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DSS says maternity payment bundle includes a behavioral-health measure; reimbursement limits may affect screening capture
Summary
DSS deputy Medicaid director said Connecticut’s maternity payment bundle (launched 2025-01-01) includes pay-for-reporting for several quality measures, one of which is a behavioral-health risk assessment; staff noted low reimbursement levels may limit billing for negative screens and thus undercount screenings.
Fatmata Williams, deputy Medicaid director, told the task force that the state’s maternity payment bundle, launched Jan. 1, 2025, includes a pay-for-reporting component for about five quality measures and that one measure is a behavioral health risk assessment for pregnant and postpartum people.
"I co designed the maternity payment bundle ... which was launched in, 01/01/2025," Fatmata said, and explained the bundle contains pay-for-reporting on several measures that can be used to incentivize provider reporting regardless of payer, but that such work must be budgeted and appropriated.
During questions, members raised whether low reimbursement for the screening code discourages billing for negative screens. Fatmata and others confirmed Medicaid pays for the screening code but noted reimbursement is low, which may mean providers screen without submitting separate billing under some circumstances — a pattern that could reduce the measured screening rate even when screening occurs in practice.
The DSS presentation prompted the group to plan targeted follow-up questions so staff can return with code-level explanations and top-provider lists to help subgroups understand where care is being documented and where screenings may be missed in claims-based measures.
