Connecticut 2020 Regular Session

Connecticut Senate Bill SB00328 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1
2	2
3	3	LCO No. 1988 1 of 40
4	4
5	5	General Assembly Raised Bill No. 328
6	6	February Session, 2020
7	7	LCO No. 1988
8	8
9	9
10	10	Referred to Committee on INSURANCE AND REAL ESTATE
11	11
12	12
13	13	Introduced by:
14	14	(INS)
15	15
16	16
17	17
18	18
19	19	AN ACT CONCERNING HE ALTH CARE COST GROWT H
20	20	BENCHMARKS, CANADIAN DRUG REIMPORTATION, STOP -LOSS
21	21	INSURANCE AND REINSU RANCE.
22	22	Be it enacted by the Senate and House of Representatives in General
23	23	Assembly convened:
24	24
25	25	Section 1. Section 19a-754a of the 2020 supplement to the general 1
26	26	statutes is repealed and the following is substituted in lieu thereof 2
27	27	(Effective July 1, 2020): 3
28	28	(a) There is established an Office of Health Strategy, which shall be 4
29	29	within the Department of Public Health for administrative purposes 5
30	30	only. The department head of said office shall be the executive director 6
31	31	of the Office of Health Strategy, who shall be appointed by the Governor 7
32	32	in accordance with the provisions of sections 4-5 to 4-8, inclusive, with 8
33	33	the powers and duties therein prescribed. 9
34	34	(b) The Office of Health Strategy shall be responsible for the 10
35	35	following: 11
36	36	(1) Developing and implementing a comprehensive and cohesive 12
37	37	health care vision for the state, including, but not limited to, a 13 Raised Bill No. 328
38	38
39	39
40	40
41	41	LCO No. 1988 2 of 40
42	42
43	43	coordinated state health care cost containment strategy; 14
44	44	(2) Promoting effective health planning and the provision of quality 15
45	45	health care in the state in a manner that ensures access for all state 16
46	46	residents to cost-effective health care services, avoids the duplication of 17
47	47	such services and improves the availability and financial stability of 18
48	48	such services throughout the state; 19
49	49	(3) [Directing] (A) Developing, innovating, directing and overseeing 20
50	50	health care delivery and payment models in the state that reduce health 21
51	51	care cost growth and improve the quality of patient care, including, but 22
52	52	not limited to, the State Innovation Model Initiative and related 23
53	53	successor initiatives, (B) setting an annual health care cost growth 24
54	54	benchmark and primary care target pursuant to section 3 of this act, (C) 25
55	55	developing and adopting health care quality benchmarks pursuant to 26
56	56	section 8 of this act, (D) enhancing the transparency of health care 27
57	57	entities, as defined in section 2 of this act, (E) monitoring the 28
58	58	development of accountable care organizations and patient-centered 29
59	59	medical homes in the state, and (F) monitoring the adoption of 30
60	60	alternative payment methodologies in the state; 31
61	61	(4) (A) Coordinating the state's health information technology 32
62	62	initiatives, (B) seeking funding for and overseeing the planning, 33
63	63	implementation and development of policies and procedures for the 34
64	64	administration of the all-payer claims database program established 35
65	65	under section 19a-775a, (C) establishing and maintaining a consumer 36
66	66	health information Internet web site under section 19a-755b, and (D) 37
67	67	designating an unclassified individual from the office to perform the 38
68	68	duties of a health information technology officer as set forth in sections 39
69	69	17b-59f and 17b-59g; 40
70	70	(5) Directing and overseeing the Health Systems Planning Unit 41
71	71	established under section 19a-612 and all of its duties and 42
72	72	responsibilities as set forth in chapter 368z; and 43
73	73	(6) Convening forums and meetings with state government and 44
74	74	external stakeholders, including, but not limited to, the Connecticut 45 Raised Bill No. 328
75	75
76	76
77	77
78	78	LCO No. 1988 3 of 40
79	79
80	80	Health Insurance Exchange, to discuss health care issues designed to 46
81	81	develop effective health care cost and quality strategies. 47
82	82	(c) The Office of Health Strategy shall constitute a successor, in 48
83	83	accordance with the provisions of sections 4-38d, 4-38e and 4-39, to the 49
84	84	functions, powers and duties of the following: 50
85	85	(1) The Connecticut Health Insurance Exchange, established 51
86	86	pursuant to section 38a-1081, relating to the administration of the all-52
87	87	payer claims database pursuant to section 19a-755a; and 53
88	88	(2) The Office of the Lieutenant Governor, relating to the (A) 54
89	89	development of a chronic disease plan pursuant to section 19a-6q, (B) 55
90	90	housing, chairing and staffing of the Health Care Cabinet pursuant to 56
91	91	section 19a-725, and (C) (i) appointment of the health information 57
92	92	technology officer, and (ii) oversight of the duties of such health 58
93	93	information technology officer as set forth in sections 17b-59f and 17b-59
94	94	59g. 60
95	95	(d) Any order or regulation of the entities listed in subdivisions (1) 61
96	96	and (2) of subsection (c) of this section that is in force on July 1, 2018, 62
97	97	shall continue in force and effect as an order or regulation until 63
98	98	amended, repealed or superseded pursuant to law. 64
99	99	Sec. 2. (NEW) (Effective July 1, 2020) For the purposes of this section 65
100	100	and sections 3 to 9, inclusive, of this act: 66
101	101	(1) "Device manufacturer" means a manufacturer that manufactures 67
102	102	a device for which annual sales in this state exceed ten million dollars; 68
103	103	(2) "Drug manufacturer" means the manufacturer of a drug that is: 69
104	104	(A) Included in information and data submitted by a health carrier 70
105	105	pursuant to section 38a-479qqq of the general statutes; (B) studied or 71
106	106	listed pursuant to subsection (c) or (d) of section 19a-754b of the general 72
107	107	statutes; or (C) in a therapeutic class of drugs that the executive director 73
108	108	determines, through public or private reports, has had a substantial 74
109	109	impact on prescription drug expenditures, net of rebates, as a 75 Raised Bill No. 328
110	110
111	111
112	112
113	113	LCO No. 1988 4 of 40
114	114
115	115	percentage of total health care expenditures; 76
116	116	(3) "Executive director" means the executive director of the office; 77
117	117	(4) "Health care cost growth benchmark" means the annual 78
118	118	benchmark established pursuant to section 3 of this act; 79
119	119	(5) "Health care entity" means an accountable care organization, 80
120	120	ambulatory surgical center, clinic, hospital or provider organization in 81
121	121	this state, other than a health care provider contracting unit that, for a 82
122	122	given calendar year: (A) Has a patient panel of not more than ten 83
123	123	thousand patients; or (B) represents health care providers who 84
124	124	collectively receive less than twenty million dollars in net patient service 85
125	125	revenue from health carriers; 86
126	126	(6) "Health care facility" has the same meaning as provided in section 87
127	127	19a-630 of the general statutes; 88
128	128	(7) "Health care quality benchmark" means an annual benchmark 89
129	129	established pursuant to section 8 of this act; 90
130	130	(8) "Health care provider" has the same meaning as provided in 91
131	131	section 19a-17b of the general statutes; 92
132	132	(9) "Health status adjusted total medical expenses" means: (A) The 93
133	133	total cost of care for the patient population of a provider organization 94
134	134	with at least thirty-six thousand member months for a given calendar 95
135	135	year, which cost (i) is calculated for such year on the basis of the allowed 96
136	136	claims for all categories of medical expenses and all nonclaims 97
137	137	payments for such year, including, but not limited to, cost-sharing 98
138	138	payments, adjusted by health status and expressed on a per member, 99
139	139	per month basis for all members in this state, (ii) is reported to the 100
140	140	executive director separately for Medicaid, Medicare and 101
141	141	nongovernment health plans for such year, and (iii) discloses the health 102
142	142	adjustment risk score and the version of the risk adjustment tool used to 103
143	143	calculate such score for such provider organization for such year; and 104
144	144	(B) the total aggregate medical expenses for all health care providers and 105 Raised Bill No. 328
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146	146
147	147
148	148	LCO No. 1988 5 of 40
149	149
150	150	provider organizations with fewer than thirty-six thousand member 106
151	151	months for a given calendar year; 107
152	152	(10) "Hospital outpatient department" has the same meaning as such 108
153	153	term is used in Section 413.65 of Title 42 of the Code of Federal 109
154	154	Regulations, as amended from time to time; 110
155	155	(11) "Institutional provider" means any health care provider that 111
156	156	provides skilled nursing facility services, or acute, chronic or 112
157	157	rehabilitation hospital services, in this state; 113
158	158	(12) "Office" means the Office of Health Strategy established under 114
159	159	section 19a-754a of the general statutes, as amended by this act; 115
160	160	(13) "Other entity" means a device manufacturer, drug manufacturer 116
161	161	or pharmacy benefits manager; 117
162	162	(14) "Payer" means a payer that, during a given calendar year, pays 118
163	163	health care providers for health care services on behalf of, or pays 119
164	164	pharmacies for prescription drugs dispensed to, more than ten 120
165	165	thousand individuals in this state; 121
166	166	(15) "Pharmacy benefits manager" has the same meaning as provided 122
167	167	in section 38a-479ooo of the general statutes; 123
168	168	(16) "Primary care target" means the annual target established 124
169	169	pursuant to section 3 of this act; 125
170	170	(17) "Provider organization" means a group of persons, including, but 126
171	171	not limited to, an accountable care organization, association, business 127
172	172	trust, corporation, independent practice association, partnership, 128
173	173	physician organization, physician-hospital organization or provider 129
174	174	network, that is in the business of health care delivery or management 130
175	175	in this state and represents a health care provider in contracting with a 131
176	176	payer for payment for health care services; and 132
177	177	(18) "Total health care expenditures" means the per capita sum of all 133
178	178	health care expenditures in this state from public and private sources 134 Raised Bill No. 328
179	179
180	180
181	181
182	182	LCO No. 1988 6 of 40
183	183
184	184	for a given calendar year, including: (A) All categories of medical 135
185	185	expenses and all nonclaims payments to health care providers and 136
186	186	health care facilities, as included in the health status adjusted total 137
187	187	medical expenses reported, if any, by the executive director pursuant to 138
188	188	subsection (c) of section 5 of this act; (B) all patient cost-sharing 139
189	189	amounts, including, but not limited to, deductibles and copayments; (C) 140
190	190	the net cost of nongovernment health insurance; (D) prescription drug 141
191	191	expenditures net of rebates and discounts; (E) device manufacturer 142
192	192	expenditures net of rebates and discounts; and (F) any other 143
193	193	expenditures specified by the executive director. 144
194	194	Sec. 3. (NEW) (Effective July 1, 2020) (a) Not later than December 1, 145
195	195	2020, and annually thereafter, the executive director shall establish a 146
196	196	health care cost growth benchmark for the calendar year next 147
197	197	succeeding. Such health care cost growth benchmark shall address the 148
198	198	average growth in total health care expenditures across all payers and 149
199	199	populations in this state for such year, and the executive director shall 150
200	200	include within such health care cost growth benchmark a primary care 151
201	201	target to ensure primary care spending as a percentage of total health 152
202	202	care expenditures reaches a goal of ten per cent for the calendar year 153
203	203	beginning January 1, 2025. 154
204	204	(b) In establishing each health care cost growth benchmark pursuant 155
205	205	to subsection (a) of this section, the executive director shall, at a 156
206	206	minimum: 157
207	207	(1) Consider any change in the consumer price index for all urban 158
208	208	consumers in the northeast region from the preceding calendar year, 159
209	209	and the most recent publicly available information concerning the 160
210	210	growth rate of the gross state product; 161
211	211	(2) Evaluate current primary care spending as a percentage of total 162
212	212	health care expenditures; and 163
213	213	(3) (A) Hold an informational public hearing concerning such health 164
214	214	care cost growth benchmark: 165 Raised Bill No. 328
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216	216
217	217
218	218	LCO No. 1988 7 of 40
219	219
220	220	(i) At a time and place designated by the executive director in a notice 166
221	221	prominently posted by the executive director on the office's Internet 167
222	222	web site; 168
223	223	(ii) In a form and manner prescribed by the executive director; and 169
224	224	(iii) On the basis of the most recent report, if any, prepared by the 170
225	225	executive director pursuant to subsection (c) of section 5 of this act, and 171
226	226	any other information that the executive director, in the executive 172
227	227	director's discretion, deems relevant for the purposes of such hearing. 173
228	228	(B) Notwithstanding subparagraph (A) of this subdivision, the 174
229	229	executive director shall not be required to hold an informational public 175
230	230	hearing concerning a health care cost growth benchmark for any 176
231	231	calendar year beginning on or after January 1, 2022, if such health care 177
232	232	cost growth benchmark is the same as the health care cost growth 178
233	233	benchmark for the preceding calendar year. 179
234	234	(c) If the executive director determines, after any informational public 180
235	235	hearing held pursuant to subdivision (3) of subsection (b) of this section, 181
236	236	that a modification to the health care cost growth benchmark is, in the 182
237	237	executive director's discretion, reasonably warranted, the executive 183
238	238	director may modify such health care cost growth benchmark. The 184
239	239	executive director need not hold an additional informational public 185
240	240	hearing concerning such modified health care cost growth benchmark. 186
241	241	(d) The executive director shall post each health care cost growth 187
242	242	benchmark on the office's Internet web site. 188
243	243	(e) The executive director may enter into such contractual agreements 189
244	244	as may be necessary to carry out the purposes of this section, including, 190
245	245	but not limited to, contractual agreements with actuarial, economic and 191
246	246	other experts and consultants to assist the executive director in 192
247	247	establishing health care cost growth benchmarks. 193
248	248	Sec. 4. (NEW) (Effective July 1, 2020) (a) (1) Not later than May 1, 2022, 194
249	249	and annually thereafter, the executive director shall hold an 195 Raised Bill No. 328
250	250
251	251
252	252
253	253	LCO No. 1988 8 of 40
254	254
255	255	informational public hearing to compare the growth in total health care 196
256	256	expenditures during the preceding calendar year to the health care cost 197
257	257	growth benchmark established pursuant to section 3 of this act for such 198
258	258	year. Such hearing shall include an examination of: 199
259	259	(A) The report, if any, most recently prepared by the executive 200
260	260	director pursuant to subsection (c) of section 5 of this act; 201
261	261	(B) The expenditures of health care entities and payers, including, but 202
262	262	not limited to, health care cost trends, primary care spending as a 203
263	263	percentage of total health care expenditures, and the factors 204
264	264	contributing to such costs and expenditures; 205
265	265	(C) Whether one category of expenditures may be offset by savings 206
266	266	in another category of expenditures; and 207
267	267	(D) Any other matters that the executive director, in the executive 208
268	268	director's discretion, deems relevant for the purposes of this section. 209
269	269	(2) The executive director may require that any health care entity or 210
270	270	payer that is found to be a significant contributor to health care cost 211
271	271	growth in this state during the preceding calendar year participate in 212
272	272	such hearing. Each such health care entity or payer that is required to 213
273	273	participate in such hearing shall provide testimony on issues identified 214
274	274	by the executive director, and provide additional information on actions 215
275	275	taken to reduce such health care entity's contribution to future state-216
276	276	wide health care costs and expenditures. 217
277	277	(b) Not later than October 1, 2022, and annually thereafter, the 218
278	278	executive director shall prepare and submit a report, in accordance with 219
279	279	section 11-4a of the general statutes, to the joint standing committees of 220
280	280	the General Assembly having cognizance of matters relating to 221
281	281	insurance and public health. Such report shall be based on the executive 222
282	282	director's analysis of the information submitted during the most recent 223
283	283	informational public hearing conducted pursuant to subsection (a) of 224
284	284	this section and any other information that the executive director, in the 225
285	285	executive director's discretion, deems relevant for the purposes of this 226 Raised Bill No. 328
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287	287
288	288
289	289	LCO No. 1988 9 of 40
290	290
291	291	section, and shall: 227
292	292	(1) Describe health care spending trends in this state, including, but 228
293	293	not limited to, trends in primary care spending as a percentage of total 229
294	294	health care expenditures, and the factors underlying such trends; and 230
295	295	(2) Disclose the executive director's recommendations, if any, 231
296	296	concerning strategies to increase the efficiency of this state's health care 232
297	297	system, including, but not limited to, any recommended legislation 233
298	298	concerning this state's health care system. 234
299	299	Sec. 5. (NEW) (Effective July 1, 2020) (a) Not later than March 1, 2022, 235
300	300	and annually thereafter, each institutional provider, on behalf of such 236
301	301	institutional provider and its parent organization and affiliated entities, 237
302	302	health care provider that is not an institutional provider and provider 238
303	303	organization in this state, shall submit to the executive director, for the 239
304	304	preceding calendar year: 240
305	305	(1) Data concerning: 241
306	306	(A) The utilization of health care services provided by such provider 242
307	307	or organization; 243
308	308	(B) The charges, prices imposed and payments received by such 244
309	309	provider or organization for such services; 245
310	310	(C) The costs incurred, and revenues earned, by such provider or 246
311	311	organization in providing such services; and 247
312	312	(D) Any other matter that the executive director deems relevant for 248
313	313	the purposes of this section; and 249
314	314	(2) If such provider is a hospital, the data described in subdivision (1) 250
315	315	of this subsection, and such additional data, information and documents 251
316	316	designated by the executive director, including, but not limited to, 252
317	317	charge masters, cost data, audited financial statements and merged 253
318	318	billing and discharge data, provided such provider shall not be required 254
319	319	to submit any data contained in a report that is filed pursuant to 255 Raised Bill No. 328
320	320
321	321
322	322
323	323	LCO No. 1988 10 of 40
324	324
325	325	chapters 368aa to 368ll, inclusive, of the general statutes and available to 256
326	326	the executive director. 257
327	327	(b) The executive director shall establish standards to ensure that the 258
