2023 Connecticut General Statutes › Title 17b - Social Services › Chapter 319v - Medical Assistance › Section 17b-261m. - Administrative services organization. Contract for services. Establishment of rates.

(a) The Commissioner of Social Services may contract with one or more administrative services organizations to provide care coordination, utilization management, disease management, customer service and review of grievances for recipients of assistance under the HUSKY Health program. Such organization may also provide network management, credentialing of providers, monitoring of copayments and premiums and other services as required by the commissioner. Subject to approval by applicable federal authority, the Department of Social Services shall utilize the contracted organization's provider network and billing systems in the administration of the program. In order to implement the provisions of this section, the commissioner may establish rates of payment to providers of medical services under this section if the establishment of such rates is required to ensure that any contract entered into with an administrative services organization pursuant to this section is cost neutral to such providers in the aggregate and ensures patient access. Utilization may be a factor in determining cost neutrality.
(b) Any contract entered into with an administrative services organization, pursuant to subsection (a) of this section, shall include a provision to reduce inappropriate use of hospital emergency department services, which may include a cost-sharing requirement and intensive care management services.
(P.A. 10-179, S. 20; P.A. 11-44, S. 115; 11-61, S. 124; Dec. Sp. Sess. P.A. 12-1, S. 7; P.A. 13-234, S. 79, 93; P.A. 14-62, S. 1; P.A. 15-69, S. 22, 23; June Sp. Sess. P.A. 15-5, S. 397.)
History: P.A. 10-179 effective July 1, 2010; P.A. 11-44 designated existing provisions as Subsec. (a) and amended same by adding provision allowing commissioner to establish rates for providers, and added Subsec. (b) re contract provision to reduce inappropriate use of hospital emergency department services, effective July 1, 2011; P.A. 11-61 amended Subsec. (a) by adding provision excluding utilization as factor in determining cost neutrality, effective July 1, 2011; Dec. Sp. Sess. P.A. 12-1 amended Subsec. (a) to replace “shall not” with “may” and add “for the fiscal year ending June 30, 2013” re utilization as a factor in determining cost neutrality, effective December 21, 2012; P.A. 13-234 amended Subsec. (a) to delete “for the fiscal year ending June 30, 2013.” re utilization as a factor in determining cost neutrality, effective July 1, 2013, and further amended Subsec. (a) to remove reference to Charter Oak Health Plan, effective January 1, 2014; P.A. 14-62 amended Subsec. (b) to add provisions re contract to require intensive case management services and re what such services include and to define “frequent users”, and added Subsecs. (c) to (e) re contractual and reporting requirements of contracting administrative services organization and monitoring of such organization by commissioner, effective July 1, 2016; P.A. 15-69 amended Subsec. (a) to change “Medicaid and HUSKY Plan, Parts A and B” to “the HUSKY Health program”, effective June 19, 2015; June Sp. Sess. P.A. 15-5 amended Subsec. (b) to add “and intensive care management services” and delete provisions re intensive case management services, and deleted former Subsecs. (c) to (e) re requirements for access to care and reporting, effective July 1, 2016.