Sec. 17b-239. (Formerly Sec. 17-312). Payments to hospitals. Regulations. (a)
The rate to be paid by the state to hospitals receiving appropriations granted by the
General Assembly and to freestanding chronic disease hospitals, providing services to
persons aided or cared for by the state for routine services furnished to state patients,
shall be based upon reasonable cost to such hospital, or the charge to the general public
for ward services or the lowest charge for semiprivate services if the hospital has no
ward facilities, imposed by such hospital, whichever is lowest, except to the extent, if
any, that the commissioner determines that a greater amount is appropriate in the case
of hospitals serving a disproportionate share of indigent patients. Such rate shall be
promulgated annually by the Commissioner of Social Services. Nothing contained
herein shall authorize a payment by the state for such services to any such hospital in
excess of the charges made by such hospital for comparable services to the general
public. Notwithstanding the provisions of this section, for the rate period beginning July
1, 2000, rates paid to freestanding chronic disease hospitals and freestanding psychiatric
hospitals shall be increased by three per cent. For the rate period beginning July 1, 2001,
a freestanding chronic disease hospital or freestanding psychiatric hospital shall receive
a rate that is two and one-half per cent more than the rate it received in the prior fiscal
year and such rate shall remain effective until December 31, 2002. Effective January
1, 2003, a freestanding chronic disease hospital or freestanding psychiatric hospital shall
receive a rate that is two per cent more than the rate it received in the prior fiscal year.
Notwithstanding the provisions of this subsection, for the period commencing July 1,
2001, and ending June 30, 2003, the commissioner may pay an additional total of no
more than three hundred thousand dollars annually for services provided to long-term
ventilator patients. For purposes of this subsection, "long-term ventilator patient" means
any patient at a freestanding chronic disease hospital on a ventilator for a total of sixty
days or more in any consecutive twelve-month period. Effective July 1, 2004, each
freestanding chronic disease hospital shall receive a rate that is two per cent more than
the rate it received in the prior fiscal year.
(b) Effective October 1, 1991, the rate to be paid by the state for the cost of special
services rendered by such hospitals shall be established annually by the commissioner
for each such hospital based on the reasonable cost to each hospital of such services
furnished to state patients. Nothing contained herein shall authorize a payment by the
state for such services to any such hospital in excess of the charges made by such hospital
for comparable services to the general public.
(c) The term "reasonable cost" as used in this section means the cost of care furnished such patients by an efficient and economically operated facility, computed in
accordance with accepted principles of hospital cost reimbursement. The commissioner
may adjust the rate of payment established under the provisions of this section for the
year during which services are furnished to reflect fluctuations in hospital costs. Such
adjustment may be made prospectively to cover anticipated fluctuations or may be made
retroactive to any date subsequent to the date of the initial rate determination for such
year or in such other manner as may be determined by the commissioner. In determining
"reasonable cost" the commissioner may give due consideration to allowances for fully
or partially unpaid bills, reasonable costs mandated by collective bargaining agreements
with certified collective bargaining agents or other agreements between the employer
and employees, provided "employees" shall not include persons employed as managers
or chief administrators, requirements for working capital and cost of development of
new services, including additions to and replacement of facilities and equipment. The
commissioner shall not give consideration to amounts paid by the facilities to employees
as salary, or to attorneys or consultants as fees, where the responsibility of the employees,
attorneys or consultants is to persuade or seek to persuade the other employees of the
facility to support or oppose unionization. Nothing in this subsection shall prohibit the
commissioner from considering amounts paid for legal counsel related to the negotiation
of collective bargaining agreements, the settlement of grievances or normal administration of labor relations.
