O F F I C E O F L E G I S L A T I V E R E S E A R C H
P U B L I C A C T S U M M A R Y
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PA 23-186—sSB 989
Human Services Committee
Judiciary Committee
AN ACT CONCERNING NO NPROFIT PROVIDER RET ENTION OF
CONTRACT SAVINGS, CO MMUNITY HEALTH WORKE R MEDICAID
REIMBURSEMENT AND ST UDIES OF MEDICAID RA TES OF
REIMBURSEMENT, NURSI NG HOME TRANSPORTATI ON AND
NURSING HOME WAITING LISTS
SUMMARY: This act makes several changes in laws concerning human services
providers. Specifically, it does the following:
1. requires the Department of Social Services (DSS) to (1) conduct a two-part
study of Medicaid reimbursement rates and (2) implement a program to
provide Medicaid reimbursement to certified community health workers
(CHW) (§§ 1 & 4);
2. requires DSS and certain other state agencies to allow nonprofit private
provider organizations that provide health and human services to retain any
savings from a purchase of service contract at the end of each fiscal year,
so long as the organization otherwise meets contractual requirements (§§ 2
& 3);
3. allows nursing homes to provide nonemergency transportation for their
residents to travel to their family members’ homes under certain
circumstances and requires DSS to evaluate whether federal funding may
be available for this transportation (§ 5); and
4. requires the State Long-Term Care Ombudsman and the Department of
Public Health (DPH) and DSS commissioners to convene a working group
on nursing home waiting list requirements and report any recommended
changes to the Human Services and Public Health committees by January
1, 2024 (§ 6).
EFFECTIVE DATE: Upon passage, except provisions on nonprofit providers’
contract savings and nursing home transportation are effective on July 1, 2023.
§ 1 — MEDICAID REIMBURSEMENT RATE STUDY
The act requires the DSS commissioner, within available appropriations, to
conduct a two-part study of Medicaid reimbursement that must compare state
Medicaid rates to (1) Medicaid rates in neighboring states and (2) Medicare rates
and cost-of-living increases.
For the first part, DSS must examine Medicaid rates for physician specialists,
dentists, and behavioral health providers; and for the second part, it must review
the reimbursement system for all other aspects of the Medicaid program (e.g.,
ambulance services, federally qualified health centers, specialty hospitals, complex O L R P U B L I C A C T S U M M A R Y
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nursing care, and methadone maintenance). The department must file interim
reports with the Appropriations and Human Services committees on the first part
by February 1, 2024, and on the second part by January 1, 2025.
The act specifies that it does not impact Medicaid reimbursement rates for FYs
24 or 25.
§§ 2 & 3 — NONPROFIT PROVIDER CONTRACT SAVINGS
The act requires certain state agencies to allow nonprofit private provider
organizations to retain any savings from a purchase of service contract at the end
of the fiscal year. A “purchase of service contract” is a contract between a state
agency and private provider organization for direct health and human services for
agency clients. It generally excludes administrative or clerical services; material
goods, training, or consulting services; or contracts with individuals (CGS § 4-
70b(1)). The act specifically applies to contracts with the Department of
Developmental Services (DDS), the Department of Mental Health and Addiction
Services (DMHAS), DSS, or the Department of Children and Families (DCF) for
health and human services. These services directly support health, safety, and
welfare for state residents, including those with behavioral health disorders,
disabilities, or autism spectrum disorder.
The act allows a provider to only use retained funds to strengthen quality, invest
in deferred maintenance, and make asset improvements, but it explicitly allows
them to expend retained funds on programs funded by the same state agency. To
retain savings, a provider must otherwise meet its contractual arrangements,
including obligations for services provided and clients served. It must also apply to
the state agency, describing how it plans to reinvest savings, and report to the state
agency on how it will reinvest savings for the allowed purposes described above.
The act requires DCF, DDS, DMHAS, and DSS commissioners to (1) prescribe
application forms and report frequency; (2) review and respond to any submitted
application within 90 days after receiving it; and (3) approve, disapprove, or modify
any application in accordance with the allowed purposes described above.
The act prohibits DCF, DDS, DMHAS, and DSS from attempting to recover or
otherwise offset funds retained by a provider from their contracted cost for services
(i.e., it prohibits agency efforts to recoup savings at the end of each fiscal year).
The act also prohibits these agencies from allowing a provider to retain savings if
(1) the contract is federally funded and (2) it is prohibited by federal law or
regulations or would jeopardize federal funding.
