Opinion ID: 779909
Heading Depth: 2
Heading Rank: 2

Heading: Connecticut's State Plan

Text: 6 In 1996, Connecticut enacted legislation providing that, in the determination of rates for federally qualified health centers, the Commissioner of Social Services [of Connecticut] shall apply Medicare productivity standards. Conn. Gen.Stat. § 17b-245a (2002). A productivity standard, sometimes also known as a productivity screen, imposes a minimum-visit requirement on affected providers. That is, if a health care provider does not meet or exceed the minimum number of patient visits per year, its reimbursement is reduced in proportion to the amount by which the provider fell short of the minimum. 3 In short, Connecticut reduces Medicaid payments to unproductive FQHCs to the same extent that CMS would reduce its Medicare payments to those providers. 7 Medicare productivity screens are authorized by, but not defined in, formally promulgated HHS regulations. The Medicare statute provides for payment of the reasonable cost of services rendered, 42 U.S.C. § 1395f(b)(1) (2000), and directs the Secretary to define reasonable in regulations, see 42 U.S.C. § 1395x(v)(1)(A) (2000). The Secretary's regulations, in turn, delegate to CMS the power to establish tests of reasonableness, includ[ing]... screening guidelines. 42 C.F.R. §§ 405.2468(c) (2002). When the Health Care Financing Administration (HCFA, the predecessor to CMS) and HHS issued § 405.2468 in 1992, a preamble to the rule noted that HCFA planned to use a productivity screen of 4,200 patient-visits per full-time physician. See Medicare Program; Payment for Federally Qualified Health Center Services, 57 Fed.Reg. 24,961, 24,967 (June 12, 1992). 8 Although the 4,200 number does not appear in the CFR, CMS uses that figure as a productivity screen for FQHCs. See Centers for Medicare & Medicaid Services, Rural Health Clinic and Federally Qualified Health Center Manual § 503. Consistent with the regulation, CMS permits waiver of the productivity screen requirements where a provider has demonstrated reasonable justification for not meeting the standard. Id.; see 42 C.F.R. § 405.2468(d)(1). 9 Connecticut law, therefore, incorporated both the 4,200 productivity screen and the relevant waiver provision beginning in 1996 when the State enacted § 17b-245a. 4 Connecticut's Department of Social Services (CDSS) has applied the 4,200 productivity screen since that time, although the record does not clearly indicate whether CDSS also made waivers available. Connecticut did not amend its state regulations to reflect these changes until 2001. See Conn. Agencies Regs. §§ 17b-262-661(11), -663 (2001). CMS approved the corresponding Connecticut State Plan amendments on June 21, 2001. 5