(d) The state shall also pay to such hospitals for each outpatient clinic and emergency
room visit a reasonable rate to be established annually by the commissioner for each
hospital, such rate to be determined by the reasonable cost of such services. The emergency room visit rates in effect June 30, 1991, shall remain in effect through June 30,
1993, except those which would have been decreased effective July 1, 1991, or July 1,
1992, shall be decreased. Nothing contained herein shall authorize a payment by the
state for such services to any hospital in excess of the charges made by such hospital
for comparable services to the general public. For those outpatient hospital services paid
on the basis of a ratio of cost to charges, the ratios in effect June 30, 1991, shall be
reduced effective July 1, 1991, by the most recent annual increase in the consumer price
index for medical care. For those outpatient hospital services paid on the basis of a ratio
of cost to charges, the ratios computed to be effective July 1, 1994, shall be reduced
by the most recent annual increase in the consumer price index for medical care. The
emergency room visit rates in effect June 30, 1994, shall remain in effect through December 31, 1994. The Commissioner of Social Services shall establish a fee schedule for
outpatient hospital services to be effective on and after January 1, 1995. Except with
respect to the rate periods beginning July 1, 1999, and July 1, 2000, such fee schedule
shall be adjusted annually beginning July 1, 1996, to reflect necessary increases in the
cost of services. Notwithstanding the provisions of this subsection, the fee schedule for
the rate period beginning July 1, 2000, shall be increased by ten and one-half per cent,
effective June 1, 2001. Notwithstanding the provisions of this subsection, outpatient
rates in effect as of June 30, 2003, shall remain in effect through June 30, 2005.
(e) The commissioner shall adopt regulations, in accordance with the provisions of
chapter 54, establishing criteria for defining emergency and nonemergency visits to
hospital emergency rooms. All nonemergency visits to hospital emergency rooms shall
be paid at the hospital's outpatient clinic services rate. Nothing contained in this subsection or the regulations adopted hereunder shall authorize a payment by the state for such
services to any hospital in excess of the charges made by such hospital for comparable
services to the general public.
(f) On and after October 1, 1984, the state shall pay to an acute care general hospital
for the inpatient care of a patient who no longer requires acute care a rate determined
by the following schedule: For the first seven days following certification that the patient
no longer requires acute care the state shall pay the hospital at a rate of fifty per cent of
the hospital's actual cost; for the second seven-day period following certification that
the patient no longer requires acute care the state shall pay seventy-five per cent of the
hospital's actual cost; for the third seven-day period following certification that the
patient no longer requires acute care and for any period of time thereafter, the state shall
pay the hospital at a rate of one hundred per cent of the hospital's actual cost. On and
after July 1, 1995, no payment shall be made by the state to an acute care general hospital
for the inpatient care of a patient who no longer requires acute care and is eligible for
Medicare unless the hospital does not obtain reimbursement from Medicare for that stay.
(g) Effective June 1, 2001, the commissioner shall establish inpatient hospital rates
in accordance with the method specified in regulations adopted pursuant to this section
and applied for the rate period beginning October 1, 2000, except that the commissioner
shall update each hospital's target amount per discharge to the actual allowable cost per
discharge based upon the 1999 cost report filing multiplied by sixty-two and one-half
per cent if such amount is higher than the target amount per discharge for the rate period
beginning October 1, 2000, as adjusted for the ten per cent incentive identified in Section
4005 of Public Law 101-508. If a hospital's rate is increased pursuant to this subsection,
the hospital shall not receive the ten per cent incentive identified in Section 4005 of
Public Law 101-508. For rate periods beginning October 1, 2001, through March 31,
2008, the commissioner shall not apply an annual adjustment factor to the target amount
per discharge. Effective April 1, 2005, the revised target amount per discharge for each
hospital with a target amount per discharge less than three thousand seven hundred fifty
dollars shall be three thousand seven hundred fifty dollars. Effective April 1, 2006, the
revised target amount per discharge for each hospital with a target amount per discharge
less than four thousand dollars shall be four thousand dollars. Effective April 1, 2007,
the revised target amount per discharge for each hospital with a target amount per discharge less than four thousand two hundred fifty dollars shall be four thousand two
hundred fifty dollars.
(1949, 1953, S. 1586d; 1961, P.A. 474, S. 2; 1967, P.A. 726, S. 1; 1969, P.A. 339, S. 1; P.A. 73-117, S. 23, 31; P.A.
