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OLR Bill Analysis
sSB 1110
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.
SUMMARY
This bill codifies two new third-party liability (TPL) requirements
under federal law for the state’s Medicaid program (§§ 1 & 2). The first
requires liable third-party payers to accept the Department of Social
Services (DSS) authorization as the TPL’s prior authorization for
Medicaid claims for payment. The second change shortens, from 90 to
60 days, the timeframe in which a third party must respond to the state
about a Medicaid reimbursement claim. The bill also applies TPL
provisions to state-funded medical assistance given to certain children
under age 12 regardless of their immigration status (§§ 7 & 8).
The bill requires the DSS commissioner to ensure fuel vendors for the
Low-Income Home Energy Assistance Program (LIHEAP) are given the
option to electronically submit their invoices and receive payments.
Among other changes, it also requires payment to a fuel vendor within
ten days, rather than 30 days as under current law, after receiving an
authorized fuel slip or invoice (§ 4).
The bill allows the DSS commissioner to implement a bundled
Medicaid payment for maternity services, to the extent allowed under
federal law and within available appropriations (§ 5).
The bill also expands the situations in which DSS may use state funds
to pay for certain emergency housing, conforming with current practice.
Current law limits the use of state funds to pay for emergency housing
for recipients of Temporary Family Assistance and State Administered 2023SB-01110-R000443-BA.DOCX
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General Assistance in hotels or motels to only during natural or man-
made disasters or other catastrophic events (CGS § 17b-807). The bill
repeals this limitation (§§ 6 & 9).
Lastly, the bill repeals additional provisions in statute, including the
now defunct Connecticut Medicare Assignment Program (§§ 3, 6 & 9)
and makes numerous technical changes.
EFFECTIVE DATE: Upon passage unless otherwise noted below.
§§ 1 & 2 ― THIRD PARTY LIABILITY FOR MEDICAID PAYMEN TS
Under federal law, Medicaid is generally the “payer of last resort,”
which means that health insurers and other third parties legally liable
for health care services received by Medicaid beneficiaries must pay for
them. Federal law also requires states to have laws enhancing the states’
ability to identify and get payment for Medicaid claims from legally
liable third-party sources.
Under existing Connecticut law, claims for recovery or
indemnification submitted by DSS, or its designee, cannot be denied
solely on the lack of prior authorization, among other reasons, if (1) the
claim is submitted within three years and (2) any action by the state to
enforce its rights to the claim begins within six years of the claim
submission.
The bill codifies two new requirements under section 202 of the
Consolidated Appropriations Act of 2022, Public Law 117-103. First,
when claims are submitted to a TPL for recovery or indemnification for
a service provided under the state’s Medicaid plan or a Medicaid
waiver, and the TPL requires prior authorization for that service, it must
accept DSS’s prior authorization as its own. This requirement does not
apply to Medicare, Medicare Advantage, or Medicare Part D plans.
Second, the bill shortens the required response time from TPLs,
including health insurers. Under current law, an insurer or TPL, upon
receipt of a claim submitted by DSS or the department’s designee must
respond within 90 days after (1) receiving the claim or (2) the effective
date of the law, whichever is later. The bill instead requires an insurer 2023SB-01110-R000443-BA.DOCX
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or TPL to respond to a DSS inquiry about a claim for reimbursement
within 60 days after receiving the claim.
Under existing law, failure to pay the claim, issue a written reason for
denying it, or requesting information necessary to determine its legal
obligation to pay it within 120 days after receiving the claim creates an
uncontestable obligation to pay it.
The bill makes technical and conforming changes.
EFFECTIVE DATE: October 1, 2023
§§ 7 & 8 ― TPL PROVISIONS FOR STATE-FUNDED MEDICAL
ASSISTANCE
By January 1, 2023, existing law requires the DSS commissioner to
provide state-funded medical assistance, within available
appropriations, to certain children ages 12 and under regardless of their
immigration status. Under the law, DSS must provide the assistance to
children who are not eligible for Medicaid, the Children’s Health
Insurance Program (CHIP, also known as HUSKY B), or affordable
employer-sponsored insurance, and have household incomes (1) up to
201% of the federal poverty limit (FPL) without an asset limit (aligning
with HUSKY A limits under Medicaid) or (2) over 201% and up to 323%
of FPL (generally aligning with HUSKY B limits under CHIP).
