HB 5456 Summary

• Repeals previous section 17b-245b and establishes that the Commissioner of Social Services shall reimburse federally qualified health centers using an all-inclusive encounter rate per patient encounter based on the prospective payment system required by federal law (42 USC 1396a(bb)).

• Multiple encounters with health professionals on the same day for the same service type constitute a single encounter for reimbursement purposes, except when a patient requires additional diagnosis and treatment after the first encounter.

• Requires the Department of Social Services to rebase each federally qualified health center's encounter rates by December 31, 2024, based on fiscal year 2023 costs divided by the number of patient encounters, with new rates not less than previously received rates.

• Establishes a process for federally qualified health centers to request rate adjustments for increases in scope of services, requiring the department to meet with center representatives within 30 days and issue a detailed decision within 120 days, with specific factors the department cannot consider when reviewing such requests.

• Mandates annual Medicaid reimbursement rate increases for federally qualified health centers effective January 1st each year using the most recent Medicare Economic Index increase.