The proposed 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 bill mandates the Commissioner of Social Services to implement phased increases to Medicaid provider rates, aiming for these rates to reach at least 75% of the most recent Medicare rates or align with a five-state benchmark by June 30, 2028. Additionally, the bill requires annual adjustments to maintain parity between pediatric and adult healthcare services and simplifies reimbursement processes by consolidating existing fee schedules. It also repeals and replaces Section 17b-245d of the general statutes, introducing new requirements for federally qualified health centers (FQHCs) regarding encounter rates and service scope notifications.

Key amendments include provisions for retroactive rate adjustments if the Department of Social Services delays decisions, and a civil penalty for FQHCs that fail to notify the department of service reductions affecting reimbursement rates. The bill also mandates annual increases in Medicaid reimbursement rates for FQHCs based on the Medicare Economic Index and establishes a new Council on Medical Assistance Program Oversight to review and ensure adequate Medicaid provider reimbursement rates. The effective dates for these provisions range from July 1, 2025, to January 1, 2026.

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