Connecticut 2023 Regular Session

Connecticut Senate Bill SB01110 Compare Versions

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Version 2 (New)

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	3	+	LCO No. 4248 1 of 16
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7		-	General Assembly Substitute Bill No. 1110
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	6	+	General Assembly Raised Bill No. 1110
8	7		January Session, 2023
	8	+	LCO No. 4248
	9	+
	10	+
	11	+	Referred to Committee on HUMAN SERVICES
	12	+
	13	+
	14	+	Introduced by:
	15	+	(HS)
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11	18
12	19
13		-
14		-	AN ACT CONCERNING REQUIREMENTS FOR THIRD -PARTY
15		-	MEDICAID PAYMENT REIMBURSEMENTS, VENDOR PAYMENT
16		-	STANDARDS IN THE LOW -INCOME HOME ENERGY ASSISTANCE
17		-	PROGRAM AND MEDICAID PAYMENTS FOR MATERNITY SERVICES.
	20	+	AN ACT CONCERNING VARIOUS REVISIONS TO THE DEPARTMENT
	21	+	OF SOCIAL SERVICES STATUTES.
18	22		Be it enacted by the Senate and House of Representatives in General
19	23		Assembly convened:
20	24
21		-	Section 1. Section 17b-265 of the general statutes is repealed and the 1
22		-	following is substituted in lieu thereof (Effective October 1, 2023): 2
23		-	(a) In accordance with 42 USC 1396k, the Department of Social 3
24		-	Services shall be subrogated to any right of recovery or indemnification 4
25		-	that an applicant or recipient of medical assistance or any legally liable 5
26		-	relative of such applicant or recipient has against an insurer or other 6
27		-	legally liable third party including, but not limited to, a self-insured 7
28		-	plan, group health plan, as defined in Section 607(1) of the Employee 8
29		-	Retirement Income Security Act of 1974, service benefit plan, managed 9
30		-	care organization, health care center, pharmacy benefit manager, dental 10
31		-	benefit manager, third-party administrator or other party that is, by 11
32		-	statute, contract or agreement, legally responsible for payment of a 12
33		-	claim for a health care item or service, for the cost of all health care items 13
34		-	or services furnished to the applicant or recipient, including, but not 14
35		-	limited to, hospitalization, pharmaceutical services, physician services, 15
36		-	nursing services, behavioral health services, long-term care services and 16
37		-	other medical services, not to exceed the amount expended by the 17 Substitute Bill No. 1110
	25	+	Section 1. Section 17b-8 of the general statutes is repealed and the 1
	26	+	following is substituted in lieu thereof (Effective from passage): 2
	27	+	(a) The Commissioner of Social Services shall submit an application 3
	28	+	for a federal waiver or renewal of such waiver of any assistance program 4
	29	+	requirements, except such application pertaining to routine operational 5
	30	+	issues, and any proposed amendment to the Medicaid state plan to 6
	31	+	make a change in program requirements that would have required a 7
	32	+	waiver were it not for the passage of the Patient Protection and 8
	33	+	Affordable Care Act, P.L. 111-148, and the Health Care and Education 9
	34	+	Reconciliation Act of 2010, P.L. 111-152 to the joint standing committees 10
	35	+	of the General Assembly having cognizance of matters relating to 11
	36	+	human services and appropriations and the budgets of state agencies, 12
	37	+	and, for the waiver application required under section 17b-312, the joint 13
	38	+	standing committee of the General Assembly having cognizance of 14
	39	+	matters relating to insurance, prior to the submission of such application 15 Raised Bill No. 1110
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44		-	department for such care and treatment of the applicant or recipient. In 18
45		-	the case of such a recipient who is an enrollee in a care management 19
46		-	organization under a Medicaid care management contract with the state 20
47		-	or a legally liable relative of such an enrollee, the department shall be 21
48		-	subrogated to any right of recovery or indemnification which the 22
49		-	enrollee or legally liable relative has against such a private insurer or 23
50		-	other third party for the medical costs incurred by the care management 24
51		-	organization on behalf of an enrollee. Whenever funds owed to a person 25
52		-	are collected pursuant to this section and the person who otherwise 26
53		-	would have been entitled to such funds is subject to a court-ordered 27
54		-	current or arrearage child support payment obligation in an IV-D 28
55		-	support case, such funds shall first be paid to the state for 29
56		-	reimbursement of Medicaid funds paid on behalf of such person for 30
57		-	medical expenses incurred for injuries related to a legal claim by such 31
58		-	person that was the subject of the state's right of subrogation, and 32
59		-	remaining funds, if any, shall then be paid to the Office of Child Support 33
60		-	Services for distribution pursuant to the federally mandated child 34
61		-	support distribution system implemented pursuant to subsection (j) of 35
62		-	section 17b-179. Any additional claim of the state to the remainder of 36
63		-	such funds, if any, shall be paid in accordance with state law. 37
64		-	(b) An applicant or recipient or legally liable relative, by the act of the 38
65		-	applicant's or recipient's receiving medical assistance, shall be deemed 39
66		-	to have made a subrogation assignment and an assignment of claim for 40
67		-	benefits to the department. The department shall inform an applicant of 41
68		-	such assignments at the time of application. Any entitlements from a 42
69		-	contractual agreement with an applicant or recipient, legally liable 43
70		-	relative or a state or federal program for such medical services, not to 44
71		-	exceed the amount expended by the department, shall be so assigned. 45
72		-	Such entitlements shall be directly reimbursable to the department by 46
73		-	[third party] third-party payors. The Department of Social Services may 47
74		-	assign its right to subrogation or its entitlement to benefits to a designee 48
75		-	or a health care provider participating in the Medicaid program and 49
76		-	providing services to an applicant or recipient, in order to assist the 50
77		-	provider in obtaining payment for such services. In accordance with 51 Substitute Bill No. 1110
	43	+	LCO No. 4248 2 of 16
	44	+
	45	+	or proposed amendment to the federal government. Not later than thirty 16
	46	+	days after the date of their receipt of such application or proposed 17
	47	+	amendment, the joint standing committees shall: (1) Hold a public 18
	48	+	hearing on the waiver application, or (2) in the case of a proposed 19
	49	+	amendment to the Medicaid state plan, notify the Commissioner of 20
	50	+	Social Services whether or not said joint standing committees intend to 21
	51	+	hold a public hearing. Any notice to the commissioner indicating that 22
	52	+	the joint standing committees intend to hold a public hearing on a 23
	53	+	proposed amendment to the Medicaid state plan shall state the date on 24
	54	+	which the joint standing committees intend to hold such public hearing, 25
	55	+	which shall not be later than sixty days after the joint standing 26
	56	+	committees' receipt of the proposed amendment. At the conclusion of a 27
	57	+	public hearing held in accordance with the provisions of this section, the 28
	58	+	joint standing committees shall advise the commissioner of their 29
	59	+	approval, denial or modifications, if any, of the commissioner's waiver 30
	60	+	application or proposed amendment. If the joint standing committees 31
	61	+	advise the commissioner of their denial of the commissioner's waiver 32
	62	+	application or proposed amendment, the commissioner shall not submit 33
	63	+	the application for a federal waiver or proposed amendment to the 34
	64	+	federal government. If such committees do not concur, the committee 35
	65	+	chairpersons shall appoint a committee of conference which shall be 36
	66	+	composed of three members from each joint standing committee. At 37
	67	+	least one member appointed from each joint standing committee shall 38
	68	+	be a member of the minority party. The report of the committee of 39
	69	+	conference shall be made to each joint standing committee, which shall 40
	70	+	vote to accept or reject the report. The report of the committee of 41
	71	+	conference may not be amended. If a joint standing committee rejects 42
	72	+	the report of the committee of conference, that joint standing committee 43
	73	+	shall notify the commissioner of the rejection and the commissioner's 44
	74	+	waiver application or proposed amendment shall be deemed approved. 45
	75	+	If the joint standing committees accept the report, the committee having 46
	76	+	cognizance of matters relating to appropriations and the budgets of state 47
	77	+	agencies shall advise the commissioner of their approval, denial or 48
