[{"_1":2,"_111":-5,"_112":-5},"loaderData",{"_3":4,"_25":26},"root",{"_5":6,"_17":10,"_18":19,"_20":21,"_22":10,"_23":-5,"_24":-5},"user",{"_7":8,"_9":10,"_11":10,"_12":-5,"_13":-5,"_14":15,"_16":-5},"roles",[],"isAuthenticated",false,"isPremium","planName","subscriptionStatus","featureFlags",{},"insightsBudget","isDevelopmentHost","userPreferences",{},"recaptchaSiteKey","6LcvOJcUAAAAAHsB-gPGfGktcRlKpH7OTIU_dMTD","isImpersonating","impersonation","affiliateStatus","routes/v2/article/layout",{"_27":28,"_29":30},"notFound",true,"relatedArticles",[31,75,87,99],{"_32":33,"_34":35,"_36":37,"_38":39,"_40":41,"_42":43,"_44":45,"_46":47,"_48":49,"_50":51,"_52":53,"_54":55,"_56":57,"_58":59,"_60":61,"_62":63,"_64":65,"_66":67,"_68":69,"_70":71,"_72":73,"_74":73},"mediaId",6318007,"mediaKeyId","2368214-a77158f1e504c1c4c054160b8ab98361","parentId",2368214,"title","Independent pharmacists tell committee that Medicaid audit rules and extrapolation penalties threaten small pharmacies","audioSeconds",1582,"startMs",23589000,"endMs",25171000,"viewUrl","/Search/View?dp=1&key=2368214-a77158f1e504c1c4c054160b8ab98361&start=23589&end=25171","thumbnailUrl","https://assets.pipeline.soar.com/2368214-a77158f1e504c1c4c054160b8ab98361/thumbnail_23589000.jpg","articleUrl","/articles/6318007/Connecticut/Independent-pharmacists-tell-committee-that-Medicaid-audit-rules-and-extrapolation-penalties-threaten-small-pharmacies","mediaUrl","https://secure.pipeline.soar.com/6318007-c03f67683b5420b2355a45e15cfea77c/orig.mp4?Expires=1770112822&Signature=duk9E7ISJApsS9rRUafw5x7vrLyCSSzQPrDBtZc9KmT2jHl3VzOZqhUQzohtq9s9j-fnyb-CF44USJz9KY-t6MHn1Azlgr1Y1s9mFrCaZ8AB0E2AYWzQLlcAdf1lSh0bFp1YomDw9xO181KeePpwR4K47CXag2gmjQcf9UuQCGyyziJNyEUu7pbFJNRH1hKU~qm5fUNvs7dMzgroJZhtOgiqaoVQz6~VzbKPdPqBPifFpPeyf-BBNqt-dkVTvlQ-mnlW2jNs~rOjmpvchgxEzuFAtJo8lxiEixSsDK-gO98EJdXtjxvoC4HWQ3e5xTS~rnBYce4qMFjhTWSr370lpg__&Key-Pair-Id=KUT5TJCACFTXG","author","CGA - Human Services Committee","date","2025-02-20T00:00:00Z","article","(continued) recoupments use broad extrapolation.

Independent and association witnesses described cases in which Medicaid desk audits found relatively minor documentation or clerical problems — for example, missing patient signatures after an emergency change in protocol — and then applied extrapolation across a multi‑year universe of claims. Because Medicaid reimburses most drug costs at or near pharmacies’ purchase price (via NADAC) and pays a relatively small dispensing fee, witnesses said extrapolation of entire claim amounts (not just the $10‑$11 dispensing fee) creates massive recoupments that can exceed hundreds of thousands of dollars for a small pharmacy.

Pharmacists described their experiences: Grieves Pharmacy in Darien reported a proposed ~$705,000 recoupment tied to a software setting that had not been reactivated after a COVID waiver expired. After appeals and legal counsel the amount was reduced, but speakers said the process left staff terrified and the business financially stressed. Other witnesses gave similar examples: audits citing a small administrative error (a stamp used instead of a signature, duplicate refills) then used extrapolation to recoup sums that threatened viability of otherwise compliant businesses. Speakers argued extrapolation should be reserved for verified fraud cases or repeated programmatic non‑compliance across multiple audits, not used as an automatic multiplier for technical or clerical mistakes.

