Connecticut 2019 Regular Session

Connecticut House Bill HB07267 Compare Versions

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7	7		General Assembly Substitute Bill No. 7267
8	8		January Session, 2019
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12	12		AN ACT CONCERNING PU BLIC OPTIONS FOR HEALTH CARE IN
13	13		CONNECTICUT.
14	14		Be it enacted by the Senate and House of Representatives in General
15	15		Assembly convened:
16	16
17	17		Section 1. (NEW) (Effective July 1, 2019) For the purposes of this 1
18	18		section and sections 2 to 5, inclusive, of this act: 2
19	19		(1) "Account" means the ConnectHealth Trust Account established 3
20	20		under section 4 of this act; 4
21	21		(2) "Advisory council" means the ConnectHealth Advisory Council 5
22	22		established under section 3 of this act; 6
23	23		(3) "Affordable Care Act" means the Patient Protection and 7
24	24		Affordable Care Act, P.L. 111-148, as amended by the Health Care and 8
25	25		Education Reconciliation Act, P.L. 111-152, as both may be amended 9
26	26		from time to time, and regulations adopted thereunder; 10
27	27		(4) "ConnectHealth Plan" means the health benefit plan designed 11
28	28		and made available to individuals in this state as part of the program; 12
29	29		(5) "Essential health benefits" means benefits that are essential 13
30	30		health benefits within the meaning of (A) the Affordable Care Act, or 14
31	31		(B) sections 38a-492q and 38a-518q of the general statutes; 15
32	32		(6) "Exchange" means the Connecticut Health Insurance Exchange 16
33	33		established under section 38a-1081 of the general statutes; 17 Substitute Bill No. 7267
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40	40		(7) "Health benefit plan" has the same meaning as provided in 18
41	41		section 38a-1080 of the general statutes; 19
42	42		(8) "Internal Revenue Code" means the Internal Revenue Code of 20
43	43		1986, or any subsequent corresponding internal revenue code of the 21
44	44		United States, as amended from time to time; 22
45	45		(9) "Program" means the ConnectHealth Program established by the 23
46	46		Comptroller pursuant to section 2 of this act; 24
47	47		(10) "Qualified health plan" has the same meaning as provided in 25
48	48		section 38a-1080 of the general statutes; and 26
49	49		(11) "Third-party administrator" has the same meaning as provided 27
50	50		in section 38a-720 of the general statutes. 28
51	51		Sec. 2. (NEW) (Effective July 1, 2019) (a) The Comptroller shall, 29
52	52		within available appropriations and in consultation with the advisory 30
53	53		council and the Office of Health Strategy, establish a program to be 31
54	54		known as the "ConnectHealth Program". The purpose of the program 32
55	55		shall be to offer high-quality, low-cost health insurance coverage to 33
56	56		enrollees in this state under a ConnectHealth Plan. Under the program, 34
57	57		the Comptroller, in consultation with the advisory council and the 35
58	58		Office of Health Strategy, shall: 36
59	59		(1) Establish enrollment criteria for the ConnectHealth Plan; 37
60	60		(2) Design and offer the ConnectHealth Plan, which shall, at a 38
61	61		minimum: (A) Be made available to prospective enrollees in this state 39
62	62		not later than January 1, 2021; (B) provide coverage for essential health 40
63	63		benefits; (C) provide a level of covered benefits that meets or exceeds 41
64	64		the level of covered benefits provided under qualified health plans; (D) 42
65	65		impose premiums, deductibles and enrollee cost-sharing in amounts 43
66	66		that do not exceed the amounts imposed under qualified health plans; 44
67	67		and (E) include an affordability scale for premiums, deductibles and 45
68	68		enrollee cost-sharing that varies according to an enrollee's household 46
69	69		income; 47 Substitute Bill No. 7267
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76	76		(3) Determine whether to offer the ConnectHealth Plan through the 48
77	77		exchange as a qualified health plan; 49
78	78		(4) Subject to the provisions of subsection (c) of this section: (A) 50
79	79		Establish a schedule of payments and reimbursement rates for the 51
80	80		ConnectHealth Plan; (B) provide, within available appropriations, 52
81	81		state-financed cost-sharing subsidies to enrollees in the ConnectHealth 53
82	82		Plan who do not qualify for cost-sharing subsidies under the 54
83	83		Affordable Care Act; and (C) seek a waiver from the United States 55
84	84		Department of the Treasury or the United States Department of Health 56
85	85		and Human Services, as applicable, pursuant to Section 1332 of the 57
86	86		Affordable Care Act; 58
87	87		(5) Use any data submitted to the all-payer claims database program 59
88	88		established under section 19a-755a of the general statutes to evaluate, 60
