SB 985 — AN ACT CONCERNING LEGISLATIVE APPROVAL FOR CHANGES TO THE HUSKY HEALTH PROGRAM REIMBURSEMENT AND CARE DELIVERY MODEL.

LCO(4) No.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;

4940 5 of 15 Committee Bill No.985 (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;

(8)sSB985 The/ executiveFile directorNo. of the Commission on Women, Children, Seniors, Equity and Opportunity, or the executive director's designee;

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165 (8) The executive director of the Commission on Women, Children, Seniors, Equity and Opportunity, or the executive director's designee;

LCO(12) No.The Comptroller, or the Comptroller's designee, who shall be an ex-officio nonvoting member;

4940 6 of 15 Committee Bill No.985 (12) The Comptroller, or the Comptroller's designee, who shall be an ex-officio nonvoting member;

(4) the sufficiency of provider rates to maintain the MedicaidsSB985 network/ ofFile providersNo. and service access;

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165 Medicaid network of providers and service access;

(10) coordination of the Medicaid LCOcare No.management programs with state and federal health care reforms;

4940 7 of 15 Committee Bill No.985 care management programs with state and federal health care reforms;

The commissioner shall also provide the council with quarterly financial reports for each coveredsSB985 Medicaid/ populationFile whichNo. reports shall include a breakdown of sums expended for each covered population.

165 8 sSB985 File No.

165 covered Medicaid population which reports shall include a breakdown of sums expended for each covered population.

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 LCOto No.advise the council on specific needs of children and adults with complex health care needs.

4940 8 of 15 Committee Bill No.

985 to advise the council on specific needs of children and adults with complex health care needs.

(ii) statutory changes needed to promote effectivesSB985 service/ deliveryFile forNo. such children and young adults and their families;

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165 effective service delivery for such children and young adults and their families;

(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 LCOquality No.of care is measured;

4940 9 of 15 Committee Bill No.985 quality of care is measured;

4.5.

Sec.sSB985 / File No.

5.165 10 sSB985 File No.

165 Sec.

6.

(b) No person shall, except for purposes directly connected with the administration of programs of the Department of Social Services and in accordance with the regulations of the commissioner, solicit, disclose, receive or make use of, or authorize, knowingly permit, participate in or acquiesce in the use of, any list of the names of, or any information concerning, persons applying for or receiving assistance from the LCODepartment No.of Social Services or persons participating in a program administered by said department, directly or indirectly derived from the records, papers, files or communications of the state or its subdivisions or agencies, or acquired in the course of the performance of official duties.

4940The 10Commissioner of 15Social CommitteeServices Billshall No.985disclose Department(1) to any authorized representative of Socialthe ServicesLabor orCommissioner personssuch participatinginformation indirectly arelated programto unemployment compensation, administered bypursuant saidto department,chapter directly567 or indirectlyinformation derivednecessary fromfor implementation of sections 17b-112l, 17b-688b, 17b-688c and 17b-688h and section 122 of public act 97-2 of the records,June papers,18 filesspecial orsession, communications(2) to any authorized representative of the stateCommissioner of Mental Health and Addiction Services any information necessary for the implementation and operation of the basic needs supplement program, (3) to any authorized representative of the Commissioner of Administrative Services or itsthe subdivisionsCommissioner of Emergency Services and Public Protection such information as the Commissioner of Social Services determines is directly related to and necessary for the Department of Administrative Services or agencies,the Department of Emergency Services and Public Protection for purposes of performing their functions of collecting social servicesrecoveries andoverpayments or acquiredamounts due as support in social services cases, investigating social services fraud or locating absent parents of public assistance recipients, (4) to any authorized representative of the courseCommissioner of Children andFamilies necessary informationconcerning achildor theimmediate family of a child receiving services from the performanceDepartment of officialSocial duties.Services, including safety net services, if (A) the Commissioner of sSB985 / File No.

