Connecticut 2025 Regular Session

Connecticut House Bill HB07191 Compare Versions

Version 1 (Old)

Version 2 (New)

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	3	+	LCO No. 5846 1 of 6
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5		-	General Assembly ~~Substitute~~ Bill No. 7191
	5	+	General Assembly Raised Bill No. 7191
6	6		January Session, 2025
	7	+	LCO No. 5846
	8	+
	9	+
	10	+	Referred to Committee on HUMAN SERVICES
	11	+
	12	+
	13	+	Introduced by:
	14	+	(HS)
	15	+
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8	17
9	18
10	19		AN ACT CONCERNING MEDICAID RATE INCREASES, PLANNING
11	20		AND SUSTAINABILITY.
12	21		Be it enacted by the Senate and House of Representatives in General
13	22		Assembly convened:
14	23
15	24		Section 1. (NEW) (Effective July 1, 2025) (a) As used in this section, (1) 1
16	25		"Medicaid rate study" means the study commissioned by the 2
17		-	Department of Social Services pursuant to ~~section 1 of~~ public act 23-186, 3
18		-	~~and (2)~~ "five-state rate benchmark" means the average of rates for the 4
19		-	~~same~~ health care services in Maine, Massachusetts, New Jersey, New 5
20		-	~~York~~ and Oregon. 6
	26	+	Department of Social Services pursuant to public act 23-186, and (2) 3
	27	+	"five-state rate benchmark" means the average of rates for the same 4
	28	+	health care services in Maine, Massachusetts, New Jersey, New York 5
	29	+	and Oregon. 6
21	30		(b) Within available appropriations, the Commissioner of Social 7
22	31		Services shall phase in increases to Medicaid provider rates in 8
23	32		accordance with the Medicaid rate study. The commissioner shall phase 9
24	33		in the rate increases commencing on July 1, 2025, such that by June 30, 10
25	34		2028, all such rates equal (1) not less than seventy-five per cent of the 11
26	35		most recent Medicare rates for the same health care services, or (2) for 12
27	36		such services with no corresponding Medicare rates, a percentage of the 13
28	37		five-state benchmark that results in an equivalent rate increase. 14
29	38		(c) On and after June 30, 2028, the commissioner shall adjust such 15
30		-	rates every year (1) to not less than seventy-five per cent of the most 16
31		-	recent Medicare rates for the same health care services, (2) to an 17
32		-	equivalent percentage of the five-state rate benchmark for such services 18
33		-	with no corresponding Medicare rates, or (3) by increasing such rates by 19 Substitute Bill No. 7191
	39	+	Raised Bill No. 7191
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35	41
36		-	LCO 2 of 6
37	42
38		-	any percentage increase in the Medicare Economic Index, as defined in 20
39		-	section 3 of this act, in the discretion of the commissioner. 21
40		-	(d) In increasing such rates and making such rate adjustments, the 22
41		-	commissioner shall adjust provider rates for pediatric and adult health 23
42		-	care services to achieve parity between such rates for the same health 24
43		-	care services. 25
44		-	(e) The commissioner shall streamline and consolidate existing fee 26
45		-	schedules used for provider or service reimbursement so that every 27
46		-	provider is being reimbursed using the same fee schedule. In 28
47		-	streamlining and consolidating existing fee schedules, the 29
48		-	commissioner shall incorporate, to the extent applicable, the most recent 30
49		-	Medicare fee schedule for services covered by Medicare as well as 31
50		-	Medicaid. 32
51		-	Sec. 2. Section 17b-245d of the general statutes is repealed and the 33
52		-	following is substituted in lieu thereof (Effective July 1, 2025): 34
53		-	(a) On or before February 1, 2013, and on January first annually 35
54		-	thereafter, each federally qualified health center shall file with the 36
55		-	Department of Social Services the following documents for the previous 37
56		-	state fiscal year: (1) Medicaid cost report; (2) audited financial 38
57		-	statements; and (3) any additional information reasonably required by 39
58		-	the department. Any federally qualified health center that does not use 40
59		-	the state fiscal year as its fiscal year shall have six months from the 41
60		-	completion of such health center's fiscal year to file [said] such 42
61		-	documents with the department. 43
62		-	[(b) Each federally qualified health center shall provide to the 44
63		-	Department of Social Services a copy of its original scope of project, as 45
