(a) The Commissioner of Social Services may, with regard to the provision of behavioral health services provided pursuant to a state plan under Title XIX or Title XXI of the Social Security Act: (1) Contract with one or more administrative services organizations to provide clinical management, intensive care management, provider network development and other administrative services; (2) delegate responsibility to the Department of Children and Families for the clinical management portion of such administrative contract or contracts that pertain to HUSKY A and B, and other children, adolescents and families served by the Department of Children and Families; and (3) delegate responsibility to the Department of Mental Health and Addiction Services for the clinical management portion of such administrative contract or contracts that pertain to Medicaid recipients who are not enrolled in HUSKY A.
(b) For purposes of this section, the term “clinical management” describes the process of evaluating and determining the appropriateness of the utilization of behavioral health services and providing assistance to clinicians or beneficiaries to ensure appropriate use of resources and may include, but is not limited to, authorization, concurrent and retrospective review, discharge review, quality management, provider certification and provider performance enhancement. The Commissioners of Social Services, Children and Families, and Mental Health and Addiction Services shall jointly develop clinical management policies and procedures.
(May 9 Sp. Sess. P.A. 02-7, S. 58; P.A. 05-280, S. 94; P.A. 06-196, S. 204; P.A. 10-119, S. 3; P.A. 13-234, S. 91; P.A. 14-62, S. 4; P.A. 15-69, S. 10, 11; June Sp. Sess. P.A. 15-5, S. 395.)
History: May 9 Sp. Sess. P.A. 02-7 effective August 15, 2002; P.A. 05-280 amended Subsec. (a)(1) to add provider network development and Subsec. (a)(2) to eliminate limitation on delegation of clinical management portion of administrative contract to Department of Children and Families to that pertaining to children under 18 years of age or individuals otherwise receiving behavioral health services from department, and amended Subsec. (b) to extend time period during which policies and procedures are valid if not adopted as regulations to December 31, 2006, from December 1, 2003, effective July 13, 2005; P.A. 06-196 made a technical change in Subsec. (b), effective June 7, 2006; P.A. 10-119 amended Subsec. (a) by adding “or under the Charter Oak Health Plan”, by changing “an administrative services organization” to “one or more administrative services organizations” in Subdiv. (1), by adding “contracts that pertain to HUSKY Plan Parts A and B, and other children, adolescents and families served by the Department of Children and Families” in Subdiv. (2) and by adding Subdiv. (3) re delegation of duties to Department of Mental Health and Addiction Services, and amended Subsec. (b) by adding “Mental Health and Addiction Services”, by removing December 31, 2006, re regulations adoption date and by making technical changes, effective June 7, 2010; P.A. 13-234 amended Subsec. (a) to delete references to Charter Oak Health Plan, effective January 1, 2014; P.A. 14-62 amended Subsec. (a) to add reference to intensive case management, amended Subsec. (b) to delete provisions re policies, procedures and regulations, and added Subsecs. (c) to (f) re intensive case management concerning hospital emergency department use for behavioral health, contractual provisions concerning patient care, federal reimbursement for management costs and policies, procedures and regulations, respectively, effective July 1, 2016; P.A. 15-69 changed “HUSKY Plan Parts A and B” to “HUSKY A and B” in Subsec. (a), changed provision re notice publication from Connecticut Law Journal to department's web site and eRegulations system in Subsec. (b) and made a conforming change, effective June 19, 2015; June Sp. Sess. P.A. 15-5 substituted “intensive care management” for “intensive case management” in Subsec. (a) and deleted former Subsecs. (c) to (f) re intensive case management, access to services, and implementing policies and procedures while in process of adopting in regulation form, effective July 1, 2016.