Sec. 17b-296. Provision for clinicians in managed care plans. Provision by managed care organizations of services under HUSKY Plan.
Sec. 17b-296. Provision for clinicians in managed care plans. Provision by
managed care organizations of services under HUSKY Plan. (a) Each managed care
plan shall include sufficient numbers of appropriately trained and certified clinicians
of pediatric care, including primary, medical subspecialty and surgical specialty physicians, as well as providers of necessary related services such as dental services, mental
health services, social work services, developmental evaluation services, occupational
therapy services, physical therapy services, speech therapy and language services,
school-linked clinic services and other public health services to assure enrollees the
option of obtaining benefits through such providers.
(b) Each managed care organization that on or after October 1, 2001, enters into a
contract with the department to provide comprehensive services under the HUSKY
Plan, Part A or the HUSKY Plan, Part B, or both, shall have primary responsibility
for ensuring that its behavioral health and dental subcontractors adhere to the contract
between the department and the managed care organization, including the provision of
timely payments to providers and interest payments in accordance with subdivision (15)
of section 38a-816. The managed care organization shall submit to the department a
claims aging inventory report including all data on all services paid by subcontractors
in accordance with the terms of the contract with the department.
(c) Upon the initial contract or the renewal of a contract between a managed care
organization and a behavioral health or dental subcontractor, the department shall require that the managed care organizations impose a performance bond, letter of credit,
statement of financial reserves or payment withhold for behavioral health and dental
subcontractors that provide services under the HUSKY Plan, Part A or the HUSKY
Plan, Part B, or both. Any such performance bond, letter of credit, statement of financial
reserves or payment withhold that may be required by the department pursuant to a
contract with a managed care organization shall be in an amount sufficient to assure the
settlement of provider claims in the event that the contract between the managed care
organization and the behavioral health or dental subcontractor is terminated. Upon the
initial contract or the renewal of a contract between a managed care organization and
a behavioral health or dental subcontractor, the managed care organization shall negotiate and enter into a contract termination agreement with its behavioral health and dental
subcontractors that shall include, but not be limited to, provisions concerning financial
responsibility for the final settlement of provider claims and data reporting to the department. The managed care organization shall submit reports to the department, at such
times as the department shall determine, concerning any payments made from such
performance bond or any payment withholds, the timeliness of claim payments to providers and the payment of any interest to providers.
(d) Prior to the approval by the department of a contract between a managed care
organization and a behavioral health and dental subcontractor for services provided
under the HUSKY Plan, Part A or the HUSKY Plan, Part B, or both, the managed care
organization shall submit a plan to the department for the resolution of any outstanding
claims submitted by providers to a previous behavioral health or dental subcontractor
of the managed care organization for services provided to members enrolled in the
HUSKY Plan, Part A or the HUSKY Plan, Part B, or both. Such plan for the resolution
of outstanding claims shall include a claims aging inventory report and shall comply with
the terms of the contract between the department and the managed care organization.
(October 29 Sp. Sess. P.A. 97-1, S. 8, 23; June Sp. Sess. P.A. 01-2, S. 23; June Sp. Sess. P.A. 01-9, S. 129, 131.)
History: Oct. 29 Sp. Sess. P.A. 97-1 effective October 30, 1997; June Sp. Sess. P.A. 01-2 designated existing provisions
as Subsec. (a) and added Subsecs. (b) to (d) re subcontractor services under the HUSKY Plan; June Sp. Sess. P.A. 01-9
revised effective date of June Sp. Sess. P.A. 01-2 but without affecting this section.