89	89		on an ongoing basis, the impact of the ConnectHealth Plan on: (A) 61
90	90		Individuals in this state; (B) health care providers and health care 62
91	91		facilities in this state; and (C) the individual and group health 63
92	92		insurance markets in this state; and 64
93	93		(6) Implement a competitive process to select, and enter into a 65
94	94		contract with, one or more third-party administrators to administer the 66
95	95		ConnectHealth Plan, and permit such third-party administrator or 67
96	96		third-party administrators to directly receive individual premiums and 68
97	97		federal premium tax credits in accordance with all applicable 69
98	98		provisions of the Affordable Care Act and the Internal Revenue Code. 70
99	99		(b) The Comptroller may, in the Comptroller's discretion and within 71
100	100		available appropriations, engage the services of such third-party 72
101	101		actuaries, professionals and specialists that the Comptroller deems 73
102	102		necessary to assist the Comptroller in performing the Comptroller's 74
103	103		duties under subsection (a) of this section. 75
104	104		(c) (1) Not later than March 1, 2020, the Comptroller, in consultation 76
105	105		with the advisory council and the Office of Health Strategy, shall 77
106	106		submit, in accordance with section 11-4a of the general statutes, to the 78 Substitute Bill No. 7267
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113	113		joint standing committee of the General Assembly having cognizance 79
114	114		of matters relating to insurance: 80
115	115		(A) A plan to make the ConnectHealth Plan available to prospective 81
116	116		enrollees in this state not later than January 1, 2021; 82
117	117		(B) Strategies to ensure that health care providers and health care 83
118	118		facilities in this state participate in the ConnectHealth Plan; 84
119	119		(C) An analysis of the likely impact of the ConnectHealth Plan on 85
120	120		the individual and group health insurance markets in this state; 86
121	121		(D) A proposed schedule of the initial payments and reimbursement 87
122	122		rates for the ConnectHealth Plan; 88
123	123		(E) A proposal to implement state-financed cost-sharing subsidies 89
124	124		for enrollees in the ConnectHealth Plan who do not qualify for cost-90
125	125		sharing subsidies under the Affordable Care Act, which proposal shall 91
126	126		include, but need not be limited to, (i) eligibility criteria for enrollees to 92
127	127		receive such subsidies, (ii) the recommended amount or amounts of 93
128	128		such subsidies, and (iii) a plan to administer and disburse such 94
129	129		subsidies; and 95
130	130		(F) A proposed application for a waiver from the United States 96
131	131		Department of the Treasury or the United States Department of Health 97
132	132		and Human Services, as applicable, pursuant to Section 1332 of the 98
133	133		Affordable Care Act. 99
134	134		(2) If the committee does not act within sixty days after receiving a 100
135	135		submittal under subdivision (1) of this subsection, each proposal 101
136	136		described in subparagraphs (D) to (F), inclusive, of said subdivision 102
137	137		shall be deemed to be denied by the committee. 103
138	138		Sec. 3. (NEW) (Effective July 1, 2019) (a) (1) There is established the 104
139	139		ConnectHealth Advisory Council. The council shall consist of ten 105
140	140		members, as follows: 106 Substitute Bill No. 7267
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147	147		(A) Two appointed by the speaker of the House of Representatives, 107
148	148		one of whom shall represent the interests of hospitals in this state and 108
149	149		one of whom shall represent the interests of community-based health 109
150	150		care providers in this state; 110
151	151		(B) Two appointed by the president pro tempore of the Senate, one 111
152	152		of whom shall represent the interests of consumers in this state and 112
153	153		one of whom shall represent the interests of nurses practicing in this 113
154	154		state; 114
155	155		(C) One appointed by the majority leader of the House of 115
156	156		Representatives, who shall represent the interests of patients in this 116
157	157		state; 117
158	158		(D) One appointed by the majority leader of the Senate, who shall 118
159	159		have expertise in health policy; 119
160	160		(E) Two appointed by the minority leader of the House of 120
161	161		Representatives, one of whom shall represent the interests of health 121
162	162		insurers offering individual health insurance policies in this state and 122
163	163		one of whom shall represent the interests of physicians practicing in 123
164	164		this state; and 124
165	165		(F) Two appointed by the minority leader of the Senate, one of 125
