(a) The Commissioner of Social Services may, when the commissioner finds it to be in the public interest, fund part or all of the cost of benefits to any recipient under sections 17b-260 to 17b-262, inclusive, 17b-264 to 17b-285, inclusive, 17b-357 to 17b-361, inclusive, 17b-290, 17b-292, 17b-295, 17b-297a, 17b-297b and 17b-300 through the purchase of insurance from any organization authorized to do a health insurance business in this state or from any organization specified in subsection (b) of this section.
(b) The Commissioner of Social Services may require recipients of Medicaid or other public assistance to receive medical care on a prepayment or per capita basis, in accordance with federal law and regulations, if such prepayment is anticipated to result in lower medical assistance costs to the state. The commissioner may enter into contracts for the provision of comprehensive health care on a prepayment or per capita basis in accordance with federal law and regulations, with the following: (1) A health care center subject to the provisions of chapter 698a; (2) a consortium of federally qualified community health centers and other community-based providers of health services which are funded by the state; (3) other consortia of providers of health care services established for the purposes of this subsection; or (4) an integrated service network providing care management and comprehensive health care on a prepayment or per capita basis to elderly and disabled recipients of Medicaid who may also be eligible for Medicare.
(c) Providers of comprehensive health care services as described in subdivisions (2), (3) and (4) of subsection (b) of this section shall not be subject to the provisions of chapter 698a or, in the case of an integrated service network, sections 17b-239 to 17b-245, inclusive, 17b-281, 17b-340, 17b-342 and 17b-343. Any such provider shall be certified by the Commissioner of Social Services in accordance with criteria established by the commissioner, including, but not limited to, minimum reserve fund requirements.
(d) The commissioner shall pay all capitation claims which would otherwise be reimbursed to the health plans described in subsection (b) of this section in May, 2010, no later than June 30, 2010. Each subsequent payment made by the commissioner to such health plans for capitation claims due shall be made in the second month following the month to which the capitation applies.
(e) On or after May 1, 2000, the payment to the Commissioner of Social Services of (1) any monetary sanction imposed by the commissioner on a managed care organization under the provisions of a contract between the commissioner and such organization entered into pursuant to this section or sections 17b-290, 17b-292, 17b-295, 17b-297a, 17b-297b and 17b-300, or (2) any sum agreed upon by the commissioner and such an organization as settlement of a claim brought by the commissioner or the state against such an organization for failure to comply with the terms of a contract with the commissioner or fraud affecting the Department of Social Services shall be deposited in an account designated for use by the department for expenditures for children's health programs and services.
(1967, P.A. 759, S. 1(g); P.A. 75-420, S. 4, 6; P.A. 77-614, S. 608, 610; P.A. 83-51; P.A. 93-262, S. 1, 87; May Sp. Sess. P.A. 94-5, S. 27, 30; P.A. 95-160, S. 26, 69; P.A. 96-139, S. 12, 13; June 18 Sp. Sess. P.A. 97-2, S. 112, 165; P.A. 98-239, S. 23, 35; June Sp. Sess. P.A. 00-2, S. 19, 53; P.A. 02-89, S. 31; P.A 03-278, S. 62; P.A. 05-280, S. 24; Sept. Sp. Sess. P.A. 09-5, S. 65; P.A. 10-3, S. 10; P.A. 15-69, S. 44; P.A. 21-123, S. 2.)
History: P.A. 75-420 replaced welfare commissioner with commissioner of social services; P.A. 77-614 replaced commissioner of social services with commissioner of income maintenance, effective January 1, 1979; P.A. 83-51 added Subsec. (b) allowing the commissioner to enter into contracts for comprehensive health care on a prepayment or per capita basis and allowing recipients to receive medical care on such basis; 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 specified with whom the commissioner may contract for the provision of comprehensive health care, allowed comprehensive health care providers not to be subject to chapter 698a and required the health care providers to be certified by the commissioner, effective July 1, 1994; Sec. 17-134g transferred to Sec. 17b-266 in 1995; P.A. 95-160 added Subsec. (d) requiring the commissioner to pay all capitation claims to be reimbursed to health plans in June, 1997, no later than July 31, 1997, effective July 1, 1995; P.A. 96-139 changed effective date of P.A. 95-160 but without affecting this section; June 18 Sp. Sess. P.A. 97-2 authorized the commissioner to enter into comprehensive health care contracts with integrated service networks and exempted such networks from the provisions of chapter 698a or sections 17b-239 to 17b-245, inclusive, 17b-281, 17b-340 or 17b-342 to 17b-344, inclusive, effective July 1, 1997; (Revisor's note: New Subsec. (e) added by vetoed P.A. 97-240 and reprinted in Sec. 112 of June 18 Sp. Sess. P.A. 