Sec. 17a-22f. Behavioral health services. Contract with administrative services organization to provide clinical management and other services. Policies and procedures. Regulations.
Sec. 17a-22f. Behavioral health services. Contract with administrative services organization to provide clinical management and other services. Policies and
procedures. Regulations. (a) The Commissioner of Social Services may, with regard
to the provision of behavioral health services provided pursuant to a state plan under
Title XIX or Title XXI of the Social Security Act: (1) Contract with an administrative
services organization to provide clinical management, provider network development
and other administrative services; and (2) delegate responsibility to the Department
of Children and Families for the clinical management portion of such administrative
contract.
(b) For purposes of this section, the term "clinical management" describes the process of evaluating and determining the appropriateness of the utilization of behavioral
health services and providing assistance to clinicians or beneficiaries to ensure appropriate use of resources and may include, but is not limited to, authorization, concurrent
and retrospective review, discharge review, quality management, provider certification
and provider performance enhancement. The Commissioners of Social Services and
Children and Families shall jointly develop clinical management policies and procedures. The Department of Social Services may implement policies and procedures necessary to carry out the purposes of this section, including any necessary changes to existing
behavioral health policies and procedures concerning utilization management, while in
the process of adopting such policies and procedures in regulation form, provided the
commissioner publishes notice of intention to adopt the regulations in the Connecticut
Law Journal within twenty days of implementing such policies and procedures. Policies
and procedures implemented pursuant to this subsection shall be valid until the earlier
of (1) the time such regulations are effective, or (2) December 31, 2006.
(May 9 Sp. Sess. P.A. 02-7, S. 58; P.A. 05-280, S. 94; P.A. 06-196, S. 204.)
History: May 9 Sp. Sess. P.A. 02-7 effective August 15, 2002; P.A. 05-280 amended Subsec. (a)(1) to add provider
network development and Subsec. (a)(2) to eliminate limitation on delegation of clinical management portion of administrative contract to Department of Children and Families to that pertaining to children under 18 years of age or individuals
otherwise receiving behavioral health services from department, and amended Subsec. (b) to extend time period during
which policies and procedures are valid if not adopted as regulations to December 31, 2006, from December 1, 2003,
effective July 13, 2005; P.A. 06-196 made a technical change in Subsec. (b), effective June 7, 2006.