64		-	approved by the federal Health Resources and Services Administration, 46
65		-	and all subsequently approved amendments to its original scope of 47
66		-	project. Each federally qualified health center shall notify the 48
67		-	department, in writing, of all approvals for additional amendments to 49
68		-	its scope of project, and provide to the department a copy of such 50
69		-	amended scope of project, not later than thirty days after such 51 Substitute Bill No. 7191
	43	+	LCO No. 5846 2 of 6
	44	+
	45	+	rates every year in accordance with (1) the most recent Medicare rates 16
	46	+	for the same health care services, (2) for such services with no 17
	47	+	corresponding Medicare rates, an equivalent percentage of the five-state 18
	48	+	rate benchmark, or (3) by the Medicare Economic Index, as defined in 19
	49	+	section 3 of this act, in the discretion of the commissioner. 20
	50	+	(d) In increasing such rates and making such rate adjustments, the 21
	51	+	commissioner shall adjust provider rates for pediatric and adult health 22
	52	+	care services to achieve parity between such rates for the same health 23
	53	+	care services. 24
	54	+	(e) The commissioner shall streamline and consolidate existing fee 25
	55	+	schedules used for provider or service reimbursement so that every 26
	56	+	provider is being reimbursed using the same fee schedule. In 27
	57	+	streamlining and consolidating existing fee schedules, the 28
	58	+	commissioner shall incorporate, to the extent applicable, the most recent 29
	59	+	Medicare fee schedule for services covered by Medicare as well as 30
	60	+	Medicaid. 31
	61	+	Sec. 2. Section 17b-245d of the general statutes is repealed and the 32
	62	+	following is substituted in lieu thereof (Effective July 1, 2025): 33
	63	+	(a) On or before February 1, 2013, and on January first annually 34
	64	+	thereafter, each federally qualified health center shall file with the 35
	65	+	Department of Social Services the following documents for the previous 36
	66	+	state fiscal year: (1) Medicaid cost report; (2) audited financial 37
	67	+	statements; and (3) any additional information reasonably required by 38
	68	+	the department. Any federally qualified health center that does not use 39
	69	+	the state fiscal year as its fiscal year shall have six months from the 40
	70	+	completion of such health center's fiscal year to file said documents with 41
	71	+	the department. 42
	72	+	[(b) Each federally qualified health center shall provide to the 43
	73	+	Department of Social Services a copy of its original scope of project, as 44
	74	+	approved by the federal Health Resources and Services Administration, 45
	75	+	and all subsequently approved amendments to its original scope of 46
	76	+	Raised Bill No. 7191
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74		-	approvals. 52
75		-	(c) If there is an increase or a decrease in the scope of services 53
76		-	furnished by a federally qualified health center, the federally qualified 54
77		-	health center shall notify the Department of Social Services, in writing, 55
78		-	of any such increase or decrease not later than thirty days after such 56
79		-	increase or decrease and provide any additional information reasonably 57
80		-	requested by the department not later than thirty days after the request. 58
81		-	(d) The Commissioner of Social Services may impose a civil penalty 59
82		-	of five hundred dollars per day on any federally qualified health center 60
83		-	that fails to provide any information required pursuant to this section 61
84		-	not later than thirty days after the date such information is due. 62
85		-	(e) The department may adjust a federally qualified health center's 63
86		-	encounter rate based upon an increase or decrease in the scope of 64
87		-	services furnished by the federally qualified health center, in accordance 65
88		-	with 42 USC 1396a(bb)(3)(B), following receipt of the written 66
89		-	notification described in subsection (c) of this section or based upon the 67
90		-	department's review of documents filed in accordance with subsections 68
91		-	(a) and (b) of this section.] 69
92		-	(b) On or before December 31, 2025, the Department of Social Services 70
93		-	shall rebase each federally qualified health center's encounter rates 71
94		-	based upon such center's costs during fiscal year 2024 divided by the 72
