Connecticut 2015 Regular Session

Connecticut Senate Bill SB00751 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	General Assembly Substitute Bill No. 751
2		-	January Session, 2015 _____SB00751INS___031915____
	1	+	General Assembly Committee Bill No. 751
	2	+	January Session, 2015 LCO No. 3304
	3	+	03304SB00751INS
	4	+	Referred to Committee on INSURANCE AND REAL ESTATE
	5	+	Introduced by:
	6	+	(INS)
3	7
4	8		General Assembly
5	9
6		-	~~Substitute~~ Bill No. 751
	10	+	Committee Bill No. 751
7	11
8	12		January Session, 2015
9	13
10		-	_____SB00751INS___031915____
	14	+	LCO No. 3304
	15	+
	16	+	03304SB00751INS
	17	+
	18	+	Referred to Committee on INSURANCE AND REAL ESTATE
	19	+
	20	+	Introduced by:
	21	+
	22	+	(INS)
11	23
12	24		AN ACT REQUIRING THE CONNECTICUT HEALTH INSURANCE EXCHANGE TO POST PROVIDER NETWORK INFORMATION ON ITS INTERNET WEB SITE.
13	25
14	26		Be it enacted by the Senate and House of Representatives in General Assembly convened:
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16	28		Section 1. Section 38a-1084 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2015):
17	29
18	30		The exchange shall:
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20	32		(1) Administer the exchange for both qualified individuals and qualified employers;
21	33
22	34		(2) Commission surveys of individuals, small employers and health care providers on issues related to health care and health care coverage;
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24	36		(3) Implement procedures for the certification, recertification and decertification, consistent with guidelines developed by the Secretary under Section 1311(c) of the Affordable Care Act, and section 38a-1086, of health benefit plans as qualified health plans;
25	37
26	38		(4) Provide for the operation of a toll-free telephone hotline to respond to requests for assistance;
27	39
28	40		(5) Provide for enrollment periods, as provided under Section 1311(c)(6) of the Affordable Care Act;
29	41
30		-	(6) Maintain an Internet web site through which enrollees and prospective enrollees of qualified health plans may obtain standardized comparative information on such plans including, but not limited to, accurate and current listings of the health care providers ~~and facilities~~ in each qualified health plan's network, the enrollee satisfaction survey information under Section 1311(c)(4) of the Affordable Care Act and any other information or tools to assist enrollees and prospective enrollees evaluate qualified health plans offered through the exchange;
	42	+	(6) Maintain an Internet web site through which enrollees and prospective enrollees of qualified health plans may obtain standardized comparative information on such plans including, but not limited to, accurate and current listings of the health care providers in each qualified health plan's network, the enrollee satisfaction survey information under Section 1311(c)(4) of the Affordable Care Act and any other information or tools to assist enrollees and prospective enrollees evaluate qualified health plans offered through the exchange;
31	43
32	44		(7) Publish the average costs of licensing, regulatory fees and any other payments required by the exchange and the administrative costs of the exchange, including information on moneys lost to waste, fraud and abuse, on an Internet web site to educate individuals on such costs;
33	45
34	46		(8) On or before the open enrollment period for plan year 2017, assign a rating to each qualified health plan offered through the exchange in accordance with the criteria developed by the Secretary under Section 1311(c)(3) of the Affordable Care Act, and determine each qualified health plan's level of coverage in accordance with regulations issued by the Secretary under Section 1302(d)(2)(A) of the Affordable Care Act;
35	47
36	48		(9) Use a standardized format for presenting health benefit options in the exchange, including the use of the uniform outline of coverage established under Section 2715 of the Public Health Service Act, 42 USC 300gg-15, as amended from time to time;
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38	50		(10) Inform individuals, in accordance with Section 1413 of the Affordable Care Act, of eligibility requirements for the Medicaid program under Title XIX of the Social Security Act, as amended from time to time, the Children's Health Insurance Program (CHIP) under Title XXI of the Social Security Act, as amended from time to time, or any applicable state or local public program, and enroll an individual in such program if the exchange determines, through screening of the application by the exchange, that such individual is eligible for any such program;
39	51
40	52		(11) Collaborate with the Department of Social Services, to the extent possible, to allow an enrollee who loses premium tax credit eligibility under Section 36B of the Internal Revenue Code and is eligible for HUSKY Plan, Part A or any other state or local public program, to remain enrolled in a qualified health plan;
