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