	78	+	modifications, if any, of the commissioner's waiver application or 49
	79	+	proposed amendment. If the joint standing committees do not so advise 50 Raised Bill No. 1110
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84		-	subsection (b) of section 38a-472, a provider that has received an 52
85		-	assignment from the department shall notify the recipient's health 53
86		-	insurer or other legally liable third party including, but not limited to, a 54
87		-	self-insured plan, group health plan, as defined in Section 607(1) of the 55
88		-	Employee Retirement Income Security Act of 1974, service benefit plan, 56
89		-	managed care organization, health care center, pharmacy benefit 57
90		-	manager, dental benefit manager, third-party administrator or other 58
91		-	party that is, by statute, contract or agreement, legally responsible for 59
92		-	payment of a claim for a health care item or service, of the assignment 60
93		-	upon rendition of services to the applicant or recipient. Failure to so 61
94		-	notify the health insurer or other legally liable third party shall render 62
95		-	the provider ineligible for payment from the department. The provider 63
96		-	shall notify the department of any request by the applicant or recipient 64
97		-	or legally liable relative or representative of such applicant or recipient 65
98		-	for billing information. This subsection shall not be construed to affect 66
99		-	the right of an applicant or recipient to maintain an independent cause 67
100		-	of action against such [third party] third-party tortfeasor. 68
101		-	(c) Claims for recovery or indemnification submitted by the 69
102		-	department, or the department's designee, shall not be denied solely on 70
103		-	the basis of the date of the submission of the claim, the type or format of 71
104		-	the claim, the lack of prior authorization or the failure to present proper 72
105		-	documentation at the point-of-service that is the basis of the claim, if (1) 73
106		-	the claim is submitted by the state within the three-year period 74
107		-	beginning on the date on which the item or service was furnished; and 75
108		-	(2) any action by the state to enforce its rights with respect to such claim 76
109		-	is commenced within six years of the state's submission of the claim. 77
110		-	(d) (1) A party to whom a claim for recovery or indemnification is 78
111		-	submitted for an item or service furnished under the Medicaid state 79
112		-	plan, or a waiver of such plan, who requires prior authorization for such 80
113		-	item or service shall accept authorization provided by the Department 81
114		-	of Social Services that the item or service is covered under such plan or 82
115		-	waiver as if such authorization were the prior authorization made by 83
116		-	such party for the item or service. 84 Substitute Bill No. 1110
	83	+	LCO No. 4248 3 of 16
	84	+
	85	+	the commissioner during the thirty-day period, the waiver application 51
	86	+	or proposed amendment shall be deemed approved. Any application 52
	87	+	for a federal waiver, waiver renewal or proposed amendment submitted 53
	88	+	to the federal government by the commissioner, pursuant to this section, 54
	89	+	shall be in accordance with the approval or modifications, if any, of the 55
	90	+	joint standing committees of the General Assembly having cognizance 56
	91	+	of matters relating to human services and appropriations and the 57
	92	+	budgets of state agencies, and, for the waiver application required under 58
	93	+	section 17b-312, the joint standing committee of the General Assembly 59
	94	+	having cognizance of matters relating to insurance. 60
	95	+	[(b) The Commissioner of Social Services shall annually, not later 61
	96	+	than December fifteenth, notify the joint standing committee of the 62
	97	+	General Assembly having cognizance of matters relating to 63
	98	+	appropriations and the budgets of state agencies and the joint standing 64
	99	+	committee of the General Assembly having cognizance of matters 65
	100	+	relating to human services of potential Medicaid waivers and 66
	101	+	amendments to the Medicaid state plan that may result in a cost savings 67
	102	+	for the state. The commissioner shall notify the committees of the 68
	103	+	possibility of any Medicaid waiver application or proposed amendment 69
	104	+	to the Medicaid state plan that the commissioner is considering in 70
	105	+	developing a budget for the next fiscal year before the commissioner 71
	106	+	submits such budget for legislative approval.] 72
	107	+	[(c)] (b) Thirty days prior to submission of an application for a waiver 73
	108	+	from federal law, renewal of such waiver or proposed amendment to 74
	109	+	the joint standing committees of the General Assembly under subsection 75
	110	+	(a) of this section, the Commissioner of Social Services shall publish a 76
	111	+	notice that the commissioner intends to seek such a waiver or waiver 77
	112	+	renewal, or submit a proposed amendment to the federal government 78
	113	+	in the Connecticut Law Journal and on the Department of Social 79
	114	+	Services' Internet web site, along with a summary of the provisions of 80
	115	+	the waiver application or the proposed amendment and the manner in 81
	116	+	which individuals may submit comments. The commissioner shall 82
	117	+	allow thirty days for written comments on the waiver application or 83
	118	+	proposed amendment prior to submission of the application for a 84 Raised Bill No. 1110
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123		-	(2) The provisions of subdivision (1) of this subsection shall not apply 85
124		-	with respect to a claim for recovery or indemnification submitted to 86
125		-	Medicare, a Medicare Advantage plan or a Medicare Part D plan. 87
126		-	[(d)] (e) When a recipient of medical assistance has personal health 88
127		-	insurance in force covering care or other benefits provided under such 89
128		-	program, payment or part-payment of the premium for such insurance 90
129		-	may be made when deemed appropriate by the Commissioner of Social 91
130		-	Services. The commissioner shall limit reimbursement to medical 92
131		-	assistance providers for coinsurance and deductible payments under 93
132		-	Title XVIII of the Social Security Act to assure that the combined 94
133		-	Medicare and Medicaid payment to the provider shall not exceed the 95
134		-	maximum allowable under the Medicaid program fee schedules. 96
135		-	[(e)] (f) No self-insured plan, group health plan, as defined in Section 97
136		-	607(1) of the Employee Retirement Income Security Act of 1974, service 98
137		-	benefit plan, managed care plan, or any plan offered or administered by 99
138		-	a health care center, pharmacy benefit manager, dental benefit manager, 100
139		-	third-party administrator or other party that is, by statute, contract or 101
140		-	agreement, legally responsible for payment of a claim for a health care 102
141		-	item or service, shall contain any provision that has the effect of denying 103
142		-	or limiting enrollment benefits or excluding coverage because services 104
143		-	are rendered to an insured or beneficiary who is eligible for or who 105
144		-	received medical assistance under this chapter. No insurer, as defined 106
145		-	in section 38a-497a, shall impose requirements on the state Medicaid 107
146		-	agency, which has been assigned the rights of an individual eligible for 108
147		-	Medicaid and covered for health benefits from an insurer, that differ 109
148		-	from requirements applicable to an agent or assignee of another 110
149		-	individual so covered. 111
150		-	[(f)] (g) The Commissioner of Social Services shall not pay for any 112
151		-	services provided under this chapter if the individual eligible for 113
152		-	medical assistance has coverage for the services under an accident or 114
153		-	health insurance policy. 115
154		-	[(g)] (h) An insurer or other legally liable third party, upon receipt of 116 Substitute Bill No. 1110
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	123	+
	124	+	waiver, waiver renewal or proposed amendment to the General 85
	125	+	Assembly under subsection (a) of this section and shall include all 86
	126	+	written comments with the waiver, waiver renewal application or 87
	127	+	proposed amendment in the submission to the General Assembly. 88
	128	+	[(d)] (c) The commissioner shall include with any waiver application 89
	129	+	or proposed amendment submitted to the federal government pursuant 90
	130	+	to this section: (1) Any written comments received pursuant to 91
	131	+	subsection [(c)] (b) of this section; and (2) any additional written 92
	132	+	comments submitted to the joint standing committees at such 93
	133	+	proceedings. The joint standing committees shall transmit any such 94
	134	+	materials to the commissioner for inclusion with any such waiver 95
	135	+	application or proposed amendment. 96