95		-	number of patient encounters for a particular service during the same 73
96		-	fiscal year, provided such new encounter rate shall be not less than the 74
97		-	encounter rate received before such rates are rebased and shall not 75
98		-	interfere with any annual inflationary rate adjustment. 76
99		-	(c) The Department of Social Services shall adjust a federally qualified 77
100		-	health center's encounter rate based upon an increase or decrease in the 78
101		-	scope of services furnished in a written notification to the department 79
102		-	by the federally qualified health center, in accordance with 42 USC 80
103		-	1396a(bb)(3)(B), following receipt by the department of the written 81
104		-	notification. If a federally qualified health center experiences additional 82
105		-	direct or indirect costs as a result of an increase in such center's scope of 83 Substitute Bill No. 7191
	80	+	LCO No. 5846 3 of 6
	81	+
	82	+	project. Each federally qualified health center shall notify the 47
	83	+	department, in writing, of all approvals for additional amendments to 48
	84	+	its scope of project, and provide to the department a copy of such 49
	85	+	amended scope of project, not later than thirty days after such 50
	86	+	approvals. 51
	87	+	(c) If there is an increase or a decrease in the scope of services 52
	88	+	furnished by a federally qualified health center, the federally qualified 53
	89	+	health center shall notify the Department of Social Services, in writing, 54
	90	+	of any such increase or decrease not later than thirty days after such 55
	91	+	increase or decrease and provide any additional information reasonably 56
	92	+	requested by the department not later than thirty days after the request. 57
	93	+	(d) The Commissioner of Social Services may impose a civil penalty 58
	94	+	of five hundred dollars per day on any federally qualified health center 59
	95	+	that fails to provide any information required pursuant to this section 60
	96	+	not later than thirty days after the date such information is due. 61
	97	+	(e) The department may adjust a federally qualified health center's 62
	98	+	encounter rate based upon an increase or decrease in the scope of 63
	99	+	services furnished by the federally qualified health center, in accordance 64
	100	+	with 42 USC 1396a(bb)(3)(B), following receipt of the written 65
	101	+	notification described in subsection (c) of this section or based upon the 66
	102	+	department's review of documents filed in accordance with subsections 67
	103	+	(a) and (b) of this section.] 68
	104	+	(b) On or before December 31, 2025, the Department of Social Services 69
	105	+	shall rebase each federally qualified health center's encounter rates 70
	106	+	based upon such center's costs during fiscal year 2024 divided by the 71
	107	+	number of patient encounters for a particular service during the same 72
	108	+	fiscal year, provided such new encounter rate shall be not less than the 73
	109	+	encounter rate received before such rates are rebased and shall not 74
	110	+	interfere with any annual inflationary rate adjustment. 75
	111	+	(c) The Department of Social Services shall adjust a federally qualified 76
	112	+	health center's encounter rate based upon an increase or decrease in the 77
	113	+	Raised Bill No. 7191
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110		-	services, it shall request a rate adjustment based upon the increase in 84
111		-	scope of services on forms issued by the department for such purpose. 85
112		-	Not later than thirty days after receipt of such rate adjustment request, 86
113		-	the department shall meet with representatives of the federally qualified 87
114		-	health center for the purpose of reviewing the center's additional direct 88
115		-	and indirect costs relating to the increase in scope of services. If the 89
116		-	increase in scope of services is related to amendments approved by the 90
117		-	federal Health Resources and Services Administration to the federally 91
118		-	qualified health center's original scope of project, the federally qualified 92
119		-	health center shall provide to the department a copy of such amended 93
120		-	scope of project. Not later than thirty days after meeting with the 94
121		-	federally qualified health center, the department shall issue a detailed 95
122		-	rate adjustment decision relating to the increase in scope of services. In 96
