2023 Connecticut General Statutes › Title 17b - Social Services › Chapter 319v - Medical Assistance › Section 17b-245f. - Diabetes. Program to recommend federally-qualified health centers and other covered entities. Working group. Medicaid waiver. Report to General Assembly. Regulations.

(a) For the purposes of this section:
(1) “Commissioner” means the Commissioner of Social Services;
(2) “Covered entity” has the same meaning as provided in Section 340B of the Public Health Service Act, 42 USC 256b, as amended from time to time;
(3) “Covered outpatient drug” has the same meaning as said term is used in Section 340B of the Public Health Service Act, 42 USC 256b, as amended from time to time;
(4) “Department” means the Department of Social Services; and
(5) “Federally-qualified health center” has the same meaning as provided in Section 1905(l)(2)(B) of the Social Security Act, 42 USC 1396d(l)(2)(B), as amended from time to time.
(b) (1) Not later than November 1, 2020, the commissioner shall establish a working group to:
(A) Determine whether the commissioner should establish a program to assist individuals in this state who have been diagnosed with diabetes by referring said individuals to federally-qualified health centers and other covered entities for treatment regardless of whether said individuals have health coverage; and
(B) If the working group determines that the commissioner should establish the program described in subparagraph (A) of this subdivision, develop the criteria that the department shall apply in recommending a federally-qualified health center or other covered entity to an individual described in said subparagraph based on the individual's diabetic condition, any medically necessary care for said condition, the individual's residence address and any other factors that the working group deems relevant to carry out the purposes of the program.
(2) The working group shall consist of the following members:
(A) Two members appointed by the chief executive officer of Community Health Center, Incorporated, or the legal successor to said entity;
(B) Two members appointed by the chief executive officer of Community Health Center Association of Connecticut, Incorporated, or the legal successor to said entity;
(C) One member appointed by the Senate chairman of the joint standing committee of the General Assembly having cognizance of matters relating to insurance, who shall be an advocate for insulin coverage or public health;
(D) One member appointed by the House chairman of the joint standing committee of the General Assembly having cognizance of matters relating to insurance, who shall be an advocate for the interests of hospitals;
(E) One member appointed by the Senate ranking member of the joint standing committee of the General Assembly having cognizance of matters relating to insurance, who shall have experience with health care equity or be an advocate for the interests of hospitals;
(F) One member appointed by the House ranking member of the joint standing committee of the General Assembly having cognizance of matters relating to insurance, who shall be an advocate for insulin coverage or public health;
(G) The Commissioner of Social Services, or the Commissioner of Social Services' designee;
(H) The Commissioner of Public Health, or the Commissioner of Public Health's designee; and
(I) The Secretary of the Office of Policy and Management, or the secretary's designee.
(3) All initial appointments to the working group shall be made not later than November 1, 2020. Any vacancy shall be filled by the appointing authority.
(4) The commissioner shall select a chairperson of the working group from among the members of the working group. Such chairperson shall schedule the first meeting of the working group, which shall be held not later than January 11, 2021.
(5) A majority of the members of the working group shall constitute a quorum for the transaction of any business. Any action taken by the working group shall be by majority vote of the members present.
(6) Not later than May 1, 2021, the working group shall, in accordance with the provisions of section 11-4a, submit its recommendation under subparagraph (A) of subdivision (1) of this subsection and criteria, if any, developed under subparagraph (B) of subdivision (1) of this subsection to the commissioner and the joint standing committee of the General Assembly having cognizance of matters relating to insurance. The working group shall terminate on the date on which the working group submits its recommendation and criteria, if any, pursuant to this subdivision or May 1, 2021, whichever is earlier.
(7) The commissioner may reestablish the working group after the date on which the working group submits its recommendation and criteria, if any, pursuant to subdivision (6) of this subsection or May 1, 2021, whichever is earlier, to develop new criteria described in subparagraph (B) of subdivision (1) of this subsection in accordance with the requirements of subdivisions (1) to (6), inclusive, of this subsection, except as otherwise provided in this subdivision. The commissioner shall send notice to each appointing authority disclosing that the commissioner has reestablished the working group and the date on which the commissioner reestablished the working group. The appointing authorities shall appoint all members of the reestablished working group not later than sixty days after the date on which the commissioner reestablished the working group. The commissioner shall schedule the first meeting of the reestablished working group for a date that is not later than ninety days after the date on which the commissioner reestablished the working group. The reestablished working group shall submit its new criteria to the commissioner and the joint standing committee of the General Assembly having cognizance of matters relating to insurance, in accordance with the provisions of section 11-4a, not later than two hundred forty days after the commissioner reestablished the working group. The reestablished working group shall terminate on the date that it submits said criteria or on that date that is two hundred forty days after the commissioner reestablished the working group, whichever is later.
