State Codes and Statutes
Statutes > Connecticut > Title17a > Chap319 > Sec17a-22pSec. 17a-22p. Administrative services organization for Behavioral Health Partnership. Services to be provided. Coordination of Behavioral Health Partnership and Medicaid managed care benefits. (a) The Departments of Children and Families and Social Services shall enter a joint contract with an administrative services organization to perform eligibility verification, utilization management, intensive care management, quality management, coordination of medical and behavioral health services, provider network development and management, recipient and provider services and reporting. The contract shall provide for the organization to commence such activities on or after October 1, 2005.
(b) Claims under the Behavioral Health Partnership shall be paid by the Department of Social Services' Medicaid management information systems vendor, except that the Department of Children and Families may, at its discretion, continue to use existing claims payment systems.
(c) The administrative services organization shall authorize services, based solely on guidelines established by the clinical management committee, established pursuant to section 17a-22k. The administrative services organization may make exceptions to the guidelines when requested by a member, or the member's legal guardian or service provider, and determined by the administrative services organization to be in the best interest of the member. Decisions regarding the interpretation of such guidelines shall be made by the Departments of Children and Families and Social Services. No administrative services organization shall have any financial incentive to approve, deny or reduce services. The administrative services organization shall ensure that service providers and persons seeking services have timely access to program information and timely responses to inquiries, including inquiries concerning the clinical guidelines for services.
(d) The administrative services organization shall provide or arrange for on-site assistance to facilitate the appropriate placement, as soon as practicable, of children with behavioral health diagnoses who the administrative services organization knows to have been in an emergency department for over forty-eight hours. The administrative services organization shall provide or arrange for on-site assistance to arrange for the discharge or appropriate placement, as soon as practicable, for children the administrative services organization knows to have remained in an inpatient hospital unit for more than five days longer than is medically necessary, as agreed by the administrative services organization and the hospital.
(e) The Departments of Children and Families and Social Services shall develop, in consultation with the Behavioral Health Partnership, a comprehensive plan for monitoring the performance of the administrative services organization which shall include data on service authorizations, individual outcomes, appeals, outreach and accessibility, comments from program participants compiled from written surveys and face-to-face interviews.
(f) The Behavioral Health Partnership shall establish policies to coordinate benefits received under the partnership with those received through Medicaid managed care organizations for persons covered by both a Medicaid managed care organization and the Behavioral Health Partnership. Such policies shall specify a coordinated delivery of both physical and behavioral health care. The policies shall be submitted to the Behavioral Health Partnership Oversight Council for review and comment.
(P.A. 05-280, S. 101.)
History: P.A. 05-280 effective July 13, 2005.
