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General Assembly Raised Bill No. 7191
January Session, 2025
LCO No. 5846
Referred to Committee on HUMAN SERVICES
Introduced by:
(HS)
AN ACT CONCERNING MEDICAID RATE INCREASES, PLANNING
AND SUSTAINABILITY.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. (NEW) (Effective July 1, 2025) (a) As used in this section, (1) 1
"Medicaid rate study" means the study commissioned by the 2
Department of Social Services pursuant to public act 23-186, and (2) 3
"five-state rate benchmark" means the average of rates for the same 4
health care services in Maine, Massachusetts, New Jersey, New York 5
and Oregon. 6
(b) Within available appropriations, the Commissioner of Social 7
Services shall phase in increases to Medicaid provider rates in 8
accordance with the Medicaid rate study. The commissioner shall phase 9
in the rate increases commencing on July 1, 2025, such that by June 30, 10
2028, all such rates equal (1) not less than seventy-five per cent of the 11
most recent Medicare rates for the same health care services, or (2) for 12
such services with no corresponding Medicare rates, a percentage of the 13
five-state benchmark that results in an equivalent rate increase. 14
(c) On and after June 30, 2028, the commissioner shall adjust such 15
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rates every year in accordance with (1) the most recent Medicare rates 16
for the same health care services, (2) for such services with no 17
corresponding Medicare rates, an equivalent percentage of the five-state 18
rate benchmark, or (3) by the Medicare Economic Index, as defined in 19
section 3 of this act, in the discretion of the commissioner. 20
(d) In increasing such rates and making such rate adjustments, the 21
commissioner shall adjust provider rates for pediatric and adult health 22
care services to achieve parity between such rates for the same health 23
care services. 24
(e) The commissioner shall streamline and consolidate existing fee 25
schedules used for provider or service reimbursement so that every 26
provider is being reimbursed using the same fee schedule. In 27
streamlining and consolidating existing fee schedules, the 28
commissioner shall incorporate, to the extent applicable, the most recent 29
Medicare fee schedule for services covered by Medicare as well as 30
Medicaid. 31
Sec. 2. Section 17b-245d of the general statutes is repealed and the 32
following is substituted in lieu thereof (Effective July 1, 2025): 33
(a) On or before February 1, 2013, and on January first annually 34
thereafter, each federally qualified health center shall file with the 35
Department of Social Services the following documents for the previous 36
state fiscal year: (1) Medicaid cost report; (2) audited financial 37
statements; and (3) any additional information reasonably required by 38
the department. Any federally qualified health center that does not use 39
the state fiscal year as its fiscal year shall have six months from the 40
completion of such health center's fiscal year to file said documents with 41
the department. 42
[(b) Each federally qualified health center shall provide to the 43
Department of Social Services a copy of its original scope of project, as 44
approved by the federal Health Resources and Services Administration, 45
and all subsequently approved amendments to its original scope of 46
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project. Each federally qualified health center shall notify the 47
department, in writing, of all approvals for additional amendments to 48
its scope of project, and provide to the department a copy of such 49
amended scope of project, not later than thirty days after such 50
approvals. 51
(c) If there is an increase or a decrease in the scope of services 52
furnished by a federally qualified health center, the federally qualified 53
health center shall notify the Department of Social Services, in writing, 54
of any such increase or decrease not later than thirty days after such 55
increase or decrease and provide any additional information reasonably 56
requested by the department not later than thirty days after the request. 57
(d) The Commissioner of Social Services may impose a civil penalty 58
of five hundred dollars per day on any federally qualified health center 59
that fails to provide any information required pursuant to this section 60
not later than thirty days after the date such information is due. 61
(e) The department may adjust a federally qualified health center's 62
encounter rate based upon an increase or decrease in the scope of 63
services furnished by the federally qualified health center, in accordance 64
with 42 USC 1396a(bb)(3)(B), following receipt of the written 65
notification described in subsection (c) of this section or based upon the 66
department's review of documents filed in accordance with subsections 67
(a) and (b) of this section.] 68
(b) On or before December 31, 2025, the Department of Social Services 69
shall rebase each federally qualified health center's encounter rates 70
based upon such center's costs during fiscal year 2024 divided by the 71
number of patient encounters for a particular service during the same 72
fiscal year, provided such new encounter rate shall be not less than the 73
encounter rate received before such rates are rebased and shall not 74
interfere with any annual inflationary rate adjustment. 75
(c) The Department of Social Services shall adjust a federally qualified 76
health center's encounter rate based upon an increase or decrease in the 77
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scope of services furnished in a written notification to the department 78
by the federally qualified health center, in accordance with 42 USC 79
1396a(bb)(3)(B), following receipt of the written notification. If a 80
federally qualified health center experiences additional direct or indirect 81
costs as a result of an increase in such center's scope of services, it shall 82
request a rate adjustment based upon the increase in scope of services 83
on forms issued by the department for such purpose. Not later than 84