41	53
42	54		(12) Establish and make available by electronic means a calculator to determine the actual cost of coverage after application of any premium tax credit under Section 36B of the Internal Revenue Code and any cost-sharing reduction under Section 1402 of the Affordable Care Act;
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44	56		(13) Establish a program for small employers through which qualified employers may access coverage for their employees and that shall enable any qualified employer to specify a level of coverage so that any of its employees may enroll in any qualified health plan offered through the exchange at the specified level of coverage;
45	57
46	58		(14) Offer enrollees and small employers the option of having the exchange collect and administer premiums, including through allocation of premiums among the various insurers and qualified health plans chosen by individual employers;
47	59
48	60		(15) Grant a certification, subject to Section 1411 of the Affordable Care Act, attesting that, for purposes of the individual responsibility penalty under Section 5000A of the Internal Revenue Code, an individual is exempt from the individual responsibility requirement or from the penalty imposed by said Section 5000A because:
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50	62		(A) There is no affordable qualified health plan available through the exchange, or the individual's employer, covering the individual; or
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52	64		(B) The individual meets the requirements for any other such exemption from the individual responsibility requirement or penalty;
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54	66		(16) Provide to the Secretary of the Treasury of the United States the following:
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56	68		(A) A list of the individuals granted a certification under subdivision (15) of this section, including the name and taxpayer identification number of each individual;
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58	70		(B) The name and taxpayer identification number of each individual who was an employee of an employer but who was determined to be eligible for the premium tax credit under Section 36B of the Internal Revenue Code because:
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60	72		(i) The employer did not provide minimum essential health benefits coverage; or
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62	74		(ii) The employer provided the minimum essential coverage but it was determined under Section 36B(c)(2)(C) of the Internal Revenue Code to be unaffordable to the employee or not provide the required minimum actuarial value; and
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64	76		(C) The name and taxpayer identification number of:
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66	78		(i) Each individual who notifies the exchange under Section 1411(b)(4) of the Affordable Care Act that such individual has changed employers; and
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68	80		(ii) Each individual who ceases coverage under a qualified health plan during a plan year and the effective date of that cessation;
69	81
70	82		(17) Provide to each employer the name of each employee, as described in subparagraph (B) of subdivision (16) of this section, of the employer who ceases coverage under a qualified health plan during a plan year and the effective date of the cessation;
71	83
72	84		(18) Perform duties required of, or delegated to, the exchange by the Secretary or the Secretary of the Treasury of the United States related to determining eligibility for premium tax credits, reduced cost-sharing or individual responsibility requirement exemptions;
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74	86		(19) Select entities qualified to serve as Navigators in accordance with Section 1311(i) of the Affordable Care Act and award grants to enable Navigators to:
75	87
76	88		(A) Conduct public education activities to raise awareness of the availability of qualified health plans;
77	89
78	90		(B) Distribute fair and impartial information concerning enrollment in qualified health plans and the availability of premium tax credits under Section 36B of the Internal Revenue Code and cost-sharing reductions under Section 1402 of the Affordable Care Act;
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80	92		(C) Facilitate enrollment in qualified health plans;
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82	94		(D) Provide referrals to the Office of the Healthcare Advocate or health insurance ombudsman established under Section 2793 of the Public Health Service Act, 42 USC 300gg-93, as amended from time to time, or any other appropriate state agency or agencies, for any enrollee with a grievance, complaint or question regarding the enrollee's health benefit plan, coverage or a determination under that plan or coverage; and
