	human services agencies and recommend uniform system 36
67	67	improvements and reallocation of physical resources and designation of 37
68	68	a single responsibility across human services agencies lines to facilitate 38
69	69	shared services and eliminate duplication. 39
70	70	Sec. 3. Subsection (a) of section 17b-349 of the general statutes is 40
71	71	repealed and the following is substituted in lieu thereof (Effective July 1, 41
72	72	2020): 42
73	73	(a) The rates paid by the state to community health centers [and 43
74	74	freestanding medical clinics] participating in the Medicaid program 44
75	75	may be adjusted annually on the basis of the cost reports submitted to 45
76	76	the Commissioner of Social Services. [, except that rates effective July 1, 46 Raised Bill No. 194
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80	80	LCO No. 1565 3 of 10
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82	82	1989, shall remain in effect through June 30, 1990.] The Department of 47
83	83	Social Services may develop an alternative payment methodology to 48
84	84	replace the encounter-based reimbursement system. Such methodology 49
85	85	shall be approved by the joint standing committees of the General 50
86	86	Assembly having cognizance of matters relating to human services and 51
87	87	appropriations and the budgets of state agencies. Until such 52
88	88	methodology is implemented, the Department of Social Services shall 53
89	89	distribute supplemental funding, within available appropriations, to 54
90	90	federally qualified health centers based on cost, volume and quality 55
91	91	measures as determined by the Commissioner of Social Services. (1) 56
92	92	Beginning with the one-year rate period commencing on October 1, 57
93	93	2012, and annually thereafter, the Commissioner of Social Services may 58
94	94	add to a community health center's rates, if applicable, a capital cost rate 59
95	95	adjustment that is equivalent to the center's actual or projected year-to-60
96	96	year increase in total allowable depreciation and interest expenses 61
97	97	associated with major capital projects divided by the projected service 62
98	98	visit volume. For the purposes of this subsection, "capital costs" means 63
99	99	expenditures for land or building purchases, fixed assets, movable 64
100	100	equipment, capitalized financing fees and capitalized construction 65
101	101	period interest and "major capital projects" means projects with costs 66
102	102	exceeding two million dollars. The commissioner may revise such 67
103	103	capital cost rate adjustment retroactively based on actual allowable 68
104	104	depreciation and interest expenses or actual service visit volume for the 69
105	105	rate period. (2) The commissioner shall establish separate capital cost 70
106	106	rate adjustments for each Medicaid service provided by a center. (3) The 71
107	107	commissioner shall not grant a capital cost rate adjustment to a 72
108	108	community health center for any depreciation or interest expenses 73
109	109	associated with capital costs that were disapproved by the federal 74
110	110	Department of Health and Human Services or another federal or state 75
111	111	government agency with capital expenditure approval authority related 76
112	112	to health care services. (4) The commissioner may allow actual debt 77
113	113	service in lieu of allowable depreciation and interest expenses 78
114	114	associated with capital items funded with a debt obligation, provided 79
115	115	debt service amounts are deemed reasonable in consideration of the 80
116	116	interest rate and other loan terms. (5) The commissioner shall 81 Raised Bill No. 194
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122	122	implement policies and procedures necessary to carry out the 82
123	123	provisions of this subsection while in the process of adopting such 83
124	124	policies and procedures in regulation form, provided notice of intent to 84
125	125	adopt such regulations is [published in the Connecticut Law Journal not 85
126	126	later than twenty days after implementation] posted on the 86
127	127	eRegulations System prior to adoption of the policies and procedures. 87
128	128	Such policies and procedures shall be valid until the time final 88
129	129	regulations are effective. 89
130	130	Sec. 4. Section 38a-479aa of the general statutes is repealed and the 90
131	131	following is substituted in lieu thereof (Effective July 1, 2020): 91
132	132	(a) As used in this part and subsection (b) of section 20-138b: 92
133	133	(1) "Covered benefits" means health care services to which an enrollee 93
134	134	is entitled under the terms of a managed care plan; 94
135	135	(2) "Enrollee" means an individual who is eligible to receive health 95
136	136	care services through a preferred provider network; 96
137	137	(3) "Health care services" means health care related services or 97
138	138	products rendered or sold by a provider within the scope of the 98
139	139	provider's license or legal authorization, and includes hospital, medical, 99
140	140	surgical, dental, vision and pharmaceutical services or products; 100
141	141	(4) "Managed care organization" means (A) a managed care 101
142	142	organization, as defined in section 38a-478, (B) any other health insurer, 102