	136	+	Sec. 2. Section 17b-265 of the general statutes is repealed and the 97
	137	+	following is substituted in lieu thereof (Effective October 1, 2023): 98
	138	+	(a) In accordance with 42 USC 1396k, the Department of Social 99
	139	+	Services shall be subrogated to any right of recovery or indemnification 100
	140	+	that an applicant or recipient of medical assistance or any legally liable 101
	141	+	relative of such applicant or recipient has against an insurer or other 102
	142	+	legally liable third party including, but not limited to, a self-insured 103
	143	+	plan, group health plan, as defined in Section 607(1) of the Employee 104
	144	+	Retirement Income Security Act of 1974, service benefit plan, managed 105
	145	+	care organization, health care center, pharmacy benefit manager, dental 106
	146	+	benefit manager, third-party administrator or other party that is, by 107
	147	+	statute, contract or agreement, legally responsible for payment of a 108
	148	+	claim for a health care item or service, for the cost of all health care items 109
	149	+	or services furnished to the applicant or recipient, including, but not 110
	150	+	limited to, hospitalization, pharmaceutical services, physician services, 111
	151	+	nursing services, behavioral health services, long-term care services and 112
	152	+	other medical services, not to exceed the amount expended by the 113
	153	+	department for such care and treatment of the applicant or recipient. In 114
	154	+	the case of such a recipient who is an enrollee in a care management 115
	155	+	organization under a Medicaid care management contract with the state 116
	156	+	or a legally liable relative of such an enrollee, the department shall be 117 Raised Bill No. 1110
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161		-	a claim submitted by the department or the department's designee, in 117
162		-	accordance with the requirements of subsection (c) of this section, for 118
163		-	payment of a health care item or service covered under a state medical 119
164		-	assistance program administered by the department, shall, not later 120
165		-	than [ninety] sixty days after receipt of the claim or not later than [ninety 121
166		-	days after the effective date of this section] November 30, 2023, 122
167		-	whichever is later, (1) make payment on the claim, (2) request 123
168		-	information necessary to determine its legal obligation to pay the claim, 124
169		-	or (3) issue a written reason for denial of the claim. Failure to pay, 125
170		-	request information necessary to determine legal obligation to pay or 126
171		-	issue a written reason for denial of a claim not later than one hundred 127
172		-	twenty days after receipt of the claim, or not later than [one hundred 128
173		-	twenty days after the effective date of this section] January 30, 2024, 129
174		-	whichever is later, creates an uncontestable obligation to pay the claim. 130
175		-	The provisions of this subsection shall apply to all claims, including 131
176		-	claims submitted by the department or the department's designee prior 132
177		-	to July 1, 2021. 133
178		-	[(h)] (i) On and after July 1, 2021, an insurer or other legally liable 134
179		-	third party who has reimbursed the department for a health care item 135
180		-	or service paid for and covered under a state medical assistance 136
181		-	program administered by the department shall, upon determining it is 137
182		-	not liable and at risk for cost of the health care item or service, request 138
183		-	any refund from the department not later than twelve months from the 139
184		-	date of its reimbursement to the department. 140
185		-	Sec. 2. Section 17b-265g of the general statutes is repealed and the 141
186		-	following is substituted in lieu thereof (Effective October 1, 2023): 142
187		-	Any health insurer, including a self-insured plan, group health plan, 143
188		-	as defined in Section 607(1) of the Employee Retirement Income Security 144
189		-	Act of 1974, service benefit plan, managed care organization, health care 145
190		-	center, pharmacy benefit manager, dental benefit manager or other 146
191		-	party that is, by statute, contract or agreement, legally responsible for 147
192		-	payment of a claim for a health care item or service, and which may or 148
193		-	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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	161	+
	162	+	subrogated to any right of recovery or indemnification which the 118
	163	+	enrollee or legally liable relative has against such a private insurer or 119
	164	+	other third party for the medical costs incurred by the care management 120
	165	+	organization on behalf of an enrollee. Whenever funds owed to a person 121
	166	+	are collected pursuant to this section and the person who otherwise 122
	167	+	would have been entitled to such funds is subject to a court-ordered 123
	168	+	current or arrearage child support payment obligation in an IV-D 124
	169	+	support case, such funds shall first be paid to the state for 125
	170	+	reimbursement of Medicaid funds paid on behalf of such person for 126
	171	+	medical expenses incurred for injuries related to a legal claim by such 127
	172	+	person that was the subject of the state's right of subrogation, and 128
	173	+	remaining funds, if any, shall then be paid to the Office of Child Support 129
	174	+	Services for distribution pursuant to the federally mandated child 130
	175	+	support distribution system implemented pursuant to subsection (j) of 131
	176	+	section 17b-179. Any additional claim of the state to the remainder of 132
	177	+	such funds, if any, shall be paid in accordance with state law. 133
	178	+	(b) An applicant or recipient or legally liable relative, by the act of the 134
	179	+	applicant's or recipient's receiving medical assistance, shall be deemed 135
	180	+	to have made a subrogation assignment and an assignment of claim for 136
	181	+	benefits to the department. The department shall inform an applicant of 137
	182	+	such assignments at the time of application. Any entitlements from a 138
	183	+	contractual agreement with an applicant or recipient, legally liable 139
	184	+	relative or a state or federal program for such medical services, not to 140
	185	+	exceed the amount expended by the department, shall be so assigned. 141
	186	+	Such entitlements shall be directly reimbursable to the department by 142
	187	+	third party payors. The Department of Social Services may assign its 143
	188	+	right to subrogation or its entitlement to benefits to a designee or a 144
	189	+	health care provider participating in the Medicaid program and 145
	190	+	providing services to an applicant or recipient, in order to assist the 146
	191	+	provider in obtaining payment for such services. In accordance with 147
	192	+	subsection (b) of section 38a-472, a provider that has received an 148
	193	+	assignment from the department shall notify the recipient's health 149
	194	+	insurer or other legally liable third party including, but not limited to, a 150
	195	+	self-insured plan, group health plan, as defined in Section 607(1) of the 151 Raised Bill No. 1110
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200		-	shall, as a condition of doing business in the state, be required to: 150
201		-	(1) Provide, with respect to an individual who is eligible for, or is 151
202		-	provided, medical assistance under the Medicaid state plan, to all third-152
203		-	party administrators, pharmacy benefit managers, dental benefit 153
204		-	managers or other entities with which the health insurer has a contract 154
205		-	or arrangement to adjudicate claims for a health care item or service, 155
206		-	and to the Commissioner of Social Services, or the commissioner's 156
207		-	designee, any and all information in a manner and format prescribed by 157
208		-	the commissioner, or commissioner's designee, necessary to determine 158
209		-	when the individual, his or her spouse or the individual's dependents 159
210		-	may be or have been covered by a health insurer and the nature of the 160
211		-	coverage that is or was provided by such health insurer including the 161
212		-	name, address and identifying number of the plan; 162
213		-	(2) [accept] Accept the state's right of recovery and the assignment to 163
214		-	the state of any right of an individual or other entity to payment from 164
215		-	the health insurer for an item or service for which payment has been 165
216		-	made under the Medicaid state plan; 166
217		-	(3) [respond to] Respond not later than sixty days after receiving any 167
218		-	inquiry [by] from the commissioner, or the commissioner's designee, 168
219		-	regarding a claim for payment for any health care item or service that is 169
220		-	submitted not later than three years after the date of the provision of the 170
221		-	item or service; and 171
222		-	(4) [agree] Agree (A) to accept authorization provided by the 172