97-2 is void and was therefore not codified); P.A. 98-239 amended Subsec. (a) to allow the Commissioner of Social Services to fund part or all of the health care insurance costs for recipients of the HUSKY Plan, Part B through the purchase of insurance from any organization authorized to conduct a health insurance business in this state or from any organization specified in Subsec. (b), effective June 8, 1998; June Sp. Sess. P.A. 00-2 added Subsec. (e) re payments made to the commissioner of certain monetary sanctions or settlements deposited in account designated for use for expenditures for children's health programs and services, effective June 21, 2000; P.A. 02-89 amended Subsec. (c) to replace reference to Sec. 17b-344 with reference to Sec. 17b-343, reflecting the repeal of Sec. 17b-344 by the same public act; P.A. 03-278 made technical changes in Subsec. (c), effective July 9, 2003; P.A. 05-280 amended Subsec. (a) by making a technical change for purposes of gender neutrality and substituting reference to Sec. 17b-361 for reference to repealed Sec. 17b-362, effective July 1, 2005; Sept. Sp. Sess. P.A. 09-5 amended Subsec. (d) by replacing June, 1997, with June, 2011, and replacing July 31, 1997, with July 31, 2011, effective October 5, 2009; P.A. 10-3 amended Subsec. (d) by replacing June, 2011, with May, 2010, replacing July 31, 2011, with June 30, 2010, and adding provision requiring commissioner to make subsequent payments for capitation claims in second month following month to which capitation applies, effective April 14, 2010; P.A. 15-69 replaced references to Secs. 17b-289 to 17b-303 and Sec. 16 of Oct. 29 Sp. Sess. P.A. 97-1 in Subsec. (a), and Secs. 17b-289 to 17b-304 in Subsec. (e), with references to Secs. 17b-290, 17b-292, 17b-294a, 17b-295, 17b-297a, 17b-297b and 17b-300, effective June 19, 2015; P.A. 21-123 amended Subsecs. (a) and (e) by deleting references to section 17b-294a, effective July 6, 2021.
Structure Connecticut General Statutes
Chapter 319v - Medical Assistance
Section 17b-220. (Formerly Sec. 17-292g). - Reimbursement of medical providers.
Section 17b-221. (Formerly Sec. 17-292h). - Regulations. Reimbursement of hospitals.
Section 17b-221a. - Revenue from Riverview Hospital to be used to pay Medicaid claims.
Section 17b-222. (Formerly Sec. 17-294). - “Humane institution” defined. Daily report.
Section 17b-223. (Formerly Sec. 17-295). - Support in humane institutions.
Section 17b-224. (Formerly Sec. 17-295b). - Liability of patient for per capita cost of care.
Section 17b-225. (Formerly Sec. 17-295c). - Availability of patient information to certain agencies.
Section 17b-226a. - Provider billing rates for goods and services.
Section 17b-227. (Formerly Sec. 17-297). - Payment for services in state humane institutions.
Section 17b-229. (Formerly Sec. 17-299). - Liability for prior charges.
Section 17b-230. (Formerly Sec. 17-300). - Claim of state on death of institution patient.
Section 17b-231. (Formerly Sec. 17-301). - Refund for support of persons in state institutions.
Section 17b-237. (Formerly Sec. 17-310). - State aid toward support of children at center.
Section 17b-238. (Formerly Sec. 17-311). - State payments to hospitals.
Section 17b-239b. - Chronic disease hospitals. Prior authorization procedures. Regulations.
Section 17b-239c. - Interim disproportionate share payments to short-term general hospitals.
Section 17b-239d. - Payments for outpatient hospital services.
Section 17b-239e. - Hospital rate plan. Supplemental pools and payments. Quality measures.
Section 17b-241b. - Rate for private psychiatric residential treatment facilities.
Section 17b-243. (Formerly Sec. 17-313a). - Payments to rehabilitation centers.
Section 17b-245a. - Payments to federally qualified health centers.
Section 17b-245e. - Telehealth services provided under the Medicaid program. Report.
Section 17b-249. (Formerly Sec. 17-317). - Support of mentally ill persons accused of crime.
Section 17b-252. (Formerly Sec. 17-12q). - Connecticut Partnership for Long-Term Care.
Section 17b-256e. - Reports re potential participants in affordable pharmaceutical drug program.
Section 17b-256f. - Eligibility for Medicare savings programs. Regulations.
Section 17b-257b. - Alien eligibility for state medical assistance. Regulations.
Section 17b-257d. - Notice of terminating alien's state medical assistance.
Section 17b-257e. - Postpartum care for women without legal immigration status. Income eligibility.
Section 17b-258. (Formerly Sec. 17-12jj). - Health insurance assistance for unemployed persons.
Section 17b-259. (Formerly Sec. 17-274). - Medically necessary services.
Section 17b-260. (Formerly Sec. 17-134a). - Acceptance of federal grants for medical assistance.
Section 17b-260c. - Medicaid waiver to provide coverage for family planning services.
Section 17b-261. (Formerly Sec. 17-134b). - Medicaid. Eligibility. Assets. Waiver from federal law.
Section 17b-261b. - Program eligibility determined by department. Spousal support.
Section 17b-261c. - Medical assistance. Changes in circumstances.
Section 17b-261d. - Disease management initiative. Implementation. Annual report.