143	143	or (C) a reinsurer with respect to health insurance; 103
144	144	(5) "Managed care plan" has the same meaning as provided in section 104
145	145	38a-478; 105
146	146	(6) "Person" means an individual, agency, political subdivision, 106
147	147	partnership, corporation, limited liability company, association or any 107
148	148	other entity; 108
149	149	(7) "Preferred provider network" means a person that is not a 109
150	150	managed care organization, but that pays claims for the delivery of 110 Raised Bill No. 194
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156	156	health care services, accepts financial risk for the delivery of health care 111
157	157	services and establishes, operates or maintains an arrangement or 112
158	158	contract with providers relating to (A) the health care services rendered 113
159	159	by the providers, and (B) the amounts to be paid to the providers for 114
160	160	such services. "Preferred provider network" does not include (i) a 115
161	161	workers' compensation preferred provider organization established 116
162	162	pursuant to section 31-279-10 of the regulations of Connecticut state 117
163	163	agencies, (ii) an independent practice association or physician hospital 118
164	164	organization whose primary function is to contract with insurers and 119
165	165	provide services to providers, (iii) a clinical laboratory, licensed 120
166	166	pursuant to section 19a-30, whose primary payments for any contracted 121
167	167	or referred services are made to other licensed clinical laboratories or for 122
168	168	associated pathology services, or (iv) a pharmacy benefits manager 123
169	169	responsible for administering pharmacy claims whose primary function 124
170	170	is to administer the pharmacy benefit on behalf of a health benefit plan; 125
171	171	(8) "Provider" means an individual or entity duly licensed or legally 126
172	172	authorized to provide health care services; and 127
173	173	(9) "Commissioner" means the Insurance Commissioner. 128
174	174	(b) No preferred provider network may enter into or renew a 129
175	175	contractual relationship with a managed care organization or conduct 130
176	176	business in this state unless the preferred provider network is licensed 131
177	177	by the commissioner. Any person seeking to obtain or renew a license 132
178	178	shall submit an application to the commissioner, on such form as the 133
179	179	commissioner may prescribe, and shall include the filing described in 134
180	180	this subsection, except that a person seeking to renew a license may 135
181	181	submit only the information necessary to update its previous filing. 136
182	182	Such license shall be issued or renewed annually on July first and 137
183	183	applications shall be submitted by May first of each year in order to 138
184	184	qualify for the license issue or renewal date. The filing required from 139
185	185	such preferred provider network shall include the following 140
186	186	information: (1) The identity of the preferred provider network and any 141
187	187	company or organization controlling the operation of the preferred 142
188	188	provider network, including the name, business address, contact 143 Raised Bill No. 194
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194	194	person, a description of the controlling company or organization and, 144
195	195	where applicable, the following: (A) A certificate from the Secretary of 145
196	196	the State regarding the preferred provider network's and the controlling 146
197	197	company's or organization's good standing to do business in the state; 147
198	198	(B) a copy of the preferred provider network's and the controlling 148
199	199	company's or organization's financial statement completed in 149
200	200	accordance with sections 38a-53 and 38a-54, as applicable, for the end of 150
201	201	its most recently concluded fiscal year, along with the name and address 151
202	202	of any public accounting firm or internal accountant which prepared or 152
203	203	assisted in the preparation of such financial statement; (C) a list of the 153
204	204	names, official positions and occupations of members of the preferred 154
205	205	provider network's and the controlling company's or organization's 155
206	206	board of directors or other policy-making body and of those executive 156
207	207	officers who are responsible for the preferred provider network's and 157
208	208	controlling company's or organization's activities with respect to the 158
209	209	health care services network; (D) a list of the preferred provider 159
210	210	network's and the controlling company's or organization's principal 160
211	211	owners; (E) in the case of an out-of-state preferred provider network, 161
212	212	controlling company or organization, a certificate that such preferred 162
213	213	provider network, company or organization is in good standing in its 163
214	214	state of organization; (F) in the case of a Connecticut or out-of-state 164
215	215	preferred provider network, controlling company or organization, a 165
216	216	report of the details of any suspension, sanction or other disciplinary 166
217	217	action relating to such preferred provider network, or controlling 167
218	218	company or organization in this state or in any other state; and (G) the 168