Pharmacists and associations proposed several changes: (1) restrict extrapolation to explicit fraud investigations or to repeat, unresolved audit findings across multiple audits; (2) when an auditing error is clerical or administrative, limit recoupment to the dispensing fee rather than the full drug cost; (3) require DSS to adopt clear, mandatory receipt‑confirmation methods for policy or billing rule changes so pharmacies have documented notice of material changes; (4) create a mechanism to report and correct situations where NADAC pricing may reimburse pharmacies below their true acquisition cost.

DSS witnesses said pharmacy audits are not unusually punitive compared with other provider audits, that pharmacy audits extrapolate less often than other provider types, and that the statute and audit program provide avenues for auditors to evaluate individual findings (including clerical errors) rather than automatically extrapolating. DSS officials also said the audit process and NADAC price system are complex; the department recommended targeted statutory fixes rather than a wholesale change. Pharmacists replied that, in practice, the 1.75% audit‑error threshold and current NADAC‑based recoupment math almost guarantee extrapolation when claims include a small number of very high‑cost drugs (for example specialty biologics), since most of the reimbursement is for drug cost and not fee/profit.

Committee members asked whether the problem was statutory language or implementation. Pharmacists urged the committee to change the statute to remove extrapolation as a routine enforcement tool and to require more nuanced remedies for documentation or clerical errors so that small businesses are not put out of business by administrative mistakes. The committee requested written examples and documentation from pharmacies to explore statutory and regulatory solutions.","mediaType","Video","parentTitle","Human Services Public Hearing","oneSentenceSummary","Independent pharmacists told the Human Services Committee that Connecticut’s Medicaid audit system — and the practice of extrapolating sample errors across multi‑year claim universes — is producing runaway recoupments that can threaten small community pharmacies after clerical errors or software misconfigurations.","taxTitle","2025 Legislature CT, Connecticut","taxId",77677,"location","Connecticut","headline","","shortSummary",{"_32":76,"_34":35,"_36":37,"_38":77,"_40":78,"_42":79,"_44":80,"_46":81,"_48":82,"_50":83,"_52":84,"_54":55,"_56":57,"_58":85,"_60":61,"_62":63,"_64":86,"_66":67,"_68":69,"_70":71,"_72":73,"_74":73},6318009,"Advocates press Human Services Committee to expand Medicaid dental benefits, remove $1,000 adult cap",1792,26454000,28246000,"/Search/View?dp=1&key=2368214-a77158f1e504c1c4c054160b8ab98361&start=26454&end=28246","https://assets.pipeline.soar.com/2368214-a77158f1e504c1c4c054160b8ab98361/thumbnail_26454000.jpg","/articles/6318009/Connecticut/Advocates-press-Human-Services-Committee-to-expand-Medicaid-dental-benefits-remove-1000-adult-cap","https://secure.pipeline.soar.com/6318009-620b5b3fd937b1c6fe0ed3ba70839af2/orig.mp4?Expires=1770112822&Signature=MBUMY5NXSv023XEg1PDOw3RK6q1IEjieLyomAtQsApAINXNBtzd9tT7qBCiLRr~0kHXDcXdc2tXt-1sPcc-HDA6jzquG1gn2Sj8IA2cllBnnKbiiHwAWp4PGNwD0zTJ1z0zEyQCYOToQEOFq-A9RBg22orbg4wGfn4ylMbTMy3vDs58d99-S7bqnsUIbkKt961XxX2KEaRakfm7rV1I1mW~fSELH8RJg0QnHLjkdw9bWW2pyq-5gKDaAa3heg9jRu8nIAax~HKzmTXfhSgzcUjG8JVw3gVGLhd4cwiuQ5pmDHSPNztQOHbgbEq0sNAq~Ekx7ldoUuATLLz1en-BbhQ__&Key-Pair-Id=KUT5TJCACFTXG","Multiple dental providers, public‑health researchers and community advocates urged the Human Services Committee on Feb. 20 to expand adult Medicaid dental coverage (Senate Bill 12 99) and to revise payment rules so school‑based and mobile dental programs are financially viable. Witnesses said a limited adult benefit — one cleaning a year and a $1,000 annual cap on services — forces many patients to postpone care until they stall into emergencies, with correspondingly higher costs and worse health outcomes.

