Connecticut law schedules Medicaid rate reviews and guides opioid prescribing

The Social Services commissioner must create a regular process to review Medicaid provider payment rates and compare them with Medicare rates when possible. The reviews cover rates paid to Medicaid providers. The commissioner may raise and reset rates at each year's end only if funds are set aside for that purpose. The process takes effect July 1, 2026. The first review is due by January 1, 2027, and all rates must be reviewed by January 1, 2032. New reviews must begin every five years. The commissioner must report yearly, starting by January 15, 2028, on the review process and recommended funding.

The Medical Assistance Program Oversight Council includes a representative of the state dental partnership's Dental Policy Advisory Council. The representative serves on the council that oversees the state's medical assistance program. This membership provision takes effect July 1, 2026.

Medicaid prescribing practitioners must consider whether nonopioid care is feasible when prescribing opioids for a beneficiary's pain. The rule covers state-licensed practitioners enrolled as Medicaid providers and authorized to prescribe opioids. Examples of nonopioid care include physical therapy, acupuncture, chiropractic treatment, and spinal cord stimulation. This requirement takes effect July 1, 2026.

The Social Services commissioner must report on Medicaid coverage rules and approvals for biomarker testing. The report concerns Medicaid coverage of biomarker testing and beneficiaries whose testing received coverage approval. The report must address how prior approval rules may affect beneficiaries' access to testing. The report is due to the legislature's human services committee by October 1, 2026, and must count approvals during the year ending June 30, 2026.

A working group must study whether spouses could be paid for personal care they provide to spouses in state-funded home care programs. The study concerns spouses enrolled in home care programs funded through the state medical assistance program. The group includes state officials, lawmakers, a personal care services consumer, and a service provider representative. The group must report by January 1, 2027, and ends when it reports or on that date, whichever is later.