*** ATTENTION ***

Changes to the SAGA Medical Program
Effective April 1, 2010

 

Community Health Network of Connecticut, Inc. (CHNCT) will discontinue managing the medical component of the State-Administered General Assistance (SAGA) program. This change will be retroactive to April 1, 2010.

Pursuant to section 2001 (a)(40)(A) of the Patient Protection and Affordable Care Act, the SAGA program is being discontinued and individuals formerly covered under SAGA will be covered under Medicaid effective April 1, 2010. This change transfers the 45,000 single, low-income adults covered by SAGA into the Medicaid program. These adults will now have access to the fee-for-service Medicaid health care benefit package. This will have a positive impact on the state budget as the state will now receive federal reimbursement for what were previously all state expenditures.

The program name for this new Medicaid population is "Medicaid for Low Income Adults," which will be referred to as "Medicaid LIA."

In order for the state to receive federal reimbursement for services provided to this client population retroactive to April 1, 2010, CHNCT will be recouping claims from providers that were paid on behalf of SAGA clients for dates of service on or after April 1, 2010.

Providers should submit claims for dates of service on or after April 1, 2010 to HP Enterprise Services for processing under the Medicaid program. Authorizations provided by CHNCT for dates of service April 1, 2010 through June 30, 2010 will be honored. Claims will be paid in accordance with Medicaid fee-for-service reimbursement rules.

Providers should follow the existing Medicaid fee-for-service prior authorization protocol for services formally managed by CHNCT for Medicaid LIA clients.

For any authorization that CHNCT already approved to a provider with dates of service in July 2010 - DSS will honor those authorizations and providers do NOT need to contact or resubmit to DSS for an approval. Any alterations to the plan of care - Providers must contact DSS.

If you are currently a CHNCT participating SAGA provider, and are not enrolled in the Medicaid program but would like to continue rendering care to your established patients, please contact Connecticut Medical Assistance Program at 1.800.842.8440.