AN ACT CONCERNING HUSKY REFORM.

This bill requires licensed health care professionals who provide pre- and postnatal care to women to provide them with information about, and screen them for, postpartum depression. It also requires the Department of Social Services (DSS) to cover specific mental health screenings and related services for HUSKY recipients. And it requires the Behavioral Health Partnership (BHP) to play a role in the provision of these services.

The bill also requires DSS to (1) extend medical assistance to certain legal aliens and (2) apply for federal waivers to (a) enable more children with special health care needs to get services, (b) provide family planning services to more women, and (c) obtain federal Medicaid matching funds for two state-funded medical assistance programs.

The bill requires the DSS commissioner to develop and implement a provider-directed care coordination program for HUSKY recipients.

And it revises the law that directs DSS to provide Medicaid coverage for smoking cessation treatment.

EFFECTIVE DATE: July 1, 2009, except the provision requiring the waiver for Medicaid coverage of State Administered General Assistance (SAGA) and Charter Oak is effective upon passage.

The bill requires licensed health care professionals who provide prenatal care to provide a patient with information about postpartum depression. It also requires such professionals providing postnatal care to women to screen them for postpartum depression symptoms during each visit in the first six months after they give birth.

The bill requires HUSKY coverage for certain mental health services. These include:

1. screenings of pregnant women and mothers of infants for behavioral health needs, including prenatal and postpartum depression, stress, and anxiety;

2. medical services for a child under age five determined to be at high risk for a developmental disability due to the mother's physical or mental condition, which could include depression or substance abuse;

3. medical services for in-home therapy to a mother of an infant or young child when the mother is diagnosed as depressed and participates in a program certified by DSS or the Department of Children and Families, including the Child First program;

4. screening of new mothers for postpartum depression symptoms during each visit to a licensed health care professional during the fist six months after the child's birth; and

5. mental health services provided by practitioners who (a) participate in evidence-based models and (b) are DSS- or DCF-certified.

The bill requires the DSS commissioner to study the results of the screenings and report on them annually to the Medicaid Managed Care Council, with the first report due by July 1, 2010.

The bill requires the BHP, in coordination with the administrative services organization (Value Options, Inc. ) with which it contracts, to provide behavioral health services to HUSKY recipients to:

1. develop HUSKY managed care organizations and professional associations that include providers of pediatric, obstetrics and gynecology services, and family practitioners;

2. develop practitioner training for screening of prenatal and postpartum depression; and

3. provide referrals for BHP services.

DSS and DCF formed the BHP to plan and implement an integrated behavioral health service system for children and families. BHP's primary goal is to provide enhanced access to, and coordination of, a more complete and effective system of community-based behavioral health services and supports and to improve member outcomes.

The bill requires the DSS commissioner, by January 1, 2010, to seek federal funds to provide medical assistance to qualified alien children and pregnant women who were admitted into the U. S. less than five years before the “date services are provided. ”

The recently passed federal Children's Health Insurance Program Reauthorization Act (CHIPRA, PL 111-3) permits states to claim federal Medicaid (HUSKY A in Connecticut) and State Children's Health Insurance Program (SCHIP, HUSKY B) funds to provide health care coverage to pregnant women and children who are recent (within five years) immigrants.

Federal 1996 welfare reform law generally bars legal immigrants who have been in the U. S. for fewer than five years from receiving federally funded assistance. States can provide this assistance with state-only funds, which Connecticut has done since 1997.

The bill requires this waiver to provide funding for supports and services in home and community settings to children with special health care needs. The waiver must also (1) expand services available under the HUSKY Plus program and (2) extend HUSKY Plus to individuals regardless of income through a “buy-in premium-based option. ”

The state uses its SCHIP block grant primarily to fund the HUSKY B and HUSKY Plus programs, the latter of which provides supplemental services to children with severe physical disabilities. To qualify for HUSKY Plus, a family must be eligible for HUSKY B, the income limit for which is 300% of the federal poverty level (FPL). Families with higher incomes can buy into HUSKY B, but their children are not eligible for HUSKY Plus benefits.

PA 05-120 directed DSS to seek a federal Medicaid 1115 waiver to provide family planning coverage to adults in households with income up to 185% of the FPL. (These are individuals who would not otherwise qualify for HUSKY A. ) DSS never requested the waiver.

The bill requires the commissioner to (1) apply for this waiver by September 1, 2009 or (2) if he fails to do so, report to the Human Services Committee by September 15, 2009 explaining the reasons why.