166	166		whom shall represent the interests of health insurers offering small 126
167	167		group health insurance policies in this state and one of whom shall 127
168	168		represent the interests of insurance producers licensed in this state. 128
169	169		(2) The members of the advisory council shall select a chairperson 129
170	170		from the membership of the advisory council, and the advisory council 130
171	171		may establish rules governing the advisory council's internal 131
172	172		procedures. 132
173	173		(3) The Governor, Lieutenant Governor, Comptroller, Secretary of 133
174	174		the Office of Policy and Management, Insurance Commissioner and 134
175	175		Commissioner of Social Services shall serve as ex-officio, nonvoting 135
176	176		members of the advisory council. 136 Substitute Bill No. 7267
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183	183		(b) Initial appointments to the advisory council shall be made on or 137
184	184		before October 1, 2019. If an appointing authority fails to appoint an 138
185	185		advisory council member on or before October 1, 2019, the president 139
186	186		pro tempore of the Senate and the speaker of the House of 140
187	187		Representatives shall jointly appoint an advisory council member 141
188	188		meeting the required specifications on behalf of such appointing 142
189	189		authority and such advisory council member shall serve a full term. 143
190	190		The presence of not less than six advisory council members shall 144
191	191		constitute a quorum for the transaction of business. The initial term for 145
192	192		advisory council members appointed by the minority leader of the 146
193	193		House of Representatives and the minority leader of the Senate shall 147
194	194		be three years. The initial term for advisory council members 148
195	195		appointed by the majority leader of the House of Representatives and 149
196	196		the majority leader of the Senate shall be four years. The initial term for 150
197	197		the advisory council members appointed by the speaker of the House 151
198	198		of Representatives and the president pro tempore of the Senate shall be 152
199	199		five years. Terms pursuant to this subsection shall expire on June 153
200	200		thirtieth in accordance with the provisions of this subsection. Any 154
201	201		vacancy shall be filled by the appointing authority for the balance of 155
202	202		the unexpired term. Not later than thirty days prior to the expiration of 156
203	203		a term as provided for in this subsection, the appointing authority may 157
204	204		reappoint the current advisory council member or shall appoint a new 158
205	205		member to the advisory council. Other than an initial term, an 159
206	206		advisory council member shall serve for a term of five years and until a 160
207	207		successor advisory council member is appointed. Each member of the 161
208	208		advisory council shall be eligible for reappointment. Any member of 162
209	209		the advisory council may be removed by the appropriate appointing 163
210	210		authority for misfeasance, malfeasance or wilful neglect of duty. 164
211	211		(c) The advisory council shall advise the Comptroller and the Office 165
212	212		of Health Strategy on matters concerning the ConnectHealth Program 166
213	213		and the ConnectHealth Plan, including, but not limited to: 167
214	214		(1) Implementation of the ConnectHealth Plan; 168
215	215		(2) Affordability of the ConnectHealth Plan; 169 Substitute Bill No. 7267
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222	222		(3) Marketing of the ConnectHealth Plan to prospective enrollees; 170
223	223		(4) Outreach to prospective enrollees and enrollees in the 171
224	224		ConnectHealth Plan; and 172
225	225		(5) Periodic evaluations of the ConnectHealth Plan. 173
226	226		(d) The advisory council shall not be construed to be a department, 174
227	227		institution or agency of this state. The staff of the joint standing 175
228	228		committee of the General Assembly having cognizance of matters 176
229	229		relating to insurance shall provide administrative support to the 177
230	230		advisory council. 178
231	231		Sec. 4. (NEW) (Effective July 1, 2019) There is established an account 179
232	232		to be known as the "ConnectHealth Trust Account", which shall be a 180
233	233		separate, nonlapsing account within the General Fund. The account 181
234	234		shall contain all moneys required by law to be deposited in the 182
235	235		account. Investment earnings from any moneys in the account shall be 183
236	236		credited to the account and shall become part of the assets of the 184
237	237		account. Any balance remaining in the account at the end of any fiscal 185
238	238		year shall be carried forward in the account for the fiscal year next 186
