Sec. 17b-28a. Waiver Application Development Council. Medicaid waiver
unit. (a) There is established a Waiver Application Development Council that shall be
composed of the following members: The chairpersons and ranking members of the
joint standing committee of the General Assembly having cognizance of matters relating
to appropriations, or their designees; the chairpersons and ranking members of the joint
standing committee of the General Assembly having cognizance of matters relating to
human services, or their designees; the chairpersons and ranking members of the joint
standing committee of the General Assembly having cognizance of matters relating to
public health, or their designees; the Commissioner of Social Services, or his designee;
the Commissioner of Public Health, or his designee; the Commissioner of Mental Health
and Addiction Services, or his designee; the Commissioner of Mental Retardation, or
his designee; the Secretary of the Office of Policy and Management, or his designee; the
State Comptroller, or his designee; a representative of advocacy for mental retardation to
be appointed by the president pro tempore of the Senate; a representative of advocacy
for the elderly to be appointed by the majority leader of the Senate; a representative
of the nursing home industry to be appointed by the minority leader of the Senate; a
representative of the home health care industry, independent of the nursing home industry, to be appointed by the speaker of the House of Representatives; a representative of
the mental health profession to be appointed by the majority leader of the House of
Representatives; a representative of the substance abuse profession to be appointed by
the minority leader of the House of Representatives; a health care provider to be appointed by the president pro tempore of the Senate; two elderly consumers of Medicaid
services who are also eligible for Medicare, to be appointed by the speaker of the House
of Representatives; a representative of the managed care industry, to be appointed by
the president pro tempore of the Senate; a social services care provider, to be appointed
by the majority leader of the House of Representatives; a family support care provider,
to be appointed by the majority leader of the Senate; two persons with disabilities who
are consumers of Medicaid services, one to be appointed by the president pro tempore
of the Senate and one to be appointed by the minority leader of the House of Representatives; a representative of legal advocacy for Medicaid clients, to be appointed by the
minority leader of the Senate; and six members of the General Assembly, one member
appointed by the president pro tempore of the Senate; one member appointed by the
majority leader of the Senate; one member appointed by the minority leader of the
Senate; one member appointed by the speaker of the House of Representatives; one
member appointed by the majority leader of the House of Representatives; and one
member appointed by the minority leader of the House of Representatives. The council
shall be responsible for advising the Department of Social Services, which shall be the
lead agency in the development of a Medicaid Research and Demonstration Waiver
under Section 1115 of the Social Security Act for application to the Office of State
Health Reform of the United States Department of Health and Human Services by May
1, 1996. The council shall advise the department with respect to specific provisions
within the waiver application, including but not limited to, the identification of populations to be included in a managed care program, a timetable for inclusion of distinct
populations, expansion of access to care, quality assurance and grievance procedures
for consumers and providers. The council shall also advise the department with respect
to the goals of the waiver, including but not limited to, the expansion of access and
coverage, making state health spending more efficient and to the reduction of uncompensated care.
(b) There is established a Medicaid waiver unit within the Department of Social
Services for the purposes of developing the waiver under subsection (a) of this section.
The Medicaid waiver unit's responsibilities shall include but not be limited to the following: (1) Administrating the Medicaid managed care program, established pursuant to
section 17b-28; (2) contracting with and evaluating prepaid health plans providing Medicaid services, including negotiation and establishment of capitated rates; (3) assessing
quality assurance information compiled by the federally required independent quality
assurance contractor; (4) monitoring contractual compliance; (5) evaluating enrollment
broker performance; (6) providing assistance to the Insurance Department for the regulation of Medicaid managed care health plans; and (7) developing a system to compare
performance levels among prepaid health plans providing Medicaid services.
(P.A. 95-257, S. 7, 58; P.A. 96-268, S. 30, 34; June 18 Sp. Sess. P.A. 97-2, S. 114, 165; June 18 Sp. Sess. P.A. 97-8,