The bill requires the DSS commissioner, by January 1, 2010, to apply for a federal Health Insurance and Flexibility and Accountability (HIFA) demonstration waiver to provide Medicaid coverage to individuals qualifying for either the SAGA medical assistance program or the Charter Oak Health Plan (see BACKGROUND). Currently, state funds are used to pay for the SAGA program and the subsidized portion of the Charter Oak Health Plan. Medicaid coverage would provide a federal match for these state expenditures.

The bill requires the commissioner to submit the application to the Human Services and Appropriations committees before sending it to the federal Medicaid agency, in accordance with state law. If he fails to do so by the above date, he must report to both committees explaining (1) why he has not done so and (2) an estimate of the cost savings that such a waiver would provide in a single calendar year. This report must be submitted by January 2, 2010.

Current law requires the DSS commissioner, by January 1, 2008, to seek a waiver to cover SAGA recipients with income up to 100% of the federal poverty level. He never sought the waiver.

The bill's provider-directed care coordination program must pay primary care providers (PCP) for care coordination services they provide to individuals who need care beyond what the PCP offers.

1. develop written care plans that include evidence of family participation;

2. have staff members dedicated to care coordination;

3. maintain documentation of care plans;

4. be designated as the patient's provider by patient selection or by assignment when the patient does not choose a provider;

5. provide services 24 hours per day, seven days per week;

6. arrange for the patient's comprehensive health care needs; and

7. provide integration, coordination, and continuity of care with referrals for specialty care and other necessary health care services.

DSS is currently running a pilot primary care case management program for HUSKY recipients in two parts of the state. The program contains many of the same elements that the bill's program includes.

In 1999, the legislature directed DSS to amend the Medicaid state plan to provide coverage for smoking cessation treatment. In 2002, the requirement was amended to ensure it was treatment ordered by a licensed health care professional, in accordance with a plan it submitted to the Human Services and Appropriations committees by January 1, 2003. In 2008, the legislature added a requirement that all prescriptive options had to be available to patients if the initial treatment failed. DSS has never amended the Medicaid plan.

The bill repeals all of these provisions except for the one requiring DSS to amend the plan for smoking cessation treatment.

This model program is designed to decrease the incidence of serious emotional disturbance, developmental and learning problems, and abuse and neglect among high-risk young children in the greater Bridgeport area. When mental health or child developmental problems first arise, the program works with pediatricians, teachers, and other community providers to identify, assess, and intervene with these children and their families.

Federal Medicaid law (Section 1115 of the Social Security Act) allows states to request “demonstration” waivers of federal rules to expand health care coverage when those rules would otherwise not allow this or to limit whom the program covers. These waivers generally run for five years but can be renewed.

The federal government introduced the HIFA waiver in 2001, which used the existing 1115 Medicaid waiver to encourage states, through their Medicaid- and State Children's Health Insurance Program-funded programs, to experiment with alternate strategies in an effort to reduce the number of uninsured residents. The federal Medicaid agency gave states broad authority under these waivers, including limiting enrollment, modifying benefit structures, and increasing beneficiaries' cost sharing which, without the waiver, would not be allowed. At the same time, states were expected to expand coverage.

States may still request 1115 waivers, which are research and demonstration waivers that allow states to experiment with coverage. These states must be able to demonstrate that they are “budget neutral” over the life of the demonstration, meaning they cannot be expected to cost the federal government more than it would cost without the waiver.

State law requires the DSS commissioner, when submitting an application for a federal waiver for anything more than routine operational issues, to submit the waiver to the Human Services and Appropriations committees before sending it to the federal government. The committees have 30 days to hold a hearing and advise the commissioner of their approval, denial, or modification. If the committees deny the application, the commissioner may not submit it to the federal government. The law also sets up a process for when the committees do not agree. If the committees do not act within the 30-day period, the application is deemed approved.

In 2003, the legislature directed DSS to seek a Medicaid waiver to cover SAGA medical assistance recipients by March 1, 2004 (PA 03-3, June 30 SS). In 2007, the legislature extended the deadline to January 1, 2008 and extended the waiver to individuals with incomes up to 100% of the FPL (PA 07-185). Currently, SAGA medical assistance is available to individuals with income up to about 55% of the FPL.

Since August 2008, the Charter Oak Health Plan has offered state residents another health insurance option. Individuals must be uninsured for at least six months to qualify, and benefits are provided by managed care organizations with which DSS contracts. The state provides both premium and deductible assistance to individuals whose incomes are under 300% of the FPL.

sSB 988 (File 195) requires DSS to seek a HIFA waiver for SAGA and Charter Oak by January 1, 2010. sHB 6417, requires DSS, by January 1, 2010, to seek a federal waiver to cover SAGA recipients.

Yea

Nay

(03/19/2009)