Substitute Senate Bill No. 989
Public Act No. 23-186
AN ACT CONCERNING NONPROFIT PROVIDER RETENTION OF
CONTRACT SAVINGS, COMMUNITY HEALTH WORKER MEDICAID
REIMBURSEMENT AND STUDIES OF MEDICAID RATES OF
REIMBURSEMENT, NURSING HOME TRANSPORTATION AND
NURSING HOME WAITING LISTS.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. (Effective from passage) (a) Within available appropriations,
the Commissioner of Social Services shall conduct a two-part study of
Medicaid rates of reimbursement beginning with (1) an examination of
such rates for physician specialists, dentists and behavioral health
providers followed by (2) a review of the reimbursement system for all
other aspects of the Medicaid program, including, but not limited to,
ambulance services, the encounter-based reimbursement model for
federally qualified health centers and reimbursement rates for specialty
hospitals, complex nursing care and methadone maintenance.
(b) The rate reimbursement study shall include, but need not be
limited to: (1) A comparison of the state's Medicaid rates with Medicaid
rates provided by neighboring states; and (2) a comparison of the state's
Medicaid rates with Medicare rates and cost-of-living increases
provided under Medicare compared to the state Medicaid program.
(c) The commissioner shall file interim reports, in accordance with the Substitute Senate Bill No. 989
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provisions of section 11-4a of the general statutes, (1) not later than
February 1, 2024, on the aspects of the study conducted pursuant to
subdivision (1) of subsection (a) of this section; and (2) not later than
January 1, 2025, on the aspects of the study conducted pursuant to
subdivision (2) of subsection (a) of this section with the joint standing
committees of the General Assembly having cognizance of matters
relating to appropriations and the budgets of state agencies and human
services. Nothing in this section shall be construed to impact Medicaid
rates of reimbursement for the fiscal years ending June 30, 2024, and
June 30, 2025.
Sec. 2. (NEW) (Effective July 1, 2023) (a) As used in this section, (1)
"private provider organization" and "purchase of service contract" each
have the same meanings as provided in section 4-70b of the general
statutes; (2) "health and human services" means services provided under
contract with a state agency that directly support the health, safety and
welfare of residents, including, but not limited to, those residents who
may have conditions that include, but are not limited to, behavioral
health disorders, intellectual disabilities, developmental disabilities,
physical disabilities and autism spectrum disorder; (3) "attempt to
recover or otherwise offset" means efforts to recoup savings at the end
of each fiscal year; and (4) "state agency" means the Departments of
Developmental Services, Mental Health and Addiction Services, Social
Services and Children and Families.
(b) Subject to the provisions of subsection (c) of this section, each state
agency that contracts with a nonprofit private provider organization for
health and human services shall allow such nonprofit organization that
otherwise meets contractual requirements, including, but not limited to,
its contractual obligations regarding services provided and clients
served, to retain any savings from a purchase of service contract at the
end of each fiscal year. No state agency shall attempt to recover or
otherwise offset funds retained by such nonprofit organization from the Substitute Senate Bill No. 989
Public Act No. 23-186 3 of 8
contracted cost for services.
(c) Any nonprofit private provider organization allowed to retain
savings under this section shall submit an application to the contracting
state agency on how savings are planned to be reinvested and report to
the contracting state agency on how savings will be reinvested to
strengthen quality, invest in deferred maintenance and make asset
improvements. The commissioner of each state agency shall prescribe
the form and manner of such application form and the frequency of such
reports. The commissioner of each state agency shall review an
application submitted pursuant to this subsection and respond to a
nonprofit private provider organization not later than ninety days after
receiving such application from such provider organization. Retained
funds may only be used for the purposes of strengthening quality,
investing in deferred maintenance and making asset improvements. The
commissioner of each state agency shall approve, disapprove or modify
any application for funds in accordance with the allowable uses in this
subsection. Nonprofit private provider organizations providing health
and human services shall be permitted to expend retained funds on
programs that are funded by the same state agency.
