2011 Connecticut Code
Title 17a Social and Human Services and Resources
Chapter 319 Department of Children and Families
Sec. 17a-22p. Use of administrative services organizations for Behavioral Health Partnership. Services to be provided. Coordination of benefits.

      Sec. 17a-22p. Use of administrative services organizations for Behavioral Health Partnership. Services to be provided. Coordination of benefits. (a) The Departments of Children and Families, Social Services and Mental Health and Addiction Services shall enter into one or more joint contracts or agreements with an administrative services organization or organizations to perform eligibility verification, utilization management, intensive care management, quality management, coordination of medical and behavioral health services, provider network development and management, recipient and provider services and reporting.

      (b) Claims under the Behavioral Health Partnership shall be paid by the Department of Social Services' Medicaid management information systems vendor, except that the Department of Children and Families and the Department of Mental Health and Addiction Services may, at their discretion, continue to use existing claims payment systems.

      (c) Administrative services organizations shall authorize services, based solely on guidelines established by the clinical management committee, established pursuant to section 17a-22k. Administrative services organizations may make exceptions to the guidelines when requested by a member, or the member's legal guardian or service provider, and determined by the administrative services organization to be in the best interest of the member. Decisions regarding the interpretation of such guidelines shall be made by the Departments of Children and Families, Social Services and Mental Health and Addiction Services. No administrative services organization shall have any financial incentive to approve, deny or reduce services. Administrative services organizations shall ensure that service providers and persons seeking services have timely access to program information and timely responses to inquiries, including inquiries concerning the clinical guidelines for services.

      (d) The administrative services organization for HUSKY Plan Parts A and B shall provide or arrange for on-site assistance to facilitate the appropriate placement, as soon as practicable, of children with behavioral health diagnoses who the administrative services organization knows to have been in an emergency department for over forty-eight hours. The administrative services organization shall provide or arrange for on-site assistance to arrange for the discharge or appropriate placement, as soon as practicable, for children who the administrative services organization knows to have remained in an inpatient hospital unit for more than five days longer than is medically necessary, as agreed by the administrative services organization and the hospital.

      (e) The Departments of Children and Families, Social Services and Mental Health and Addiction Services shall develop, in consultation with the Behavioral Health Partnership, a comprehensive plan for monitoring the performance of administrative services organizations which shall include data on service authorizations, individual outcomes, appeals, outreach and accessibility, comments from program participants compiled from written surveys and face-to-face interviews.

      (f) The Behavioral Health Partnership shall establish policies to coordinate benefits received under the partnership with other benefits received under Medicaid. Such policies shall specify a coordinated delivery of both physical and behavioral health care. The policies shall be submitted to the Behavioral Health Partnership Oversight Council for review and comment.

      (P.A. 05-280, S. 101; P.A. 10-119, S. 10; 10-179, S. 72.)

      History: P.A. 05-280 effective July 13, 2005; P.A. 10-119 amended Subsec. (a) by adding "and Mental Health and Addiction Services", substituting "into one or more joint contracts or agreements" for "a joint contract", adding "or organizations" and deleting provision re commencing activities, amended Subsec. (b) by adding "and the Department of Mental Health and Addiction Services" and making a technical change, amended Subsecs. (c) and (e) by substituting "administrative services organizations" for "administrative services organization" and adding "and Mental Health and Addiction Services", amended Subsec. (d) by adding "for HUSKY Plan Parts A and B" and amended Subsec. (f) by adding provision re coordination of benefits with those received through entity that contracts with Department of Social Services for management of medical benefits for persons covered by Medicaid or Charter Oak Health Plan, effective June 7, 2010; P.A. 10-179 amended Subsec. (f) by replacing provisions re benefits received through Medicaid managed care organizations with provision re other benefits received under Medicaid, effective July 1, 2010.