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General Assembly Substitute Bill No. 1110
January Session, 2023
AN ACT CONCERNING REQUIREMENTS FOR THIRD -PARTY
MEDICAID PAYMENT REIMBURSEMENTS, VENDOR PAYMENT
STANDARDS IN THE LOW -INCOME HOME ENERGY ASSISTANCE
PROGRAM AND MEDICAID PAYMENTS FOR MATERNITY SERVICES.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. Section 17b-265 of the general statutes is repealed and the 1
following is substituted in lieu thereof (Effective October 1, 2023): 2
(a) In accordance with 42 USC 1396k, the Department of Social 3
Services shall be subrogated to any right of recovery or indemnification 4
that an applicant or recipient of medical assistance or any legally liable 5
relative of such applicant or recipient has against an insurer or other 6
legally liable third party including, but not limited to, a self-insured 7
plan, group health plan, as defined in Section 607(1) of the Employee 8
Retirement Income Security Act of 1974, service benefit plan, managed 9
care organization, health care center, pharmacy benefit manager, dental 10
benefit manager, third-party administrator or other party that is, by 11
statute, contract or agreement, legally responsible for payment of a 12
claim for a health care item or service, for the cost of all health care items 13
or services furnished to the applicant or recipient, including, but not 14
limited to, hospitalization, pharmaceutical services, physician services, 15
nursing services, behavioral health services, long-term care services and 16
other medical services, not to exceed the amount expended by the 17 Substitute Bill No. 1110
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department for such care and treatment of the applicant or recipient. In 18
the case of such a recipient who is an enrollee in a care management 19
organization under a Medicaid care management contract with the state 20
or a legally liable relative of such an enrollee, the department shall be 21
subrogated to any right of recovery or indemnification which the 22
enrollee or legally liable relative has against such a private insurer or 23
other third party for the medical costs incurred by the care management 24
organization on behalf of an enrollee. Whenever funds owed to a person 25
are collected pursuant to this section and the person who otherwise 26
would have been entitled to such funds is subject to a court-ordered 27
current or arrearage child support payment obligation in an IV-D 28
support case, such funds shall first be paid to the state for 29
reimbursement of Medicaid funds paid on behalf of such person for 30
medical expenses incurred for injuries related to a legal claim by such 31
person that was the subject of the state's right of subrogation, and 32
remaining funds, if any, shall then be paid to the Office of Child Support 33
Services for distribution pursuant to the federally mandated child 34
support distribution system implemented pursuant to subsection (j) of 35
section 17b-179. Any additional claim of the state to the remainder of 36
such funds, if any, shall be paid in accordance with state law. 37
(b) An applicant or recipient or legally liable relative, by the act of the 38
applicant's or recipient's receiving medical assistance, shall be deemed 39
to have made a subrogation assignment and an assignment of claim for 40
benefits to the department. The department shall inform an applicant of 41
such assignments at the time of application. Any entitlements from a 42
contractual agreement with an applicant or recipient, legally liable 43
relative or a state or federal program for such medical services, not to 44
exceed the amount expended by the department, shall be so assigned. 45
Such entitlements shall be directly reimbursable to the department by 46
[third party] third-party payors. The Department of Social Services may 47
assign its right to subrogation or its entitlement to benefits to a designee 48
or a health care provider participating in the Medicaid program and 49
providing services to an applicant or recipient, in order to assist the 50
provider in obtaining payment for such services. In accordance with 51 Substitute Bill No. 1110
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subsection (b) of section 38a-472, a provider that has received an 52
assignment from the department shall notify the recipient's health 53
insurer or other legally liable third party including, but not limited to, a 54
self-insured plan, group health plan, as defined in Section 607(1) of the 55
Employee Retirement Income Security Act of 1974, service benefit plan, 56
managed care organization, health care center, pharmacy benefit 57
manager, dental benefit manager, third-party administrator or other 58
party that is, by statute, contract or agreement, legally responsible for 59
payment of a claim for a health care item or service, of the assignment 60
