Sec. 17b-298. Regulations re quality of care under HUSKY Plan. Outcome criteria. Sanctions. Reports re HUSKY Plans to General Assembly.
Sec. 17b-298. Regulations re quality of care under HUSKY Plan. Outcome
criteria. Sanctions. Reports re HUSKY Plans to General Assembly. (a) The commissioner shall adopt regulations, in accordance with chapter 54, to establish appropriate
contract standards to oversee and ensure the quality of care provided under the HUSKY
Plan, Part B. Such regulations shall require the establishment of an internal quality
assurance plan by each managed care plan which shall be in writing and available to
the public.
(b) The commissioner shall develop criteria for assessing the outcomes of health
care provided to children under the HUSKY Plan, Part B.
(c) The commissioner shall contract for the external quality review of the HUSKY
Plan, Part B. Such review shall include, but not be limited to, an evaluation of access
to care, medical record standards, provider credentialing and individual case review.
(d) The commissioner may impose the following sanctions on any managed care
plan which does not meet the quality of care required by standards adopted pursuant to
subsection (a) of this section or the standards developed for external quality review by
a contract under the provisions of subsection (c) of this section:
(1) Require the managed care plan to submit and implement a plan of correction;
(2) Limit new enrollment during any period of noncompliance;
(3) Withhold state payments that may become due until the deficiencies are corrected; and
(4) Prohibit the managed care plan from renewing or entering into new contracts
to serve enrollees.
(e) Not later than January 1, 1999, and annually thereafter, the commissioner shall
submit a report to the Governor and the General Assembly which shall outline the overall
effect of the HUSKY Plan, Part B on access to, utilization and quality of primary and
preventive health care services for children and the impact of such plan on the health
status of enrollees.
(f) Not later than July 1, 1998, or the close of the calendar quarter following federal
approval of the state children's health insurance plan, and quarterly thereafter, the commissioner shall submit a report to the Governor and the General Assembly which shall
analyze enrollment levels in the HUSKY Plan, Part B in relation to the availability of
state and federal funds for such plan and, if necessary, establish priorities for access
under the HUSKY Plan, Part B to health insurance for eligible beneficiaries in families
with income of less than two hundred thirty-five per cent of the federal poverty level.
(October 29 Sp. Sess. P.A. 97-1, S. 10, 23.)
History: Oct. 29 Sp. Sess. P.A. 97-1 effective October 30, 1997.