77-574, S. 4, 6; P.A. 79-560, S. 26, 39; P.A. 81-472, S. 111, 159; P.A. 84-367, S. 1, 3; P.A. 85-482, S. 1, 2; P.A. 87-27,
S. 1; 87-516, S. 1, 5; P.A. 88-156, S. 19; P.A. 89-296, S. 6, 9; June Sp. Sess. P.A. 91-8, S. 13, 43, 63; May Sp. Sess. P.A.
92-16, S. 25, 89; P.A. 93-262, S. 1, 87; May Sp. Sess. P.A. 94-5, S. 2, 30; P.A. 95-160, S. 25, 69; 95-306, S. 1, 7; 95-351,
S. 28, 30; P.A. 96-139, S. 12, 13; P.A. 98-131, S. 1, 2; P.A. 99-279, S. 13, 14, 45; June Sp. Sess. P.A. 00-2, S. 15, 53; June
Sp. Sess. P.A. 01-2, S. 11, 66, 69; June Sp. Sess. P.A. 01-3, S. 1, 2, 6; June Sp. Sess. P.A. 01-9, S. 119, 120, 121, 129, 131;
May 9 Sp. Sess. P.A. 02-7, S. 57; June 30 Sp. Sess. P.A. 03-3, S. 67, 68; P.A. 04-258, S. 1, 3; May Sp. Sess. P.A. 04-2, S. 34.)
History: 1961 act changed technical language, added standard of comparable charges to Subsec. (a), deleted requirement
of Subsec. (b) that special services be professional and added Subsec. (c); 1967 act changed term "welfare" to "state"
patients, restricted standard of comparable charges in Subsec. (a), made allowances for unpaid bills, working capital
requirements and services development costs in determination of "actual cost" in Subsec. (c) and added Subsec. (d); 1969
act allowed alternative rates in Subsec. (a) based on charges for ward or semiprivate facilities and placed limit on rate for
outpatient clinic visit in Subsec. (d); P.A. 73-117 replaced hospital cost commission with committee established in accordance with Sec. 17-311; P.A. 77-574 included allowances for costs associated with collective bargaining agreements in
Subsec. (c); P.A. 79-560 replaced committee with commissioner of income maintenance; P.A. 81-472 made technical
changes; P.A. 84-367 changed the basis of the rate from "actual" to "reasonable" cost and added Subsec. (e) setting rates
for the inpatient care of patients who no longer require acute care; P.A. 85-482 amended Subsec. (d) by substituting "one
hundred sixteen" per cent for "one hundred fifty" per cent of combined average fee of general practitioner and specialist
for office visit as maximum rate for an outpatient clinic visit; P.A. 87-27 amended Subsec. (c) to exclude from "reasonable
cost" amounts paid to employees, attorneys or consultants due to unionization disputes; P.A. 87-516 allowed the commissioner to establish a rate cap if he receives approval for a disproportionate share exemption pursuant to federal regulations;
P.A. 88-156 added freestanding chronic disease hospitals providing services to persons aided or cared for by the state for
routine services furnished to state patients and gave the commissioner the discretion to set a higher rate for hospitals serving
a disproportionate share of indigent patients; P.A. 89-296 amended Subsec. (d) to prohibit the state from paying a hospital
for services in excess of the charges made by the hospital for comparable services to the public, added a new Subsec. (e)
requiring the commissioner to adopt regulations establishing criteria for defining emergency and nonemergency visits to
hospital emergency rooms and relettered former Subsec. (e) as Subsec. (f); June Sp. Sess. P.A. 91-8 amended Subsec. (b)
to add a provision re payment by the state of charges in excess of charges made when comparable service is rendered to
the general public and amended Subsec. (d) re rates paid by the state for outpatient clinic, services, emergency room visits
and outpatient hospital services paid on the basis of a ratio of cost to charges; May Sp. Sess. P.A. 92-16 amended Subsec.