S. 29, 88.)
History: P.A. 95-257, S. 7 effective July 1, 1995 (Revisor's note: A reference in Subsec. (b)(7) to "Department of
Insurance" was changed editorially by the Revisors to "Insurance Department" for consistency with customary statutory
usage); P.A. 96-268 added the chairpersons and ranking members of the committee having cognizance of matters relating
to human services, or their designees, to the Waiver Application Development Council, effective July 1, 1996; June 18
Sp. Sess. P.A. 97-2 amended Subsec. (a) by adding the chairpersons and ranking members of the joint standing committee
of the General Assembly having cognizance of matters relating to public health, or their designees, the Commissioner of
Social Services, or his designee, the Commissioner of Public Health, or his designee, the Commissioner of Mental Health
and Addiction Services, or his designee, the Commissioner of Mental Retardation, or his designee, the Secretary of the
Office of Policy and Management, or his designee, the State Comptroller, or his designee, a representative of advocacy
for mental retardation to be appointed by the president pro tempore of the Senate, a representative of advocacy for the
elderly to be appointed by the majority leader of the Senate, a representative of the nursing home industry to be appointed
by the minority leader of the Senate, a representative of the home health care industry, independent of the nursing home
industry, to be appointed by the speaker of the House of Representatives, a representative of the mental health profession
to be appointed by the majority leader of the House of Representatives, a representative of the substance abuse profession
to be appointed by the minority leader of the House of Representatives, a health care provider to be appointed by the
president pro tempore of the Senate, two elderly consumers of Medicaid services who are also eligible for Medicare, to
be appointed by the speaker of the House of Representatives, a representative of the managed care industry, to be appointed
by the president pro tempore of the Senate, a social services care provider, to be appointed by the majority leader of the
House of Representatives, a family support care provider to be appointed by the majority leader of the Senate, two person
with disabilities who are consumers of Medicaid services, one to be appointed by the president pro tempore of the Senate
and one to be appointed by the minority leader of the House of Representatives, and a representative of legal advocacy for
Medicaid clients, to be appointed by the minority leader of the Senate to the Waiver Application Development Council
and made conforming changes, effective July 1, 1997; June 18 Sp. Sess. P.A. 97-8 deleted Subdiv. (6) in Subsec. (b) re
provision of data to Connecticut Health Care Data Institute, renumbering remaining Subdivs. accordingly, effective July
1, 1997.
Sec. 17b-28b. Competitive bidding for Medicaid managed care plans. On and
after January 1, 1997, the Department of Social Services may award, on the basis of a
competitive bidding procedure, contracts for Medicaid managed care health plans.
(P.A. 96-268, S. 29, 34.)
History: P.A. 96-268 effective July 1, 1996.
Sec. 17b-28c. Application for a federal waiver for pilot program based on
principles of national Program of All-Inclusive Care for the Elderly (PACE). The
Commissioner of Social Services may submit an application for a federal waiver for
the purpose of conducting a pilot program based on the principles of the national Program
of All-Inclusive Care for the Elderly (PACE): (1) To provide comprehensive health care
and care management services for elderly and disabled Medicaid recipients who may
also be eligible for Medicare; and (2) to simplify eligibility for Medicaid. The program
shall be designed to reduce costs and increase efficiency in the operation of the Medicaid
program and to improve the coordination of health care benefits with the Medicare
program. Under said program, the Commissioner of Social Services, in consultation
with the Insurance Commissioner, may initially enter into contracts with integrated
service networks which have successfully completed a feasibility study, in conjunction
with a PACE technical assistance center, for the provision of comprehensive long-term
health care and care management for participating Medicaid recipients on a prepayment
or per capita basis. The Commissioner of Social Services may make payments on such
basis to designated PACE sites from funds appropriated to the Medicaid account. The
Commissioner of Social Services, in such contracts, may establish conditions necessary
to operate such pilot program within available appropriations, including, but not limited
to, requiring a nursing facility to reduce its number of beds in a certificate of networks
shall emphasize the utilization of primary and community-based services to avoid utilization of institutional care. Eligible Medicaid recipients shall have a choice of enrolling
in an integrated service network or receiving Medicaid covered services in a fee-for-service program, and no copays or a lower level of optional Medicaid state plan services
than currently covered under fee-for-service Medicaid, shall be used to induce individuals to transfer into the networks.
(June 18 Sp. Sess. P.A. 97-2, S. 113, 165; P.A. 98-198, S. 2, 4.)
History: June 18 Sp. Sess. P.A. 97-2 effective July 1, 1997; P.A. 98-198 amended Subsec. (a) to (1) allow the commissioner to submit an application for a federal waiver for purpose of conducting a pilot program based on the principles of
the national Program of All-Inclusive Care for the Elderly (PACE), in lieu of requiring commissioner to submit an application for a federal waiver for an 1115 research and demonstration program; (2) authorize commissioner to "initially" enter
into contracts with integrated service networks which have successfully completed a feasibility study, in conjunction with
a PACE technical assistance center, for provision of health care for Medicaid recipients; (3) authorize commissioner to
make payments to designated PACE sites from funds appropriated to Medicaid account; (4) allow commissioner to establish
conditions in such contracts necessary to operate such pilot program within available appropriations; and (5) eliminate
provisions which specify what the program may include; and eliminated Subsecs. (b) and (c) in their entirety, effective
June 8, 1998.