219	219	identity, address and current relationship of any related or predecessor 169
220	220	controlling company or organization. For purposes of this 170
221	221	subparagraph, "related" means that a substantial number of the board 171
222	222	or policy-making body members, executive officers or principal owners 172
223	223	of both companies are the same; (2) a general description of the 173
224	224	preferred provider network and participation in the preferred provider 174
225	225	network, including: (A) The geographical service area of and the names 175
226	226	of the hospitals included in the preferred provider network; (B) the 176
227	227	primary care physicians, the specialty physicians, any other contracting 177
228	228	providers and the number and percentage of each group's capacity to 178 Raised Bill No. 194
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234	234	accept new patients; (C) a list of all entities on whose behalf the 179
235	235	preferred provider network has contracts or agreements to provide 180
236	236	health care services; (D) a table listing all major categories of health care 181
237	237	services provided by the preferred provider network; (E) an 182
238	238	approximate number of total enrollees served in all of the preferred 183
239	239	provider network's contracts or agreements; (F) a list of subcontractors 184
240	240	of the preferred provider network, not including individual 185
241	241	participating providers, that assume financial risk from the preferred 186
242	242	provider network and to what extent each subcontractor assumes 187
243	243	financial risk; (G) a contingency plan describing how contracted health 188
244	244	care services will be provided in the event of insolvency; and (H) any 189
245	245	other information requested by the commissioner; and (3) the name and 190
246	246	address of the person to whom applications may be made for 191
247	247	participation. 192
248	248	(c) Any person developing a preferred provider network, or 193
249	249	expanding a preferred provider network into a new county, pursuant to 194
250	250	this section and subsection (b) of section 20-138b, shall publish a notice, 195
251	251	in at least one newspaper having a substantial circulation in the service 196
252	252	area in which the preferred provider network operates or will operate, 197
253	253	indicating such planned development or expansion. Such notice shall 198
254	254	include the medical specialties included in the preferred provider 199
255	255	network, the name and address of the person to whom applications may 200
256	256	be made for participation and a time frame for making application. The 201
257	257	preferred provider network shall provide the applicant with written 202
258	258	acknowledgment of receipt of the app lication. Each complete 203
259	259	application shall be considered by the preferred provider network in a 204
260	260	timely manner. 205
261	261	(d) (1) Each preferred provider network shall file with the 206
262	262	commissioner and make available upon request from a provider the 207
263	263	general criteria for its selection or termination of providers. Disclosure 208
264	264	shall not be required of criteria deemed by the preferred provider 209
265	265	network to be of a proprietary or competitive nature that would hurt the 210
266	266	preferred provider network's ability to compete or to manage health 211
267	267	care services. For purposes of this section, criteria is of a proprietary or 212 Raised Bill No. 194
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273	273	competitive nature if it has the tendency to cause providers to alter their 213
274	274	practice pattern in a manner that would circumvent efforts to contain 214
275	275	health care costs and criteria is of a proprietary nature if revealing the 215
276	276	criteria would cause the preferred provider network's competitors to 216
277	277	obtain valuable business information. 217
278	278	(2) If a preferred provider network uses criteria that have not been 218
279	279	filed pursuant to subdivision (1) of this subsection to judge the quality 219
280	280	and cost-effectiveness of a provider's practice under any specific 220
281	281	program within the preferred provider network, the preferred provider 221
282	282	network may not reject or terminate the provider participating in that 222
283	283	program based upon such criteria until the provider has been informed 223
284	284	of the criteria that the provider's practice fails to meet. 224
285	285	(e) Each preferred provider network shall permit the Insurance 225
286	286	Commissioner to inspect its books and records. 226
287	287	(f) Each preferred provider network shall permit the commissioner to 227
288	288	examine, under oath, any officer or agent of the preferred provider 228
289	289	network or controlling company or organization with respect to the use 229
290	290	of the funds of the preferred provider network, company or 230
291	291	organization, and compliance with (1) the provisions of this part, and 231
292	292	(2) the terms and conditions of its contracts to provide health care 232
293	293	services. 233
294	294	(g) Each preferred provider network shall file with the commissioner 234
295	295	a notice of any material modification of any matter or document 235
