§ 17b-239e — Hospital rate plan. Supplemental pools and payments. Quality measures.

Connecticut § 17b-239e

• Jurisdiction: Connecticut
• Title 17b: Social Services
• Ch. 319v: Medical Assistance

Text

(a) For the purposes of this section, “settlement agreement” has the same meaning as provided in section 12-263z. (b) Subject to federal approval, the Department of Social Services shall establish supplemental pools for certain hospitals in accordance with the terms of the settlement agreement, including any court order issued in accordance with the provisions of section 12-263z . Such pools shall include, but not be limited to, as applicable, general, small hospital, mid-sized hospital and large hospital supplemental pools. (c) (1) The department shall distribute supplemental payments to applicable hospitals in accordance with the settlement agreement, including any court order issued in accordance with the provisions of section 12-263z . The commissioner shall diligently pursue the federal approvals required for the supplemental pools and payments set forth in this section. (2) To the extent required by the settlement agreement, including any court order issued in accordance with the provisions of section 12-263z , the Department of Social Services shall pay Medicaid supplemental payments to nongovernmental licensed short-term general hospitals located in the state as follows: (A) For the fiscal years ending June 30, 2020, and June 30, 2021, five hundred forty-eight million three hundred thousand dollars in each such fiscal year; and (B) for the fiscal years ending June 30, 2022, through June 30, 2026, five hundred sixty-eight million three hundred thousand dollars in each such fiscal year. For fiscal years commencing on and after July 1, 2026, the total amount of supplemental payments paid to such hospitals shall continue at the level in effect for the prior fiscal year unless modified through any provision of the general statutes or appropriations act. (3) From July 1, 2019, through June 30, 2026, the Department of Social Services shall make supplemental payments to the applicable hospitals on or before the last day of the first month of each calendar quarter, except that payments scheduled to be made before December 19, 2019, shall be made not later than thirty days after December 19, 2019. (4) If a nongovernmental licensed short-term general hospital located in the state merges or consolidates with or is acquired by another hospital, such that the hospital does not continue to maintain a separate short-term general hospital license, the supplemental payments that would have been paid to the hospital that no longer maintains such license shall be paid instead to the surviving hospital, beginning with the first calendar quarter that commences on or after the effective date of the merger, consolidation or acquisition. If a nongovernmental licensed short-term general hospital located in the state dissolves, ceases to operate or otherwise terminates licensed short-term general hospital services, the supplemental payments that would have been paid to such hospital shall not be paid to any other hospital for the remainder of the fiscal year in which such hospital dissolves, ceases operations or otherwise terminates such services. Commencing with the fiscal year after the hospital dissolved, ceased to operate or otherwise terminated such services, the supplemental payments that would have been made to such hospital shall be redistributed to all other nongovernmental licensed short-term general hospitals located in the state in accordance with the distribution methodology set forth in the settlement agreement for each supplemental pool. (5) Both the state and federal share of supplemental payments set forth in this subsection shall be appropriated to the Department of Social Services. Such supplemental payments shall not be subject to rescissions or holdbacks. Nothing in this section shall affect the authority of the state to recover overpayments and collect unpaid liabilities, as authorized by law. (d) To the extent required by the settlement agreement, including any court order issued in accordance with the provisions of section 12-263z , the commissioner shall make the supplemental payments set forth in this section effective for the dates of service set forth in this section, including payment adjustments to reconcile, in accordance with this section, supplemental payments made to hospitals for the calendar quarter ending September 30, 2019, as interim payments. Such reconciliation shall ensure that, after accounting for such payment adjustments, the actual supplemental payments made to each hospital shall be the amounts due to each hospital pursuant to the settlement agreement, even if federal approvals are received after each applicable date that supplemental payments are required to be made, provided the supplemental payments remain subject to federal approval. If federal approval of such payments is not obtained, such payments may later be recovered by the commissioner by recoupment against other Medicaid payments due to a hospital or in any manner authorized by law.

Legislative History

(P.A. 11-44, S. 112; 11-61, S. 121; Dec. Sp. Sess. P.A. 12-1, S. 5; P.A. 13-234, S. 77; June Sp. Sess. P.A. 15-5, S. 382; June Sp. Sess. P.A. 17-2, S. 618; June Sp. Sess. P.A. 17-4, S. 11; P.A. 18-81, S. 55; P.A. 19-117, S. 307; Dec. Sp. Sess. P.A. 19-1, S. 6.) History: P.A. 11-44 effective July 1, 2011; P.A. 11-61 amended Subsec. (b) by adding provision excluding utilization as a factor in determining cost neutrality, effective July 1, 2011; Dec. Sp. Sess. P.A. 12-1 amended Subsec. (b) to replace “shall not” with “may” and add “for the fiscal year ending June 30, 2013” re utilization as a factor in determining cost neutrality, effective December 21, 2012; P.A. 13-234 amended Subsec. (b) to add provision re supplemental inpatient pool for low-cost hospitals, and to delete “for the fiscal year ending June 30, 2013.”, effective July 1, 2013; June Sp. Sess. P.A. 15-5 amended Subsec. (b) to replace “shall” with “may” re establishment of supplemental inpatient pool and change “low cost hospitals” to “certain hospitals”, effective July 1, 2015; June Sp. Sess. P.A. 17-2 substantially amended Subsec. (b) including to replace provision re blended inpatient hospital case rate with provisions re establishment of and payments from supplemental pools, effective October 1, 2017; June Sp. Sess. P.A. 17-4 substantially amended Subsec. (b) including add in provisions re establishments of and payments from supplemental pools, effective November 21, 2017; P.A. 18-81 amended Subsec. (b)(2) by adding Subpara. (C) re amount of funds in supplemental pools for the fiscal year ending June 30, 2020, effective July 1, 2018; P.A. 19-117 amended Subsec. (b) by deleting provision re Department of Social Services to publish public notice for Medicaid state plan amendments necessary to establish pools, deleting former Subdiv. (2) re amount of funds in supplemental pools, redesignating existing Subdiv. (3) as new Subdiv. (2) and amending same to delete provision re sending distribution criteria and exception, deleting former Subdiv. (4) re supplemental payments for fiscal years ending June 30, 2018 and June 30, 2019, and adding Subsec. (c) re amounts allocated based on hospital's performance on quality measures, effective July 1, 2019; Dec. Sp. Sess. P.A. 19-1 substantially revised section re establishment of supplemental pools and making of supplemental payments to certain hospitals, effective December 19, 2019.