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 Section 17b-245d of the general statutes is repealed and the 33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