upon rendition of services to the applicant or recipient. Failure to so 61
notify the health insurer or other legally liable third party shall render 62
the provider ineligible for payment from the department. The provider 63
shall notify the department of any request by the applicant or recipient 64
or legally liable relative or representative of such applicant or recipient 65
for billing information. This subsection shall not be construed to affect 66
the right of an applicant or recipient to maintain an independent cause 67
of action against such [third party] third-party tortfeasor. 68
(c) Claims for recovery or indemnification submitted by the 69
department, or the department's designee, shall not be denied solely on 70
the basis of the date of the submission of the claim, the type or format of 71
the claim, the lack of prior authorization or the failure to present proper 72
documentation at the point-of-service that is the basis of the claim, if (1) 73
the claim is submitted by the state within the three-year period 74
beginning on the date on which the item or service was furnished; and 75
(2) any action by the state to enforce its rights with respect to such claim 76
is commenced within six years of the state's submission of the claim. 77
(d) (1) A party to whom a claim for recovery or indemnification is 78
submitted for an item or service furnished under the Medicaid state 79
plan, or a waiver of such plan, who requires prior authorization for such 80
item or service shall accept authorization provided by the Department 81
of Social Services that the item or service is covered under such plan or 82
waiver as if such authorization were the prior authorization made by 83
such party for the item or service. 84 Substitute Bill No. 1110
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(2) The provisions of subdivision (1) of this subsection shall not apply 85
with respect to a claim for recovery or indemnification submitted to 86
Medicare, a Medicare Advantage plan or a Medicare Part D plan. 87
[(d)] (e) When a recipient of medical assistance has personal health 88
insurance in force covering care or other benefits provided under such 89
program, payment or part-payment of the premium for such insurance 90
may be made when deemed appropriate by the Commissioner of Social 91
Services. The commissioner shall limit reimbursement to medical 92
assistance providers for coinsurance and deductible payments under 93
Title XVIII of the Social Security Act to assure that the combined 94
Medicare and Medicaid payment to the provider shall not exceed the 95
maximum allowable under the Medicaid program fee schedules. 96
[(e)] (f) No self-insured plan, group health plan, as defined in Section 97
607(1) of the Employee Retirement Income Security Act of 1974, service 98
benefit plan, managed care plan, or any plan offered or administered by 99
a health care center, pharmacy benefit manager, dental benefit manager, 100
third-party administrator or other party that is, by statute, contract or 101
agreement, legally responsible for payment of a claim for a health care 102
item or service, shall contain any provision that has the effect of denying 103
or limiting enrollment benefits or excluding coverage because services 104
are rendered to an insured or beneficiary who is eligible for or who 105
received medical assistance under this chapter. No insurer, as defined 106
in section 38a-497a, shall impose requirements on the state Medicaid 107
agency, which has been assigned the rights of an individual eligible for 108
Medicaid and covered for health benefits from an insurer, that differ 109
from requirements applicable to an agent or assignee of another 110
individual so covered. 111
[(f)] (g) The Commissioner of Social Services shall not pay for any 112
services provided under this chapter if the individual eligible for 113
medical assistance has coverage for the services under an accident or 114
health insurance policy. 115
[(g)] (h) An insurer or other legally liable third party, upon receipt of 116 Substitute Bill No. 1110
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a claim submitted by the department or the department's designee, in 117
accordance with the requirements of subsection (c) of this section, for 118
payment of a health care item or service covered under a state medical 119
assistance program administered by the department, shall, not later 120
than [ninety] sixty days after receipt of the claim or not later than [ninety 121
days after the effective date of this section] November 30, 2023, 122
whichever is later, (1) make payment on the claim, (2) request 123
information necessary to determine its legal obligation to pay the claim, 124
or (3) issue a written reason for denial of the claim. Failure to pay, 125
request information necessary to determine legal obligation to pay or 126
issue a written reason for denial of a claim not later than one hundred 127