223		-	Department of Social Services that an item or service is covered under 173
224		-	the Medicaid state plan, or a waiver of such plan, as if such 174
225		-	authorization were the prior authorization made by such health insurer 175
226		-	for such item or service, and (B) not to deny a claim submitted by the 176
227		-	state solely on the basis of the date of submission of the claim, the type 177
228		-	or format of the claim form or a failure to present proper documentation 178
229		-	at the point-of-sale that is the basis of the claim, if [(A)] (i) the claim is 179
230		-	submitted by the state or its agent within the three-year period 180
231		-	beginning on the date on which the item or service was furnished; and 181 Substitute Bill No. 1110
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	200	+
	201	+	Employee Retirement Income Security Act of 1974, service benefit plan, 152
	202	+	managed care organization, health care center, pharmacy benefit 153
	203	+	manager, dental benefit manager, third-party administrator or other 154
	204	+	party that is, by statute, contract or agreement, legally responsible for 155
	205	+	payment of a claim for a health care item or service, of the assignment 156
	206	+	upon rendition of services to the applicant or recipient. Failure to so 157
	207	+	notify the health insurer or other legally liable third party shall render 158
	208	+	the provider ineligible for payment from the department. The provider 159
	209	+	shall notify the department of any request by the applicant or recipient 160
	210	+	or legally liable relative or representative of such applicant or recipient 161
	211	+	for billing information. This subsection shall not be construed to affect 162
	212	+	the right of an applicant or recipient to maintain an independent cause 163
	213	+	of action against such third party tortfeasor. 164
	214	+	(c) Claims for recovery or indemnification submitted by the 165
	215	+	department, or the department's designee, shall not be denied solely on 166
	216	+	the basis of the date of the submission of the claim, the type or format of 167
	217	+	the claim, the lack of prior authorization or the failure to present proper 168
	218	+	documentation at the point-of-service that is the basis of the claim, if (1) 169
	219	+	the claim is submitted by the state within the three-year period 170
	220	+	beginning on the date on which the item or service was furnished; and 171
	221	+	(2) any action by the state to enforce its rights with respect to such claim 172
	222	+	is commenced within six years of the state's submission of the claim. 173
	223	+	(d) (1) A party to whom a claim for recovery or indemnification is 174
	224	+	submitted for an item or service furnished under the Medicaid state 175
	225	+	plan, or a waiver of such plan, who requires prior authorization for such 176
	226	+	item or service shall accept authorization provided by the Department 177
	227	+	of Social Services that the item or service is covered under such plan or 178
	228	+	waiver as if such authorization were the prior authorization made by 179
	229	+	such party for the item or service. 180
	230	+	(2) The provisions of subdivision (1) of this subsection shall not apply 181
	231	+	with respect to a claim for recovery or indemnification submitted to 182
	232	+	Medicare, a Medicare Advantage plan or a Medicare Part D plan. 183 Raised Bill No. 1110
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238		-	[(B)] (ii) any legal action by the state to enforce its rights with respect to 182
239		-	such claim is commenced within six years of the state's submission of 183
240		-	such claim. 184
241		-	Sec. 3. Subsection (e) of section 12-746 of the general statutes is 185
242		-	repealed and the following is substituted in lieu thereof (Effective from 186
243		-	passage): 187
244		-	(e) Amounts rebated pursuant to this section shall not be considered 188
245		-	income for purposes of sections 8-119l, 8-345, 12-170d, 12-170aa, [17b-189
246		-	550,] 47-88d and 47-287. 190
247		-	Sec. 4. Section 16a-41a of the general statutes is repealed and the 191
248		-	following is substituted in lieu thereof (Effective July 1, 2023): 192
249		-	(a) The Commissioner of Social Services shall submit to the joint 193
250		-	standing committees of the General Assembly having cognizance of 194
251		-	energy planning and activities, appropriations, and human services the 195
252		-	following on the implementation of the block grant program authorized 196
253		-	under the Low-Income Home Energy Assistance Act of 1981, as 197
254		-	amended: 198
255		-	(1) Not later than August first, annually, a Connecticut energy 199
256		-	assistance program annual plan which establishes guidelines for the use 200
257		-	of funds authorized under the Low-Income Home Energy Assistance 201
258		-	Act of 1981, as amended, and includes the following: 202
259		-	(A) Criteria for determining which households are to receive 203
260		-	emergency assistance; 204
261		-	(B) A description of systems used to ensure referrals to other energy 205
262		-	assistance programs and the taking of simultaneous applications, as 206
263		-	required under section 16a-41; 207
264		-	(C) A description of outreach efforts; 208
265		-	(D) Estimates of the total number of households eligible for assistance 209 Substitute Bill No. 1110
	236	+	LCO No. 4248 7 of 16
	237	+
	238	+	[(d)] (e) When a recipient of medical assistance has personal health 184
	239	+	insurance in force covering care or other benefits provided under such 185
	240	+	program, payment or part-payment of the premium for such insurance 186
	241	+	may be made when deemed appropriate by the Commissioner of Social 187
	242	+	Services. The commissioner shall limit reimbursement to medical 188
	243	+	assistance providers for coinsurance and deductible payments under 189
	244	+	Title XVIII of the Social Security Act to assure that the combined 190
	245	+	Medicare and Medicaid payment to the provider shall not exceed the 191
	246	+	maximum allowable under the Medicaid program fee schedules. 192
	247	+	[(e)] (f) No self-insured plan, group health plan, as defined in Section 193
	248	+	607(1) of the Employee Retirement Income Security Act of 1974, service 194
	249	+	benefit plan, managed care plan, or any plan offered or administered by 195
	250	+	a health care center, pharmacy benefit manager, dental benefit manager, 196
	251	+	third-party administrator or other party that is, by statute, contract or 197
	252	+	agreement, legally responsible for payment of a claim for a health care 198
	253	+	item or service, shall contain any provision that has the effect of denying 199
	254	+	or limiting enrollment benefits or excluding coverage because services 200
	255	+	are rendered to an insured or beneficiary who is eligible for or who 201
	256	+	received medical assistance under this chapter. No insurer, as defined 202
	257	+	in section 38a-497a, shall impose requirements on the state Medicaid 203
	258	+	agency, which has been assigned the rights of an individual eligible for 204
	259	+	Medicaid and covered for health benefits from an insurer, that differ 205
	260	+	from requirements applicable to an agent or assignee of another 206
	261	+	individual so covered. 207
	262	+	[(f)] (g) The Commissioner of Social Services shall not pay for any 208
	263	+	services provided under this chapter if the individual eligible for 209
	264	+	medical assistance has coverage for the services under an accident or 210
	265	+	health insurance policy. 211
	266	+	[(g)] (h) An insurer or other legally liable third party, upon receipt of 212
	267	+	a claim submitted by the department or the department's designee, in 213
	268	+	accordance with the requirements of subsection (c) of this section, for 214
	269	+	payment of a health care item or service covered under a state medical 215
	270	+	assistance program administered by the department, shall, not later 216 Raised Bill No. 1110
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272		-	under the program and the number of households in which one or more 210
273		-	elderly or physically disabled individuals eligible for assistance reside; 211
274		-	(E) Design of a basic grant for eligible households that does not 212
275		-	discriminate against such households based on the type of energy used 213
276		-	for heating; and 214
277		-	(F) A payment plan for fuel deliveries beginning November 1, [2018] 215
278		-	2023, that ensures a vendor of deliverable fuel who completes deliveries 216
279		-	authorized by a community action agency that contracts with the 217
280		-	commissioner to administer a fuel assistance program is [paid] provided 218
281		-	the option to be paid electronically by the community action agency and 219
282		-	is paid not later than [thirty] ten business days after the date the 220
283		-	community action agency receives an authorized fuel slip or invoice for 221
