Bill Text: CT SB00106 | 2016 | General Assembly | Introduced

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Bill Title: An Act Concerning A Medicaid Ambulatory Payment Classification System For Certain Hospital Services.

Spectrum: Committee Bill

Status: (Introduced - Dead) 2016-02-19 - Public Hearing 02/23 [SB00106 Detail]

Download: Connecticut-2016-SB00106-Introduced.html

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General Assembly		Raised Bill No. 106
February Session, 2016		LCO No. 1203
		*01203_______HS_*
Referred to Committee on HUMAN SERVICES
Introduced by:
(HS)

AN ACT CONCERNING A MEDICAID AMBULATORY PAYMENT CLASSIFICATION SYSTEM FOR CERTAIN HOSPITAL SERVICES.

Be it enacted by the Senate and House of Representatives in General Assembly convened:

Section 1. Subdivision (2) of subsection (d) of section 17b-239 of the 2016 supplement to the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

(2) On or after July 1, 2013, with the exception of publicly operated psychiatric hospitals, hospitals shall be paid for outpatient and emergency room [episodes of care] services based on prospective rates established by the commissioner within available appropriations and in accordance with [the Medicare Ambulatory Payment Classification] an ambulatory payment classification system, [in conjunction with a state conversion factor,] provided the Department of Social Services completes a fiscal analysis of the impact of such rate payment system on each hospital. The Commissioner of Social Services shall, in accordance with the provisions of section 11-4a, file a report on the results of the fiscal analysis not later than six months after implementing the rate payment system with the joint standing committees of the General Assembly having cognizance of matters relating to human services and appropriations and the budgets of state agencies. [The Medicare Ambulatory Payment Classification system shall be augmented to provide payment for services not generally covered under the Medicare Ambulatory Payment Classification system, including, but not limited to, mammograms, durable medical equipment, physical, occupational and speech therapy.] Nothing contained in this subsection shall authorize a payment by the state for such [episodes of care] services to any hospital in excess of the charges made by such hospital for comparable services to the general public. Effective upon implementation of the [Ambulatory Payment Classification] ambulatory payment classification system, a covered outpatient hospital service that [does not have an established Medicare Ambulatory Payment Classification code] is not being reimbursed using such ambulatory payment classification system shall be paid in accordance with a fee schedule or an alternative payment methodology, as determined by the commissioner. The commissioner may, within available appropriations, establish a supplemental pool to provide payments to offset losses incurred by publicly operated acute care hospitals and acute care children's hospitals licensed by the Department of Public Health as a result of the implementation of the ambulatory payment classification system. Prior to the implementation of the [Ambulatory Payment Classification] ambulatory payment classification system, each hospital's charges shall be based on the charge master in effect as of June 1, 2015. After implementation of such system, annual increases in each hospital's charge master shall not exceed, in the aggregate, the annual increase in the Medicare economic index. [The Commissioner of Social Services shall establish a fee schedule for outpatient hospital services to be effective on and after January 1, 1995, and may annually modify such fee schedule if such modification is needed to ensure that the conversion to an administrative services organization is cost neutral to hospitals in the aggregate and ensures patient access. Utilization may be a factor in determining cost neutrality.]

This act shall take effect as follows and shall amend the following sections:
Section 1	from passage	17b-239(d)(2)

Statement of Purpose:

To allow for Medicaid-specific payments for certain hospital services by removing references to Medicare and to authorize a supplemental payment pool to offset losses that may be experienced by certain hospitals as a result of the new payment methodology.

[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not underlined.]