(d) Notwithstanding any provisions to the contrary in this section, a
state agency shall not allow a nonprofit private provider organization
to retain surplus funds from the contracted cost of services under a
contract funded in whole, or in part, with federal funds when allowing
such organization to retain such funds would jeopardize federal
funding or reimbursement for such contract or when such allowance is
prohibited by federal law or regulations.
(e) The Commissioner of Social Services, in consultation with the
Secretary of the Office of Policy and Management and the
Commissioners of Children and Families, Mental Health and Addiction
Services and Developmental Services, may undertake a study of the
contracting and billing practices of such nonprofit private provider Substitute Senate Bill No. 989
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organizations to ensure compliance with all Medicaid waivers and
Medicaid state plan amendments. Any study started under this
subsection shall be completed not later than December 31, 2024.
(f) Notwithstanding the provisions of subsections (a) to (e), inclusive,
of this section, the Commissioner of Developmental Services, in
consultation with the Secretary of the Office of Policy and Management,
may extend the provisions of this section to other private provider
organizations with which the Department of Developmental Services
contracts, provided they meet all of the requirements set forth in this
section, including, but not limited to, meeting all terms and conditions
of their contracts for services with the Department of Developmental
Services.
Sec. 3. Section 4-216 of the general statutes is repealed and the
following is substituted in lieu thereof (Effective July 1, 2023):
(a) No state agency may execute a personal service agreement having
a cost of more than fifty thousand dollars or a term of more than one
year, without the approval of the secretary. A state agency may apply
for an approval by submitting the following information to the
secretary: (1) A description of the services to be purchased and the need
for such services; (2) an estimate of the cost of the services and the term
of the agreement; (3) whether the services are to be on-going; (4)
whether the state agency has contracted out for such services during the
preceding two years and, if so, the name of the contractor, term of the
agreement with such contractor and the amount paid to the contractor;
(5) whether any other state agency has the resources to provide the
services; (6) whether the agency intends to purchase the services by
competitive negotiation and, if not, why; and (7) whether it is possible
to purchase the services on a cooperative basis with other state agencies.
The secretary shall approve or disapprove an application within fifteen
business days after receiving it and any necessary supporting
information, provided if the secretary does not act within such Substitute Senate Bill No. 989
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fifteen-day period the application shall be deemed to have been
approved. The secretary shall immediately notify the Auditors of Public
Accounts of any application which the secretary receives for approval
of a personal services agreement for audit services and give said
auditors an opportunity to review the application during such fifteen-
day period and advise the secretary as to whether such audit services
are necessary and, if so, could be provided by said auditors.
(b) Each personal service agreement having a cost of more than fifty
thousand dollars or a term of more than one year shall be based on
competitive negotiation or competitive quotations, unless the state
agency purchasing the personal services applies to the secretary for a
waiver from such requirement and the secretary grants the waiver in
accordance with the guidelines adopted under section 4-215.
[(c) The secretary shall establish an incentive program for nonprofit
providers of human services that shall (1) allow providers who
otherwise meet contractual requirements to retain any savings realized
by the providers from the contracted cost for services, and (2) provide
that future contracted amounts from the state for the same types of
services are not reduced solely to reflect savings achieved in previous
contracts by such providers. For purposes of this subsection, "nonprofit
providers of human services" includes, but is not limited to, nonprofit
providers of services to persons with intellectual, physical or mental
disabilities or autism spectrum disorder. Any nonprofit provider of
human services allowed to retain savings under the incentive program
shall submit a report to the secretary on how excess funds were
reinvested to strengthen quality, invest in deferred maintenance and
make asset improvements.]
Sec. 4. (NEW) (Effective from passage) (a) For purposes of this section,
"certified community health worker" has the same meaning as provided
in section 20-195ttt of the general statutes. The Commissioner of Social
Services shall design and implement a program to provide Medicaid Substitute Senate Bill No. 989
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reimbursement to certified community health workers for services
provided to HUSKY Health program members, including, but not
limited to: (1) Coordination of medical, oral and behavioral health care
services and social supports; (2) connection to and navigation of health
systems and services; (3) prenatal, birth, lactation and postpartum
supports; and (4) health promotion, coaching and self-management
education.