Sec. 17b-28d. Amendment to state Medicaid plan to increase federal matching
funds for Medicaid services provided to children requiring special education. The
Commissioner of Social Services, in consultation with the Commissioner of Education,
shall submit to the Centers for Medicare and Medicaid Services an amendment to the
state Medicaid plan required by Title XIX of the Social Security Act to enhance federal
financial participation for Medicaid services provided to Medicaid enrolled children
requiring special education pursuant to an individualized education plan. The amendment shall propose (1) the establishment of either a simplified cost-based or fixed fee
method of determining state expenditures for eligible Medicaid services provided to
such children, and (2) the replacement of the annual activity cost reports for all school-based child health services provided to such children. Any fixed fee established by the
Department of Social Services shall be a per diem or monthly rate per child and shall
reflect reimbursable administrative expenses.
(P.A. 98-239, S. 8, 35; P.A. 03-19, S. 37.)
History: P.A. 98-239 effective July 1, 1998; P.A. 03-19 made technical changes, including replacing "Health Care
Financing Administration" with "Centers for Medicare and Medicaid Services", effective May 12, 2003.
Sec. 17b-28e. Amendment to Medicaid state plan re optional services. Not later
than September 30, 2002, the Commissioner of Social Services shall submit an amendment to the Medicaid state plan to implement the provisions of public act 02-1 of the
May 9 special session* concerning optional services under the Medicaid program. Said
state plan amendment shall supersede any regulations of Connecticut state agencies
concerning such optional services.
(May 9 Sp. Sess. P.A. 02-7, S. 104; P.A. 04-257, S. 31.)
*Public act 02-1 of the May 9 special session is entitled "An Act Concerning Adjustments to the State Budget for the
Biennium ending June 30, 2003, State Revenues and Operating a Motor Vehicle while under the Influence of Intoxicating
Liquor". (See Reference Table captioned "Public Acts of May 9, 2002" in Volume 16 which lists the sections amended,
created or repealed by the act.)
History: May 9 Sp. Sess. P.A. 02-7 effective August 15, 2002; P.A. 04-257 made a technical change, effective June
14, 2004.
Sec. 17b-28f. Managed care subcontractors. Report on costs and profit. On
and after July 1, 2002, each managed care subcontractor paying claims for mental health
or dental care paid by a Medicaid managed care plan shall submit a report on a quarterly
basis to the Commissioner of Social Services on the proportion and amount of its monthly
payment received from the plan which has been (1) paid directly to providers of health
services, and (2) used by the subcontractor for its own administrative costs and profit.
(P.A. 02-3, S. 6.)
History: P.A. 02-3 effective April 1, 2002.
Sec. 17b-29. Council to monitor implementation of temporary family assistance program and the employment services program. Appointments. Reports. (a)
There is established a council to monitor the implementation of the temporary family
assistance program and the employment services program. The council shall be composed of the chairmen and ranking members of the joint standing committee of the
General Assembly having cognizance of matters relating to human services, or their
designees, the chairmen and ranking members of the joint standing committee of the
General Assembly having cognizance of matters relating to labor, or their designees,
one child care provider and one expert on child support enforcement, to be appointed
by the president pro tempore of the Senate; one representative of advocacy groups, to
be appointed by the majority leader of the Senate; two education and training specialists,
one experienced in job training and one experienced in basic adult education, one to be
appointed by the minority leader of the Senate and one to be appointed by the minority
leader of the House of Representatives; one member of the public who is a current
recipient of benefits under the temporary family assistance program, to be appointed
by speaker of the House of Representatives; and two members, one experienced in higher
education programs and one experienced in teenage pregnancy issues, to be appointed by
the majority leader of the House of Representatives. The council shall elect a chairperson
from among its members. The council shall convene its first meeting not later than
September 1, 1997.
(b) Beginning September 1, 1997, at meetings scheduled by the council, the Commissioner of Social Services and the Labor Commissioner shall update the council on
the implementation of the temporary family assistance program and the employment
services program. The council shall submit recommendations to the department regarding, but not limited to, the availability of quality child care and the provision of seamless
child care services, procedures for informing parents and teenagers about family planning and pregnancy prevention, client education regarding their rights and responsibilities, the effectiveness of child support enforcement, the effect of reduced exemptions,
time limits and increased sanctions, the coordination with Medicaid managed care and
health care reform measures and the fiscal im