296	296	furnished pursuant to this part, and shall include such supporting 236
297	297	documents as are necessary to explain the modification. 237
298	298	(h) Each preferred provider network shall maintain a minimum net 238
299	299	worth of either (1) the greater of (A) five hundred thousand dollars, or 239
300	300	(B) an amount equal to eight per cent of its annual expenditures as 240
301	301	reported on its most recent financial statement completed and filed with 241
302	302	the commissioner in accordance with sections 38a-53 and 38a-54, as 242
303	303	applicable, or (2) another amount determined by the commissioner. 243 Raised Bill No. 194
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309	309	(i) Each preferred provider network shall maintain or arrange for a 244
310	310	letter of credit, bond, surety, reinsurance, reserve or other financial 245
311	311	security acceptable to the commissioner for the exclusive use of paying 246
312	312	any outstanding amounts owed participating providers in the event of 247
313	313	insolvency or nonpayment except that any remaining security may be 248
314	314	used for the purpose of reimbursing managed care organizations in 249
315	315	accordance with subsection (b) of section 38a-479bb. Such outstanding 250
316	316	amount shall be at least an amount equal to the greater of (1) an amount 251
317	317	sufficient to make payments to participating providers for four months 252
318	318	determined on the basis of the four months within the past year with the 253
319	319	greatest amounts owed by the preferred provider network to 254
320	320	participating providers, (2) the actual outstanding amount owed by the 255
321	321	preferred provider network to participating providers, or (3) another 256
322	322	amount determined by the commissioner. Such amount may be credited 257
323	323	against the preferred provider network's minimum net worth 258
324	324	requirements set forth in subsection (h) of this section. The 259
325	325	commissioner shall review such security amount and calculation on a 260
326	326	quarterly basis. 261
327	327	(j) Each preferred provider network shall pay the applicable license 262
328	328	or renewal fee specified in section 38a-11. The commissioner shall use 263
329	329	the amount of such fees solely for the purpose of regulating preferred 264
330	330	provider networks. 265
331	331	(k) In no event, including, but not limited to, nonpayment by the 266
332	332	managed care organization, insolvency of the managed care 267
333	333	organization, or breach of contract between the managed care 268
334	334	organization and the preferred provider network, shall a preferred 269
335	335	provider network bill, charge, collect a deposit from, seek 270
336	336	compensation, remuneration or reimbursement from, or have any 271
337	337	recourse against an enrollee or an enrollee's designee, other than the 272
338	338	managed care organization, for covered benefits provided, except that 273
339	339	the preferred provider network may collect any copayments, 274
340	340	deductibles or other out-of-pocket expenses that the enrollee is required 275
341	341	to pay pursuant to the managed care plan. 276 Raised Bill No. 194
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347	347	(l) Each contract or agreement between a preferred provider network 277
348	348	and a participating provider shall contain a provision that if the 278
349	349	preferred provider network fails to pay for health care services as set 279
350	350	forth in the contract, the enrollee shall not be liable to the participating 280
351	351	provider for any sums owed by the preferred provider network or any 281
352	352	sums owed by the managed care organization because of nonpayment 282
353	353	by the managed care organization, insolvency of the managed care 283
354	354	organization or breach of contract between the managed care 284
355	355	organization and the preferred provider network. 285
356	356	(m) Each utilization review determination made by or on behalf of a 286
357	357	preferred provider network shall be made in accordance with section 287
358	358	38a-591d. 288
359	359	[(n) The requirements of subsections (h) and (i) of this section shall 289
360	360	not apply to a consortium of federally qualified health centers funded 290
361	361	by the state, providing services only to recipients of programs 291
362	362	administered by the Department of Social Services. The Commissioner 292
363	363	of Social Services shall adopt regulations, in accordance with chapter 54, 293
364	364	to establish criteria to certify any such federally qualified health center, 294
365	365	including, but not limited to, minimum reserve fund requirements.] 295
366	366	This act shall take effect as follows and shall amend the following
367	367	sections:
368	368
369	369	Section 1 July 1, 2020 17a-485d(c)
370	370	Sec. 2 July 1, 2020 17b-59a(b)
371	371	Sec. 3 July 1, 2020 17b-349(a)
372	372	Sec. 4 July 1, 2020 38a-479aa
373	373
374	374	Statement of Purpose:
375	375	To revise certain provisions in the general statutes containing obsolete
376	376	references to the Department of Social Services.
377	377	[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except
378	378	that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not
379	379	underlined.]
380	380