The bill applies third party liability provisions in existing law and
those under the bill to the state-funded medical assistance (equivalent
coverage to HUSKY and the state’s children’s health insurance
program) provided to these children. By law, unchanged by the bill, a
child who is eligible for assistance under these provisions must continue
to receive it until he or she is 19 years old, so long as he or she continues
to (1) meet income requirements and (2) be ineligible for Medicaid,
CHIP, or affordable employer-sponsored insurance.
§ 4 ― ENERGY ASSISTANCE VENDOR PAYMENT STANDARDS
The bill requires the DSS commissioner to ensure an adequate supply
of fuel vendors for LIHEAP by: 2023SB-01110-R000443-BA.DOCX
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1. establishing (a) county and regional pricing standards for
deliverable fuel and (b) a discount on the vendor’s retail price,
2. reimbursing fuel providers based on the price of the fuel on the
delivery date, and
3. allowing a vendor to electronically submit an authorized fuel slip
or invoice for payment.
By November 1, 2023, the commissioner must require each
community action agency (CAA) administering a fuel assistance
program to make payment to a fuel vendor within 10 days, rather than
30 days as under current law, after receiving an authorized fuel slip or
invoice for payment from the vendor. She must also require these CAAs
to offer vendors the options of electronic (1) payments and (2)
submission of their authorized fuel slips or invoices for payment.
By law, the commissioner must submit the LIHEAP annual plan by
August 1 of each year to the Appropriations, Energy, and Human
Services Committees. Under current law, the plan must include a
payment plan for fuel deliveries that ensures fuel vendors who complete
CAA-authorized deliveries are paid by the CAA within 30 days of
receiving the vendor’s fuel slip or invoice. Under the bill, these payment
plans must ensure vendors are paid by the CAA within 10 days of fuel
slip or invoice receipt and are given the option to be paid electronically.
EFFECTIVE DATE: July 1, 2023
§ 5 ― BUNDLED MEDICAID PAYMENT FOR MATERNITY
SERVICES
The bill authorizes the DSS commissioner, to the extent allowed
under federal law and within available appropriations, to implement a
bundled Medicaid payment for maternity services and any other
alternative payment methodology or combination of methodologies for
these services that she determines are designed to improve health
quality, equity, member experience, cost containment, and coordination
of care. 2023SB-01110-R000443-BA.DOCX
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By law, for certain programs including Medicaid, DSS may
implement policies and procedures while in the process of adopting
them as regulations (CGS § 17b-10(b)). The bill explicitly allows the DSS
commissioner to implement policies and procedures this way under the
bill and requires her to post notice of her intent to adopt regulations on
the eRegulations System within 20 days of implementing the policies
and procedures, which are valid until final regulations are adopted.
EFFECTIVE DATE: July 1, 2023
§ 3, 6 & 9 ― REPEALER
The bill eliminates the Connecticut Medicare Assignment Program
(ConnMAP), a state program that limits participating providers to
billing Medicare Part B enrollees only up to the 20% co-payment for the
service (Medicare pays the remaining 80%) (CGS §§ 17b-550 to -554).
This program is effectively obsolete, as federal law requires Medicare-
participating providers to accept the Medicare-determined reasonable
charge as payment in full for services rendered to Medicare
beneficiaries.
The bill eliminates the requirement for DSS, in collaboration with the
Departments of Children and Families and Public Health, to establish a
child health quality improvement program to promote the
implementation of evidence-based strategies by providers participating
in HUSKY to improve delivery and access of children’s services and
annually report on its efficacy (CGS § 17b-306a).
It also makes conforming changes to eliminate references to these
provisions elsewhere in statute (§ 3).
COMMITTEE ACTION
Human Services Committee
Joint Favorable Substitute
Yea 21 Nay 0 (03/21/2023)