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Council on Medical Assistance Program Oversight Council on Medical Assistance Program Oversight Husky Health

Statutory Requirements

Connecticut General Statutes

Sec. 17b-28. Council on Medical Assistance Program Oversight. Duties. Appointments. Funding. Standing subcommittee. Reports. (a) There is established a Council on Medical Assistance Program Oversight which shall advise the Commissioner of Social Services on the planning and implementation of the health care delivery system for the following health care programs: The HUSKY Plan, Parts A and B and the Medicaid program, including, but not limited to, the portions of the program serving low income adults, the aged, blind and disabled individuals, individuals who are dually eligible for Medicaid and Medicare and individuals with preexisting medical conditions. The council shall monitor planning and implementation of matters related to Medicaid care management initiatives including, but not limited to, (1) eligibility standards, (2) benefits, (3) access, (4) quality assurance, (5) outcome measures, and (6) the issuance of any request for proposal by the Department of Social Services for utilization of an administrative services organization in connection with such initiatives.

(b) On or before June 30, 2011, the council shall be composed of the chairpersons and ranking members of the joint standing committees of the General Assembly having cognizance of matters relating to human services, public health and appropriations and the budgets of state agencies, or their designees; two members of the General Assembly, one to be appointed by the president pro tempore of the Senate and one to be appointed by the speaker of the House of Representatives; the director of the Commission on Aging, or a designee; the director of the Commission on Children, or a designee; a representative of each organization that has been selected by the state to provide managed care and a representative of a primary care case management provider, to be appointed by the president pro tempore of the Senate; two representatives of the insurance industry, to be appointed by the speaker of the House of Representatives; two advocates for persons receiving Medicaid, one to be appointed by the majority leader of the Senate and one to be appointed by the minority leader of the Senate; one advocate for persons with substance use disorders, to be appointed by the majority leader of the House of Representatives; one advocate for persons with psychiatric disabilities, to be appointed by the minority leader of the House of Representatives; two advocates for the Department of Children and Families foster families, one to be appointed by the president pro tempore of the Senate and one to be appointed by the speaker of the House of Representatives; two members of the public who are currently recipients of Medicaid, one to be appointed by the majority leader of the House of Representatives and one to be appointed by the minority leader of the House of Representatives; two representatives of the Department of Social Services, to be appointed by the Commissioner of Social Services; two representatives of the Department of Public Health, to be appointed by the Commissioner of Public Health; two representatives of the Department of Mental Health and Addiction Services, to be appointed by the Commissioner of Mental Health and Addiction Services; two representatives of the Department of Children and Families, to be appointed by the Commissioner of Children and Families; two representatives of the Office of Policy and Management, to be appointed by the Secretary of the Office of Policy and Management; and one representative of the office of the State Comptroller, to be appointed by the State Comptroller.


(c) On and after July 1, 2011, the council shall be composed of the following members:

(1) The chairpersons and ranking members of the joint standing committees of the General Assembly having cognizance of matters relating to aging, human services, public health and appropriations and the budgets of state agencies, or their designees; (2) Five appointed by the speaker of the House of Representatives, one of whom shall be a member of the General Assembly, one of whom shall be a community provider of adult Medicaid health services, one of whom shall be a recipient of Medicaid benefits for the aged, blind and disabled or an advocate for such a recipient, one of whom shall be a representative of the state’s federally qualified health clinics and one of whom shall be a member of the Connecticut Hospital Association; (3) Five appointed by the president pro tempore of the Senate, one of whom shall be a member of the General Assembly, one of whom shall be a representative of the home health care industry, one of whom shall be a primary care medical home provider, one of whom shall be an advocate for Department of Children and Families foster families and one of whom shall be a representative of the business community with experience in cost efficiency management; (4) Three appointed by the majority leader of the House of Representatives, one of whom shall be an advocate for persons with substance abuse disabilities, one of whom shall be a Medicaid dental provider and one of whom shall be a representative of the for-profit nursing home industry; (5) Three appointed by the majority leader of the Senate, one of whom shall be a representative of school-based health centers, one of whom shall be a recipient of benefits under the HUSKY program and one of whom shall be a physician who serves Medicaid clients; (6) Three appointed by the minority leader of the House of Representatives, one of whom shall be an advocate for persons with disabilities, one of whom shall be a dually eligible Medicaid-Medicare beneficiary or an advocate for such a beneficiary and one of whom shall be a representative of the not-for-profit nursing home industry; (7) Three appointed by the minority leader of the Senate, one of whom shall be a low-income adult recipient of Medicaid benefits or an advocate for such a recipient, one of whom shall be a representative of hospitals and one of whom shall be a representative of the business community with experience in cost efficiency management; (8) The executive director of the Commission on Women, Children and Seniors, or the executive director’s designee; (9) A member of the Commission on Women, Children and Seniors, designated by the executive director; (10) A representative of the Long-Term Care Advisory Council; (11) The Commissioners of Social Services, Children and Families, Public Health, Developmental Services and Mental Health and Addiction Services, and the Commissioner on Aging, or their designees, who shall be ex-officio nonvoting members; (12) The Comptroller, or the Comptroller’s designee, who shall be an ex-officio nonvoting member; (13) The Secretary of the Office of Policy and Management, or the secretary’s designee, who shall be an ex-officio nonvoting member; and (14) One representative of an administrative services organization which contracts with the Department of Social Services in the administration of the Medicaid program, who shall be a nonvoting member.

(d) The council shall choose a chairperson from among its members. The Joint Committee on Legislative Management shall provide administrative support to such chairperson.

