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General Assembly Raised Bill No. 955
January Session, 2021
LCO No. 3831
Referred to Committee on HUMAN SERVICES
Introduced by:
(HS)
AN ACT CONCERNING OU TDATED DEPARTMENT OF SOCIAL
SERVICES STATUTES.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. Subsection (a) of section 16a-41a of the general statutes is 1
repealed and the following is substituted in lieu thereof (Effective July 1, 2
2021): 3
(a) The Commissioner of Social Services shall submit to the joint 4
standing committees of the General Assembly having cognizance of 5
energy planning and activities, appropriations, and human services the 6
following on the implementation of the block grant program authorized 7
under the Low-Income Home Energy Assistance Act of 1981, as 8
amended: 9
(1) Not later than August first, annually, a Connecticut energy 10
assistance program annual plan which establishes guidelines for the use 11
of funds authorized under the Low-Income Home Energy Assistance 12
Act of 1981, as amended, and includes the following: 13
(A) Criteria for determining which households are to receive 14 Raised Bill No. 955
LCO No. 3831 2 of 15
emergency [and weatherization] assistance; 15
(B) A description of systems used to ensure referrals to other energy 16
assistance programs and the taking of simultaneous applications, as 17
required under section 16a-41; 18
(C) A description of outreach efforts; 19
(D) Estimates of the total number of households eligible for assistance 20
under the program and the number of households in which one or more 21
elderly or physically disabled individuals eligible for assistance reside; 22
(E) Design of a basic grant for eligible households that does not 23
discriminate against such households based on the type of energy used 24
for heating; and 25
(F) A payment plan for fuel deliveries beginning November 1, 2018, 26
that ensures a vendor of deliverable fuel who completes deliveries 27
authorized by a community action agency that contracts with the 28
commissioner to administer a fuel assistance program is paid by the 29
community action agency not later than thirty business days after the 30
date the community action agency receives an authorized fuel slip or 31
invoice for payment from the vendor; 32
(2) Not later than January thirtieth, annually, a report covering the 33
preceding months of the program year, including: 34
(A) In each community action agency geographic area [and 35
Department of Social Services region,] the number of fuel assistance 36
applications filed, approved and denied, and the number of emergency 37
assistance requests made, approved and denied; [and the number of 38
households provided weatherization assistance;] 39
(B) In each such area and district, the total amount of fuel [,] and 40
emergency [and weatherization] assistance, itemized by such type of 41
assistance, and total expenditures to date; 42
(C) For each state-wide office of each state agency administering the 43 Raised Bill No. 955
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program [,] and each community action agency, [and each Department 44
of Social Services region,] administrative expenses under the program, 45
by line item, and an estimate of outreach expenditures; and 46
(D) A list of community action agencies that failed to make timely 47
payments to vendors of deliverable fuel in the Connecticut energy 48
assistance program and the steps taken by the commissioner to ensure 49
future timely payments by such agencies; and 50
(3) Not later than November first, annually, a report covering the 51
preceding twelve calendar months, including: 52
(A) In each community action agency geographic area [and 53
Department of Social Services region,] (i) seasonal totals for the 54
categories of data submitted under subdivision (1) of this subsection, (ii) 55
the number of households receiving fuel assistance in which elderly or 56
physically disabled individuals reside, and (iii) the average combined 57
benefit level of fuel, emergency and renter assistance; 58
[(B) Types of weatherization assistance provided; 59
(C) Percentage of weatherization assistance provided to tenants;] 60
[(D)] (B) The number of homeowners and tenants whose heat or total 61
energy costs are not included in their rent receiving fuel and emergency 62
assistance under the program by benefit level; 63
[(E)] (C) The number of homeowners and tenants whose heat is 64
included in their rent and who are receiving assistance, by benefit level; 65
and 66
[(F)] (D) The number of households receiving assistance, by energy 67
type and total expenditures for each energy type. 68
Sec. 2. Subsection (c) of section 17a-485d of the general statutes is 69
repealed and the following is substituted in lieu thereof (Effective July 1, 70
2021): 71 Raised Bill No. 955
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(c) The Commissioner of Social Services [shall] may take such action 72
[as may be] necessary to amend the Medicaid state plan to provide for 73
coverage of optional adult rehabilitation services supplied by providers 74
of mental health services or substance abuse rehabilitation services for 75
adults with serious and persistent mental illness or who have 76
alcoholism or other substance use disorders, that are certified by the 77