(b) The Commissioner of Social Services and the commissioner's
designees shall consult with certified community health workers,
Medicaid beneficiaries and advocates, including, but not limited to,
advocates for persons with physical, mental and developmental
disabilities, and others throughout the design and implementation of
the certified community health worker reimbursement program in a
manner that (1) is inclusive of community-based and clinic-based
certified community health workers; (2) is representative of medical
assistance program member demographics; and (3) helps shape the
reimbursement program's design and implementation. The
commissioner, in consultation with community health workers,
Medicaid beneficiaries and such advocates, shall explore options for the
reimbursement program's design that ensures access to such
community health workers, encourages workforce growth to support
such access and averts the risk of creating financial incentives for other
providers to limit access to such community health workers.
(c) Not later than January 1, 2024, and annually thereafter until the
reimbursement program is fully implemented, the Commissioner of
Social Services shall submit a report, in accordance with the provisions
of section 11-4a of the general statutes, to the joint standing committee
of the General Assembly having cognizance of matters relating to
human services and the Council on Medical Assistance Program
Oversight. The initial report shall be submitted not less than six months
prior to the implementation of the reimbursement program. The reports Substitute Senate Bill No. 989
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shall contain an update on the certified community health worker
reimbursement program design, including, but not limited to (1) an
analysis regarding the program elements designed to ensure access to
such services, promote workforce growth and avert the risk of creating
financial incentives for other providers to limit access to such
community health workers, and (2) an evaluation of any impact of the
program on health outcomes and health equity.
Sec. 5. (Effective July 1, 2023) (a) Any nursing home facility, as defined
in section 19a-490 of the general statutes, with available vehicles
equipped to transport nonambulatory residents, may provide
nonemergency transportation of such residents to the homes of such
residents' family members, provided: (1) Such family members live
within fifteen miles of the nursing home facility, and (2) such
transportation is approved not less than five business days in advance
by a physician or physician's assistant, licensed pursuant to chapter 370
of the general statutes, or an advanced practice registered nurse licensed
pursuant to chapter 378 of the general statutes. Nothing in this section
shall be construed to authorize or require any payment or
reimbursement to a nursing home facility for such nonemergency
transportation services.
(b) The Commissioner of Social Services shall evaluate whether the
need for such transportation would qualify as a health-related social
need and file a report not later than October 1, 2023, with the Council on
Medical Assistance Program Oversight on such evaluation and
potential federal funding that may be available for such transportation.
For purposes of this subsection, "health-related social need" means a
health need deriving from an adverse social condition that contributes
to poor health and health disparities, including, but not limited to, the
need for reliable transportation.
Sec. 6. (Effective from passage) (a) The State Ombudsman, appointed
pursuant to section 17a-870 of the general statutes, and the Substitute Senate Bill No. 989
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Commissioners of Public Health and Social Services shall convene a
working group concerning any revisions necessary to nursing home
waiting list requirements as described in section 19a-533 of the general
statutes. The working group shall include, but need not be limited to,
the State Ombudsman, or the State Ombudsman's designee; the
Commissioners of Public Health and Social Services, or their designees;
and not fewer than two representatives of the nursing home industry,
appointed by the Commissioner of Social Services.
(b) The State Ombudsman, or the State Ombudsman's designee, and
the Commissioner of Social Services, or the commissioner's designee,
shall serve as chairpersons of the working group, which shall meet not
less than once monthly. Not later than January 1, 2024, the State
Ombudsman and the Commissioners of Public Health and Social
Services shall file a report, in accordance with section 11-4a of the
general statutes, with the joint standing committees of the General
Assembly having cognizance of matters relating to human services and
public health with recommendations concerning any changes to the
waiting list requirements, including, but not limited to, authorizing
nursing homes to maintain waiting lists in electronic form.