123		-	conducting such review, the department shall not consider the 97
124		-	following factors as relevant or determinative with respect to whether 98
125		-	the federally qualified health center incurred additional direct or 99
126		-	indirect costs associated with the increase in scope of services: (1) The 100
127		-	federally qualified health center's encounter rates for other service 101
128		-	categories, including dental, behavioral health or medical services; (2) 102
129		-	whether or not the federally qualified health center is showing a profit; 103
130		-	(3) whether or not the federally qualified health center is in receipt of 104
131		-	grant moneys or other third-party reimbursements; (4) whether the 105
132		-	federally qualified health center's current encounter rates are higher or 106
133		-	lower than encounter rates of similar federally qualified health centers; 107
134		-	and (5) any other factor unrelated to increased costs associated with an 108
135		-	increase in change of scope of services. A federally qualified health 109
136		-	center may appeal the department's rate adjustment decision not later 110
137		-	than ten days after it receives notice of the rate adjustment. Not later 111
138		-	than ninety days after filing its rate adjustment appeal notice, the 112
139		-	federally qualified health center shall submit its items of aggrievement 113
140		-	to the department. Upon review and an opportunity for the department 114
141		-	to request any clarifying or supporting information from the federally 115
142		-	qualified health center, the department shall issue its decision, along 116
143		-	with its rationale, not later than one hundred twenty days after the 117
144		-	federally qualified health center's rate adjustment request. If the 118 Substitute Bill No. 7191
	117	+	LCO No. 5846 4 of 6
	118	+
	119	+	scope of services furnished in a written notification to the department 78
	120	+	by the federally qualified health center, in accordance with 42 USC 79
	121	+	1396a(bb)(3)(B), following receipt of the written notification. If a 80
	122	+	federally qualified health center experiences additional direct or indirect 81
	123	+	costs as a result of an increase in such center's scope of services, it shall 82
	124	+	request a rate adjustment based upon the increase in scope of services 83
	125	+	on forms issued by the department for such purpose. Not later than 84
	126	+	thirty days after receipt of such rate adjustment request, the department 85
	127	+	shall meet with representatives of the federally qualified health center 86
	128	+	for the purpose of reviewing the center's additional direct and indirect 87
	129	+	costs relating to the increase in scope of services. If the increase in scope 88
	130	+	of services is related to amendments approved by the federal Health 89
	131	+	Resources and Services Administration to the federally qualified health 90
	132	+	center's original scope of project, the federally qualified health center 91
	133	+	shall provide to the department a copy of such amended scope of 92
	134	+	project. Not later than thirty days after meeting with the federally 93
	135	+	qualified health center, the department shall issue a detailed rate 94
	136	+	adjustment decision relating to the increase in scope of services. In 95
	137	+	conducting such review, the department shall not consider the 96
	138	+	following factors as relevant or determinative with respect to whether 97
	139	+	the federally qualified health center incurred additional direct or 98
	140	+	indirect costs associated with the increase in scope of services: (1) The 99
	141	+	federally qualified health center's encounter rates for other service 100
	142	+	categories, including dental, behavioral health or medical services; (2) 101
	143	+	whether or not the federally qualified health center is showing a profit; 102
	144	+	(3) whether or not the federally qualified health center is in receipt of 103
	145	+	grant moneys or other third-party reimbursements; (4) whether the 104
	146	+	federally qualified health center's current encounter rates are higher or 105
	147	+	lower than encounter rates of similar federally qualified health centers; 106
	148	+	and (5) any other factor unrelated to increased costs associated with an 107
	149	+	increase in change of scope of services. A federally qualified health 108