(c) (1) Not later than January 1, 2022, the commissioner shall establish the program described in subparagraph (A) of subdivision (1) of subsection (b) of this section, and the department shall apply the criteria developed pursuant to subparagraph (B) of subdivision (1) of subsection (b) of this section, unless:
(A) The working group recommends, pursuant to subparagraph (A) of subdivision (1) of subsection (b) of this section, that the commissioner should not establish said program; or
(B) Not later than October 1, 2021, the commissioner submits, in accordance with section 11-4a, to the joint standing committee of the General Assembly having cognizance of matters relating to insurance:
(i) The commissioner's determination that the goals of said program would, in the commissioner's judgment, be more successfully accomplished by applying for a Medicaid research and demonstration waiver under Section 1115 of the Social Security Act, as amended from time to time; or
(ii) A memorandum prepared by the general counsel of the department detailing the barriers federal law poses to the establishment and successful implementation of said program.
(2) If the commissioner informs the joint standing committee of the General Assembly having cognizance of matters relating to insurance that the commissioner has determined that the goals of the program described in subparagraph (A) of subdivision (1) of subsection (b) of this section would, in the commissioner's judgment, be more successfully accomplished by applying for a Medicaid research and demonstration waiver under Section 1115 of the Social Security Act, as amended from time to time, the commissioner shall apply for such a waiver to establish said program and, if the Centers for Medicare and Medicaid Services approves the commissioner's waiver application, establish said program in accordance with the terms of such waiver and all federal and state laws governing said program.
(d) If the commissioner establishes the program pursuant to subsection (c) of this section, the commissioner shall, as part of said program, establish and maintain an Internet web site to collect information from, and provide information to, each individual in this state who has been diagnosed with diabetes by referring the individual to a federally-qualified health center or other covered entity for treatment regardless of whether such individual has health coverage. The Internet web site shall, at a minimum:
(1) Enable the individual to disclose to the department the individual's name, residence address, age, contact information, including, but not limited to, electronic mail address or telephone number, income and race, whether the individual has been diagnosed with diabetes and the name of each outpatient prescription drug that has been prescribed to the individual for the treatment of diabetes; and
(2) Enable the department to:
(A) Determine whether each outpatient prescription drug disclosed to the department pursuant to subdivision (1) of this subsection is a covered outpatient drug that is available at a reduced cost to the individual through a federally-qualified health center that is a covered entity or any other covered entity;
(B) Disclose to the individual:
(i) The name, business address and telephone number of any federally-qualified health center that is a covered entity or any other covered entity that the department recommends to the individual according to the criteria established pursuant to subsection (b) of this section; and
(ii) General information regarding health care provided by the recommended federally-qualified health center or other covered entity described in subparagraph (B)(i) of this subdivision, including, but not limited to, any information that would assist the individual to obtain primary care through such federally-qualified health center or other covered entity; and
(C) Disclose to the recommended federally-qualified health center or other covered entity described in subparagraph (B)(i) of this subdivision the individual's name, contact information and a statement disclosing that the department has recommended the federally-qualified health center or other covered entity to the individual.
(e) Each federally-qualified health center or other covered entity that receives an individual's name, contact information and a statement disclosing that the department has recommended the federally-qualified health center or other covered entity to an individual pursuant to subparagraph (C) of subdivision (2) of subsection (d) of this section shall make a good faith effort to schedule an appointment for the individual on a date that is not later than thirty days after the date on which the department disclosed to the recommended federally-qualified health center or other covered entity the information described in subparagraph (C) of subdivision (2) of subsection (d) of this section.
(f) The commissioner may adopt regulations, in accordance with the provisions of chapter 54, to carry out the purposes of this section.
(July Sp. Sess. P.A. 20-4, S. 1.)
History: July Sp. Sess. P.A. 20-4 effective July 31, 2020.