The165 Commissioner11 ofsSB985 SocialFile Services shall disclose (1) to any authorized representative of the Labor Commissioner such information directly related to unemployment compensation, administered pursuant to chapter 567 or information necessary for implementation of sections 17b-112l, 17b-688b, 17b-688c and 17b-688h and section 122 of public act 97-2 of the June 18 special session, (2) to any authorized representative of the Commissioner of Mental Health and Addiction Services any information necessary for the implementation and operation of the basic needs supplement program, (3) to any authorized representative of the Commissioner of Administrative Services or the Commissioner of Emergency Services and Public Protection such information as the Commissioner of Social Services determines is directly related to and necessary for the Department of Administrative Services or the Department of Emergency Services and Public Protection for purposes of performing their functions of collecting social servicesrecoveries andoverpayments or amounts due as support in social services cases, investigating social services fraud or locating absent parents of public assistance recipients, (4) to any authorized representative of the Commissioner of Children andFamilies necessary informationconcerning achildor theimmediate family of a child receiving services from the Department of Social Services, including safety net services, if (A) the Commissioner of Children and Families or the Commissioner of Social Services has determined that imminent danger to such child's health, safety or welfare exists to target the services of the family services programs administered by the Department of Children and Families, or (B) the Commissioner of Children and Families requires access to the federal Parent Locator Service established pursuant to 42 USC 653 in order to identify a parent or putative parent of a child, (5) to a town official or other contractor or authorized representative of the Labor LCO No.

4940165 11Children and Families or the Commissioner of 15Social CommitteeServices Billhas No.985determined that imminent danger to such child's health, safety or welfare exists to target the services of the family services programs administered by the Department of Children and Families, or (B) the Commissioner of Children and Families requires access to the federal Parent Locator Service established pursuant to 42 USC 653 in order to identify a parent or putative parent of a child, (5) to a town official or other contractor or authorized representative of the Labor Commissioner such information concerning an applicant for or a recipient of assistance under state-administered general assistance deemednecessary by theCommissioner ofSocialServicesandtheLabor Commissioner to carry out their respective responsibilities to serve such persons under the programs administered by the Labor Department that are designed to serve applicants for or recipients of state- administered general assistance, (6) to any authorized representative of the Commissioner of Mental Health and Addiction Services for the purposes of the behavioral health [managed care] program established by section 17a-453, (7) to any authorized representative of the Commissioner of Early Childhood to carry out his or her respective responsibilities under the two-generational academic achievement and workforce readiness initiative established pursuant to section 17b-112l and programs that regulate child care services or youth camps, (8) to a health insurance provider, in IV-D support cases, as defined in subdivision (13) of subsection (b) of section 46b-231, information concerning a child and the custodial parent of such child that is necessary to enroll such child in a health insurance plan available through such provider when the noncustodial parent of such child is under court order to provide health insurance coverage but is unable to provide such information, provided the Commissioner of Social Services determines, after providing prior notice of the disclosure to such custodial parent and an opportunity for such parent to object, that such disclosure is in the best interests of the child, (9) to any authorized representative of the Department of Correction, in IV-D support cases, as defined in subdivision (13) of subsection (b) of section 46b-231, information concerning noncustodial parents that is necessary to identifysSB985 inmates/ orFile parolees with IV-D support cases who may benefit from Department of Correction educational, training, skill building, work or rehabilitation programming that will significantly increase an inmate's or parolee's ability to fulfill such inmate's support obligation, (10) to any authorized representative of the Judicial Branch, in IV-D support cases, as defined in subdivision (13) of subsection (b) of section 46b-231, information concerning noncustodial parents that is necessary LCO No.

4940165 12 ofsSB985 15File CommitteeNo. Bill No.985 to:

165 identify inmates or parolees with IV-D support cases who may benefit from Department of Correction educational, training, skill building, work or rehabilitation programming that will significantly increase an inmate's or parolee's ability to fulfill such inmate's support obligation, (10) to any authorized representative of the Judicial Branch, in IV-D support cases, as defined in subdivision (13) of subsection (b) of section 46b-231, information concerning noncustodial parents that is necessary to:

6.7.