Speakers included clinical specialists, the Connecticut State Dental Association, community health centers and the Connecticut Oral Health Initiative. Testimony cited national and state research linking periodontal disease to diabetes, heart disease and pregnancy complications, and data showing high rates of tooth loss and untreated dental disease among low‑income adults and residents in long‑term care.

Two payment issues drew sustained attention. First, witnesses asked the legislature to allow a second preventive cleaning annually for Medicaid adults and to remove certain restorative services from the $1,000 cap so necessary periodontal treatment and dentures are covered. Advocates argued that preventing disease reduces costly emergency visits and downstream medical costs. Second, school‑based and mobile dental operators described how federal rules and the FQHC prospective payment structure create perverse incentives: mobile programs and school‑based dental clinics often provide a hygienist visit on one day and a dental exam or restorative care on another day, but some FQHC and mobile payment rules bundle those visits into single payments — leaving providers with unreimbursed exam or restorative work when a hygienist visit is billed separately. Witnesses urged targeted language to unbundle or create an appropriate per‑visit payment method for mobile/school settings to make those programs sustainable.

Connecticut Children's Hospital CEO Jim Schmerling and other hospital witnesses also testified that improved dental coverage for adults reduces avoidable emergency visits and could lower Medicaid spending over time. Community groups and providers said better adult dental coverage supports child health as well: parents who receive care are more likely to model preventive behaviors and bring children for regular care.

Committee members asked how much budgetary impact the proposals would have and whether MSD/care settings could be redesigned to avoid cost shifting. Speakers offered ranges of likely savings from reduced ER visits and described pilot programs and national evidence that increased preventive coverage is cost‑effective, while acknowledging that fiscal estimates require more detailed modeling.

Supporters asked the committee to consider modest, phased policy changes this session: add a second cleaning for adults, exempt specific periodontal and denture services from the $1,000 cap, and create a payment path for school‑based and mobile dental teams so hygiene and dentist visits at schools are reimbursed in practice.
","Hospital, dental and community health witnesses told the Human Services Committee that expanding adult Medicaid dental coverage — including a second annual cleaning, periodontal care and changes to FQHC/mobile dental payment rules — would improve health outcomes and reduce emergency costs.",{"_32":88,"_34":35,"_36":37,"_38":89,"_40":90,"_42":91,"_44":92,"_46":93,"_48":94,"_50":95,"_52":96,"_54":55,"_56":57,"_58":97,"_60":61,"_62":63,"_64":98,"_66":67,"_68":69,"_70":71,"_72":73,"_74":73},6318013,"Deaf community urges creation of State Interpreting Standards Board to address interpreter shortage",5584,1279000,6863000,"/Search/View?dp=1&key=2368214-a77158f1e504c1c4c054160b8ab98361&start=1279&end=6863","https://assets.pipeline.soar.com/2368214-a77158f1e504c1c4c054160b8ab98361/thumbnail_1279000.jpg","/articles/6318013/Connecticut/Deaf-community-urges-creation-of-State-Interpreting-Standards-Board-to-address-interpreter-shortage","https://secure.pipeline.soar.com/6318013-0b883d8b76064350ada03d7d63ea7860/orig.mp4?Expires=1770112822&Signature=NYOnoGm2chPiw16WRcJHePurRRcb3XV2OjXABXji9Pk1Y5dYyWDmBCrLF2GAIBFHfZzUs~0~JtrhK3skjspGnMdZSaj7i49uoyPksrqBTlcoZRc7kaVRkBvgirCurZ62o8SSbgESyuszuVuU1rcvLWu-T2Rp4rrb0QrUSwbE09ClETuR46xfLfGiIiZAohNj6GdH~55NeXhK9VrH~5JqbTWOb~A1zpdx0GpUSlZ7XH53qDeGpSH~AY~CxWzJR2jCM5xPW-oXMEhtWOUgnVAoJ7exvi4JCALZiNzAuYxdeO7MVeHfWsJhotxMMGclgsA8abiggXYwzw9kiNNjOK5Ekg__&Key-Pair-Id=KUT5TJCACFTXG","Testimony at the Human Services Committee hearing on Feb. 20 centered on House Bill 6932, which would establish a State Interpreting Standards Board to set qualifications, maintain a grievance process and expand pathways for sign-language and tactile interpreters in Connecticut. Presenters representing consumer and provider groups said the state faces a long-running shortage of in-person interpreters — particularly for medical and tactile interpretation for deafblind clients — and that remote/video interpreting often fails to meet patients’ communication needs.

