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--- version:Public Act No. 26-146
+++ version:(document, no version)
@@ -1,214 +1,115 @@
-Substitute House Bill No. 5561
+OFFICE OF FISCAL ANALYSIS
+Legislative Office Building, Room 5200
+Hartford, CT 06106  (860) 240-0200
+http://www.cga.ct.gov/ofa
+sHB-5561
+AN ACT CONCERNING MEDICAID RATE INCREASES FOR
+CERTAIN PROVIDERS.
 
-Public Act No. 26-146
+Primary Analyst: ES 4/7/26
+Contributing Analyst(s): NB, LD, JP
+Reviewer: RW
 
-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:
+OFA Fiscal Note
 
-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
+State Impact:
+Agency Affected Fund-Effect FY 27 $ FY 28 $
+Social Services, Dept. GF - Cost $35.4
+million
+$39.4
+million
+Social Services, Dept. GF - Cost See Below See Below
+Note: GF=General Fund
 
-Public Act No. 26-146 2 of 7
+Municipal Impact: None
+Explanation
+The bill results in increased costs to the Department of Social Services
+(DSS) associated with increasing various provider rates under
+Medicaid, as described by relevant sections below.
+Section 2 results in a cost to DSS of approximately $350,000 in FY 27
+and FY 28 due to excluding prevention services from the annual cap on
+Medicaid dental payments.
+Section 3 may result in a cost to the extent that adding periodontal
+therapy to Medicaid nonemergency dental services for health y adults
+expands coverage beyond current practice.
+Section 5  results in a cost to increase  Medicaid rates for services
+provided by a safety net pediatric dental clinic to not less than the rates
+for such services provided by a federally qualified health center
+(FQHC). The extent of the state cost is dependent on the Medicaid rates
+established and associated utilization. For context, the current average
+2026HB-05561-R000445-FN.DOCX Page 2 of 4
 
-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 statute s, 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
-Substitute House Bill No. 5561
+FQHC dental rate is $204 per visit.
+The bill also allows DSS to establish a supplemental payment pool to
+reimburse a safety net pediatric dental clinic for uncompensated care ,
+resulting in a potential cost should DSS choose to fund such pool.
+Section 7 results in a cost to increase Medicaid rates for optometrists
+to equal rates paid for ophthalmologists. Based on the average cost per
+unit of service, optometrist rates would increase from approximately
+$42 per unit of service to $98 per unit, resulting in increased state costs
+of approximately $14.5 million in FY 27 and $15.8 million in FY 28.
+Section 8  results in a cost to increase Medica id rates for services
+provided by a doula, psychologist, acupuncturist and an emergency
+room physician. The extent of the cost is based on the applied increases,
+which are not specified in the bill.
+Section 9 requires DSS to annually increase the fee schedule for all
+home health services by 10% from 7/1/26 through 6/30/31,  resulting
+in costs of approximately $9 million in FY 27 and $11.1 million in FY 28
+growing to approximately $16.2 million in FY 31.
+This section also results in costs of approximately $2.5 million in FY
+27 and $2.8 million in FY 28 due to prohibiting  a reduction in home
+health rates for subsequent visits by the same psychiatric nurse to the
+same address to provide behavioral health services.
+The bill results in additional costs associated with requiring rather
+than allowing DSS to increase payments for certain extraordinary costs,
+to the extent they would not have otherwise done so.
+Section 10 results in costs of $2.5 million in FY 27 and $2.8 million in
+FY 28 due to increasing the fee schedule for homemaker -companion
+services by 13% in each year. The bill requires rates to be increased b y
+10% each year for FY 29 through FY 31 , resulting in costs of
+approximately $2.6 million in FY 29, $3.1 million in FY 30 and $3.7
+million in FY 31.
+2026HB-05561-R000445-FN.DOCX Page 3 of 4
 
-Public Act No. 26-146 3 of 7
+This section results in additional costs of $240,500 in FY 27 and
+$285,700 in FY 28 due to increasing the fee schedule for meals on wheels
+providers by 4.9% in FY 27.
+Section 11 results in a cost of $506,900 in FY 27 and FY 28 to increase
+the Medicaid rate for Gaylord Specialty Care by two hundred six dollars
+per patient per day.
+Section 12 prohibits DSS from taking certain actions related to the use
+of non-opioid drugs compared to opioid drugs for pain management or
+treatment. To the extent the provisions result in changes in utilization or
+use of specific drugs, DSS will experience a fiscal impact that cannot be
+determined at this time.
+Section 13 allows DSS to require a practitioner prescribing an opioid
+drug to a Medicaid recipient, to complete training in effective pain
+management, as a condition of receiving the associated Medicaid
+payment. This may result in savings to the extent providers do not
+participate in the training and DSS chooses to withhold payment.
+Section 14 results in a cost to increase Medicaid rates for providers of
+family planning service s. The extent of the cost is dependent on the
+applied increase, which is not specified in the bill.
+Section 15  results in a cost to annually increase rates for certain
+facilities beginning in FY 27.  The extent of the cost is dependent on the
+base rates, as determined by the most recent cost report filed by a
+facility, and the most recent increase in the consumer price index for all
+urban consumers.
+Section 18 results in a cost of approximately $5.8 million in FY 27 and
+FY 28 associated with increasing certain rates in accordance with the
+Medicaid rate study  supported by PA 23-186. Costs reflect increased
+rates for durable medical equipment and ($2 million) and prosthetics
+2026HB-05561-R000445-FN.DOCX Page 4 of 4
 
-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 sha ll 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;
-Substitute House Bill No. 5561
+and orthotics ($1.8 million).1
+The bill makes technical, conforming and other changes that have no
+fiscal impact.
+The Out Years
+The annualized ongoing fiscal impact identified above would
+continue into the future subject to inflation and Medicaid rate increases
+discussed above.
 
-Public Act No. 26-146 4 of 7
-
-(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
-Substitute House Bill No. 5561
-
-Public Act No. 26-146 5 of 7
-
-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
-Substitute House Bill No. 5561
-
-Public Act No. 26-146 6 of 7
-
-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, a cupuncture 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.
-Substitute House Bill No. 5561
-
-Public Act No. 26-146 7 of 7
-
-(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 provision s 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
+1 While the bill requires that rates for supplies and complex rehabilitation technology
+be increased in accordance with the rates study, the benchmark summary analysis
+shows that (1) no net funding is needed to meet the study benchmarks for supplies,
+and (2) no specific reference is made to complex rehab technology.