Department of Mental Health and Addiction Services. The 78
Commissioner of Social Services [shall] may adopt regulations, in 79
accordance with the provisions of chapter 54, as the commissioner 80
deems necessary, to implement optional rehabilitation services under 81
the Medicaid program. The commissioner [shall] may implement 82
policies and procedures to administer such services while in the process 83
of adopting such policies or procedures in regulation form, provided 84
[notice of intention to adopt the regulations is printed in the Connecticut 85
Law Journal within forty-five days of implementation, and any] the 86
commissioner posts the policies and procedures on the eRegulations 87
System prior to adopting the policies and procedures. Any such policies 88
or procedures shall be valid until the time final regulations are effective. 89
Sec. 3. Subsection (d) of section 17b-8 of the general statutes is 90
repealed and the following is substituted in lieu thereof (Effective July 1, 91
2021): 92
(d) The commissioner shall include with any waiver application or 93
proposed amendment submitted to the federal government pursuant to 94
this section: (1) Any written comments received pursuant to subsection 95
(c) of this section; and (2) [a complete transcript of the joint standing 96
committee proceedings held pursuant to subsection (a) of this section, 97
including] any additional written comments submitted to the joint 98
standing committees at such proceedings. The joint standing 99
committees shall transmit any such materials to the commissioner for 100
inclusion with any such waiver application or proposed amendment. 101
Sec. 4. Subsection (b) of section 17b-59a of the general statutes is 102
repealed and the following is substituted in lieu thereof (Effective July 1, 103
2021): 104 Raised Bill No. 955
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(b) The Commissioner of Social Services, in consultation with the 105
executive director of the Office of Health Strategy, established under 106
section 19a-754a, shall (1) develop, throughout the Departments of 107
Developmental Services, Public Health, Correction, Children and 108
Families, Veterans Affairs and Mental Health and Addiction Services, 109
uniform management information, uniform statistical information, 110
uniform terminology for similar facilities, and uniform electronic health 111
information technology standards, [and uniform regulations for the 112
licensing of human services facilities,] (2) plan for increased 113
participation of the private sector in the delivery of human services, (3) 114
provide direction and coordination to federally funded programs in the 115
human services agencies and recommend uniform system 116
improvements and reallocation of physical resources and designation of 117
a single responsibility across human services agencies lines to facilitate 118
shared services and eliminate duplication. 119
Sec. 5. Section 17b-306a of the general statutes is repealed and the 120
following is substituted in lieu thereof (Effective July 1, 2021): 121
(a) The Commissioner of Social Services, in collaboration with the 122
Commissioners of Public Health and Children and Families, shall 123
establish a child health quality improvement program for the purpose 124
of promoting the implementation of evidence-based strategies by 125
providers participating in the HUSKY Health program to improve the 126
delivery of and access to children's health services. Such strategies shall 127
focus on physical, dental and mental health services and shall include, 128
but need not be limited to: (1) Methods for early identification of 129
children with special health care needs; (2) integration of care 130
coordination and care planning into children's health services; (3) 131
implementation of standardized data collection to measure 132
performance improvement; and (4) implementation of family-centered 133
services in patient care, including, but not limited to, the development 134
of parent-provider partnerships. The Commissioner of Social Services 135
shall seek the participation of public and private entities that are 136
dedicated to improving the delivery of health services, including 137
medical, dental and mental health providers, academic professionals 138 Raised Bill No. 955
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with experience in health services research and performance 139
measurement and improvement, and any other entity deemed 140
appropriate by the Commissioner of Social Services, to promote such 141
strategies. The commissioner shall ensure that such strategies reflect 142
new developments and best practices in the field of children's health 143
services. As used in this section, "evidence-based strategies" means 144
policies, procedures and tools that are informed by research and 145
supported by empirical evidence, including, but not limited to, research 146
developed by organizations such as the American Academy of 147
Pediatrics, the American Academy of Family Physicians, the National 148
Association of Pediatric Nurse Practitioners and the Institute of 149
Medicine. 150
(b) Not later than July 1, 2008, and annually thereafter, the 151
Commissioner of Social Services shall report, in accordance with section 152