Section 17b-261e. - Mobile field hospital: HUSKY Health program coverage.
Section 17b-261f. - Mobile field hospital account.
Section 17b-261i. - Administrative services for Medicaid recipients. Regulations.
Section 17b-261j. - Easy Breathing model in HUSKY Health program.
Section 17b-261l. - Treatment of reverse annuity mortgage loan proceeds under Medicaid. Regulations.
Section 17b-261o. - Imposition of penalty period when undue hardship exists. Exception.
Section 17b-261t. - Contents of Medicaid benefits cards.
Section 17b-261v. - Parent or needy caretaker relative. Review of Medicaid coverage options.
Section 17b-262. (Formerly Sec. 17-134d). - Regulations. Admissions to nursing home facilities.
Section 17b-263c. - Medical homes. Regulations.
Section 17b-264. (Formerly Sec. 17-134e). - Extension of other public assistance provisions.
Section 17b-265b. - Reimbursement rates for pathologists.
Section 17b-265c. - Medicaid and Medicare dually eligible pilot program.
Section 17b-265g. - Health insurer. Duties owed to the state and Commissioner of Social Services.
Section 17b-266a. - Contract with pharmacy benefits management organization.
Section 17b-268. (Formerly Sec. 17-134i). - Withdrawal of member of group providing services.
Section 17b-269. (Formerly Sec. 17-134j). - Bonding of officers and employees.
Section 17b-270. (Formerly Sec. 17-134k). - Liability of agency and its officers.
Section 17b-271. (Formerly Sec. 17-134l). - Termination of agreement.
Section 17b-272. (Formerly Sec. 17-134m). - Personal fund allowance.
Section 17b-274b. - Pharmaceutical purchasing initiative. Annual report.
Section 17b-274e. - Prescription drugs. Utilization of cost-efficient dosages.
Section 17b-274f. - Step therapy program for Medicaid prescription drugs.
Section 17b-275. (Formerly Sec. 17-134r). - Physician and pharmacy lock-in procedure.
Section 17b-276b. - Nonemergency medical transportation services. Prior authorization.
Section 17b-276c. - Payment for medically necessary mode of transportation service.
Section 17b-277b. - Healthy Start program. Plan. Review.
Section 17b-277c. - Medicaid coverage for donor breast milk. Requirements. Regulations.
Section 17b-278a. - Coverage for treatment for smoking cessation.
Section 17b-278b. - Medical assistance for breast and cervical cancer.
Section 17b-278f. - Amendment to state Medicaid plan to provide treatment for tuberculosis.
Section 17b-278g. - Medical assistance for eyeglasses and contact lenses. Regulations.
Section 17b-278h. - Medical assistance for chiropractic services. Regulations.
Section 17b-278j. - Complex rehabilitation technology. Definitions. Report.
Section 17b-278k. - Electronic transmission of prescriptions for durable medical equipment.
Section 17b-280c. - Methadone maintenance. Minimum rates.
Section 17b-281b. - Used durable medical equipment. Payments to vendors or suppliers.
Section 17b-281c. - Authority of commissioner to modify medical equipment fee schedules.
Section 17b-282b. - Implementation of state-wide dental plan. Waiver.
Section 17b-282c. - Nonemergency dental services. Regulations.
Section 17b-282d. - Commissioner to modify nonemergency dental services. Regulations.
Section 17b-282e. - Orthodontic services for Medicaid recipients under twenty-one years of age.
Section 17b-282f. - Mobile dental clinics. Medicaid coverage areas. Regulations.
Section 17b-284. (Formerly Sec. 17-134ff). - Medical assistance for certain employed persons.
Section 17b-286. - Medicaid management information system. Reports.
Section 17b-288. - Organ transplant account. Regulations.
Section 17b-290. - Definitions.
Section 17b-291. - Children's health insurance plan.
Section 17b-292a. - Information for redetermination of eligibility under HUSKY Plan.
Section 17b-292b. - Prenatal care under HUSKY B. Unborn child option. Income eligibility.
Section 17b-293. - Minimum benefit coverage under HUSKY Plan, Part B.
Section 17b-294. - HUSKY Plus programs.
Section 17b-294a. - HUSKY Plus program. Administration. Eligibility. Regulations.
Section 17b-295. - Cost-sharing requirements under HUSKY B.
Section 17b-297. - Outreach programs for HUSKY Plan, Part A and Part B.
Section 17b-299. - Applications. Approval.
Section 17b-300. - Notification of member's change of circumstance.
Section 17b-301. - Recovery of payment for false statement, misrepresentation or concealment.
Section 17b-303. - Income disregard. Application for federal waiver.
Section 17b-304. - Regulations.
Section 17b-306a. - Child health quality improvement program. Purpose and scope. Annual reports.
Section 17b-307. - Primary care case management pilot program.
Section 17b-311. - Charter Oak Health Plan.
Section 17b-312. - Medicaid waiver to seek federal funds to support the Covered Connecticut program.
Section 17b-313. - Innovation waiver for health care expansion.