284		-	payment from the vendor; 222
285		-	(2) Not later than January thirtieth, annually, a report covering the 223
286		-	preceding months of the program year, including: 224
287		-	(A) In each community action agency geographic area, the number of 225
288		-	fuel assistance applications filed, approved and denied, and the number 226
289		-	of emergency assistance requests made, approved and denied; 227
290		-	(B) In each such area, the total amount of fuel and emergency 228
291		-	assistance, itemized by such type of assistance, and total expenditures 229
292		-	to date; 230
293		-	(C) For each state-wide office of each state agency administering the 231
294		-	program and each community action agency, administrative expenses 232
295		-	under the program, by line item, and an estimate of outreach 233
296		-	expenditures; and 234
297		-	(D) A list of community action agencies that failed to make timely 235
298		-	payments to vendors of deliverable fuel in the Connecticut energy 236
299		-	assistance program and the steps taken by the commissioner to ensure 237
300		-	future timely payments by such agencies; and 238 Substitute Bill No. 1110
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	275	+
	276	+	than [ninety] sixty days after receipt of the claim or not later than 217
	277	+	[ninety] sixty days after the effective date of this section, whichever is 218
	278	+	later, (1) make payment on the claim, (2) request information necessary 219
	279	+	to determine its legal obligation to pay the claim, or (3) issue a written 220
	280	+	reason for denial of the claim. Failure to pay, request information 221
	281	+	necessary to determine legal obligation to pay or issue a written reason 222
	282	+	for denial of a claim not later than one hundred twenty days after receipt 223
	283	+	of the claim, or not later than one hundred twenty days after the 224
	284	+	effective date of this section, whichever is later, creates an uncontestable 225
	285	+	obligation to pay the claim. The provisions of this subsection shall apply 226
	286	+	to all claims, including claims submitted by the department or the 227
	287	+	department's designee prior to July 1, 2021. 228
	288	+	[(h)] (i) On and after July 1, 2021, an insurer or other legally liable 229
	289	+	third party who has reimbursed the department for a health care item 230
	290	+	or service paid for and covered under a state medical assistance 231
	291	+	program administered by the department shall, upon determining it is 232
	292	+	not liable and at risk for cost of the health care item or service, request 233
	293	+	any refund from the department not later than twelve months from the 234
	294	+	date of its reimbursement to the department. 235
	295	+	Sec. 3. Section 17b-265g of the general statutes is repealed and the 236
	296	+	following is substituted in lieu thereof (Effective October 1, 2023): 237
	297	+	Any health insurer, including a self-insured plan, group health plan, 238
	298	+	as defined in Section 607(1) of the Employee Retirement Income Security 239
	299	+	Act of 1974, service benefit plan, managed care organization, health care 240
	300	+	center, pharmacy benefit manager, dental benefit manager or other 241
	301	+	party that is, by statute, contract or agreement, legally responsible for 242
	302	+	payment of a claim for a health care item or service, and which may or 243
	303	+	may not be financially at risk for the cost of a health care item or service, 244
	304	+	shall, as a condition of doing business in the state, be required to: 245
	305	+	(1) Provide, with respect to an individual who is eligible for, or is 246
	306	+	provided, medical assistance under the Medicaid state plan, to all third-247
	307	+	party administrators, pharmacy benefit managers, dental benefit 248 Raised Bill No. 1110
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307		-	(3) Not later than November first, annually, a report covering the 239
308		-	preceding twelve calendar months, including: 240
309		-	(A) In each community action agency geographic area, (i) seasonal 241
310		-	totals for the categories of data submitted under subdivision (1) of this 242
311		-	subsection, (ii) the number of households receiving fuel assistance in 243
312		-	which elderly or physically disabled individuals reside, and (iii) the 244
313		-	average combined benefit level of fuel, emergency and renter assistance; 245
314		-	(B) The number of homeowners and tenants whose heat or total 246
315		-	energy costs are not included in their rent receiving fuel and emergency 247
316		-	assistance under the program by benefit level; 248
317		-	(C) The number of homeowners and tenants whose heat is included 249
318		-	in their rent and who are receiving assistance, by benefit level; and 250
319		-	(D) The number of households receiving assistance, by energy type 251
320		-	and total expenditures for each energy type. 252
321		-	(b) The Commissioner of Social Services shall implement a program 253
322		-	to purchase deliverable fuel for low-income households participating in 254
323		-	the Connecticut energy assistance program and the state-appropriated 255
324		-	fuel assistance program. The commissioner shall ensure an adequate 256
325		-	supply of vendors for the program by (1) establishing county and 257
326		-	regional pricing standards for deliverable fuel, (2) reimbursing fuel 258
327		-	providers based on the price of the fuel on the date of delivery, (3) 259
328		-	establishing a discount on the vendor's retail price, and (4) allowing a 260
329		-	vendor to electronically submit an authorized fuel slip or invoice for 261
330		-	payment. 262
331		-	(c) The commissioner shall ensure that no fuel vendor discriminates 263
332		-	against fuel assistance program recipients who are under the vendor's 264
333		-	standard payment, delivery, service or other similar plans. The 265
334		-	commissioner may take advantage of programs offered by fuel vendors 266
335		-	that reduce the cost of the fuel purchased, including, but not limited to, 267
336		-	fixed price, capped price, prepurchase or summer-fill programs that 268
337		-	reduce program cost and that make the maximum use of program 269 Substitute Bill No. 1110
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	312	+
	313	+	managers or other entities with which the health insurer has a contract 249
	314	+	or arrangement to adjudicate claims for a health care item or service, 250
	315	+	and to the Commissioner of Social Services, or the commissioner's 251
	316	+	designee, any and all information in a manner and format prescribed by 252
	317	+	the commissioner, or commissioner's designee, necessary to determine 253
	318	+	when the individual, his or her spouse or the individual's dependents 254
	319	+	may be or have been covered by a health insurer and the nature of the 255
	320	+	coverage that is or was provided by such health insurer including the 256
	321	+	name, address and identifying number of the plan; 257
	322	+	(2) [accept] Accept the state's right of recovery and the assignment to 258
	323	+	the state of any right of an individual or other entity to payment from 259
	324	+	the health insurer for an item or service for which payment has been 260
	325	+	made under the Medicaid state plan; 261
	326	+	(3) [respond to] Respond not later than sixty days after receiving any 262
	327	+	inquiry [by] from the commissioner, or the commissioner's designee, 263
	328	+	regarding a claim for payment for any health care item or service that is 264
	329	+	submitted not later than three years after the date of the provision of the 265
	330	+	item or service; and 266
	331	+	(4) [agree] Agree (A) to accept authorization provided by the 267
	332	+	Department of Social Services that an item or service is covered under 268
	333	+	the Medicaid state plan, or a waiver of such plan, as if such 269
	334	+	authorization were the prior authorization made by said health insurer 270
	335	+	for such item or service, and (B) not to deny a claim submitted by the 271
	336	+	state solely on the basis of the date of submission of the claim, the type 272
	337	+	or format of the claim form or a failure to present proper documentation 273
	338	+	at the point-of-sale that is the basis of the claim, if [(A)] (i) the claim is 274
	339	+	submitted by the state or its agent within the three-year period 275
	340	+	beginning on the date on which the item or service was furnished; and 276
	341	+	[(B)] (ii) any legal action by the state to enforce its rights with respect to 277
	342	+	such claim is commenced within six years of the state's submission of 278
	343	+	such claim. 279
	344	+	Sec. 4. Subsection (e) of section 12-746 of the general statutes is 280 Raised Bill No. 1110
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344		-	revenues. As funding allows, the commissioner shall ensure that all 270
345		-	agencies administering the fuel assistance program shall make 271