11-4a, to the joint standing committees of the General Assembly having 153
cognizance of matters relating to human services, public health and 154
appropriations, and to the Council on Medical Assistance Program 155
Oversight on (1) the implementation of any strategies developed 156
pursuant to subsection (a) of this section, and (2) the efficacy of such 157
strategies in improving the delivery of and access to health services for 158
children enrolled in the HUSKY Health program. 159
[(c) The Commissioner of Social Services, in collaboration with the 160
Council on Medical Assistance Program Oversight, shall, subject to 161
available appropriations, prepare, annually, a report concerning health 162
care choices under HUSKY A. Such report shall include, but not be 163
limited to, a comparison of the performance of each managed care 164
organization, the primary care case management program and other 165
member service delivery choices. The commissioner shall provide a 166
copy of each report to all HUSKY A members ] 167
Sec. 6. Subsection (a) of section 17b-349 of the general statutes is 168
repealed and the following is substituted in lieu thereof (Effective July 1, 169
2021): 170 Raised Bill No. 955
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(a) The rates paid by the state to community health centers [and 171
freestanding medical clinics] participating in the Medicaid program 172
may be adjusted annually on the basis of the cost reports submitted to 173
the Commissioner of Social Services. [, except that rates effective July 1, 174
1989, shall remain in effect through June 30, 1990.] The Department of 175
Social Services may develop an alternative payment methodology to 176
replace the encounter-based reimbursement system. Such methodology 177
shall be approved by the joint standing committees of the General 178
Assembly having cognizance of matters relating to human services and 179
appropriations and the budgets of state agencies. Until such 180
methodology is implemented, the Department of Social Services shall 181
distribute supplemental funding, within available appropriations, to 182
federally qualified health centers based on cost, volume and quality 183
measures as determined by the Commissioner of Social Services. (1) 184
Beginning with the one-year rate period commencing on October 1, 185
2012, and annually thereafter, the Commissioner of Social Services may 186
add to a community health center's rates, if applicable, a capital cost rate 187
adjustment that is equivalent to the center's actual or projected year-to-188
year increase in total allowable depreciation and interest expenses 189
associated with major capital projects divided by the projected service 190
visit volume. For the purposes of this subsection, "capital costs" means 191
expenditures for land or building purchases, fixed assets, movable 192
equipment, capitalized financing fees and capitalized construction 193
period interest and "major capital projects" means projects with costs 194
exceeding two million dollars. The commissioner may revise such 195
capital cost rate adjustment retroactively based on actual allowable 196
depreciation and interest expenses or actual service visit volume for the 197
rate period. (2) The commissioner shall establish separate capital cost 198
rate adjustments for each Medicaid service provided by a center. (3) The 199
commissioner shall not grant a capital cost rate adjustment to a 200
community health center for any depreciation or interest expenses 201
associated with capital costs that were disapproved by the federal 202
Department of Health and Human Services or another federal or state 203
government agency with capital expenditure approval authority related 204
to health care services. (4) The commissioner may allow actual debt 205 Raised Bill No. 955
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service in lieu of allowable depreciation and interest expenses 206
associated with capital items funded with a debt obligation, provided 207
debt service amounts are deemed reasonable in consideration of the 208
interest rate and other loan terms. (5) The commissioner shall 209
implement policies and procedures necessary to carry out the 210
provisions of this subsection while in the process of adopting such 211
policies and procedures in regulation form, provided notice of intent to 212
adopt such regulations is [published in the Connecticut Law Journal not 213
later than twenty days after implementation] posted on the 214
eRegulations System prior to adopting the policies and procedures. 215
Such policies and procedures shall be valid until the time final 216
regulations are effective. 217
Sec. 7. Section 38a-479aa of the general statutes is repealed and the 218
following is substituted in lieu thereof (Effective July 1, 2021): 219
(a) As used in this part and subsection (b) of section 20-138b: 220
(1) "Covered benefits" means health care services to which an enrollee 221
is entitled under the terms of a managed care plan; 222
(2) "Enrollee" means an individual who is eligible to receive health 223
care services through a preferred provider network; 224
(3) "Health care services" means health care related services or 225
