HB 5561

Substitute House Bill No. 5561
  Public Act No. 26-146
AN ACT CONCERNING A FIVE-YEAR MEDICAID RATE REVIEW,
DENTAL REPRESENTATION ON A MEDICAL ASSISTANCE
OVERSIGHT COUNCIL, BIOMARKER TESTING AND OPIOID
PRESCRIPTION COVERAGE REQUIREMENTS AND A STUDY
CONCERNING PAYMENT OF SPOUSES FOR STATE-SUBSIDIZED
HOME CARE.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
  Section 1. (NEW) (Effective July 1, 2026) (a) As used in this section,
"Medicaid rate study" means the study commissioned by the
Department of Social Services pursuant to section 1 of public act 23-186.
   (b) The Commissioner of Social Services shall create a five-year
process for the regular and predictable review of Medicaid rates of
reimbursement, which shall (1) examine the rates of reimbursement
paid to Medicaid providers, and (2) benchmark such rates to rates for
the same services paid by Medicare when possible under available
appropriations. Not later than January 1, 2027, the commissioner shall
review Medicaid rates of reimbursement in accordance with such
process.
   (c) The Medicaid rate review process may include the evaluation of
rates paid in individual components of the Medicaid program, provided
an evaluation of all rates paid shall be completed not later than January
  Substitute House Bill No. 5561
1, 2032. As part of this process, the commissioner may, in consultation
with the Secretary of the Office of Policy and Management, review and,
to the extent funds are appropriated for this purpose, increase and
rebase rates at the conclusion of each calendar year using an applicable,
more current Medicare base year to (1) strengthen access to care, (2)
improve quality and outcomes of care, and (3) reduce spending on acute
care services.
   (d) At the conclusion of the five-year review process prescribed by
this section, the commissioner shall commence a new review following
the same schedule of evaluation and thereafter shall continue to
commence such reviews every five years. As part of the review process,
the commissioner shall streamline and consolidate existing fee
schedules used for provider or service reimbursement so that every
provider is reimbursed for the same service using the same fee schedule.
In streamlining and consolidating existing fee schedules, the
commissioner shall take into consideration, among other factors and to
the extent applicable, the most recent Medicare fee schedule for services
covered by Medicare as well as Medicaid.
   (e) The commissioner shall develop a process to accept public
comment as part of the Medicaid rate evaluation process. Such public-
comment process shall, at a minimum, allow for the submission of
written comments by a means prescribed by the commissioner and oral
comments (1) at one or more public meetings held at a time and place
selected by the commissioner, and (2) at one or more meetings of the
Council on Medical Assistance Program Oversight, established
pursuant to section 17b-28 of the general statutes, as amended by this
act.
   (f) Not later than January 15, 2028, and annually thereafter, the
commissioner shall file a report, in accordance with the provisions of
section 11-4a of the general statutes, with the joint standing committees
of the General Assembly having cognizance of matters relating to
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appropriations and the budgets of state agencies and human services on
the rate evaluation process. The report shall include the commissioner's
recommendations on the level of appropriations required to increase
compensation for Medicaid providers for health care services in
accordance with this section and a description of the data and
methodology used to reach such recommendations.
   Sec. 2. Subsection (c) of section 17b-28 of the 2026 supplement to the
general statutes is repealed and the following is substituted in lieu
thereof (Effective July 1, 2026):
   (c) On and after October 31, 2017, the council shall be composed of
the following members:
   (1) The chairpersons and ranking members of the joint standing
committees of the General Assembly having cognizance of matters
relating to aging, human services, public health and appropriations and
the budgets of state agencies, or their designees;
   (2) Five appointed by the speaker of the House of Representatives,
one of whom shall be a member of the General Assembly, one of whom
shall be a community provider of adult Medicaid health services, one of
whom shall be a recipient of Medicaid benefits for the aged, blind and
disabled or an advocate for such a recipient, one of whom shall be a
representative of the state's federally qualified health clinics and one of
whom shall be a member of the Connecticut Hospital Association;
   (3) Five appointed by the president pro tempore of the Senate, one of
whom shall be a member of the General Assembly, one of whom shall
be a representative of the home health care industry, one of whom shall
be a primary care medical home provider, one of whom shall be an
advocate for Department of Children and Families foster families and
one of whom shall be a representative of the business community with
experience in cost efficiency management;
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  (4) Three appointed by the majority leader of the House of
Representatives, one of whom shall be an advocate for persons with
substance abuse disabilities, one of whom shall be a Medicaid dental
provider and one of whom shall be a representative of the for-profit
nursing home industry;
  (5) Three appointed by the majority leader of the Senate, one of whom
shall be a representative of school-based health centers, one of whom
shall be a recipient of benefits under the HUSKY Health program and
one of whom shall be a physician who serves Medicaid clients;