346		-	payments to program fuel vendors in advance of the delivery of energy 272
347		-	where vendor provided price-management strategies require payments 273
348		-	in advance. 274
349		-	[(c)] (d) Each community action agency administering a fuel 275
350		-	assistance program shall submit reports, as requested by the 276
351		-	Commissioner of Social Services, concerning pricing information from 277
352		-	vendors of deliverable fuel participating in the program. Such 278
353		-	information shall include, but not be limited to, the state-wide or 279
354		-	regional retail price per unit of deliverable fuel, the reduced price per 280
355		-	unit paid by the state for the deliverable fuel in utilizing price 281
356		-	management strategies offered by program vendors for all consumers, 282
357		-	the number of units delivered to the state under the program and the 283
358		-	total savings under the program due to the purchase of deliverable fuel 284
359		-	utilizing price-management strategies offered by program vendors for 285
360		-	all consumers. 286
361		-	[(d)] (e) If funding allows, the Commissioner of Social Services, in 287
362		-	consultation with the Secretary of the Office of Policy and Management, 288
363		-	shall require that, each community action agency administering a fuel 289
364		-	assistance program begin accepting applications for the program not 290
365		-	later than September first of each year. 291
366		-	[(e)] (f) Not later than November 1, [2018] 2023, the Commissioner of 292
367		-	Social Services shall require each community action agency 293
368		-	administering a fuel assistance program to make payment to a vendor 294
369		-	of deliverable fuel not later than [thirty] ten days after the community 295
370		-	action agency receives an authorized fuel slip or invoice for payment 296
371		-	from the vendor and to give the vendor the options of (1) being paid 297
372		-	electronically, and (2) submitting electronically an authorized fuel slip 298
373		-	or invoice for payment. 299
374		-	[(f)] (g) The Commissioner of Social Services shall submit each plan 300
375		-	or report described in subsection (a) of this section to the Low-Income 301 Substitute Bill No. 1110
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	349	+
	350	+	repealed and the following is substituted in lieu thereof (Effective from 281
	351	+	passage): 282
	352	+	(e) Amounts rebated pursuant to this section shall not be considered 283
	353	+	income for purposes of sections 8-119l, 8-345, 12-170d, 12-170aa, [17b-284
	354	+	550,] 47-88d and 47-287. 285
	355	+	Sec. 5. Section 16a-41a of the general statutes is repealed and the 286
	356	+	following is substituted in lieu thereof (Effective July 1, 2023): 287
	357	+	(a) The Commissioner of Social Services shall submit to the joint 288
	358	+	standing committees of the General Assembly having cognizance of 289
	359	+	energy planning and activities, appropriations, and human services the 290
	360	+	following on the implementation of the block grant program authorized 291
	361	+	under the Low-Income Home Energy Assistance Act of 1981, as 292
	362	+	amended: 293
	363	+	(1) Not later than August first, annually, a Connecticut energy 294
	364	+	assistance program annual plan which establishes guidelines for the use 295
	365	+	of funds authorized under the Low-Income Home Energy Assistance 296
	366	+	Act of 1981, as amended, and includes the following: 297
	367	+	(A) Criteria for determining which households are to receive 298
	368	+	emergency assistance; 299
	369	+	(B) A description of systems used to ensure referrals to other energy 300
	370	+	assistance programs and the taking of simultaneous applications, as 301
	371	+	required under section 16a-41; 302
	372	+	(C) A description of outreach efforts; 303
	373	+	(D) Estimates of the total number of households eligible for assistance 304
	374	+	under the program and the number of households in which one or more 305
	375	+	elderly or physically disabled individuals eligible for assistance reside; 306
	376	+	(E) Design of a basic grant for eligible households that does not 307
	377	+	discriminate against such households based on the type of energy used 308
	378	+	for heating; and 309 Raised Bill No. 1110
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382		-	Energy Advisory Board, established pursuant to section 16a-41b, not 302
383		-	later than seven days prior to submitting such plan or report to the joint 303
384		-	standing committee of the General Assembly having cognizance of 304
385		-	matters relating to energy and technology, appropriations and human 305
386		-	services. 306
387		-	Sec. 5. (NEW) (Effective July 1, 2023) To the extent permissible under 307
388		-	federal law and within available appropriations, as the single state 308
389		-	Medicaid agency designated under sections 17b-2 and 17b-260 of the 309
390		-	general statutes, the Commissioner of Social Services may implement a 310
391		-	bundled payment for maternity services and any other alternative 311
392		-	payment methodology or combination of methodologies for maternity 312
393		-	services that the commissioner determines are designed to improve 313
394		-	health quality, equity, member experience, cost containment and 314
395		-	coordination of care. The commissioner may implement policies and 315
396		-	procedures to the extent that regulations may be required to carry out 316
397		-	any of the provisions of this section while in the process of adopting 317
398		-	such policies and procedures as regulations, provided the commissioner 318
399		-	publishes notice of intent to adopt regulations on the eRegulations 319
400		-	System not later than twenty days after the date of implementation of 320
401		-	such policies and procedures. Any policies and procedures 321
402		-	implemented pursuant to this section shall be valid until the time final 322
403		-	regulations are adopted. 323
404		-	Sec. 6. Section 53a-290 of the general statutes is repealed and the 324
405		-	following is substituted in lieu thereof (Effective from passage): 325
406		-	A person commits vendor fraud when, with intent to defraud and 326
407		-	acting on such person's own behalf or on behalf of an entity, such person 327
408		-	provides goods or services to a beneficiary under sections 17b-22, 17b-328
409		-	75 to 17b-77, inclusive, 17b-79 to 17b-103, inclusive, 17b-180a, 17b-183, 329
410		-	17b-260 to 17b-262, inclusive, 17b-264 to 17b-285, inclusive, 17b-357 to 330
411		-	17b-361, inclusive, 17b-600 to 17b-604, inclusive, 17b-749 [, 17b-807] and 331
412		-	17b-808 or provides services to a recipient under Title XIX of the Social 332
413		-	Security Act, as amended, and, (1) presents for payment any false claim 333
414		-	for goods or services performed; (2) accepts payment for goods or 334 Substitute Bill No. 1110
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	383	+
	384	+	(F) A payment plan for fuel deliveries beginning November 1, [2018] 310
	385	+	2023, that ensures a vendor of deliverable fuel who completes deliveries 311
	386	+	authorized by a community action agency that contracts with the 312
	387	+	commissioner to administer a fuel assistance program is paid by the 313
	388	+	community action agency not later than [thirty] ten business days after 314
	389	+	the date the community action agency receives an authorized fuel slip 315
	390	+	or invoice for payment from the vendor; 316
	391	+	(2) Not later than January thirtieth, annually, a report covering the 317
	392	+	preceding months of the program year, including: 318
	393	+	(A) In each community action agency geographic area, the number of 319
	394	+	fuel assistance applications filed, approved and denied, and the number 320
	395	+	of emergency assistance requests made, approved and denied; 321
	396	+	(B) In each such area, the total amount of fuel and emergency 322
	397	+	assistance, itemized by such type of assistance, and total expenditures 323
	398	+	to date; 324
	399	+	(C) For each state-wide office of each state agency administering the 325
	400	+	program and each community action agency, administrative expenses 326
	401	+	under the program, by line item, and an estimate of outreach 327
	402	+	expenditures; and 328
	403	+	(D) A list of community action agencies that failed to make timely 329
	404	+	payments to vendors of deliverable fuel in the Connecticut energy 330
	405	+	assistance program and the steps taken by the commissioner to ensure 331
	406	+	future timely payments by such agencies; and 332
	407	+	(3) Not later than November first, annually, a report covering the 333
	408	+	preceding twelve calendar months, including: 334
	409	+	(A) In each community action agency geographic area, (i) seasonal 335
	410	+	totals for the categories of data submitted under subdivision (1) of this 336
	411	+	subsection, (ii) the number of households receiving fuel assistance in 337
	412	+	which elderly or physically disabled individuals reside, and (iii) the 338
