General Assembly Substitute Bill No. 7191 seeks to improve Medicaid provider rates and ensure the sustainability of Medicaid services in Connecticut. Starting July 1, 2025, the Commissioner of Social Services is required to implement phased increases to Medicaid provider rates, aiming for all rates to reach at least 75% of the most recent Medicare rates or align with a five-state benchmark by June 30, 2028. The bill also mandates annual adjustments to these rates post-2028, based on the Medicare Economic Index, and ensures parity between pediatric and adult health care service rates. Additionally, it streamlines existing fee schedules for reimbursement and emphasizes transparency in the rate adjustment process.

The legislation repeals and replaces Section 17b-245d of the general statutes, which previously outlined reporting requirements for federally qualified health centers. The new provisions require these centers to rebase their encounter rates by December 31, 2025, based on fiscal year 2024 costs, ensuring that new rates are not lower than previous ones and do not disrupt annual inflation adjustments. The bill introduces penalties for non-compliance regarding service decreases and mandates the Commissioner of Social Services to implement policies for these provisions. It also establishes a Council on Medical Assistance Program Oversight to review Medicaid provider reimbursement rates and report findings to the General Assembly annually, starting January 15, 2026.

Statutes affected:
Raised Bill:
HS Joint Favorable:
File No. 413:
APP Joint Favorable: