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General Assembly Raised Bill No. 191
February Session, 2020
LCO No. 1615
Referred to Committee on HUMAN SERVICES
Introduced by:
(HS)
AN ACT CONCERNING CH ANGES TO THE HUSKY B PROGRAM.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. Subsection (a) of section 17b-295 of the general statutes is 1
repealed and the following is substituted in lieu thereof (Effective from 2
passage): 3
(a) The commissioner shall impose cost-sharing requirements, 4
including the payment of a premium or copayment, in connection with 5
services provided under HUSKY B, to the extent permitted by federal 6
law. Copayments under HUSKY B shall [be the same as] not exceed 7
those in effect for active state employees enrolled in a point-of-8
enrollment health care plan, provided the household's annual combined 9
premiums and copayments do not exceed the maximum annual 10
aggregate cost-sharing requirement. The cost-sharing requirements 11
imposed by the commissioner shall be in accordance with the following 12
limitations: 13
(1) The commissioner may increase the maximum annual aggregate 14
cost-sharing requirements, provided such cost-sharing requirements 15 Raised Bill No. 191
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shall not exceed five per cent of the household's gross annual income. 16
(2) In accordance with federal law, the commissioner may impose a 17
premium requirement on households whose income exceeds two 18
hundred forty-nine per cent of the federal poverty level as a component 19
of the household's cost-sharing responsibility; [and, for the fiscal years 20
ending June 30, 2012, to June 30, 2016, inclusive, may annually increase 21
the premium requirement based on the percentage increase in the 22
Consumer Price Index for medical care services;] and 23
(3) The commissioner shall monitor copayments and premiums 24
under the provisions of subdivision (1) of this subsection. 25
Sec. 2. Section 17b-266 of the general statutes is repealed and the 26
following is substituted in lieu thereof (Effective from passage): 27
(a) The Commissioner of Social Services may, when the commissioner 28
finds it to be in the public interest, fund part or all of the cost of benefits 29
to any recipient under sections 17b-260 to 17b-262, inclusive, 17b-264 to 30
17b-285, inclusive, 17b-357 to 17b-361, inclusive, 17b-290, as amended 31
by this act, 17b-292, [17b-294a,] 17b-295, as amended by this act, 17b-32
297a, 17b-297b and 17b-300 through the purchase of insurance from any 33
organization authorized to do a health insurance business in this state 34
or from any organization specified in subsection (b) of this section. 35
(b) The Commissioner of Social Services may require recipients of 36
Medicaid or other public assistance to receive medical care on a 37
prepayment or per capita basis, in accordance with federal law and 38
regulations, if such prepayment is anticipated to result in lower medical 39
assistance costs to the state. The commissioner may enter into contracts 40
for the provision of comprehensive health care on a prepayment or per 41
capita basis in accordance with federal law and regulations, with the 42
following: (1) A health care center subject to the provisions of chapter 43
698a; (2) a consortium of federally qualified community health centers 44
and other community-based providers of health services which are 45
funded by the state; (3) other consortia of providers of health care 46
services established for the purposes of this subsection; or (4) an 47 Raised Bill No. 191
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integrated service network providing care management and 48
comprehensive health care on a prepayment or per capita basis to 49
elderly and disabled recipients of Medicaid who may also be eligible for 50
Medicare. 51
(c) Providers of comprehensive health care services as described in 52
subdivisions (2), (3) and (4) of subsection (b) of this section shall not be 53
subject to the provisions of chapter 698a or, in the case of an integrated 54
service network, sections 17b-239 to 17b-245, inclusive, 17b-281, 17b-340, 55
17b-342 and 17b-343. Any such provider shall be certified by the 56
Commissioner of Social Services in accordance with criteria established 57
by the commissioner, including, but not limited to, minimum reserve 58
fund requirements. 59
(d) The commissioner shall pay all capitation claims which would 60
otherwise be reimbursed to the health plans described in subsection (b) 61
of this section in May, 2010, no later than June 30, 2010. Each subsequent 62
payment made by the commissioner to such health plans for capitation 63
claims due shall be made in the second month following the month to 64
which the capitation applies. 65
(e) On or after May 1, 2000, the payment to the Commissioner of 66
Social Services of (1) any monetary sanction imposed by the 67
commissioner on a managed care organization under the provisions of 68
a contract between the commissioner and such organization entered 69
into pursuant to this section or sections 17b-290, as amended by this act, 70
17b-292, [17b-294a,] 17b-295, as amended by this act, 17b-297a, 17b-297b 71
and 17b-300, or (2) any sum agreed upon by the commissioner and such 72
an organization as settlement of a claim brought by the commissioner 73
or the state against such an organization for failure to comply with the 74
terms of a contract with the commissioner or fraud affecting the 75
Department of Social Services shall be deposited in an account 76
designated for use by the department for expenditures for children's 77
health programs and services. 78
Sec. 3. Section 17b-290 of the general statutes is repealed and the 79 Raised Bill No. 191
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following is substituted in lieu thereof (Effective from passage): 80
As used in this section and sections 17b-292, [17b-294a,] 17b-295, as 81
amended by this act, 17b-297a, 17b-297b and 17b-300: 82
(1) "Applicant" means an individual over the age of eighteen years 83
who is a natural or adoptive parent, a legal guardian, a caretaker 84
relative, foster parent or stepparent with whom the child resides and 85
shall include a child who is eighteen years of age or emancipated in 86
accordance with the provisions of sections 46b-150 to 46b-150e, 87
inclusive, and who is applying on his own behalf or on behalf of a minor 88
dependent for coverage under such plan; 89
(2) "Child" means an individual under nineteen years of age; 90
(3) "Coinsurance" means the sharing of health care expenses by the 91
insured and an insurer in a specified ratio; 92
(4) "Commissioner" means the Commissioner of Social Services; 93
(5) "Copayment" means a payment made on behalf of a member for a 94
specified service under HUSKY B; 95
(6) "Cost sharing" means arrangements made on behalf of a member 96
whereby an applicant pays a portion of the cost of health services, 97
sharing costs with the state and includes copayments, premiums, 98
deductibles and coinsurance; 99
(7) "Deductible" means the amount of out-of-pocket expenses that 100
would be paid for health services on behalf of a member before 101
becoming payable by the insurer; 102
(8) "Department" means the Department of Social Services; 103
(9) "Durable medical equipment" means equipment that meets all of 104
the following requirements: 105
(A) Can withstand repeated use; 106 Raised Bill No. 191
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(B) Is primarily and customarily used to serve a medical purpose; 107
(C) Generally is not useful to a person in the absence of an illness or 108
injury; and 109
(D) Is nondisposable; 110
(10) "Eligible beneficiary" means a child who meets the requirements 111
in section 17b-292, and the requirements specified in Section 112
2110(b)(2)(B) of the Social Security Act as amended by Section 113
10203(b)(2)(D) of the Affordable Care Act; 114
(11) "Household" has the same meaning as provided in 42 CFR 115
435.603; 116
(12) "Household income" has the same meaning as provided in 42 117
CFR 435.603; 118
(13) "HUSKY A" means Medicaid provided to children, caretaker 119
relatives and pregnant and postpartum women pursuant to section 17b-120
261 or 17b-277; 121
(14) "HUSKY B" means the health coverage for children established 122
pursuant to the provisions of sections 17b-290, as amended by this act, 123
17b-292, [17b-294a,] 17b-295, as amended by this act, 17b-297a, 17b-297b 124
and 17b-300; 125
(15) "HUSKY C" means Medicaid provided to individuals who are 126
sixty-five years of age or older or who are blind or have a disability; 127
(16) "HUSKY D" or "Medicaid Coverage for the Lowest Income 128
Populations program" means Medicaid provided to nonpregnant low-129
income adults who are age eighteen to sixty-four, as authorized 130
pursuant to section 17b-8a; 131
(17) "HUSKY Health" means the combined HUSKY A, HUSKY B, 132
HUSKY C and HUSKY D programs, that provide medical coverage to 133
eligible children, parents, relative caregivers, persons age sixty-five or 134 Raised Bill No. 191
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older, individuals with disabilities, low-income adults, and pregnant 135
women; 136
[(18) "HUSKY Plus" means the supplemental health program 137
established pursuant to section 17b-294a for medically eligible members 138
of HUSKY B whose medical needs cannot be accommodated within the 139
basic benefit package offered to members. HUSKY Plus shall 140
supplement coverage for those medically eligible members with 141
intensive physical health needs;] 142
[(19)] (18) "Member" means an eligible beneficiary who receives 143
services under HUSKY A, B, C or D; 144
[(20)] (19) "Parent" means a natural parent, stepparent, adoptive 145
parent, guardian or custodian of a child; 146
[(21)] (20) "Premium" means any required payment made by an 147
individual to offset the cost under HUSKY B; 148
[(22)] (21) "Qualified entity" means any entity: (A) Eligible for 149
payments under a state plan approved under Medicaid and which 150
provides medical services under HUSKY A, or (B) that is a qualified 151
entity, as defined in 42 USC 1396r-1a, as amended by Section 708 of 152
Public Law 106-554, and that is determined by the commissioner to be 153
capable of making the determination of eligibility. The commissioner 154
shall provide qualified entities with such forms or information on filing 155
an application electronically as is necessary for an application to be 156
made on behalf of a child under HUSKY A and information on how to 157
assist parents, guardians and other persons in completing and filing 158
such forms or electronic application; and 159
[(23)] (22) "WIC" means the federal Special Supplemental Food 160
Program for Women, Infants and Children administered by the 161
Department of Public Health pursuant to section 19a-59c. 162
Sec. 4. Section 17b-304 of the general statutes is repealed and the 163
following is substituted in lieu thereof (Effective from passage): 164 Raised Bill No. 191
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The Commissioner of Social Services shall implement the policies and 165
procedures necessary to carry out the provisions of sections 17b-292, 166
[17b-294a,] 17b-295, as amended by this act, 17b-297a, 17b-297b and 17b-167
300 while in the process of adopting such policies and procedures in 168
regulation form, provided notice of intent to adopt the regulations is 169
[published] posted on the Department of Social Services' Internet web 170
site and the eRegulations System not later than twenty days after 171
implementation. Such policies and procedures shall be valid until the 172
time final regulations are effective. 173
Sec. 5. Section 17b-294a of the general statutes is repealed. (Effective 174
from passage) 175
This act shall take effect as follows and shall amend the following
sections:
Section 1 from passage 17b-295(a)
Sec. 2 from passage 17b-266
Sec. 3 from passage 17b-290
Sec. 4 from passage 17b-304
Sec. 5 from passage Repealer section
Statement of Purpose:
To cap copayments to the HUSKY B health program and repeal a
program offering intensive services that are offered under a related
program.
[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.]