	150	+	center may appeal the department's rate adjustment decision not later 109
	151	+	than ten days after it receives notice of the rate adjustment. Not later 110
	152	+	than ninety days after filing its rate adjustment appeal notice, the 111
	153	+	Raised Bill No. 7191
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149		-	department's decision is delayed, any approved rate adjustment shall be 119
150		-	retroactive to the date on which the decision should have been issued 120
151		-	pursuant to this subsection. 121
152		-	(d) If there is a decrease in the scope of services furnished by a 122
153		-	federally qualified health center, the federally qualified health center 123
154		-	shall notify the Department of Social Services, in writing, of any 124
155		-	decrease and provide any additional information reasonably requested 125
156		-	by the department not later than thirty days after the department's 126
157		-	request. The Commissioner of Social Services may impose a civil penalty 127
158		-	of five hundred dollars per day on any federally qualified health center 128
159		-	that fails to provide any information relating to a decrease in services to 129
160		-	the extent that a discontinued service is a service for which the federally 130
161		-	qualified health center is receiving additional reimbursement as the 131
162		-	result of a prior rate adjustment related to an increase in scope of 132
163		-	services. 133
164		-	[(f)] (e) The Commissioner of Social Services shall implement policies 134
165		-	and procedures necessary to administer the provisions of this section 135
166		-	while in the process of adopting such policies and procedures as 136
167		-	regulations, provided the commissioner [prints] posts notice of intent to 137
168		-	adopt regulations [in the Connecticut Law Journal] on the eRegulations 138
169		-	System not later than twenty days after the date of implementation. 139
170		-	Policies and procedures implemented pursuant to this section shall be 140
171		-	valid until the time final regulations are adopted. 141
172		-	Sec. 3. (NEW) (Effective January 1, 2026) The Commissioner of Social 142
173		-	Services shall increase rates of Medicaid reimbursement for federally 143
174		-	qualified health centers not later than January first annually by the most 144
175		-	recent percentage increase in the Medicare Economic Index. For 145
176		-	purposes of this section, "Medicare Economic Index" means a measure 146
177		-	of inflation for physicians with respect to their practice costs and wage 147
178		-	levels as calculated by the Centers for Medicare and Medicaid Services. 148
179		-	Sec. 4. (NEW) (Effective July 1, 2025) (a) The Council on Medical 149
180		-	Assistance Program Oversight, established pursuant to section 17b-28 150 Substitute Bill No. 7191
	157	+	LCO No. 5846 5 of 6
	158	+
	159	+	federally qualified health center shall submit its items of aggrievement 112
	160	+	to the department. Upon review and an opportunity for the department 113
	161	+	to request any clarifying or supporting information from the federally 114
	162	+	qualified health center, the department shall issue its decision, along 115
	163	+	with its rationale, not later than one hundred twenty days after the 116
	164	+	federally qualified health center's rate adjustment request. If the 117
	165	+	department's decision is delayed, any approved rate adjustment shall be 118
	166	+	retroactive to the date on which the decision should have been issued 119
	167	+	pursuant to this subsection. 120
	168	+	(d) If there is a decrease in the scope of services furnished by a 121
	169	+	federally qualified health center, the federally qualified health center 122
	170	+	shall notify the Department of Social Services, in writing, of any 123
	171	+	decrease and provide any additional information reasonably requested 124
	172	+	by the department not later than thirty days after the department's 125
	173	+	request. The Commissioner of Social Services may impose a civil penalty 126
	174	+	of five hundred dollars per day on any federally qualified health center 127
	175	+	that fails to provide any information relating to a decrease in services to 128
	176	+	the extent that a discontinued service is a service for which the federally 129
	177	+	qualified health center is receiving additional reimbursement as the 130
	178	+	result of a prior rate adjustment related to an increase in scope of 131
