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DSS seeks authority for voluntary hospital global budgets as Connecticut joins federal AHEAD model
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Summary
Connecticut’s Department of Social Services and Office of Health Strategy told lawmakers Feb. 3 that the state has been selected for a federal AHEAD planning grant and needs statutory authority in HB 6836 to launch a voluntary hospital global payment (global budget) model for participating hospitals.
Commissioner Andrea Barton Reeves of the Department of Social Services and Office of Health Strategy staff described the state’s authority request to implement the All‑Payer Health Equity Approaches and Development (AHEAD) hospital global payment model and asked the Public Health Committee to approve language in House Bill 6836 to allow voluntary hospital global budgets.
DSS said the state has been awarded a $12,000,000 federal planning and implementation grant from the federal Center for Medicare & Medicaid Innovation (CMMI) to design and pilot hospital global budgets for participating hospitals. Commissioner Andrea Barton Reeves told the committee the program is voluntary for hospitals and would let participating hospitals receive a single, global payment to support hospital operations and to invest in community‑based prevention and care coordination.
Reeves said the federal grant covers design and staffing to stand up the model and that Connecticut would not be asked to provide state matching dollars for the planning grant. “This is a voluntary model,” Reeves said. “It offers more stable, predictable financing and gives hospitals a financial incentive to invest more money in prevention and care coordination.” She added the state’s model will be customized for Connecticut and will be implemented in partnership with OHS and with hospital partners.
Lawmakers and DSS staff discussed details: whether hospitals in a multi‑hospital system could participate piecemeal (the agencies said yes, though system‑wide participation is preferred), whether global budgets would change other hospital reimbursements (DSS said participation would not reduce payments to nonparticipating hospitals), and how hospitals would be recruited so the Medicare revenue coverage targets CMMI requires can be met (DSS said CMMI has set Medicare participation targets of roughly 10% in year 1 and 30% by year 3, which will guide recruitment).
Senators and representatives pressed for clarity on whether voluntary participation would remain voluntary and whether regulations would be needed later to govern details. Commissioner Reeves said the model aims to create incentives and that any changes toward mandatory participation would raise policy and statutory questions requiring additional legislative action. DSS staff said the $12,000,000 grant is for planning and implementation staffing; it is not an ongoing annual payment.
Disability and provider stakeholders were not the primary speakers in this segment; instead, testimony focused on program structure, how global budgets might help hospitals invest in primary care and social determinants of health, and how the state and hospitals will design monitoring and reporting in partnership with CMMI. Committee members asked DSS to return with analyses comparing Maryland and Pennsylvania models and to specify the number and mix of hospitals needed to meet federal Medicare revenue thresholds. DSS said that target depends on hospital size and would follow up with more precise estimates.
DSS staff said outreach has included the Connecticut Hospital Association and hospital CEOs, and that several hospitals had expressed interest in exploring participation. Committee members asked for additional detail about oversight, performance metrics, and the extent to which Medicaid beneficiaries would be covered under the model.