twenty days after receipt of the claim, or not later than [one hundred 128
twenty days after the effective date of this section] January 30, 2024, 129
whichever is later, creates an uncontestable obligation to pay the claim. 130
The provisions of this subsection shall apply to all claims, including 131
claims submitted by the department or the department's designee prior 132
to July 1, 2021. 133
[(h)] (i) On and after July 1, 2021, an insurer or other legally liable 134
third party who has reimbursed the department for a health care item 135
or service paid for and covered under a state medical assistance 136
program administered by the department shall, upon determining it is 137
not liable and at risk for cost of the health care item or service, request 138
any refund from the department not later than twelve months from the 139
date of its reimbursement to the department. 140
Sec. 2. Section 17b-265g of the general statutes is repealed and the 141
following is substituted in lieu thereof (Effective October 1, 2023): 142
Any health insurer, including a self-insured plan, group health plan, 143
as defined in Section 607(1) of the Employee Retirement Income Security 144
Act of 1974, service benefit plan, managed care organization, health care 145
center, pharmacy benefit manager, dental benefit manager or other 146
party that is, by statute, contract or agreement, legally responsible for 147
payment of a claim for a health care item or service, and which may or 148
may not be financially at risk for the cost of a health care item or service, 149 Substitute Bill No. 1110
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shall, as a condition of doing business in the state, be required to: 150
(1) Provide, with respect to an individual who is eligible for, or is 151
provided, medical assistance under the Medicaid state plan, to all third-152
party administrators, pharmacy benefit managers, dental benefit 153
managers or other entities with which the health insurer has a contract 154
or arrangement to adjudicate claims for a health care item or service, 155
and to the Commissioner of Social Services, or the commissioner's 156
designee, any and all information in a manner and format prescribed by 157
the commissioner, or commissioner's designee, necessary to determine 158
when the individual, his or her spouse or the individual's dependents 159
may be or have been covered by a health insurer and the nature of the 160
coverage that is or was provided by such health insurer including the 161
name, address and identifying number of the plan; 162
(2) [accept] Accept the state's right of recovery and the assignment to 163
the state of any right of an individual or other entity to payment from 164
the health insurer for an item or service for which payment has been 165
made under the Medicaid state plan; 166
(3) [respond to] Respond not later than sixty days after receiving any 167
inquiry [by] from the commissioner, or the commissioner's designee, 168
regarding a claim for payment for any health care item or service that is 169
submitted not later than three years after the date of the provision of the 170
item or service; and 171
(4) [agree] Agree (A) to accept authorization provided by the 172
Department of Social Services that an item or service is covered under 173
the Medicaid state plan, or a waiver of such plan, as if such 174
authorization were the prior authorization made by such health insurer 175
for such item or service, and (B) not to deny a claim submitted by the 176
state solely on the basis of the date of submission of the claim, the type 177
or format of the claim form or a failure to present proper documentation 178
at the point-of-sale that is the basis of the claim, if [(A)] (i) the claim is 179
submitted by the state or its agent within the three-year period 180
beginning on the date on which the item or service was furnished; and 181 Substitute Bill No. 1110
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[(B)] (ii) any legal action by the state to enforce its rights with respect to 182
such claim is commenced within six years of the state's submission of 183
such claim. 184
Sec. 3. Subsection (e) of section 12-746 of the general statutes is 185
repealed and the following is substituted in lieu thereof (Effective from 186
passage): 187
(e) Amounts rebated pursuant to this section shall not be considered 188
income for purposes of sections 8-119l, 8-345, 12-170d, 12-170aa, [17b-189
550,] 47-88d and 47-287. 190
Sec. 4. Section 16a-41a of the general statutes is repealed and the 191
following is substituted in lieu thereof (Effective July 1, 2023): 192
(a) The Commissioner of Social Services shall submit to the joint 193
standing committees of the General Assembly having cognizance of 194
energy planning and activities, appropriations, and human services the 195
following on the implementation of the block grant program authorized 196
