The proposed General Assembly Substitute Bill No. 7191 aims to enhance Medicaid provider rates and improve the sustainability of Medicaid services in Connecticut. Effective July 1, 2025, the bill mandates the Commissioner of Social Services to implement phased increases to Medicaid provider rates based on a Medicaid rate study, ensuring that by June 30, 2028, all Medicaid rates reach at least 75% of the most recent Medicare rates or align with a five-state rate benchmark for services without corresponding Medicare rates. The bill also requires annual adjustments to these rates post-2028, ensuring parity between pediatric and adult health care services and streamlining reimbursement processes by consolidating existing fee schedules.

Additionally, the bill repeals and replaces Section 17b-245d of the general statutes, introducing new requirements for federally qualified health centers (FQHCs) to submit annual Medicaid cost reports and financial statements. It mandates that the Department of Social Services rebase encounter rates based on costs from fiscal year 2024 and outlines a process for adjusting these rates in response to changes in service scope. The bill also includes provisions for retroactive adjustments if the department delays decisions, imposes penalties for failure to notify service decreases, and requires annual increases in Medicaid reimbursement rates based on the Medicare Economic Index. The Council on Medical Assistance Program Oversight will conduct ongoing reviews and submit annual reports with recommendations for appropriations to ensure fair compensation for Medicaid providers.

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