Conn. Gen. Stat. § 17b-245b: Federally qualified health centers. Reimbursement methodology in the Medicaid program.

(a) The Commissioner of Social Services shall, consistent with federal law, reimburse federally qualified health centers on an all-inclusive encounter rate per client encounter based on the prospective payment system required by 42 USC 1396a(bb). Any patient encounter with more than one health professional for the same type of service and multiple interactions with the same health professional that occur on the same day shall constitute a single encounter for purposes of reimbursement, except when the patient, after the first encounter, suffers illness or injury requiring additional diagnosis and treatment. A federally qualified health center shall be reimbursed in accordance with the requirements prescribed in section 17b-262-1002 of the regulations of Connecticut state agencies.

(b) A federally qualified health center may not provide nonemergency periodic dental services on different dates of service for the purpose of billing for separate encounters. Any nonemergency periodic dental service, including, but not limited to, (1) an examination, (2) prophylaxis, and (3) radiographs, including bitewings, complete series and periapical imaging, if warranted, shall be completed in one visit. A second visit to complete any service normally included during the course of a nonemergency periodic dental visit shall not be eligible for reimbursement unless (A) medically necessary, and (B) such medical necessity is clearly documented in the patient's dental record.

(c) Notwithstanding the provisions of subsection (a) of this section, not later than October 1, 2025, the Department of Social Services shall provide an alternative, updated prospective payment methodology for each federally qualified health center that is the same as rates established under the prospective payment system set forth in 42 USC 1396a(bb)(3), as may be amended from time to time, except that the base year for determining the costs of providing such services shall be the average of the reasonable costs incurred in a federally qualified health center's fiscal year ending in 2023, adjusted for any change in scope adjustments approved since the 2023 base year and for inflation as measured by the Medicare Economic Index published by the Centers for Medicare and Medicaid Services, subject to available appropriations and as provided pursuant to this section. Any rebasing established under such alternative, updated prospective payment methodology shall be phased in over the course of three years, commencing during the fiscal year ending June 30, 2026, and concluded during the fiscal year ending June 30, 2028, in accordance with the provisions of section 351 of public act 25-168*. Each federally qualified health center shall be given the option to be reimbursed under the provisions of this subsection or under the prospective payment system pursuant to federal law.

(d) The following requirements shall apply to any alternative payment methodology developed by the department for payments to federally qualified health centers: (1) The alternative payment methodology must be consistent with the requirements of 42 USC 1396a(bb), as may be amended from time to time; (2) to the extent federal law requires that federally qualified health centers be allowed to elect to use the prospective payment system set forth in 42 USC 1396a(bb)(3), as amended from time to time, any alternative payment methodology developed under this section must be an additional option and not in lieu of the alternative, updated prospective payment methodology provided for in subsection (c) of this section; and (3) in developing an alternative payment methodology, the department shall consult with federally qualified health centers prior to implementing any such methodology.