239	239		succeeding. The moneys in the account shall be allocated to the 187
240	240		Comptroller for the purposes of lowering the cost of the 188
241	241		ConnectHealth Plan and providing state-financed cost-sharing 189
242	242		subsidies to enrollees in such plan who do not qualify for cost-sharing 190
243	243		subsidies under the Affordable Care Act. 191
244	244		Sec. 5. (NEW) (Effective July 1, 2019) The Comptroller may adopt 192
245	245		regulations, in accordance with chapter 54 of the general statutes, to 193
246	246		implement the provisions of sections 1 to 4, inclusive, of this act. 194
247	247		Sec. 6. Section 3-123rrr of the general statutes is repealed and the 195
248	248		following is substituted in lieu thereof (Effective July 1, 2019): 196
249	249		As used in this section, section 7 of this act and sections 3-123sss to 197
250	250		3-123vvv, inclusive, as amended by this act: 198 Substitute Bill No. 7267
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257	257		(1) "Health Care Cost Containment Committee" means the 199
258	258		committee established in accordance with the ratified agreement 200
259	259		between the state and the State Employees Bargaining Agent Coalition 201
260	260		pursuant to subsection (f) of section 5-278. 202
261	261		(2) "Nonstate public employee" means any employee or elected 203
262	262		officer of a nonstate public employer. 204
263	263		(3) "Nonstate public employer" means a municipality or other 205
264	264		political subdivision of the state, including a board of education, quasi-206
265	265		public agency or public library. A municipality and a board of 207
266	266		education may be considered separate employers. 208
267	267		(4) "Small employer" means an employer, other than a nonstate 209
268	268		public employer, that employed an average of at least one but not 210
269	269		more than fifty employees on business days during the preceding 211
270	270		calendar year, and employs at least one employee on the first day that 212
271	271		such employer receives coverage under a group hospitalization, 213
272	272		medical, pharmacy and surgical insurance plan offered by the 214
273	273		Comptroller pursuant to this part. 215
274	274		[(4)] (5) "State employee plan" means the group hospitalization, 216
275	275		medical, pharmacy and surgical insurance plan offered to state 217
276	276		employees and retirees pursuant to section 5-259. 218
277	277		Sec. 7. (NEW) (Effective July 1, 2019) (a) Notwithstanding any 219
278	278		provision of title 38a of the general statutes, the Comptroller shall offer 220
279	279		to small employers and their employees coverage under the state 221
280	280		employee plan or another group hospitalization, medical, pharmacy 222
281	281		and surgical insurance plan developed by the Comptroller to provide 223
282	282		coverage for small employers and their employees. A small employer 224
283	283		and its employees receiving coverage provided pursuant to this section 225
284	284		shall be pooled with state employees and retirees under the state 226
285	285		employee plan, provided the small employer files an application with 227
286	286		the Comptroller for coverage pursuant to this section and the 228
287	287		Comptroller approves such application. Small employers shall remit to 229 Substitute Bill No. 7267
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294	294		the Comptroller payments for coverage provided pursuant to this 230
295	295		section. Such payments shall be equal to the payments paid by the 231
296	296		state for state employees covered under the state employee plan, 232
297	297		inclusive of any premiums paid by state employees pursuant to the 233
298	298		state employee plan, except that premium payments may be adjusted 234
299	299		to reflect the cost of health care in the geographic area in which the 235
300	300		majority of a small employer's employees work, differences from the 236
301	301		benefits and networks provided to state employees, the demographic 237
302	302		makeup of the small employer's employees or as otherwise provided 238
303	303		in this section. The Comptroller shall phase in the geographic 239
304	304		adjustment established in this subsection over a two-year period for 240
305	305		existing participants. Beginning on July 1, 2020, the Comptroller may 241
306	306		charge each small employer participating in the state employee plan an 242
307	307		administrative fee calculated on a per member, per month basis. 243
308	308		(b) The Comptroller shall offer participation in each plan described 244
309	309		in subsection (a) of this section for intervals lasting not less than three 245
310	310		years. A small employer may apply for renewal of coverage prior to 246
311	311		expiration of each interval. 247
312	312		(c) The Comptroller shall develop procedures by which small 248
