State Codes and Statutes

Statutes > Connecticut > Title17a > Chap319i > Sec17a-453a

      Sec. 17a-453a. Operation of behavioral health managed care program for recipients of medical services under the state-administered general assistance program. (a) The Commissioner of Mental Health and Addiction Services shall operate a behavioral health managed care program, within available appropriations, to: (1) Provide consistent and appropriate treatment to eligible recipients; (2) reduce treatment costs for such recipients; (3) eliminate duplicated services provided to such recipients; and (4) assist such recipients in applying for federally funded programs. Said commissioner shall adopt regulations, in accordance with chapter 54, to implement said program. For purposes of this section "eligible recipient" means an individual eligible for medical services under the state-administered general assistance program, pursuant to section 17b-192, and in need of behavioral health services, as determined by the Department of Mental Health and Addiction Services. Notwithstanding section 17a-476, 17a-676, 17b-192 or any other provision of the general statutes, services provided under the behavioral health managed care program established by this section shall not be restricted to services offered under the Medicaid program. The Department of Mental Health and Addiction Services shall be responsible for all services and payments related to the provision of the behavioral health services for eligible recipients and may conduct an audit of all aspects of the program established by this section including, but not limited to, services provided, prior authorizations, payments for services and medical records. The commissioner shall analyze the results of such audits to identify discrepancies and errors with regard to services and payments and areas that involve program implementation and operation problems. The commissioner shall adopt regulations, in accordance with the provisions of chapter 54, concerning the recovery of reimbursements made to providers based on audit findings and setting such progressive sanctions as the commissioner deems appropriate for any providers found, as a result of an audit, not to be in compliance with the standards established pursuant to this section. The regulations shall include a provision allowing the commissioner to take action to withhold reimbursement for any such provider and shall provide for a grace period before a sanction is imposed. A provider may appeal a decision of the commissioner to withhold reimbursements or to impose a sanction in accordance with the provisions of chapter 54.

      (b) The Commissioner of Mental Health and Addiction Services shall implement policies and procedures necessary for the purposes of this section while in the process of adopting such policies and procedures in regulation form, provided the commissioner prints a notice of intention to adopt the regulations in the Connecticut Law Journal not later than twenty days prior to implementing such policies and procedures. The commissioner shall submit a report on such policies and procedures each month to the joint standing committees of the General Assembly having cognizance of matters concerning public health and human services and to the Secretary of the Office of Policy and Management until final regulations are submitted to the legislative regulation review committee not later than April 1, 1998. Policies and procedures implemented pursuant to this subsection shall be valid until the time final regulations are effective.

      (c) On and after July 1, 1998, the Commissioner of Mental Health and Addiction Services shall expand the program established by this section to include services that provide basic needs support to assist in the restoration of functioning of recipients determined eligible by the Department of Social Services.

      (d) Providers of services and provider networks under the program established by this section shall be approved by the commissioner in accordance with criteria established by the commissioner, which shall include, but not be limited to, minimum reserve fund requirements.

      (P.A. 95-194, S. 18, 33; 95-257, S. 11, 58; P.A. 97-143, S. 3, 4; June 18 Sp. Sess. P.A. 97-8, S. 10, 88; June 30 Sp. Sess. P.A. 03-3, S. 47.)

      History: P.A. 95-194, S. 18 effective July 1, 1995 (Revisor's note: P.A. 95-257 authorized substitution of "Commissioner of Mental Health and Addiction Services" for "Commissioner of Mental Health", effective July 1, 1995); P.A. 97-143 made program permanent by deleting the term "pilot", effective June 13, 1997; June 18 Sp. Sess. P.A. 97-8 amended Subsec. (a) to establish a behavioral health managed care program and added Subsecs. (b) to (d), inclusive, for the same purpose, effective July 1, 1997; June 30 Sp. Sess. P.A. 03-3 amended Subsec. (a) to redefine "eligible recipient" as an "individual eligible for medical services under the state-administered general assistance program" and make a technical change, effective August 20, 2003.