	413	+	average combined benefit level of fuel, emergency and renter assistance; 339 Raised Bill No. 1110
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421		-	services performed, which exceeds either the amounts due for goods or 335
422		-	services performed, or the amounts authorized by law for the cost of 336
423		-	such goods or services; (3) solicits to perform services for or sell goods 337
424		-	to any such beneficiary, knowing that such beneficiary is not in need of 338
425		-	such goods or services; (4) sells goods to or performs services for any 339
426		-	such beneficiary without prior authorization by the Department of 340
427		-	Social Services, when prior authorization is required by said department 341
428		-	for the buying of such goods or the performance of any service; (5) 342
429		-	accepts from any person or source other than the state an additional 343
430		-	compensation in excess of the amount authorized by law; or (6) having 344
431		-	knowledge of the occurrence of any event affecting (A) his or her initial 345
432		-	or continued right to any such benefit or payment, or (B) the initial or 346
433		-	continued right to any such benefit or payment of any other individual 347
434		-	in whose behalf he or she has applied for or is receiving such benefit or 348
435		-	payment, conceals or fails to disclose such event with an intent to 349
436		-	fraudulently secure such benefit or payment either in a greater amount 350
437		-	or quantity than is due or when no such benefit or payment is 351
438		-	authorized. 352
439		-	Sec. 7. Subsection (l) of section 17b-261 of the general statutes is 353
440		-	repealed and the following is substituted in lieu thereof (Effective from 354
441		-	passage): 355
442		-	(l) On and after January 1, 2023, the Commissioner of Social Services 356
443		-	shall, within available appropriations, provide state-funded medical 357
444		-	assistance to any child twelve years of age and younger, regardless of 358
445		-	immigration status, (1) whose household income does not exceed two 359
446		-	hundred one per cent of the federal poverty level without an asset limit, 360
447		-	and (2) who does not otherwise qualify for Medicaid, the Children's 361
448		-	Health Insurance Program, or an offer of affordable, employer-362
449		-	sponsored insurance, as defined in the Affordable Care Act, as an 363
450		-	employee or a dependent of an employee. A child eligible for such 364
451		-	assistance under this subsection shall continue to receive such assistance 365
452		-	until such child is nineteen years of age, provided the child continues to 366
453		-	meet the eligibility requirements prescribed in subdivisions (1) and (2) 367 Substitute Bill No. 1110
	417	+	LCO No. 4248 12 of 16
	418	+
	419	+	(B) The number of homeowners and tenants whose heat or total 340
	420	+	energy costs are not included in their rent receiving fuel and emergency 341
	421	+	assistance under the program by benefit level; 342
	422	+	(C) The number of homeowners and tenants whose heat is included 343
	423	+	in their rent and who are receiving assistance, by benefit level; and 344
	424	+	(D) The number of households receiving assistance, by energy type 345
	425	+	and total expenditures for each energy type. 346
	426	+	(b) The Commissioner of Social Services shall implement a program 347
	427	+	to purchase deliverable fuel for low-income households participating in 348
	428	+	the Connecticut energy assistance program and the state-appropriated 349
	429	+	fuel assistance program. The commissioner shall ensure that no fuel 350
	430	+	vendor discriminates against fuel assistance program recipients who are 351
	431	+	under the vendor's standard payment, delivery, service or other similar 352
	432	+	plans. The commissioner may take advantage of programs offered by 353
	433	+	fuel vendors that reduce the cost of the fuel purchased, including, but 354
	434	+	not limited to, fixed price, capped price, prepurchase or summer-fill 355
	435	+	programs that reduce program cost and that make the maximum use of 356
	436	+	program revenues. As funding allows, the commissioner shall ensure 357
	437	+	that all agencies administering the fuel assistance program shall make 358
	438	+	payments to program fuel vendors in advance of the delivery of energy 359
	439	+	where vendor provided price-management strategies require payments 360
	440	+	in advance. 361
	441	+	(c) Each community action agency administering a fuel assistance 362
	442	+	program shall submit reports, as requested by the Commissioner of 363
	443	+	Social Services, concerning pricing information from vendors of 364
	444	+	deliverable fuel participating in the program. Such information shall 365
	445	+	include, but not be limited to, the state-wide or regional retail price per 366
	446	+	unit of deliverable fuel, the reduced price per unit paid by the state for 367
	447	+	the deliverable fuel in utilizing price management strategies offered by 368
	448	+	program vendors for all consumers, the number of units delivered to the 369
	449	+	state under the program and the total savings under the program due 370
	450	+	to the purchase of deliverable fuel utilizing price-management 371 Raised Bill No. 1110
454	451
455	452
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459	453
460		-	of this subsection. The provisions of section 17b-265, as amended by this 368
461		-	act, shall apply with respect to any medical assistance provided 369
462		-	pursuant to this subsection. 370
463		-	Sec. 8. Subsection (a) of section 17b-292 of the general statutes is 371
464		-	repealed and the following is substituted in lieu thereof (Effective from 372
465		-	passage): 373
466		-	(a) A child who resides in a household with household income that 374
467		-	exceeds one hundred ninety-six per cent of the federal poverty level but 375
468		-	does not exceed three hundred eighteen per cent of the federal poverty 376
469		-	level may be eligible for benefits under HUSKY B. Not later than 377
470		-	January 1, 2023, the Commissioner of Social Services shall, within 378
471		-	available appropriations, provide state-funded medical assistance to 379
472		-	any child twelve years of age and younger, regardless of immigration 380
473		-	status, (1) with a household income that exceeds two hundred one per 381
474		-	cent of the federal poverty level but does not exceed three hundred 382
475		-	twenty-three per cent of the federal poverty level, and (2) who does not 383
476		-	otherwise qualify for Medicaid, the Children's Health Insurance 384
477		-	Program, or an offer of affordable, employer-sponsored insurance, as 385
478		-	defined in the Affordable Care Act, as an employee or a dependent of 386
479		-	an employee. A child eligible for such assistance under this subsection 387
480		-	shall continue to receive such assistance until such child is nineteen 388
481		-	years of age, provided the child continues to meet the eligibility 389
482		-	requirements prescribed in subdivisions (1) and (2) of this subsection. 390
483		-	The provisions of section 17b-265, as amended by this act, shall apply 391
484		-	with respect to any medical assistance provided pursuant to this 392
485		-	subsection. 393
486		-	Sec. 9. Sections 17b-306a, 17b-550 to 17b-554, inclusive, and 17b-807 394
487		-	of the general statutes are repealed. (Effective from passage) 395
	454	+	LCO No. 4248 13 of 16
	455	+
	456	+	strategies offered by program vendors for all consumers. 372
	457	+	(d) If funding allows, the Commissioner of Social Services, in 373
	458	+	consultation with the Secretary of the Office of Policy and Management, 374
	459	+	shall require that, each community action agency administering a fuel 375
	460	+	assistance program begin accepting applications for the program not 376
	461	+	later than September first of each year. 377
	462	+	(e) Not later than November 1, [2018] 2023, the Commissioner of 378
	463	+	Social Services shall require each community action agency 379
	464	+	administering a fuel assistance program to make payment to a vendor 380
	465	+	of deliverable fuel not later than [thirty] ten days after the community 381
	466	+	action agency receives an authorized fuel slip or invoice for payment 382
	467	+	from the vendor. 383
	468	+	(f) The Commissioner of Social Services shall submit each plan or 384
	469	+	report described in subsection (a) of this section to the Low-Income 385
	470	+	Energy Advisory Board, established pursuant to section 16a-41b, not 386
	471	+	later than seven days prior to submitting such plan or report to the joint 387
	472	+	standing committee of the General Assembly having cognizance of 388
	473	+	matters relating to energy and technology, appropriations and human 389
	474	+	services. 390
	475	+	Sec. 6. (NEW) (Effective July 1, 2023) To the extent permissible under 391
	476	+	federal law and within available appropriations, as the single state 392