thirty days after receipt of such rate adjustment request, the department 85
shall meet with representatives of the federally qualified health center 86
for the purpose of reviewing the center's additional direct and indirect 87
costs relating to the increase in scope of services. If the increase in scope 88
of services is related to amendments approved by the federal Health 89
Resources and Services Administration to the federally qualified health 90
center's original scope of project, the federally qualified health center 91
shall provide to the department a copy of such amended scope of 92
project. Not later than thirty days after meeting with the federally 93
qualified health center, the department shall issue a detailed rate 94
adjustment decision relating to the increase in scope of services. In 95
conducting such review, the department shall not consider the 96
following factors as relevant or determinative with respect to whether 97
the federally qualified health center incurred additional direct or 98
indirect costs associated with the increase in scope of services: (1) The 99
federally qualified health center's encounter rates for other service 100
categories, including dental, behavioral health or medical services; (2) 101
whether or not the federally qualified health center is showing a profit; 102
(3) whether or not the federally qualified health center is in receipt of 103
grant moneys or other third-party reimbursements; (4) whether the 104
federally qualified health center's current encounter rates are higher or 105
lower than encounter rates of similar federally qualified health centers; 106
and (5) any other factor unrelated to increased costs associated with an 107
increase in change of scope of services. A federally qualified health 108
center may appeal the department's rate adjustment decision not later 109
than ten days after it receives notice of the rate adjustment. Not later 110
than ninety days after filing its rate adjustment appeal notice, the 111
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federally qualified health center shall submit its items of aggrievement 112
to the department. Upon review and an opportunity for the department 113
to request any clarifying or supporting information from the federally 114
qualified health center, the department shall issue its decision, along 115
with its rationale, not later than one hundred twenty days after the 116
federally qualified health center's rate adjustment request. If the 117
department's decision is delayed, any approved rate adjustment shall be 118
retroactive to the date on which the decision should have been issued 119
pursuant to this subsection. 120
(d) If there is a decrease in the scope of services furnished by a 121
federally qualified health center, the federally qualified health center 122
shall notify the Department of Social Services, in writing, of any 123
decrease and provide any additional information reasonably requested 124
by the department not later than thirty days after the department's 125
request. The Commissioner of Social Services may impose a civil penalty 126
of five hundred dollars per day on any federally qualified health center 127
that fails to provide any information relating to a decrease in services to 128
the extent that a discontinued service is a service for which the federally 129
qualified health center is receiving additional reimbursement as the 130
result of a prior rate adjustment related to an increase in scope of 131
services. 132
[(f)] (e) The Commissioner of Social Services shall implement policies 133
and procedures necessary to administer the provisions of this section 134
while in the process of adopting such policies and procedures as 135
regulations, provided the commissioner [prints] posts notice of intent to 136
adopt regulations [in the Connecticut Law Journal] on the eRegulations 137
System not later than twenty days after the date of implementation. 138
Policies and procedures implemented pursuant to this section shall be 139
valid until the time final regulations are adopted. 140
Sec. 3. (NEW) (Effective January 1, 2026) The Commissioner of Social 141
Services shall increase rates of Medicaid reimbursement for federally 142
qualified health centers not later than January first annually by the most 143
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recent increase in the Medicare Economic Index. For purposes of this 144
section, "Medicare Economic Index" means a measure of inflation for 145
physicians with respect to their practice costs and wage levels as 146
calculated by the Centers for Medicare and Medicaid Services. 147
Sec. 4. (NEW) (Effective July 1, 2025) (a) The Council on Medical 148
Assistance Program Oversight, established pursuant to section 17b-28 149
of the general statutes, shall develop and implement an ongoing 150
systemic review of Medicaid provider reimbursement rates to ensure 151
rates are adequate to sustain a sufficient provider pool to provide 152
Medicaid member access to high-quality care. 153
(b) Not later than January 15, 2026, and annually thereafter, the 154
council shall file a report, in accordance with the provisions of section 155
11-4a of the general statutes, with the joint standing committees of the 156
General Assembly having cognizance of matters relating to 157
appropriations and the budgets of state agencies and human services. 158
The report shall include the council's recommendations on necessary 159
appropriations to ensure Medicaid providers are compensated for 160
health care services in accordance with section 1 of this act. 161
This act shall take effect as follows and shall amend the following
sections:
Section 1 July 1, 2025 New section
Sec. 2 July 1, 2025 17b-245d
Sec. 3 January 1, 2026 New section
Sec. 4 July 1, 2025 New section
Statement of Purpose:
To phase in increased rates of reimbursement to Medicaid providers
over three years in accordance with a rate study commissioned by the
Department of Social Services.
[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except
that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not
underlined.]