Advocates described multiple, concrete problems: lengthy waits to secure in-person interpreters; a tiny pool of nationally certified interpreters based in Connecticut (testimony listed 66 hearing certified interpreters and eight certified deaf interpreters as state‑based); an aging interpreter workforce; a single in‑state interpreter training program with low enrollment; and inadequate tracking of interpreters’ qualifications and location. Luisa Gasco Sobolewski, co‑chair of the Governor’s Advisory Board for Persons who are Deaf, DeafBlind and Hard of Hearing, said 466 interpreters were registered to serve Connecticut but only 74 are based in‑state and many of the remainder provide remote services.

Speakers described particular harms when in‑person interpreters are unavailable. Sherry Burns and Lisa Flaherty Vaughn, both deafblind, told the committee that tactile interpretation — in which an interpreter uses touch to communicate — is essential to access health care and that last‑minute cancellations have resulted in missed medical appointments, postponed procedures and significant harm to daily living. Julia Silvestri and other sign language professionals described incidents in which hospitals defaulted to video remote interpreting even when it was not clinically appropriate, and told the committee that hospitals and other institutions sometimes lack local knowledge of regional signs and medical context.

Proponents argued a standards board would offer a focused, ongoing mechanism to: broaden acceptable certification pathways; support targeted recruitment and training pipelines (for example, working with community colleges and UConn ASL programs); maintain a public registry so consumers and institutions can find appropriate interpreters; and oversee a fair grievance and due‑process system. Supporters stressed the board could be low‑cost because many experts would volunteer, with only modest reimbursement for meeting accommodations and mileage.

Department of Aging and Disability Services Commissioner Amy Porter told the committee the state recently created a Bureau of Services for the Deaf, DeafBlind, and Hard of Hearing and hired a bureau director; the administration asked the committee to allow the new director time to review best practices and to recommend any additional structure. DSS officials also warned that standing up an enforcement role that can impose sanctions would require new statutory authorities, staff and funding. Several testifiers said those operational considerations argued for close coordination rather than delay: advocates asked DSS to work with the advisory board and the new director on a fast timeline and offered to partner on an implementation plan.

Committee members asked detailed questions about how many interpreters are available, where training programs are located, whether expanding acceptable credentials (beyond a single national test) would lower quality, and how to fund bilingual and tactile interpreter training. Respondents noted other states have adopted hybrid approaches that accept multiple credential pathways while maintaining rigorous clinical competence checks.

Several witnesses recommended measures the committee could adopt alongside a standards board, including: expanding interpreter training seats at community colleges and at UConn, targeted recruitment into rural and medically underserved regions, a public directory listing qualifications and availability, and short‑term funding to support tactile interpreter availability for medical and surgical appointments.