	477	+	Medicaid agency designated under sections 17b-2 and 17b-260 of the 393
	478	+	general statutes, the Commissioner of Social Services may implement a 394
	479	+	bundled payment for maternity services and any other alternative 395
	480	+	payment methodology or combination of methodologies that the 396
	481	+	commissioner determines are designed to improve health quality, 397
	482	+	equity, member experience, cost containment and coordination of care. 398
	483	+	The commissioner may implement policies and procedures to the extent 399
	484	+	that regulations may be required to carry out any of the provisions of 400
	485	+	this section while in the process of adopting such policies and 401
	486	+	procedures as regulations, provided the commissioner publishes notice 402
	487	+	of intent to adopt regulations on the eRegulations System not later than 403 Raised Bill No. 1110
	488	+
	489	+
	490	+
	491	+	LCO No. 4248 14 of 16
	492	+
	493	+	twenty days after the date of implementation. Policies and procedures 404
	494	+	implemented pursuant to this section shall be valid until the time final 405
	495	+	regulations are adopted. 406
	496	+	Sec. 7. Section 53a-290 of the general statutes is repealed and the 407
	497	+	following is substituted in lieu thereof (Effective from passage): 408
	498	+	A person commits vendor fraud when, with intent to defraud and 409
	499	+	acting on such person's own behalf or on behalf of an entity, such person 410
	500	+	provides goods or services to a beneficiary under sections 17b-22, 17b-411
	501	+	75 to 17b-77, inclusive, 17b-79 to 17b-103, inclusive, 17b-180a, 17b-183, 412
	502	+	17b-260 to 17b-262, inclusive, 17b-264 to 17b-285, inclusive, 17b-357 to 413
	503	+	17b-361, inclusive, 17b-600 to 17b-604, inclusive, 17b-749 [, 17b-807] and 414
	504	+	17b-808 or provides services to a recipient under Title XIX of the Social 415
	505	+	Security Act, as amended, and, (1) presents for payment any false claim 416
	506	+	for goods or services performed; (2) accepts payment for goods or 417
	507	+	services performed, which exceeds either the amounts due for goods or 418
	508	+	services performed, or the amounts authorized by law for the cost of 419
	509	+	such goods or services; (3) solicits to perform services for or sell goods 420
	510	+	to any such beneficiary, knowing that such beneficiary is not in need of 421
	511	+	such goods or services; (4) sells goods to or performs services for any 422
	512	+	such beneficiary without prior authorization by the Department of 423
	513	+	Social Services, when prior authorization is required by said department 424
	514	+	for the buying of such goods or the performance of any service; (5) 425
	515	+	accepts from any person or source other than the state an additional 426
	516	+	compensation in excess of the amount authorized by law; or (6) having 427
	517	+	knowledge of the occurrence of any event affecting (A) his or her initial 428
	518	+	or continued right to any such benefit or payment, or (B) the initial or 429
	519	+	continued right to any such benefit or payment of any other individual 430
	520	+	in whose behalf he or she has applied for or is receiving such benefit or 431
	521	+	payment, conceals or fails to disclose such event with an intent to 432
	522	+	fraudulently secure such benefit or payment either in a greater amount 433
	523	+	or quantity than is due or when no such benefit or payment is 434
	524	+	authorized. 435
	525	+	Sec. 8. Subsection (l) of section 17b-261 of the general statutes is 436 Raised Bill No. 1110
	526	+
	527	+
	528	+
	529	+	LCO No. 4248 15 of 16
	530	+
	531	+	repealed and the following is substituted in lieu thereof (Effective from 437
	532	+	passage): 438
	533	+	(l) On and after January 1, 2023, the Commissioner of Social Services 439
	534	+	shall, within available appropriations, provide state-funded medical 440
	535	+	assistance to any child twelve years of age and younger, regardless of 441
	536	+	immigration status, (1) whose household income does not exceed two 442
	537	+	hundred one per cent of the federal poverty level without an asset limit, 443
	538	+	and (2) who does not otherwise qualify for Medicaid, the Children's 444
	539	+	Health Insurance Program, or an offer of affordable, employer-445
	540	+	sponsored insurance, as defined in the Affordable Care Act, as an 446
	541	+	employee or a dependent of an employee. A child eligible for such 447
	542	+	assistance under this subsection shall continue to receive such assistance 448
	543	+	until such child is nineteen years of age, provided the child continues to 449
	544	+	meet the eligibility requirements prescribed in subdivisions (1) and (2) 450
	545	+	of this subsection. The provisions of section 17b-265, as amended by this 451
	546	+	act, shall apply with respect to any medical assistance provided 452
	547	+	pursuant to this subsection. 453
	548	+	Sec. 9. Subsection (a) of section 17b-292 of the general statutes is 454
	549	+	repealed and the following is substituted in lieu thereof (Effective from 455
	550	+	passage): 456
	551	+	(a) A child who resides in a household with household income that 457
	552	+	exceeds one hundred ninety-six per cent of the federal poverty level but 458
	553	+	does not exceed three hundred eighteen per cent of the federal poverty 459
	554	+	level may be eligible for benefits under HUSKY B. Not later than 460
	555	+	January 1, 2023, the Commissioner of Social Services shall, within 461
	556	+	available appropriations, provide state-funded medical assistance to 462
	557	+	any child twelve years of age and younger, regardless of immigration 463
	558	+	status, (1) with a household income that exceeds two hundred one per 464
	559	+	cent of the federal poverty level but does not exceed three hundred 465
	560	+	twenty-three per cent of the federal poverty level, and (2) who does not 466
	561	+	otherwise qualify for Medicaid, the Children's Health Insurance 467
	562	+	Program, or an offer of affordable, employer-sponsored insurance, as 468
	563	+	defined in the Affordable Care Act, as an employee or a dependent of 469 Raised Bill No. 1110
	564	+
	565	+
	566	+
	567	+	LCO No. 4248 16 of 16
	568	+
	569	+	an employee. A child eligible for such assistance under this subsection 470
	570	+	shall continue to receive such assistance until such child is nineteen 471
	571	+	years of age, provided the child continues to meet the eligibility 472
	572	+	requirements prescribed in subdivisions (1) and (2) of this subsection. 473
	573	+	The provisions of section 17b-265, as amended by this act, shall apply 474
	574	+	with respect to any medical assistance provided pursuant to this 475
	575	+	subsection. 476
	576	+	Sec. 10. Sections 17b-306a, 17b-550 to 17b-554, inclusive, and 17b-807 477
	577	+	of the general statutes are repealed. (Effective from passage) 478
488	578		This act shall take effect as follows and shall amend the following
489	579		sections:
490	580
491		-	Section 1 October 1, 2023 17b-265 Substitute Bill No. 1110
	581	+	Section 1 from passage 17b-8
	582	+	Sec. 2 October 1, 2023 17b-265
	583	+	Sec. 3 October 1, 2023 17b-265g
	584	+	Sec. 4 from passage 12-746(e)
	585	+	Sec. 5 July 1, 2023 16a-41a
	586	+	Sec. 6 July 1, 2023 New section
	587	+	Sec. 7 from passage 53a-290
	588	+	Sec. 8 from passage 17b-261(l)
	589	+	Sec. 9 from passage 17b-292(a)
	590	+	Sec. 10 from passage Repealer section
492	591
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496		-	14 of 14
497		-
498		-	Sec. 2 October 1, 2023 17b-265g
499		-	Sec. 3 from passage 12-746(e)
500		-	Sec. 4 July 1, 2023 16a-41a
501		-	Sec. 5 July 1, 2023 New section
502		-	Sec. 6 from passage 53a-290
503		-	Sec. 7 from passage 17b-261(l)
504		-	Sec. 8 from passage 17b-292(a)
505		-	Sec. 9 from passage Repealer section
506		-
507		-	Statement of Legislative Commissioners:
508		-	In Section 1(h), "[ninety] sixty days after the effective date of this section"
509		-	was changed to "[ninety days after the effective date of this section]
510		-	November 30, 2023"; in Section 1(h)(3), "one hundred twenty days after
511		-	the effective date of this section" was changed to "[one hundred twenty
512		-	days after the effective date of this section] January 30, 2024"; and in
513		-	Section 5, "implementation. Policies" was changed to "implementation
514		-	of such policies and procedures. Any policies", for clarity.
515		-
516		-	HS Joint Favorable Subst.
	592	+	Statement of Purpose:
	593	+	To (1) delete obsolete reporting requirements, (2) clarify liability of
	594	+	third-party private insurers and other obligors for the costs of certain
	595	+	medical assistance, (3) reduce from thirty to ten days the amount of time
	596	+	a fuel vendor participating in the Low-Income Home Energy Assistance
	597	+	Program shall be paid, and (4) establish bundled Medicaid payments for
	598	+	maternity services.
	599	+	[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except
	600	+	that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not
	601	+	underlined.]
517	602