ThesSB985 Commissioner/ ofFile SocialNo. Services, to the extent permitted by federal law, shall amend the Medicaid state plan to establish a pilot program serving not more than five hundred elderly or disabled state medicalassistancerecipientswhoarealsoeligibleforMedicareandwho voluntarily opt to participate in the program.

Such165 program13 shallsSB985 LCOFile No.

4940165 13The Commissioner of 15Social CommitteeServices, Billto No.985the demonstrateextent thepermitted feasibilityby andfederal costlaw, effectivenessshall ofamend deliveringthe comprehensiveMedicaid healthstate insuranceplan coverageto [inestablish a managedpilot careprogram setting]serving not more than five hundred elderly or disabled state medicalassistancerecipientswhoarealsoeligibleforMedicareandwho voluntarily opt to suchparticipate recipients.in the program.

Such program shall demonstrate the feasibility and cost effectiveness of delivering comprehensive health insurance coverage [in a managed care setting] to such recipients.

7.8.

8.9.

2 July 1, 2025 17a-460c(a)New section Sec.

3 July 1, 2025 17b-2817a-460c(a) Sec.

4 July 1, 2025 17b-28h17b-28 Sec.

5 July 1, 2025 17b-90(b)17b-28h Sec.

6 July 1, 2025 17b-265c17b-90(b) Sec.sSB985 / File No.

7165 July14 1,sSB985 2025File 17b-10aNo. Sec.

8165 JulySec. 1, 2025 Repealer section LCO No.

49407 14July of1, 152025 Committee17b-265c BillSec. No.

9858 StatementJuly of1, Purpose:2025 17b-10a Sec.

To9 requireJuly legislative1, approval2025 forRepealer changessection toStatement theof HUSKYLegislative HealthCommissioners: program reimbursement and care delivery model.

[ProposedIn deletionsSection are1, enclosed"Not inlater brackets.than sixty days after" was changed to "Not later than thirty days after" for accuracy and internal consistency.

ProposedIn additionsSection are2, indicatedin bythe underline,first exceptsentence, that"on whenfinancial trends in the entireHUSKY textHealth ofprogram", a"on billphysical orhealth resolutionmeasures", or"behavioral ahealth sectionquality ofindicators ain" billand or"in resolutionthe isHUSKY new,Health itprogram" iswere notadded underlined.]for Co-Sponsors:clarity;

SEN.and in the second sentence, provisions concerning the reporting of data similar to data previously reported were redrafted for clarity.

LOONEY,HS 11thJoint Dist.Favorable Subst.

S.B.sSB985 / File No.

985165 LCO15 sSB985 File No.

4940165 15The following Fiscal Impact Statement and Bill Analysis are prepared for the benefit of 15the members of the General Assembly, solely for purposes of information, summarization and explanation and do not represent the intent of the General Assembly or either chamber thereof for any purpose.

In general, fiscal impacts are based upon a variety of informational sources, including the analyst’s professional knowledge.

Whenever applicable, agency data is consulted as part of the analysis, however final products do not necessarily reflect an assessment from any specific department.

OFA Fiscal Note State Impact:

Agency Affected Fund-Effect FY 26 $ FY 27 $ Social Services, Dept.

GF - Potential See Below See Below Note:

GF=General Fund Municipal Impact:

None Explanation The 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 to the Appropriations and Human Services committees before implementing or seeking any necessary federal approval to implement such change.

To the extent this delays or prevents a change that otherwise would have occurred, the state could experience a fiscal impact that cannot be determined at this time.

The Out Years The annualized ongoing fiscal impact identified above would continue into the future subject to changes in the Medicaid payment model.

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165 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 repealslawsthat authorizeDSS to (1)awardcontracts 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 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:

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165 1.

allow the Connecticut Mental Health Center to enter into 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 MEDICAID 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:

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165 1.

hold a public hearing within 30 days after they receive the proposal;

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, theproposal isdeemed denied.

If they both accept thereport,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 sSB985 / File No.

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165 committees to transmit these materials to DSS.

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.

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165 April 2023 Report.

This report on behavioral health quality 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) sSB985 / File No.

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