If passed, HB 6932 would create a public mechanism for ongoing review and updating of rules, supporters said, making it easier for Connecticut to keep standards aligned with national practice while also giving consumers a place to file complaints and find information about interpreters.","Deaf, deafblind and hard-of-hearing advocates testified Tuesday that Connecticut is facing a persistent shortage of qualified in-person and tactile interpreters, and urged the Human Services Committee to establish a State Interpreting Standards Board (House Bill 6932) and broader pathways into the profession.",{"_32":100,"_34":35,"_36":37,"_38":101,"_40":102,"_42":103,"_44":104,"_46":105,"_48":106,"_50":107,"_52":108,"_54":55,"_56":57,"_58":109,"_60":61,"_62":63,"_64":110,"_66":67,"_68":69,"_70":71,"_72":73,"_74":73},6318001,"Providers and researchers urge Medicaid support for produce prescriptions and 'food‑as‑medicine' pilots",2172,25089000,27261000,"/Search/View?dp=1&key=2368214-a77158f1e504c1c4c054160b8ab98361&start=25089&end=27261","https://assets.pipeline.soar.com/2368214-a77158f1e504c1c4c054160b8ab98361/thumbnail_25089000.jpg","/articles/6318001/Connecticut/Providers-and-researchers-urge-Medicaid-support-for-produce-prescriptions-and-foodasmedicine-pilots","https://secure.pipeline.soar.com/6318001-f86da7a2171298b160d5430423777d98/orig.mp4?Expires=1770112822&Signature=ogDGzXITOKDiQqAuErXzxDERi8cdZLHh7TsNftklovOyuPK2nWTC4BkjMUfmnyfsD4C-mq9xaskPdFHb6qZ~LWJQYVXqpxTVAX0oQY-SsGd~NZSCCJn2UWPX6iTnZI~8KaD83mDd13d1PX9BBySh0qiP1VeFVqf5jXQTP0prSvaT1gRDZWqOB~IP1vXniViHl~OzvhyIUelA6l~ehdsi-7eIKrMI3Rzw4OQv60kxn2rhXN~8vj8BB62vcVAMMqAyNiBwhfqHerSSsZYiimZN8Bpy3vrOOIeXyi70-9I7S4PX4MHCwxLTxB7RMeGpZaNI9ln6ZPigZ9nU95wq3eG42w__&Key-Pair-Id=KUT5TJCACFTXG","Community health centers, researchers and nonprofit food‑as‑medicine providers testified on Feb. 20 in favor of House Bill 6101, which would authorize Medicaid coverage of food‑as‑medicine interventions and expand access to farmers‑market WIC nutrition benefits. Witnesses described local pilots and national evidence showing produce prescriptions increase fruit and vegetable consumption, improve HbA1c among patients with prediabetes or diabetes, and can produce downstream savings through fewer emergency visits and avoidable complications.

Speakers included leaders of food‑as‑medicine initiatives at the Yale School of Public Health, the Community Alliance for Research and Engagement, Wholesome Wave, hospital and community health center staff who run existing pilots, and community peer navigators who provide direct outreach. Examples described during testimony included programs that provide monthly cards or vouchers restricted to fresh produce, bluntly addressed food insecurity and paired the benefit with nutrition programming and culturally appropriate cooking and shopping education. Reported participant outcomes included self‑reported improvements in diet, weight loss, and measurable average reductions in HbA1c within months in cohorts with elevated levels at baseline.

Panelists argued the design matters: successful models combine (1) screening for food insecurity and clinical need; (2) regular, sustained produce subsidies (monthly cards, market vouchers or home delivery); (3) culturally tailored nutrition education and community partnerships; and (4) flexible redemption channels (farmers markets, retailers or deliveries) and provider follow‑up. Several witnesses highlighted advantages for maternal health and infant outcomes in pilot ‘‘Food for Moms’’ programs that provide guaranteed monthly produce funds during pregnancy and early postpartum.

Speakers asked the committee to pursue one or more Medicaid waiver paths (Section 1115/1115‑style or other options) to permit reimbursable produce prescriptions and to allow hospitals and clinics to implement pilots under Medicaid coverage. Witnesses stressed the local economic benefit: directing produce dollars into local markets helps regionally based farmers and supports market demand for fresh produce.

DSS said the agency is evaluating the evidence and noted that many states are experimenting with waivers; they called for a careful waiver design to ensure federal approval and to avoid unintended budgetary impacts. The committee requested further cost‑benefit modeling and recommended an implementation pathway that ties food benefits to measurable clinical outcomes.","Physicians, community health centers, university researchers and nonprofit advocates told the Human Services Committee that produce prescription and food‑as‑medicine programs improve diet, lower A1C and reduce costly hospital use, and urged Connecticut to pursue Medicaid waivers (HB 6101) to fund healthy‑food benefits tied to clinical care.","actionData","errors"]

Article not found

Independent pharmacists tell committee that Medicaid audit rules and extrapolation penalties threaten small pharmacies

Advocates press Human Services Committee to expand Medicaid dental benefits, remove $1,000 adult cap

Deaf community urges creation of State Interpreting Standards Board to address interpreter shortage

Providers and researchers urge Medicaid support for produce prescriptions and 'food‑as‑medicine' pilots