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OLR Bill Analysis
sSB 985
AN ACT CONCERNING LEGISLATIVE APPROVAL FOR CHANGES
TO THE HUSKY HEALTH PROGRAM REIMBURSEMENT AND CARE
DELIVERY MODEL.
SUMMARY
This bill requires the Department of Social Services (DSS) to submit
any proposal to change the fee-for-service Medicaid payment model to
a managed care payment model (see BACKGROUND) to the
Appropriations and Human Services committees for approval before
implementing this payment model change or seeking federal approval
to implement it. It repeals laws that authorize DSS to (1) award contracts
for Medicaid managed care health plans, (2) fund medical assistance
benefits by purchasing insurance, and (3) require medical assistance
recipients to receive medical care on a prepayment or per capita basis.
The bill also requires the DSS commissioner to report annually,
starting by December 1, 2025, to the Council on Medical Assistance
Program Oversight (MAPOC) on (1) the Medicaid program’s financial
performance and (2) Medicaid members’ access to, and quality of, care.
The bill requires these reports to include information from three specific
reports the department previously submitted to MAPOC (see
BACKGROUND). DSS’s annual report on financial performance under
the bill must include updated data similar to the data in its February
2023 report on financial trends in the HUSKY Health program. The
annual report on access to and quality of care must include data similar
to the data in the department’s (1) January 2023 report on physical
health measures and (2) April 2023 report on behavioral health quality
indicators in the HUSKY Health program.
It also makes minor and conforming changes to remove references to
managed care in Medicaid in current laws that:
1. allow the Connecticut Mental Health Center to enter into 2025SB-00985-R000165-BA.DOCX
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contracts with the Medicaid program (§ 3);
2. allow DSS to amend the Medicaid state plan to establish a pilot
program for up to 500 Medicare-eligible people served by Oak
Hill – The Connecticut Institute for the Blind, Inc. to deliver
comprehensive health insurance coverage in a managed care
setting (§ 5);
3. allow DSS to disclose information to a Department of Mental
Health and Addiction Services representative for a behavioral
health managed care program (§ 6); and
4. require DSS to amend the Medicaid state plan to establish a pilot
program for up to 500 Medicaid recipients who are elderly or
living with a disability to deliver comprehensive health
insurance coverage in a managed care setting (§ 7).
Lastly, the bill makes technical changes to remove obsolete
provisions (§ 4).
EFFECTIVE DATE: July 1, 2025
LEGISLATIVE APPROVAL PROCESS FOR MANAGED CARE
PAYMENT MODELS IN ME DICAID
The bill establishes a legislative approval process for proposals to
change the Medicaid payment model from fee-for-service to managed
care.
Comment Period and Hearing
Under the bill, DSS must submit the proposal, including any written
comments the department receives on it, to the Appropriations and
Human Services committees. The bill requires DSS to accept written
comments on the proposal before submitting it to the committees. The
department must post notice of the proposal, with a summary of its
provisions and the method for submitting written comments, 30 days
before submitting it to the committees. The committees must:
1. hold a public hearing within 30 days after they receive the
proposal; 2025SB-00985-R000165-BA.DOCX
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2. notify the DSS commissioner about the hearing’s date and time
at least 30 days before the hearing; and
3. invite her to testify on the proposal, including any costs or
benefits to the state and expected impacts on care provided to
Medicaid recipients and Medicaid provider payments.
At the end of the hearing, the committees must advise the
commissioner of their approval, denial, or modifications to the
proposal. The bill prohibits the commissioner from implementing or
seeking federal approval to implement any proposal the committees
deny.
Conference Committee
If the Appropriations and Human Services committees do not concur
on a proposal, the bill requires committee chairpersons to appoint a
conference committee, composed of three members of each committee,
including one member from the minority party from each committee.
The conference committee must report to each committee, which must
vote to accept or reject the conference committee’s report without
amendment. If either committee rejects the conference committee’s
report, the proposal is deemed denied. If they both accept the report, the
Appropriations Committee must advise the DSS commissioner of the
approval, denial, or modifications to the proposal. If the committees do
not advise the commissioner during the 30-day period, the proposal is
deemed denied.
Implementation Application
The bill requires any application for a Medicaid state plan, federal
waiver, or waiver renewal to implement a proposal to be in accordance
with the Appropriations and Human Services committees’ approval or
modifications. The bill also requires DSS to include with the application
any written comments it received during the comment period and at the
hearing. The bill requires the Appropriations and Human Services
committees to transmit these materials to DSS.
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BACKGROUND
Managed Care and Fee-for-Service Payment Models
Medicaid programs may deliver benefits through a managed care
entity or on a fee-for-service basis. Generally, under a managed care
delivery system, the Medicaid program contracts with managed care
plans to cover all or most Medicaid-covered services for Medicaid
enrollees. States pay the entity administering the plan (typically a
managed care organization) a per-member, per-month amount to cover
a defined set of services. Under a fee-for-service model, the state pays
providers directly for each covered service delivered to a Medicaid
enrollee.
DSS Reports Filed With MAPOC
February 2023 Report. This report included data on the following
topics:
1. spending by service category;
2. Medicaid growth trends, including per-member per-month
trends;
3. Medicaid as a percentage of the state budget; and
4. Medicaid administrative cost ratio.
January 2023 Report. This report included data on the following
topics:
1. core measures, developed by the federal Centers for Medicare
and Medicaid Services (CMS), to evaluate health care quality;
2. Healthcare Effectiveness Data and Information Set (HEDIS)
measures;
3. a health equity analysis; and
4. DSS actions to improve outcomes.
April 2023 Report. This report on behavioral health quality 2025SB-00985-R000165-BA.DOCX
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indicators similarly included data on CMS core and HEDIS measures on
behavioral health.
COMMITTEE ACTION
Human Services Committee
Joint Favorable Substitute
Yea 16 Nay 6 (03/04/2025)