(d) by providing that emergency room visit rates in effect on June 30, 1991, shall remain in effect through June 30, 1993,
except that those which would decrease on July 1, 1992, shall decrease; P.A. 93-262 authorized substitution of commissioner
and department of social services for commissioner and department of income maintenance, effective July 1, 1993; May
Sp. Sess. P.A. 94-5 amended Subsec. (d) to add a formula concerning outpatient hospital services paid on the basis of a
ratio of cost to charges and required the commissioner to establish a fee schedule for outpatient hospital services, effective
July 1, 1994; Sec. 17-312 transferred to Sec. 17b-239 in 1995; P.A. 95-160 amended Subsec. (a) by adding a provision
for rates to be paid to freestanding chronic disease hospitals, effective July 1, 1995; P.A. 95-306 amended Subsec. (f) by
prohibiting payment to an acute care general hospital for inpatient care of a patient if such patient is no longer in need of
such care and is eligible for Medicare, unless Medicare reimbursement is not received for such care, effective July 1, 1995;
P.A. 95-351 amended Subsec. (a) by providing that the commissioner use the "actual charge based on utilized service"
instead of the "cost of service" when determining rates paid to freestanding chronic disease hospitals, effective July 1,
1995; P.A. 96-139 changed effective date of P.A. 95-160 but without affecting this section; P.A. 98-131 added new Subsec.
(g) requiring commissioner to establish hospital inpatient rates, effective July 1, 1998; P.A. 99-279 amended Subsec. (d)
to eliminate annual increases in the fee schedule for outpatient hospital services for the rate periods beginning July 1, 1999,
and July 1, 2000, and amended Subsec. (g) to provide an exception for the rate period beginning October 1, 1998, from
the application of the three per cent annual adjustment factor to the target amount per discharge, to prohibit the commissioner
from applying an annual adjustment factor for succeeding rate periods, and to make a technical change, effective July 1,
1999; June Sp. Sess. P.A. 00-2 amended Subsec. (a) by deleting provisions re rates paid to freestanding chronic disease
hospitals on and after July 1, 1995, and inserting provisions re rates paid to freestanding chronic disease hospitals and
freestanding psychiatric hospitals, beginning July 1, 2000, and thereafter, effective July 1, 2000; June Sp. Sess. P.A. 01-2 amended Subsec. (a) to make a technical change for the purpose of gender neutrality, to require commissioner to use the
rate of the highest-paid freestanding chronic disease hospital for any freestanding chronic disease hospital having more
than an average of fifteen per cent of its inpatient days utilized as long-term ventilator patient days beginning for the rate
period ending in 2001, in lieu of rate paid for period when determining rates paid on and after July 1, 2001, notwithstanding
provisions of subsection, and to define term "long-term ventilator patient", effective July 1, 2001, and further amended
Subsec. (a) to remove discretion of commissioner re determination of appropriate amount in the case of hospitals serving
a disproportionate number share of indigent patients and to replace provisions re rates paid to freestanding chronic disease
hospitals and freestanding psychiatric hospitals for rate period beginning July 1, 2001, effective July 2, 2001; June Sp.