under the Low-Income Home Energy Assistance Act of 1981, as 197
amended: 198
(1) Not later than August first, annually, a Connecticut energy 199
assistance program annual plan which establishes guidelines for the use 200
of funds authorized under the Low-Income Home Energy Assistance 201
Act of 1981, as amended, and includes the following: 202
(A) Criteria for determining which households are to receive 203
emergency assistance; 204
(B) A description of systems used to ensure referrals to other energy 205
assistance programs and the taking of simultaneous applications, as 206
required under section 16a-41; 207
(C) A description of outreach efforts; 208
(D) Estimates of the total number of households eligible for assistance 209 Substitute Bill No. 1110
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under the program and the number of households in which one or more 210
elderly or physically disabled individuals eligible for assistance reside; 211
(E) Design of a basic grant for eligible households that does not 212
discriminate against such households based on the type of energy used 213
for heating; and 214
(F) A payment plan for fuel deliveries beginning November 1, [2018] 215
2023, that ensures a vendor of deliverable fuel who completes deliveries 216
authorized by a community action agency that contracts with the 217
commissioner to administer a fuel assistance program is [paid] provided 218
the option to be paid electronically by the community action agency and 219
is paid not later than [thirty] ten business days after the date the 220
community action agency receives an authorized fuel slip or invoice for 221
payment from the vendor; 222
(2) Not later than January thirtieth, annually, a report covering the 223
preceding months of the program year, including: 224
(A) In each community action agency geographic area, the number of 225
fuel assistance applications filed, approved and denied, and the number 226
of emergency assistance requests made, approved and denied; 227
(B) In each such area, the total amount of fuel and emergency 228
assistance, itemized by such type of assistance, and total expenditures 229
to date; 230
(C) For each state-wide office of each state agency administering the 231
program and each community action agency, administrative expenses 232
under the program, by line item, and an estimate of outreach 233
expenditures; and 234
(D) A list of community action agencies that failed to make timely 235
payments to vendors of deliverable fuel in the Connecticut energy 236
assistance program and the steps taken by the commissioner to ensure 237
future timely payments by such agencies; and 238 Substitute Bill No. 1110
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(3) Not later than November first, annually, a report covering the 239
preceding twelve calendar months, including: 240
(A) In each community action agency geographic area, (i) seasonal 241
totals for the categories of data submitted under subdivision (1) of this 242
subsection, (ii) the number of households receiving fuel assistance in 243
which elderly or physically disabled individuals reside, and (iii) the 244
average combined benefit level of fuel, emergency and renter assistance; 245
(B) The number of homeowners and tenants whose heat or total 246
energy costs are not included in their rent receiving fuel and emergency 247
assistance under the program by benefit level; 248
(C) The number of homeowners and tenants whose heat is included 249
in their rent and who are receiving assistance, by benefit level; and 250
(D) The number of households receiving assistance, by energy type 251
and total expenditures for each energy type. 252
(b) The Commissioner of Social Services shall implement a program 253
to purchase deliverable fuel for low-income households participating in 254
the Connecticut energy assistance program and the state-appropriated 255
fuel assistance program. The commissioner shall ensure an adequate 256
supply of vendors for the program by (1) establishing county and 257
regional pricing standards for deliverable fuel, (2) reimbursing fuel 258
providers based on the price of the fuel on the date of delivery, (3) 259
establishing a discount on the vendor's retail price, and (4) allowing a 260
vendor to electronically submit an authorized fuel slip or invoice for 261
payment. 262
(c) The commissioner shall ensure that no fuel vendor discriminates 263
against fuel assistance program recipients who are under the vendor's 264
standard payment, delivery, service or other similar plans. The 265
commissioner may take advantage of programs offered by fuel vendors 266
that reduce the cost of the fuel purchased, including, but not limited to, 267
fixed price, capped price, prepurchase or summer-fill programs that 268
reduce program cost and that make the maximum use of program 269 Substitute Bill No. 1110