(e) The council shall monitor and make recommendations concerning: (1) An enrollment process that ensures access for each Department of Social Services administered health care program and effective outreach and client education for such programs; (2) available services comparable to those already in the Medicaid state plan, including those guaranteed under the federal Early and Periodic Screening, Diagnostic and Treatment Services Program under 42 USC 1396d; (3) the sufficiency of accessible adult and child primary care providers, specialty providers and hospitals in Medicaid provider networks; (4) the sufficiency of provider rates to maintain the Medicaid network of providers and service access; (5) funding and agency personnel resources to guarantee timely access to services and effective management of the Medicaid program; (6) participation in care management programs including, but not limited to, medical home and health home models by existing community Medicaid providers; (7) the linguistic and cultural competency of providers and other program facilitators and data on the provision of Medicaid linguistic translation services; (8) program quality, including outcome measures and continuous quality improvement initiatives that may include provider quality performance incentives and performance targets for administrative services organizations; (9) timely, accessible and effective client grievance procedures; (10) coordination of the Medicaid care management programs with state and federal health care reforms; (11) eligibility levels for inclusion in the programs; (12) enrollee cost-sharing provisions; (13) a benefit package for each of the health care programs set forth in subsection (a) of this section; (14) coordination of coverage continuity among Medicaid programs and integration of care, including, but not limited to, behavioral health, dental and pharmacy care provided through programs administered by the Department of Social Services; and (15) the need for program quality studies within the areas identified in this section and the department’s application for available grant funds for such studies. The chairperson of the council shall ensure that sufficient members of the council participate in the review of any contract entered into by the Department of Social Services and an administrative services organization.

(f) The Commissioner of Social Services may, in consultation with an educational institution, apply for any available funding, including federal funding, to support Medicaid care management programs.

(g) The Commissioner of Social Services shall provide monthly reports to the council on the matters described in subsection (e) of this section, including, but not limited to, policy changes and proposed regulations that affect Medicaid health services. The commissioner shall also provide the council with quarterly financial reports for each covered Medicaid population which reports shall include a breakdown of sums expended for each covered population.

(h) There is established, within the Council on Medical Assistance Program Oversight, a standing subcommittee to study and make annual recommendations to the council on evidence-based best practices concerning Medicaid cost savings. The subcommittee shall file its first report to the council not later than January 1, 2015. The subcommittee shall consist of the following members, whose work on the council shall consist solely of work on the subcommittee: (1) One appointed by the speaker of the House of Representatives, who shall be a member of the Connecticut Hospital Association; (2) One appointed by the president pro tempore of the Senate, who shall be a representative of the business community with experience in cost efficiency management; (3) One appointed by the majority leader of the House of Representatives, who shall be a representative of the for-profit nursing home industry; (4) One appointed by the majority leader of the Senate, who shall be a physician who serves Medicaid clients; (5) One appointed by the minority leader of the House of Representatives, who shall be a representative of the not-for-profit nursing home industry; and (6) One appointed by the minority leader of the Senate, who shall be a representative of the business community with experience in cost efficiency management. (i) The subcommittee established pursuant to subsection (h) of this section shall choose chairpersons from among its members. (j) The council shall biannually report on its activities and progress to the General Assembly. (k) There is established, within the Council on Medical Assistance Program Oversight, a standing subcommittee to study and make recommendations to the council on children and adults who have complex health care needs. The subcommittee shall consist of council members appointed by the chairpersons of the council and other individuals who shall serve for terms prescribed by the cochairpersons to advise the council on specific needs of children and adults with complex health care needs. For the purposes of completing the reports required pursuant to subparagraphs (A) and (B) of this subsection, such individuals shall include, but need not be limited to: (1) The Child Advocate, or the Child Advocate's designee; (2) a family or child advocate; (3) the executive director of the Council on Developmental Disabilities, or the executive director's designee; (4) the executive director of the Connecticut Association of Public School Superintendents, or the executive director's designee; (5) an expert in the diagnosis, evaluation, education and treatment of children and young adults with developmental disabilities; and (6) the Healthcare Advocate, or the Healthcare Advocate's designee. The subcommittee shall submit the following reports, in accordance with section 11-4a to the council, the Governor and the joint standing committees of the General Assembly having cognizance of matters relating to children, human services and public health regarding the efficacy of support systems for children and young adults, not older than twenty-one years of age, with developmental disabilities and with or without co-occurring mental health conditions:

(A) Not later than July 1, 2017, recommendations including, but not limited to: (i) Metrics for evaluating the quality of state-funded services to such children and young adults that can be utilized by state agencies that fund such services; (ii) statutory changes needed to promote effective service delivery for such children and young adults and their families; and (iii) any other changes needed to address gaps in services identified by the subcommittee or council with respect to such children, young adults and their families; and

(B) Not later than January 1, 2018, an assessment of: (i) Early intervention services available to such children and young adults in this state; (ii) the system of community-based services for such children and young adults; (iii) the treatment provided by congregate care settings that are operated privately or by the state and provide residential supports and services to such children and young adults and how the quality of care is measured; and (iv) how the state Department of Education, local boards of education, the Department of Children and Families, the Department of Developmental Services and other appropriate agencies can work collaboratively to improve educational, developmental, medical and behavioral health outcomes for such children and young adults and reduce the number at risk of entering institutional care. As used in this subsection, "developmental disability" means a severe, chronic disability of an individual, as defined in 42 USC 15002, as amended from time to time.


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