Sess. P.A. 01-3 amended Subsec. (d) by deleting provisions re rate for outpatient clinic visit and rate cap for outpatient
clinics upon approval of disproportionate share exemption and adding provision re increase of fee schedule for rate period
beginning July 1, 2001, and amended Subsec. (g) by deleting former provisions and adding provisions re establishment
of inpatient hospital rates, effective July 1, 2001; June Sp. Sess. P.A. 01-9 amended Subsec. (d) to make ten and one-half
per cent increase applicable to rate period beginning July 1, 2000, and effective June 1, 2001, and amended Subsec. (g) to
make June 1, 2001, the date by which the commissioner is to establish inpatient hospital rates, effective July 1, 2001, and
revised effective date of June Sp. Sess. P.A. 01-2 but without affecting this section; May 9 Sp. Sess. P.A. 02-7 amended
Subsec. (a) by delaying from July 1, 2002, to January 1, 2003, a two per cent rate increase to a free standing chronic disease
hospital and a free standing psychiatric hospital and maintaining effectiveness of existing rate until December 31, 2002,
effective August 15, 2002; June 30 Sp. Sess. P.A. 03-3 amended Subsec. (d) to provide that outpatient rates in effect as of
June 30, 2003, shall remain in effect through June 30, 2005, and amended Subsec. (g) by replacing "and October 1, 2002,"
with" through September 30, 2005," re period of time during which commissioner shall not apply an annual adjustment
factor to target amount per discharge, effective August 20, 2003; P.A. 04-258 amended Subsec. (a) by providing that each
freestanding chronic disease hospital shall receive a rate that is two per cent more than the rate it received in the prior fiscal
year and amended Subsec. (g) by substituting September 30, 2004, for September 30, 2005, re time period during which
the commissioner shall not apply an annual adjustment factor to the target amount per discharge and adding provisions re
revised target amount per discharge for the periods commencing April 1, 2005, April 1, 2006, and April 1, 2007, effective
July 1, 2004; May Sp. Sess. P.A. 04-2 amended Subsec. (g) by substituting March 31, 2008, for September 30, 2004,
effective July 1, 2004.
Annotations to former section 17-312:
Cited. 175 C. 49, 60, 65. Cited. 181 C. 130-132, 135.
Subsec. (a):
Cited. 175 C. 49, 60. Cited. 181 C. 130, 133, 135.
Sec. 17b-239a. Payments to short-term general hospitals located in certain distressed municipalities and targeted investment communities with enterprise zones.
The Department of Social Services may, within available funds, make payments to all
short-term general hospitals located in distressed municipalities, as defined in section
32-9p, with a population greater than seventy thousand and to all short-term general
hospitals located in targeted investment communities with enterprise zones, as defined
in section 32-70, with a population greater than one hundred thousand. The payment
amount for each hospital shall be determined by the Commissioner of Social Services
based upon the ratio that the number of inpatient discharges paid by Medicaid on a fee-for-service basis to the hospital for the most recently filed cost report period bears to
the total hospital discharges paid by Medicaid on a fee-for-service basis for all qualifying
hospitals. Notwithstanding the provisions of this section, no payment shall be made to
a facility licensed as a children's hospital.
(June Sp. Sess. P.A. 01-3, S. 4, 6; June 30 Sp. Sess. P.A. 03-3, S. 66.)
History: June Sp. Sess. P.A. 01-3 effective July 1, 2001; June 30 Sp. Sess. P.A. 03-3 removed provision which limited
application of section to fiscal years ending June 30, 2002, and June 30, 2003, and added provision re payments to "all
short-term general hospitals located in targeted investment communities with enterprise zones, as defined in section 32-70, with a population greater than one hundred thousand", effective August 20, 2003.
Sec. 17b-240. (Formerly Sec. 17-312a). Payments to hospitals by the Office of
Health Care Access. Notwithstanding the provisions of section 17b-239, the rate to be
paid by the state to a hospital receiving appropriations granted by the General Assembly
shall be established annually by the Office of Health Care Access pursuant to the provisions of chapter 368z, provided said office receives a waiver of Medicare principles of
reimbursement from the Department of Health and Human Services pursuant to Section
222 of Public Law 92-603. This section shall be effective only for such period as said
waiver remains in effect.
(P.A. 78-250, S. 1, 2; P.A. 95-257, S. 39, 58.)
History: Sec. 17-312a transferred to Sec. 17b-240 in 1995; P.A. 95-257 replaced Commission on Hospitals and Health
Care with Office of Health Care Access, effective July 1, 1995.
Annotation to former section 17-312a:
Cited. 181 C. 130, 135.
Sec. 17b-241. (Formerly Sec. 17-312b). Payments to mental health and substance abuse residential facilities and free-standing detoxification centers. (a) Any
rates established by the Commissioner of Social Services in effect February 1, 1991,
for mental health and substance abuse residential facilities shall remain in effect through
June 30, 1992, except those which would have been decreased effective July 1, 1991,
shall be decreased. Any rate increases made during the fiscal year ending June 30, 1993,
shall not exceed the most recent annual increase in the consumer price index for urban
consumers.