products rendered or sold by a provider within the scope of the 226
provider's license or legal authorization, and includes hospital, medical, 227
surgical, dental, vision and pharmaceutical services or products; 228
(4) "Managed care organization" means (A) a managed care 229
organization, as defined in section 38a-478, (B) any other health insurer, 230
or (C) a reinsurer with respect to health insurance; 231
(5) "Managed care plan" has the same meaning as provided in section 232
38a-478; 233
(6) "Person" means an individual, agency, political subdivision, 234
partnership, corporation, limited liability company, association or any 235 Raised Bill No. 955
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other entity; 236
(7) "Preferred provider network" means a person that is not a 237
managed care organization, but that pays claims for the delivery of 238
health care services, accepts financial risk for the delivery of health care 239
services and establishes, operates or maintains an arrangement or 240
contract with providers relating to (A) the health care services rendered 241
by the providers, and (B) the amounts to be paid to the providers for 242
such services. "Preferred provider network" does not include (i) a 243
workers' compensation preferred provider organization established 244
pursuant to section 31-279-10 of the regulations of Connecticut state 245
agencies, (ii) an independent practice association or physician hospital 246
organization whose primary function is to contract with insurers and 247
provide services to providers, (iii) a clinical laboratory, licensed 248
pursuant to section 19a-30, whose primary payments for any contracted 249
or referred services are made to other licensed clinical laboratories or for 250
associated pathology services, or (iv) a pharmacy benefits manager 251
responsible for administering pharmacy claims whose primary function 252
is to administer the pharmacy benefit on behalf of a health benefit plan; 253
(8) "Provider" means an individual or entity duly licensed or legally 254
authorized to provide health care services; and 255
(9) "Commissioner" means the Insurance Commissioner. 256
(b) No preferred provider network may enter into or renew a 257
contractual relationship with a managed care organization or conduct 258
business in this state unless the preferred provider network is licensed 259
by the commissioner. Any person seeking to obtain or renew a license 260
shall submit an application to the commissioner, on such form as the 261
commissioner may prescribe, and shall include the filing described in 262
this subsection, except that a person seeking to renew a license may 263
submit only the information necessary to update its previous filing. 264
Such license shall be issued or renewed annually on July first and 265
applications shall be submitted by May first of each year in order to 266
qualify for the license issue or renewal date. The filing required from 267 Raised Bill No. 955
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such preferred provider network shall include the following 268
information: (1) The identity of the preferred provider network and any 269
company or organization controlling the operation of the preferred 270
provider network, including the name, business address, contact 271
person, a description of the controlling company or organization and, 272
where applicable, the following: (A) A certificate from the Secretary of 273
the State regarding the preferred provider network's and the controlling 274
company's or organization's good standing to do business in the state; 275
(B) a copy of the preferred provider network's and the controlling 276
company's or organization's financial statement completed in 277
accordance with sections 38a-53 and 38a-54, as applicable, for the end of 278
its most recently concluded fiscal year, along with the name and address 279
of any public accounting firm or internal accountant which prepared or 280
assisted in the preparation of such financial statement; (C) a list of the 281
names, official positions and occupations of members of the preferred 282
provider network's and the controlling company's or organization's 283
board of directors or other policy-making body and of those executive 284
officers who are responsible for the preferred provider network's and 285
controlling company's or organization's activities with respect to the 286
health care services network; (D) a list of the preferred provider 287
network's and the controlling company's or organization's principal 288
owners; (E) in the case of an out-of-state preferred provider network, 289
controlling company or organization, a certificate that such preferred 290
provider network, company or organization is in good standing in its 291
state of organization; (F) in the case of a Connecticut or out-of-state 292
preferred provider network, controlling company or organization, a 293
report of the details of any suspension, sanction or other disciplinary 294
action relating to such preferred provider network, or controlling 295
company or organization in this state or in any other state; and (G) the 296
identity, address and current relationship of any related or predecessor 297
controlling company or organization. For purposes of this 298