	179	+	services. 132
	180	+	[(f)] (e) The Commissioner of Social Services shall implement policies 133
	181	+	and procedures necessary to administer the provisions of this section 134
	182	+	while in the process of adopting such policies and procedures as 135
	183	+	regulations, provided the commissioner [prints] posts notice of intent to 136
	184	+	adopt regulations [in the Connecticut Law Journal] on the eRegulations 137
	185	+	System not later than twenty days after the date of implementation. 138
	186	+	Policies and procedures implemented pursuant to this section shall be 139
	187	+	valid until the time final regulations are adopted. 140
	188	+	Sec. 3. (NEW) (Effective January 1, 2026) The Commissioner of Social 141
	189	+	Services shall increase rates of Medicaid reimbursement for federally 142
	190	+	qualified health centers not later than January first annually by the most 143
	191	+	Raised Bill No. 7191
181	192
182	193
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184	194
185		-	of the general statutes, shall develop and implement an ongoing 151
186		-	systemic review of Medicaid provider reimbursement rates to ensure 152
187		-	rates are adequate to sustain a sufficient provider pool to provide 153
188		-	Medicaid member access to high-quality care. 154
189		-	(b) Not later than January 15, 2026, and annually thereafter, the 155
190		-	council shall file a report, in accordance with the provisions of section 156
191		-	11-4a of the general statutes, with the joint standing committees of the 157
192		-	General Assembly having cognizance of matters relating to 158
193		-	appropriations and the budgets of state agencies and human services. 159
194		-	The report shall include the council's recommendations on necessary 160
195		-	appropriations to ensure Medicaid providers are compensated for 161
196		-	health care services in accordance with section 1 of this act. 162
	195	+	LCO No. 5846 6 of 6
	196	+
	197	+	recent increase in the Medicare Economic Index. For purposes of this 144
	198	+	section, "Medicare Economic Index" means a measure of inflation for 145
	199	+	physicians with respect to their practice costs and wage levels as 146
	200	+	calculated by the Centers for Medicare and Medicaid Services. 147
	201	+	Sec. 4. (NEW) (Effective July 1, 2025) (a) The Council on Medical 148
	202	+	Assistance Program Oversight, established pursuant to section 17b-28 149
	203	+	of the general statutes, shall develop and implement an ongoing 150
	204	+	systemic review of Medicaid provider reimbursement rates to ensure 151
	205	+	rates are adequate to sustain a sufficient provider pool to provide 152
	206	+	Medicaid member access to high-quality care. 153
	207	+	(b) Not later than January 15, 2026, and annually thereafter, the 154
	208	+	council shall file a report, in accordance with the provisions of section 155
	209	+	11-4a of the general statutes, with the joint standing committees of the 156
	210	+	General Assembly having cognizance of matters relating to 157
	211	+	appropriations and the budgets of state agencies and human services. 158
	212	+	The report shall include the council's recommendations on necessary 159
	213	+	appropriations to ensure Medicaid providers are compensated for 160
	214	+	health care services in accordance with section 1 of this act. 161
197	215		This act shall take effect as follows and shall amend the following
198	216		sections:
199	217
200	218		Section 1 July 1, 2025 New section
201	219		Sec. 2 July 1, 2025 17b-245d
202	220		Sec. 3 January 1, 2026 New section
203	221		Sec. 4 July 1, 2025 New section
204	222
205		-	Statement of Legislative Commissioners:
206		-	In Section 1(a), "section 1 of" was inserted before "public act 23-186" for
207		-	clarity, Section 1(c) was redrafted for clarity and consistency, in Section
208		-	2(c), "by the department" was inserted after "receipt" for clarity, and in
209		-	Section 3, "percentage" was inserted before "increase" for clarity.
	223	+	Statement of Purpose:
	224	+	To phase in increased rates of reimbursement to Medicaid providers
	225	+	over three years in accordance with a rate study commissioned by the
	226	+	Department of Social Services.
210	227
211		-	HS Joint Favorable Subst. -LCO
212		-
	228	+	[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except
	229	+	that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not
	230	+	underlined.]