(b) Any rates established by the Commissioner of Social Services in effect February
1, 1991, for free-standing detoxification centers shall remain in effect through June 30,
1992, except those which would have been decreased effective July 1, 1991, shall be
decreased. Any rate increases made during the fiscal years ending June 30, 1993, June
30, 1994, and June 30, 1995, shall not exceed the most recent annual increase in the
consumer price index for urban consumers. Any free-standing detoxification center
which has an established rate below the average and, due to a material change in circumstances resulting in financial hardship, is aggrieved by a rate determined pursuant to
this subsection may, within ten days of receipt of written notice of such rate from the
commissioner, request in writing a hearing on such rate. The commissioner shall, upon
the receipt of all documentation necessary to evaluate the request, determine whether
there has been such a change in circumstances and shall conduct a hearing if appropriate.
(June Sp. Sess. P.A. 91-8, S. 16, 63; May Sp. Sess. P.A. 92-16, S. 33, 89; P.A. 93-262, S. 1, 87; 93-418, S. 23, 41.)
History: May Sp. Sess. P.A. 92-16 amended Subsecs. (a) and (b) by adding provision to each requiring that any rate
increases made during the fiscal year ending June 30, 1993, shall not exceed the most recent annual increase in the consumer
price index for urban consumers; P.A. 93-262 authorized substitution of commissioner and department of social services
for commissioner and department of income maintenance, effective July 1, 1993; P.A. 93-418 amended Subsec. (b) to
make provisions applicable to the fiscal years ending June 30, 1994, and June 30, 1995 and added provision regarding
free-standing detoxification centers' request for hearing on a rate established by the commissioner, effective July 1, 1993;
Sec. 17-312b transferred to Sec. 17b-241 in 1995.
Sec. 17b-241a. Payments to the Department of Mental Health and Addiction
Services for targeted case management services. Notwithstanding any provision of
the general statutes and the regulations of Connecticut state agencies, the Commissioner
of Social Services may reimburse the Department of Mental Health and Addiction Services for targeted case management services that it provides to its target population,
which, for purposes of this section, shall include individuals with severe and persistent
psychiatric illness and individuals with persistent substance dependence.
(June 30 Sp. Sess. P.A. 03-3, S. 88.)
History: June 30 Sp. Sess. P.A. 03-3 effective August 30, 2003.
Sec. 17b-242. (Formerly Sec. 17-313). Payments to home health care agencies
and homemaker-home health aide agencies. Appeals. Hearings. Regulations. (a)
The Department of Social Services shall determine the rates to be paid to home health
care agencies and homemaker-home health aide agencies by the state or any town in
the state for persons aided or cared for by the state or any such town. For the period
from February 1, 1991, to January 31, 1992, inclusive, payment for each service to the
state shall be based upon the rate for such service as determined by the Office of Health
Care Access, except that for those providers whose Medicaid rates for the year ending
January 31, 1991, exceed the median rate, no increase shall be allowed. For those providers whose rates for the year ending January 31, 1991, are below the median rate, increases
shall not exceed the lower of the prior rate increased by the most recent annual increase
in the consumer price index for urban consumers or the median rate. In no case shall
any such rate exceed the eightieth percentile of rates in effect January 31, 1991, nor
shall any rate exceed the charge to the general public for similar services. Rates effective
February 1, 1992, shall be based upon rates as determined by the Office of Health Care
Access, except that increases shall not exceed the prior year's rate increased by the
most recent annual increase in the consumer price index for urban consumers and rates
effective February 1, 1992, shall remain in effect through June 30, 1993. Rates effective
July 1, 1993, shall be based upon rates as determined by the Office of Health Care
Access except if the Medicaid rates for any service for the period ending June 30, 1993,
exceed the median rate for such service, the increase effective July 1, 1993, shall not
exceed one per cent. If the Medicaid rate for any service for the period ending June 30,
1993, is below the median rate, the increase effective July 1, 1993, s