Connecticut DSS Issues Phase 2 of Medicaid Rate Study

The Connecticut Department of Social Services (DSS) issued the final report of a two-part study of Medicaid reimbursement rates. The report recommends that DSS examine the current process for assessing home and community-based services (HCBS) waiver members and consider adoption of standardized and validated tools that could provide a comprehensive assessment of functional needs, natural supports, and level of acuity.

The study does not suggest, nor does it have the authority to make specific fee schedule rate increases or specific Medicaid policy recommendations, which will be made by the legislature after additional analysis and engagement with the Department, home care providers, and other stakeholders.
 
The study examined the state’s Medicaid rates of reimbursement compared to Medicaid rates provided in peer states and Medicare’s rates. In phase two of the rate study, $1.3 billion in services were subject to a data-driven review of rate parity for Medicaid-identified rates when compared to a benchmark. It examined all services not included in phase one, including HCBS rates under the waivers operated by DSS and the Department of Developmental Services.
 
DSS recommends the initiation of a strategic and targeted rate-setting process to ensure that any appropriated dollars invested address access issues or gaps in coverage. Specifically, the Department is recommending that several services and strategies be prioritized within available funding, including:
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• Develop a rate review process to monitor for market changes, new cost information, and that rates fall within the benchmark percentage.
• Conduct, with state agency partners, a comprehensive analysis of HCBS waiver rates, as well as options to better manage the dually eligible population.

 
The report also recommends DSS examine the program policies and procedures to align them with best practices, such as assessment-supported person-centered planning. These actions may also help Connecticut comply with the HCBS quality measures and provide for greater quality monitoring.
 
The Department will be scheduling briefings with legislators and key stakeholders.
 
Increasing reimbursement rates is a high priority for the Connecticut Chapter, and the policy is expected to be considered by the legislature in the session beginning today, January 8, 2025.