subparagraph, "related" means that a substantial number of the board 299
or policy-making body members, executive officers or principal owners 300
of both companies are the same; (2) a general description of the 301
preferred provider network and participation in the preferred provider 302 Raised Bill No. 955
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network, including: (A) The geographical service area of and the names 303
of the hospitals included in the preferred provider network; (B) the 304
primary care physicians, the specialty physicians, any other contracting 305
providers and the number and percentage of each group's capacity to 306
accept new patients; (C) a list of all entities on whose behalf the 307
preferred provider network has contracts or agreements to provide 308
health care services; (D) a table listing all major categories of health care 309
services provided by the preferred provider network; (E) an 310
approximate number of total enrollees served in all of the preferred 311
provider network's contracts or agreements; (F) a list of subcontractors 312
of the preferred provider network, not including individual 313
participating providers, that assume financial risk from the preferred 314
provider network and to what extent each subcontractor assumes 315
financial risk; (G) a contingency plan describing how contracted health 316
care services will be provided in the event of insolvency; and (H) any 317
other information requested by the commissioner; and (3) the name and 318
address of the person to whom applications may be made for 319
participation. 320
(c) Any person developing a preferred provider network, or 321
expanding a preferred provider network into a new county, pursuant to 322
this section and subsection (b) of section 20-138b, shall publish a notice, 323
in at least one newspaper having a substantial circulation in the service 324
area in which the preferred provider network operates or will operate, 325
indicating such planned development or expansion. Such notice shall 326
include the medical specialties included in the preferred provider 327
network, the name and address of the person to whom applications may 328
be made for participation and a time frame for making application. The 329
preferred provider network shall provide the applicant with written 330
acknowledgment of receipt of the application. Each complete 331
application shall be considered by the preferred provider network in a 332
timely manner. 333
(d) (1) Each preferred provider network shall file with the 334
commissioner and make available upon request from a provider the 335
general criteria for its selection or termination of providers. Disclosure 336 Raised Bill No. 955
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shall not be required of criteria deemed by the preferred provider 337
network to be of a proprietary or competitive nature that would hurt the 338
preferred provider network's ability to compete or to manage health 339
care services. For purposes of this section, criteria is of a proprietary or 340
competitive nature if it has the tendency to cause providers to alter their 341
practice pattern in a manner that would circumvent efforts to contain 342
health care costs and criteria is of a proprietary nature if revealing the 343
criteria would cause the preferred provider network's competitors to 344
obtain valuable business information. 345
(2) If a preferred provider network uses criteria that have not been 346
filed pursuant to subdivision (1) of this subsection to judge the quality 347
and cost-effectiveness of a provider's practice under any specific 348
program within the preferred provider network, the preferred provider 349
network may not reject or terminate the provider participating in that 350
program based upon such criteria until the provider has been informed 351
of the criteria that the provider's practice fails to meet. 352
(e) Each preferred provider network shall permit the Insurance 353
Commissioner to inspect its books and records. 354
(f) Each preferred provider network shall permit the commissioner to 355
examine, under oath, any officer or agent of the preferred provider 356
network or controlling company or organization with respect to the use 357
of the funds of the preferred provider network, company or 358
organization, and compliance with (1) the provisions of this part, and 359
(2) the terms and conditions of its contracts to provide health care 360
services. 361
(g) Each preferred provider network shall file with the commissioner 362
a notice of any material modification of any matter or document 363
furnished pursuant to this part, and shall include such supporting 364
documents as are necessary to explain the modification. 365
(h) Each preferred provider network shall maintain a minimum net 366
worth of either (1) the greater of (A) five hundred thousand dollars, or 367
(B) an amount equal to eight per cent of its annual expenditures as 368 Raised Bill No. 955
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reported on its most recent financial statement completed and filed with 369
the commissioner in accordance with sections 38a-53 and 38a-54, as 370
applicable, or (2) another amount determined by the commissioner. 371
(i) Each preferred provider network shall maintain or arrange for a 372