The act authorizes the DSS commissioner to study nonprofit private provider
organization contracting and billing practices to ensure compliance with Medicaid
waivers and state plan amendments. If she undertakes this study, she must (1)
consult with the Office of Policy and Management (OPM) secretary and the DCF,
DMHAS, and DDS commissioners and (2) complete it by December 31, 2024.
The act also authorizes the DDS commissioner, in consultation with the OPM
secretary, to extend the act’s provisions on retained savings to other private
provider organizations that contract with DDS, so long as they meet the act’s
requirements (e.g., meeting contract terms and conditions for DDS services). O L R P U B L I C A C T S U M M A R Y
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Prior law required the OPM secretary to establish a more general incentive
program for nonprofit human services providers to allow them to retain savings and
prohibit state agencies from reducing future contracted amounts to reflect those
savings. The act eliminates this requirement.
§ 4 — MEDICAID REIMBURSEMENT FOR CERTIFIED COMMUNITY
HEALTH WORKERS (CHW)
A CHW is a public health outreach professional with an in-depth understanding
of a community’s experience, language, culture, and socioeconomic needs who
provides services that include outreach, engagement, education, coaching, informal
counseling, social support, advocacy, care coordination, research related to social
determinants of health, and basic screenings and assessments of associated risks
(CGS § 20-195ttt(1)).
The act requires the DSS commissioner to design and implement a program to
provide Medicaid reimbursement to certified CHWs for services provided to
HUSKY Health program members, including the following services:
1. coordinating medical, oral, and behavioral health care services and social
supports;
2. navigating and connecting to health systems and services;
3. prenatal, birth, lactation, and postpartum supports; and
4. health promotion, coaching, and self-management education.
The commissioner must design and implement the program in consultation with
certified CHWs, Medicaid beneficiaries, and advocates, including advocates for
people with disabilities, and others. These consultations must (1) include
community-based and clinic-based certified CHWs, (2) represent medical
assistance program member demographics, and (3) help shape the program’s design
and implementation. The commissioner, and those with whom she consults, must
explore options for the program’s design that ensure access to CHWs, encourage
workforce growth to support this access, and avert the risk of creating financial
incentives for other providers to limit access to CHWs.
Starting by January 1, 2024, and continuing until the program is fully
implemented, the act requires the DSS commissioner to report annually to the
Human Services Committee and the Council on Medical Assistance Program
Oversight (MAPOC). The act requires her to submit the initial report at least six
months before implementing the reimbursement program. The report must include
an update on the program’s design and analyze program elements designed to (1)
ensure access to CHW services, (2) promote workforce growth, and (3) avert risk
of creating financial incentives for other providers to limit access to CHWs. It must
also evaluate the program’s impact on health outcome and health equity.
§ 5 — NURSING HOMES AND NONEMERGENCY TRAN SPORTATION
The act allows a nursing home to provide nonemergency transportation for
nonambulatory residents to their family members’ homes if (1) it has available
vehicles equipped to transport these residents; (2) the family members live within O L R P U B L I C A C T S U M M A R Y
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15 miles of the nursing home; and (3) a physician, physician’s assistant, or
advanced practice registered nurse approves the transportation at least five days in
advance. The act specifies that it must not be construed to authorize or require any
payment or reimbursement to a nursing home for this transportation service.
The act requires the DSS commissioner to (1) evaluate whether the need for this
transportation qualifies as a health-related social need and (2) by October 1, 2023,
report on this evaluation and any potential federal funding for this transportation to
MAPOC. Under the act, a “health-related social need” is a health need deriving
from an adverse social condition that contributes to poor health and health
disparities (e.g., the need for reliable transportation).
§ 6 — NURSING HOME WAITING LIST WORKING GROUP
Existing law sets requirements for nursing home waiting lists, generally
requiring nursing homes to admit applicants in the order in which they apply,
provide a receipt for each person who requests to be placed on a waiting list, and
maintain a dated list of applications, among other things (CGS § 19a-533).
The act requires the State Long-Term Care Ombudsman and the DPH and DSS
commissioners to (1) convene a working group on any necessary revisions to the
statutory requirements for nursing home waiting lists and (2) report to the Human
Services and Public Health committees by January 1, 2024, on any recommended
changes, including allowing nursing homes to keep waiting lists in electronic form.
The working group’s members must include (1) the ombudsman and
commissioners, or their designees, and (2) two nursing home industry
representatives, appointed by the DSS commissioner. The working group must
meet monthly, and the ombudsman and the DSS commissioner, or their designees,
must serve as chairpersons.