83	95
84	96		(E) Provide information in a manner that is culturally and linguistically appropriate to the needs of the population being served by the exchange;
85	97
86	98		(20) Review the rate of premium growth within and outside the exchange and consider such information in developing recommendations on whether to continue limiting qualified employer status to small employers;
87	99
88	100		(21) Credit the amount, in accordance with Section 10108 of the Affordable Care Act, of any free choice voucher to the monthly premium of the plan in which a qualified employee is enrolled and collect the amount credited from the offering employer;
89	101
90	102		(22) Consult with stakeholders relevant to carrying out the activities required under sections 38a-1080 to 38a-1090, inclusive, including, but not limited to:
91	103
92	104		(A) Individuals who are knowledgeable about the health care system, have background or experience in making informed decisions regarding health, medical and scientific matters and are enrollees in qualified health plans;
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94	106		(B) Individuals and entities with experience in facilitating enrollment in qualified health plans;
95	107
96	108		(C) Representatives of small employers and self-employed individuals;
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98	110		(D) The Department of Social Services; and
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100	112		(E) Advocates for enrolling hard-to-reach populations;
101	113
102	114		(23) Meet the following financial integrity requirements:
103	115
104	116		(A) Keep an accurate accounting of all activities, receipts and expenditures and annually submit to the Secretary, the Governor, the Insurance Commissioner and the General Assembly a report concerning such accountings;
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106	118		(B) Fully cooperate with any investigation conducted by the Secretary pursuant to the Secretary's authority under the Affordable Care Act and allow the Secretary, in coordination with the Inspector General of the United States Department of Health and Human Services, to:
107	119
108	120		(i) Investigate the affairs of the exchange;
109	121
110	122		(ii) Examine the properties and records of the exchange; and
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112	124		(iii) Require periodic reports in relation to the activities undertaken by the exchange; and
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114	126		(C) Not use any funds in carrying out its activities under sections 38a-1080 to 38a-1089, inclusive, and section 38a-1091 that are intended for the administrative and operational expenses of the exchange, for staff retreats, promotional giveaways, excessive executive compensation or promotion of federal or state legislative and regulatory modifications;
115	127
116	128		(24) Seek to include the most comprehensive health benefit plans that offer high quality benefits at the most affordable price in the exchange;
117	129
118	130		(25) Report at least annually to the General Assembly on the effect of adverse selection on the operations of the exchange and make legislative recommendations, if necessary, to reduce the negative impact from any such adverse selection on the sustainability of the exchange, including recommendations to ensure that regulation of insurers and health benefit plans are similar for qualified health plans offered through the exchange and health benefit plans offered outside the exchange. The exchange shall evaluate whether adverse selection is occurring with respect to health benefit plans that are grandfathered under the Affordable Care Act, self-insured plans, plans sold through the exchange and plans sold outside the exchange; and
119	131
120	132		(26) Seek funding for and oversee the planning, implementation and development of policies and procedures for the administration of the all-payer claims database program established under section 38a-1091.
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125	137		This act shall take effect as follows and shall amend the following sections:
126	138		Section 1 October 1, 2015 38a-1084
127	139
128	140		This act shall take effect as follows and shall amend the following sections:
129	141
130	142		Section 1
131	143
132	144		October 1, 2015
133	145
134	146		38a-1084
135	147
	148	+	Statement of Purpose:
	149	+
	150	+	To require the Connecticut Health Insurance Exchange to post on its Internet web site accurate and current listings of the health care providers in each qualified health plan's network.
	151	+
	152	+	[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not underlined.]
136	153
137	154
138		-	INS Joint Favorable Subst.
139	155
140		-	~~INS~~
	156	+	Co-Sponsors: SEN. KELLY, 21st Dist.
141	157
142		-	Joint Favorable Subst.
	158	+	Co-Sponsors:
	159	+
	160	+	SEN. KELLY, 21st Dist.
	161	+
	162	+	S.B. 751