313	313		employers may initially apply for, renew and withdraw from coverage 249
314	314		provided pursuant to this section, as well as rules of participation that 250
315	315		the Comptroller, in the Comptroller's discretion, deems necessary. 251
316	316		(d) The Comptroller shall establish accounting procedures to track 252
317	317		claims and premium payments paid by small employers receiving 253
318	318		coverage provided pursuant to this section. 254
319	319		Sec. 8. Subsections (a) to (c), inclusive, of section 3-123sss of the 255
320	320		general statutes are repealed and the following is substituted in lieu 256
321	321		thereof (Effective July 1, 2019): 257
322	322		(a) Notwithstanding any provision of title 38a, the Comptroller shall 258
323	323		offer to nonstate public employers and their nonstate public 259
324	324		employees, and their retirees, if applicable, coverage under the state 260 Substitute Bill No. 7267
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331	331		employee plan or another group hospitalization, medical, pharmacy 261
332	332		and surgical insurance plan developed by the Comptroller to provide 262
333	333		coverage for nonstate public employees and their retirees, if applicable. 263
334	334		Such nonstate public employees, or retirees, if applicable, shall be 264
335	335		pooled with the state employee plan, provided the Comptroller 265
336	336		receives an application from a nonstate public employer and the 266
337	337		application is approved in accordance with this section or section 3-267
338	338		123ttt. Premium payments for such coverage shall be remitted by the 268
339	339		nonstate public employer to the Comptroller and shall be the same as 269
340	340		those paid by the state inclusive of any premiums paid by state 270
341	341		employees, except that premium payments may be adjusted to reflect 271
342	342		the cost of health care in the geographic area in which the majority of 272
343	343		the nonstate public employer's employees work, differences from the 273
344	344		benefits and networks provided to state employees or as otherwise 274
345	345		provided in this section or section 3-123uuu, as amended by this act. 275
346	346		The Comptroller may charge each nonstate public employer 276
347	347		participating in the state employee plan an administrative fee 277
348	348		calculated on a per member, per month basis. 278
349	349		(b) (1) The Comptroller shall offer participation in such plan for not 279
350	350		less than three-year intervals. A nonstate public employer may apply 280
351	351		for renewal prior to the expiration of each interval. 281
352	352		(2) The Comptroller shall develop procedures by which nonstate 282
353	353		public employers receiving coverage for nonstate public employees 283
354	354		pursuant to the state employee plan may (A) apply for renewal, or (B) 284
355	355		withdraw from such coverage, including, but not limited to, the terms 285
356	356		and conditions under which such nonstate public employers may 286
357	357		withdraw prior to the expiration of the interval. [and the procedure by 287
358	358		which any premium payments such nonstate public employers may be 288
359	359		entitled to or premium equivalent payments made in excess of 289
360	360		incurred claims shall be refunded to such nonstate public employer.] 290
361	361		Any such procedures shall provide that nonstate public employees 291
362	362		covered by collective bargaining shall withdraw from such coverage in 292
363	363		accordance with chapters 68, 113 and 166. 293 Substitute Bill No. 7267
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370	370		(c) Nothing in sections 3-123rrr to 3-123vvv, inclusive, as amended 294
371	371		by this act, shall (1) require the Comptroller to offer coverage to every 295
372	372		nonstate public employer seeking coverage under the state employee 296
373	373		plan, [or] (2) prevent the Comptroller from procuring coverage for 297
374	374		nonstate public employees from vendors other than those providing 298
375	375		coverage to state employees, or (3) prevent the Comptroller from 299
376	376		offering plans other than the plans offered to state employees on July 300
377	377		1, 2019, provided no such plan shall be offered if such plan qualifies as 301
378	378		a high deductible health plan, as defined in Section 220(c)(2) or Section 302
379	379		223(c)(2) of the Internal Revenue Code of 1986, or any subsequent 303
380	380		corresponding internal revenue code of the United States, as amended 304
381	381		from time to time, and is used to establish a medical savings account or 305
382	382		an Archer MSA pursuant to said Section 220 or a health savings 306
383	383		account pursuant to said Section 223. 307
