(a) For purposes of this section: (1) “Methadone maintenance” means a chemical maintenance program under which an addiction to one drug, including, but not limited to, heroin, is treated with the drug methadone in a weekly program that includes on and off-site methadone administration, drug testing and counseling; and (2) “chemical maintenance provider” means a provider certified and licensed by the federal Substance Abuse and Mental Health Services Administration and the state Department of Public Health who meets all federal and state requirements, including, but not limited to, requirements specific to the provision of chemical maintenance services.
(b) The Commissioner of Social Services shall amend the Medicaid state plan to provide a minimum weekly reimbursement rate of eighty-eight dollars and fifty-two cents to a chemical maintenance provider for methadone maintenance treatment of a Medicaid beneficiary, provided no such provider receiving a higher rate shall have such rate reduced to the minimum as a result of the implementation of a new minimum reimbursement rate.
(c) Notwithstanding subsection (b) of this section, on or after July 1, 2020, any reimbursement to a chemical maintenance provider for methadone maintenance treatment shall be contingent upon meeting certain performance measures as determined by the commissioner. Such performance measures shall be developed in consultation with the Department of Mental Health and Addiction Services and chemical maintenance providers. Initial performance measures shall be developed by September 30, 2019, including the means by which such measures shall be evaluated. The initial evaluation period shall be based on the claims data for the quarter ending March 31, 2020. The performance measures and thresholds may be adjusted after the initial evaluation period. Failure to meet department-identified standards on performance measures shall result in a rate reduction of (1) up to five per cent for the quarters ending September 30, 2020, and December 31, 2020, and (2) up to ten per cent beginning January 1, 2021. No provider shall receive a rate decrease under this subsection that is more than a ten per cent decrease annually.
(d) The Commissioner of Social Services, pursuant to section 17b-10, may implement policies and procedures to administer the provisions of this section while in the process of adopting such policies and procedures in regulation form, provided the commissioner prints notice of the intent to adopt the regulations on the department's Internet web site and the eRegulations System not later than twenty days after the date of implementation. Such policies and procedures shall be valid until the time final regulations are adopted.
(P.A. 19-117, S. 311.)
History: P.A. 19-117 effective July 1, 2019.