Sec. 17b-267. (Formerly Sec. 17-134h). Use of fiscal intermediaries in connection with medical assistance.
Sec. 17b-267. (Formerly Sec. 17-134h). Use of fiscal intermediaries in connection with medical assistance. (a) If any group or association of providers of medical
assistance services wishes to have payments as provided for under sections 17b-260 to
17b-262, inclusive, 17b-264 to 17b-285, inclusive, and 17b-357 to 17b-361, inclusive,
to such providers made through a national, state or other public or private agency or
organization and nominates such agency or organization for this purpose, the Commissioner of Social Services is authorized to enter into an agreement with such agency or
organization providing for the determination by such agency or organization, subject
to such review by the Commissioner of Social Services as may be provided for by the
agreement, of the payments required to be made to such providers at the rates set by the
hospital cost commission, and for the making of such payments by such agency or
organization to such providers. Such agreement may also include provision for the
agency or organization to do all or any part of the following: With respect to the providers
of services which are to receive payments through it, (1) to serve as a center for, and
to communicate to providers, any information or instructions furnished to it by the
Commissioner of Social Services, and to serve as a channel of communication from
providers to the Commissioner of Social Services; (2) to make such audits of the records
of providers as may be necessary to insure that proper payments are made under this
section; and (3) to perform such other functions as are necessary to carry out the provisions of sections 17b-267 to 17b-271, inclusive.
(b) The Commissioner of Social Services shall not enter into an agreement with
any agency or organization under subsection (a) of this section unless (1) he finds (A)
that to do so is consistent with the effective and efficient administration of the medical
assistance program, and (B) that such agency or organization is willing and able to assist
the providers to which payments are made through it in the application of safeguards
against unnecessary utilization of services furnished by them to individuals entitled to
hospital insurance benefits under section 17b-261 and the agreement provides for such
assistance, and (2) such agency or organization agrees to furnish to the Commissioner
of Social Services such of the information acquired by it in carrying out its agreement
under sections 17b-267 to 17b-271, inclusive, as the Commissioner of Social Services
may find necessary in performing his functions under said sections.
(c) An agreement with any agency or organization under subsection (a) of this section may contain such terms and conditions as the Commissioner of Social Services
finds necessary or appropriate, may provide for advances of funds to the agency or
organization for the making of payments by it under said subsection (a), and shall provide
for payment by the Commissioner of Social Services of so much of the cost of administration of the agency or organization as is determined by the Commissioner of Social
Services to be necessary and proper for carrying out the functions covered by the
agreement.
(1971, P.A. 431, S. 1; P.A. 75-420, S. 4, 6; P.A. 77-614, S. 608, 610; P.A. 93-262, S. 1, 87; P.A. 05-280, S. 25; 05-288, S. 70.)
History: P.A. 75-420 replaced welfare commissioner with commissioner of social services; P.A. 77-614 replaced commissioner of social services with commissioner of income maintenance, effective January 1, 1979; P.A. 93-262 authorized
substitution of commissioner and department of social services for commissioner and department of income maintenance,
effective July 1, 1993; Sec. 17-134h transferred to Sec. 17b-267 in 1995; P.A. 05-280 amended Subsec. (a) by substituting
reference to Sec. 17b-361 for reference to repealed Sec. 17b-362, effective July 1, 2005; P.A. 05-288 made technical
changes in Subsecs. (b) and (c), effective July 13, 2005.
Annotations to former section 17-134h:
Cited. 168 C. 336. Cited. 204 C. 17. Cited. 216 C. 85.
Annotations to present section:
Cited as "17b-260 et seq. (providing for supplemental medical assistance)". 233 C. 557.