384	384		Sec. 9. Section 3-123uuu of the general statutes is repealed and the 308
385	385		following is substituted in lieu thereof (Effective July 1, 2019): 309
386	386		[(a) There is established an account to be known as the "state 310
387	387		employee plan premium account", which shall be a separate, 311
388	388		nonlapsing account within the General Fund. All premiums paid by 312
389	389		nonstate public employers and nonstate public employees pursuant to 313
390	390		participation in the state employee plan shall be deposited into said 314
391	391		account. The account shall be administered by the Comptroller, with 315
392	392		the advice of the Health Care Cost Containment Committee, for 316
393	393		payment of claims and administrative fees to entities providing 317
394	394		coverage or services under the state employee plan.] 318
395	395		[(b)] (a) Each nonstate public employer shall pay monthly the 319
396	396		amount determined by the Comptroller for coverage of its nonstate 320
397	397		public employees or its nonstate public employees and retirees, as 321
398	398		appropriate, under the state employee plan. A nonstate public 322
399	399		employer may require each nonstate public employee to contribute a 323
400	400		portion of the cost of his or her coverage under the plan, subject to any 324
401	401		collective bargaining obligation applicable to such nonstate public 325
402	402		employer. 326 Substitute Bill No. 7267
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409	409		(b) The Comptroller shall establish accounting procedures to track 327
410	410		claims and premium payments paid by nonstate public employers. 328
411	411		(c) If any payment due by a nonstate public employer under this 329
412	412		[subsection] section is not paid after the date such payment is due, 330
413	413		interest to be paid by such nonstate public employer shall be added, 331
414	414		retroactive to the date such payment was due, at the prevailing rate of 332
415	415		interest as determined by the Comptroller. 333
416	416		(d) If a nonstate public employer fails to make premium payments, 334
417	417		the Comptroller may direct the State Treasurer, or any other officer of 335
418	418		the state who is the custodian of any moneys made available by grant, 336
419	419		allocation or appropriation payable to such nonstate public employer 337
420	420		at any time subsequent to such failure, to withhold the payment of 338
421	421		such moneys until the amount of the premium or interest due has been 339
422	422		paid to the Comptroller, or until the State Treasurer or such custodial 340
423	423		officer determines that arrangements have been made, to the 341
424	424		satisfaction of the State Treasurer, for the payment of such premium 342
425	425		and interest. Such moneys shall not be withheld if such withholding 343
426	426		will adversely affect the receipt of any federal grant or aid in 344
427	427		connection with such moneys. 345
428	428		Sec. 10. Section 3-123vvv of the general statutes is repealed and the 346
429	429		following is substituted in lieu thereof (Effective July 1, 2019): 347
430	430		The Comptroller shall not offer coverage under the state employee 348
431	431		plan pursuant to sections 3-123rrr to 3-123uuu, inclusive, as amended 349
432	432		by this act, or section 7 of this act until the State Employees' Bargaining 350
433	433		Agent Coalition has provided its consent to the clerks of both houses 351
434	434		of the General Assembly to incorporate the terms of sections 3-123rrr 352
435	435		to 3-123uuu, inclusive, as amended by this act, and section 7 of this act 353
436	436		into its collective bargaining agreement. 354
437	437		This act shall take effect as follows and shall amend the following
438	438		sections:
439	439
440	440		Section 1 July 1, 2019 New section Substitute Bill No. 7267
441	441
442	442
443	443		LCO {\\PRDFS1\HCOUSERS\BARRYJN\WS\2019HB-07267-
444		-	~~R02~~-HB.docx }
	444	+	R01-HB.docx }
445	445		13 of 13
446	446
447	447		Sec. 2 July 1, 2019 New section
448	448		Sec. 3 July 1, 2019 New section
449	449		Sec. 4 July 1, 2019 New section
450	450		Sec. 5 July 1, 2019 New section
451	451		Sec. 6 July 1, 2019 3-123rrr
452	452		Sec. 7 July 1, 2019 New section
453	453		Sec. 8 July 1, 2019 3-123sss(a) to (c)
454	454		Sec. 9 July 1, 2019 3-123uuu
455	455		Sec. 10 July 1, 2019 3-123vvv
456	456
	457	+	Statement of Legislative Commissioners:
	458	+	In Section 1(5), "or" was substituted for "and" for accuracy; in Section
	459	+	1(9), "ConnectHealth Program" was substituted for "program" for
	460	+	consistency; in Section 3(b), "If" was substituted for "In the event that"
	461	+	for conciseness; and in Section 3(c)(3), "of" was inserted after
	462	+	"Marketing" for consistency.
457	463
458	464		INS Joint Favorable Subst. -LCO
459		-	APP Joint Favorable
460	465