letter of credit, bond, surety, reinsurance, reserve or other financial 373
security acceptable to the commissioner for the exclusive use of paying 374
any outstanding amounts owed participating providers in the event of 375
insolvency or nonpayment except that any remaining security may be 376
used for the purpose of reimbursing managed care organizations in 377
accordance with subsection (b) of section 38a-479bb. Such outstanding 378
amount shall be at least an amount equal to the greater of (1) an amount 379
sufficient to make payments to participating providers for four months 380
determined on the basis of the four months within the past year with the 381
greatest amounts owed by the preferred provider network to 382
participating providers, (2) the actual outstanding amount owed by the 383
preferred provider network to participating providers, or (3) another 384
amount determined by the commissioner. Such amount may be credited 385
against the preferred provider network's minimum net worth 386
requirements set forth in subsection (h) of this section. The 387
commissioner shall review such security amount and calculation on a 388
quarterly basis. 389
(j) Each preferred provider network shall pay the applicable license 390
or renewal fee specified in section 38a-11. The commissioner shall use 391
the amount of such fees solely for the purpose of regulating preferred 392
provider networks. 393
(k) In no event, including, but not limited to, nonpayment by the 394
managed care organization, insolvency of the managed care 395
organization, or breach of contract between the managed care 396
organization and the preferred provider network, shall a preferred 397
provider network bill, charge, collect a deposit from, seek 398
compensation, remuneration or reimbursement from, or have any 399
recourse against an enrollee or an enrollee's designee, other than the 400
managed care organization, for covered benefits provided, except that 401 Raised Bill No. 955
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the preferred provider network may collect any copayments, 402
deductibles or other out-of-pocket expenses that the enrollee is required 403
to pay pursuant to the managed care plan. 404
(l) Each contract or agreement between a preferred provider network 405
and a participating provider shall contain a provision that if the 406
preferred provider network fails to pay for health care services as set 407
forth in the contract, the enrollee shall not be liable to the participating 408
provider for any sums owed by the preferred provider network or any 409
sums owed by the managed care organization because of nonpayment 410
by the managed care organization, insolvency of the managed care 411
organization or breach of contract between the managed care 412
organization and the preferred provider network. 413
(m) Each utilization review determination made by or on behalf of a 414
preferred provider network shall be made in accordance with section 415
38a-591d. 416
[(n) The requirements of subsections (h) and (i) of this section shall 417
not apply to a consortium of federally qualified health centers funded 418
by the state, providing services only to recipients of programs 419
administered by the Department of Social Services. The Commissioner 420
of Social Services shall adopt regulations, in accordance with chapter 54, 421
to establish criteria to certify any such federally qualified health center, 422
including, but not limited to, minimum reserve fund requirements.] 423
Sec. 8. Section 17b-608 of the general statutes is repealed and the 424
following is substituted in lieu thereof (Effective July 1, 2021): 425
For the purposes of [sections 17b-609 and 17b-610] section 17b-609, 426
"persons with disabilities" means persons having disabilities which (1) 427
are attributable to a mental or physical impairment or a combination of 428
mental and physical impairments; (2) are likely to continue indefinitely; 429
(3) result in functional limitations in one or more of the following areas 430
of major life activity: Self care, receptive and expressive language, 431
learning, mobility, self-direction, capacity for independent living or 432
economic self-sufficiency; and (4) reflect the person's need for a 433 Raised Bill No. 955
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combination and sequence of special, interdisciplinary or generic care, 434
treatment or other services which are of lifelong or extended duration 435
and individually planned and coordinated. 436
Sec. 9. Sections 17b-184, 17b-274a and 17b-610 of the general statutes 437
are repealed. (Effective July 1, 2021) 438
This act shall take effect as follows and shall amend the following
sections:
Section 1 July 1, 2021 16a-41a(a)
Sec. 2 July 1, 2021 17a-485d(c)
Sec. 3 July 1, 2021 17b-8(d)
Sec. 4 July 1, 2021 17b-59a(b)
Sec. 5 July 1, 2021 17b-306a
Sec. 6 July 1, 2021 17b-349(a)
Sec. 7 July 1, 2021 38a-479aa
Sec. 8 July 1, 2021 17b-608
Sec. 9 July 1, 2021 Repealer section
Statement of Purpose:
To delete outdated or obsolete provisions of statutes concerning the
Department of Social Services.
[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except
that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not
underlined.]