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revenues. As funding allows, the commissioner shall ensure that all 270
agencies administering the fuel assistance program shall make 271
payments to program fuel vendors in advance of the delivery of energy 272
where vendor provided price-management strategies require payments 273
in advance. 274
[(c)] (d) Each community action agency administering a fuel 275
assistance program shall submit reports, as requested by the 276
Commissioner of Social Services, concerning pricing information from 277
vendors of deliverable fuel participating in the program. Such 278
information shall include, but not be limited to, the state-wide or 279
regional retail price per unit of deliverable fuel, the reduced price per 280
unit paid by the state for the deliverable fuel in utilizing price 281
management strategies offered by program vendors for all consumers, 282
the number of units delivered to the state under the program and the 283
total savings under the program due to the purchase of deliverable fuel 284
utilizing price-management strategies offered by program vendors for 285
all consumers. 286
[(d)] (e) If funding allows, the Commissioner of Social Services, in 287
consultation with the Secretary of the Office of Policy and Management, 288
shall require that, each community action agency administering a fuel 289
assistance program begin accepting applications for the program not 290
later than September first of each year. 291
[(e)] (f) Not later than November 1, [2018] 2023, the Commissioner of 292
Social Services shall require each community action agency 293
administering a fuel assistance program to make payment to a vendor 294
of deliverable fuel not later than [thirty] ten days after the community 295
action agency receives an authorized fuel slip or invoice for payment 296
from the vendor and to give the vendor the options of (1) being paid 297
electronically, and (2) submitting electronically an authorized fuel slip 298
or invoice for payment. 299
[(f)] (g) The Commissioner of Social Services shall submit each plan 300
or report described in subsection (a) of this section to the Low-Income 301 Substitute Bill No. 1110
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Energy Advisory Board, established pursuant to section 16a-41b, not 302
later than seven days prior to submitting such plan or report to the joint 303
standing committee of the General Assembly having cognizance of 304
matters relating to energy and technology, appropriations and human 305
services. 306
Sec. 5. (NEW) (Effective July 1, 2023) To the extent permissible under 307
federal law and within available appropriations, as the single state 308
Medicaid agency designated under sections 17b-2 and 17b-260 of the 309
general statutes, the Commissioner of Social Services may implement a 310
bundled payment for maternity services and any other alternative 311
payment methodology or combination of methodologies for maternity 312
services that the commissioner determines are designed to improve 313
health quality, equity, member experience, cost containment and 314
coordination of care. The commissioner may implement policies and 315
procedures to the extent that regulations may be required to carry out 316
any of the provisions of this section while in the process of adopting 317
such policies and procedures as regulations, provided the commissioner 318
publishes notice of intent to adopt regulations on the eRegulations 319
System not later than twenty days after the date of implementation of 320
such policies and procedures. Any policies and procedures 321
implemented pursuant to this section shall be valid until the time final 322
regulations are adopted. 323
Sec. 6. Section 53a-290 of the general statutes is repealed and the 324
following is substituted in lieu thereof (Effective from passage): 325
A person commits vendor fraud when, with intent to defraud and 326
acting on such person's own behalf or on behalf of an entity, such person 327
provides goods or services to a beneficiary under sections 17b-22, 17b-328
75 to 17b-77, inclusive, 17b-79 to 17b-103, inclusive, 17b-180a, 17b-183, 329
17b-260 to 17b-262, inclusive, 17b-264 to 17b-285, inclusive, 17b-357 to 330
17b-361, inclusive, 17b-600 to 17b-604, inclusive, 17b-749 [, 17b-807] and 331
17b-808 or provides services to a recipient under Title XIX of the Social 332
Security Act, as amended, and, (1) presents for payment any false claim 333
for goods or services performed; (2) accepts payment for goods or 334 Substitute Bill No. 1110
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services performed, which exceeds either the amounts due for goods or 335
services performed, or the amounts authorized by law for the cost of 336
such goods or services; (3) solicits to perform services for or sell goods 337
to any such beneficiary, knowing that such beneficiary is not in need of 338
such goods or services; (4) sells goods to or performs services for any 339