   (6) Three appointed by the minority leader of the House of
Representatives, one of whom shall be an advocate for persons with
disabilities, one of whom shall be a dually eligible Medicaid-Medicare
beneficiary or an advocate for such a beneficiary and one of whom shall
be a representative of the not-for-profit nursing home industry;
  (7) Three appointed by the minority leader of the Senate, one of
whom shall be a low-income adult recipient of Medicaid benefits or an
advocate for such a recipient, one of whom shall be a representative of
hospitals and one of whom shall be a representative of the business
community with experience in cost efficiency management;
  (8) The executive director of the Commission on Women, Children,
Seniors, Equity and Opportunity, or the executive director's designee;
  (9) A member of the Commission on Women, Children, Seniors,
Equity and Opportunity, designated by the executive director of said
commission;
  (10) A representative of the Long-Term Care Advisory Council;
  (11) The Commissioners of Social Services, Children and Families,
Public Health, Developmental Services, Aging and Disability Services
and Mental Health and Addiction Services, or their designees, who shall
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be ex-officio nonvoting members;
   (12) The Comptroller, or the Comptroller's designee, who shall be an
ex-officio nonvoting member;
   (13) The Secretary of the Office of Policy and Management, or the
secretary's designee, who shall be an ex-officio nonvoting member;
[and]
  (14) One representative of an administrative services organization
which contracts with the Department of Social Services in the
administration of the Medicaid program, who shall be a nonvoting
member; and
  (15) A representative of the Department of Social Services'
Connecticut Dental Health Partnership's Dental Policy Advisory
Council.
   Sec. 3. (Effective from passage) As used in this section, "biomarker
testing" has the same meaning as provided in section 17b-278m of the
general statutes. Not later than October 1, 2026, the Commissioner of
Social Services shall file a report, in accordance with the provisions of
section 11-4a of the general statutes, with the joint standing committee
of the General Assembly having cognizance of matters relating to
human services on (1) prior authorization requirements for Medicaid
coverage of biomarker testing, including, but not limited to, any impact
such requirements have on access to biomarker testing by Medicaid
beneficiaries, and (2) the number of Medicaid beneficiaries who have
had biomarker testing approved for Medicaid coverage in the fiscal year
ending June 30, 2026.
   Sec. 4. (NEW) (Effective July 1, 2026) (a) As used in this section, (1)
"prescribing practitioner" means a physician, dentist, podiatrist,
optometrist, physician assistant, advanced practice registered nurse or
nurse-midwife enrolled as a Medicaid provider who is licensed by the
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state and authorized to prescribe opioid drugs within the scope of such
person's practice, and (2) "opioid drug" has the same meaning as
provided in section 20-14o of the general statutes.
   (b) A prescribing practitioner who prescribes an opioid drug for the
treatment of a Medicaid beneficiary's pain shall consider the feasibility
of nonopioid treatment options, including, but not limited to,
chiropractic treatment, spinal cord stimulation, acupuncture and
physical therapy.
   (c) The Commissioner of Social Services may adopt regulations in
accordance with the provisions of chapter 54 of the general statutes to
implement the provisions of this section.
   Sec. 5. (Effective from passage) (a) There is established a working group
to study the feasibility of allowing spouses to be compensated for
providing personal care assistance for spouses enrolled in home care
programs funded under the state medical assistance program.
  (b) The working group shall consist of:
  (1) The Commissioner of Social Services, or the commissioner's
designee;
   (2) The Secretary of the Office of Policy and Management, or the
secretary's designee;
   (3) The House and Senate chairpersons of the joint standing
committee of the General Assembly having cognizance of matters
relating to human services, or their designees; and
   (4) A consumer of personal care services and a representative of an
organization providing such services, appointed by the chairpersons of
the joint standing committee of the General Assembly having
cognizance of matters relating to human services.
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   (c) The chairperson of the working group shall be selected by the
House and Senate chairpersons of the joint standing committee of the
General Assembly having cognizance of matters relating to human
services. All appointments to the working group shall be made not later
than thirty days after the effective date of this section. The chairperson
shall schedule a meeting of the working group not later than sixty days
after the effective date of this section.
   (d) The administrative staff of the joint standing committee of the
General Assembly having cognizance of matters relating to human
services shall serve as administrative staff of the working group.
   (e) Not later than January 1, 2027, the working group shall submit a
report on its findings and recommendations to the joint standing
committee of the General Assembly having cognizance of matters
relating to human services in accordance with the provisions of section
11-4a of the general statutes. The working group shall terminate on the
date that it submits such report or January 1, 2027, whichever is later.
 Governor's Action:
 Approved June 2, 2026
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