such beneficiary without prior authorization by the Department of 340
Social Services, when prior authorization is required by said department 341
for the buying of such goods or the performance of any service; (5) 342
accepts from any person or source other than the state an additional 343
compensation in excess of the amount authorized by law; or (6) having 344
knowledge of the occurrence of any event affecting (A) his or her initial 345
or continued right to any such benefit or payment, or (B) the initial or 346
continued right to any such benefit or payment of any other individual 347
in whose behalf he or she has applied for or is receiving such benefit or 348
payment, conceals or fails to disclose such event with an intent to 349
fraudulently secure such benefit or payment either in a greater amount 350
or quantity than is due or when no such benefit or payment is 351
authorized. 352
Sec. 7. Subsection (l) of section 17b-261 of the general statutes is 353
repealed and the following is substituted in lieu thereof (Effective from 354
passage): 355
(l) On and after January 1, 2023, the Commissioner of Social Services 356
shall, within available appropriations, provide state-funded medical 357
assistance to any child twelve years of age and younger, regardless of 358
immigration status, (1) whose household income does not exceed two 359
hundred one per cent of the federal poverty level without an asset limit, 360
and (2) who does not otherwise qualify for Medicaid, the Children's 361
Health Insurance Program, or an offer of affordable, employer-362
sponsored insurance, as defined in the Affordable Care Act, as an 363
employee or a dependent of an employee. A child eligible for such 364
assistance under this subsection shall continue to receive such assistance 365
until such child is nineteen years of age, provided the child continues to 366
meet the eligibility requirements prescribed in subdivisions (1) and (2) 367 Substitute Bill No. 1110
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of this subsection. The provisions of section 17b-265, as amended by this 368
act, shall apply with respect to any medical assistance provided 369
pursuant to this subsection. 370
Sec. 8. Subsection (a) of section 17b-292 of the general statutes is 371
repealed and the following is substituted in lieu thereof (Effective from 372
passage): 373
(a) A child who resides in a household with household income that 374
exceeds one hundred ninety-six per cent of the federal poverty level but 375
does not exceed three hundred eighteen per cent of the federal poverty 376
level may be eligible for benefits under HUSKY B. Not later than 377
January 1, 2023, the Commissioner of Social Services shall, within 378
available appropriations, provide state-funded medical assistance to 379
any child twelve years of age and younger, regardless of immigration 380
status, (1) with a household income that exceeds two hundred one per 381
cent of the federal poverty level but does not exceed three hundred 382
twenty-three per cent of the federal poverty level, and (2) who does not 383
otherwise qualify for Medicaid, the Children's Health Insurance 384
Program, or an offer of affordable, employer-sponsored insurance, as 385
defined in the Affordable Care Act, as an employee or a dependent of 386
an employee. A child eligible for such assistance under this subsection 387
shall continue to receive such assistance until such child is nineteen 388
years of age, provided the child continues to meet the eligibility 389
requirements prescribed in subdivisions (1) and (2) of this subsection. 390
The provisions of section 17b-265, as amended by this act, shall apply 391
with respect to any medical assistance provided pursuant to this 392
subsection. 393
Sec. 9. Sections 17b-306a, 17b-550 to 17b-554, inclusive, and 17b-807 394
of the general statutes are repealed. (Effective from passage) 395
This act shall take effect as follows and shall amend the following
sections:
Section 1 October 1, 2023 17b-265 Substitute Bill No. 1110
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Sec. 2 October 1, 2023 17b-265g
Sec. 3 from passage 12-746(e)
Sec. 4 July 1, 2023 16a-41a
Sec. 5 July 1, 2023 New section
Sec. 6 from passage 53a-290
Sec. 7 from passage 17b-261(l)
Sec. 8 from passage 17b-292(a)
Sec. 9 from passage Repealer section
Statement of Legislative Commissioners:
In Section 1(h), "[ninety] sixty days after the effective date of this section"
was changed to "[ninety days after the effective date of this section]
November 30, 2023"; in Section 1(h)(3), "one hundred twenty days after
the effective date of this section" was changed to "[one hundred twenty
days after the effective date of this section] January 30, 2024"; and in
Section 5, "implementation. Policies" was changed to "implementation
of such policies and procedures. Any policies", for clarity.
HS Joint Favorable Subst.