328	328	data, information and documents submitted to the executive director 259
329	329	pursuant to subsection (a) of this section are submitted to the executive 260
330	330	director in a uniform manner. Such standards shall enable the executive 261
331	331	director to identify, on a patient-centered and health care provider-262
332	332	specific basis, state-wide and regional trends in the availability, cost, 263
333	333	price and utilization of medical, surgical, diagnostic and ancillary 264
334	334	services and prescription drugs provided by hospital outpatient 265
335	335	departments, acute care hospitals, chronic disease hospitals, 266
336	336	rehabilitation hospitals and other specialty hospitals, clinics, including, 267
337	337	but not limited to, psychiatric clinics, urgent care facilities and facilities 268
338	338	providing ambulatory care. Such standards may require hospitals to 269
339	339	submit such data, information and documents to the executive director 270
340	340	in an electronic form, provided such standards shall provide for a 271
341	341	waiver of such requirement if such waiver is reasonable in the judgment 272
342	342	of the executive director. 273
343	343	(c) (1) Not later than December 1, 2021, and annually thereafter, the 274
344	344	executive director shall prepare, to the extent practicable, and post on 275
345	345	the office's Internet web site, a report concerning health status adjusted 276
346	346	total medical expenses for the preceding calendar year, including, but 277
347	347	not limited to, a breakdown of such health status adjusted total medical 278
348	348	expenses by: 279
349	349	(A) Major service category; 280
350	350	(B) Payment methodology; 281
351	351	(C) Relative price; 282
352	352	(D) Direct hospital inpatient cost; 283
353	353	(E) Indirect hospital inpatient cost; 284
354	354	(F) Direct hospital outpatient cost; 285 Raised Bill No. 328
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356	356
357	357
358	358	LCO No. 1988 11 of 40
359	359
360	360	(G) Indirect hospital outpatient cost; and 286
361	361	(H) Primary care spending as a percentage of total health care 287
362	362	expenditures. 288
363	363	(2) Notwithstanding subdivision (1) of this subsection, the executive 289
364	364	director shall not disclose any health care provider-specific data or 290
365	365	information unless the executive director provides at least ten days' 291
366	366	advance written notice of such disclosure to each health care provider 292
367	367	that would be affected by such disclosure. 293
368	368	(d) The executive director shall, at least annually, submit a request to 294
369	369	the federal Centers for Medicare and Medicaid Services for the health 295
370	370	status adjusted total medical expenses of provider organizations that 296
371	371	served Medicare patients during the calendar year next preceding. 297
372	372	(e) The executive director may enter into such contractual agreements 298
373	373	as may be necessary to carry out the purposes of this section, including, 299
374	374	but not limited to, contractual agreements with actuarial, economic and 300
375	375	other experts and consultants. 301
376	376	Sec. 6. (NEW) (Effective July 1, 2020) (a) (1) For each calendar year 302
377	377	beginning on or after January 1, 2022, if the executive director 303
378	378	determines that the average annual percentage change in total health 304
379	379	care expenditures for the preceding calendar year exceeded the health 305
380	380	care cost growth benchmark for such year, the executive director shall 306
381	381	identify, not later than May first of such calendar year, each health care 307
382	382	entity or payer that exceeded such health care cost growth benchmark 308
383	383	for such year. 309
384	384	(2) The executive director may require any health care entity or payer 310
385	385	that is found to be a significant contributor to health care cost growth in 311
386	386	this state during the preceding calendar year to participate in the 312
387	387	informational public hearing held pursuant to subsection (a) of section 313
388	388	4 of this act. Each such entity or payer that is required to participate in 314
389	389	such hearing shall provide testimony on issues identified by the 315
390	390	executive director, and provide additional information on actions taken 316 Raised Bill No. 328
391	391
392	392
393	393
394	394	LCO No. 1988 12 of 40
395	395
396	396	to reduce such entity's or payer's contribution to future state-wide 317
397	397	health care costs. 318
398	398	(b) Not later than thirty days after the executive director identifies 319
399	399	each health care entity or payer pursuant to subdivision (1) of subsection 320
400	400	(a) of this section, the executive director shall send a notice to each such 321
401	401	entity or payer. Such notice shall be in a form and manner prescribed by 322
402	402	the executive director, and disclose to each such entity or payer: 323
403	403	(1) That the executive director has identified such entity or payer 324
404	404	pursuant to subdivision (1) of subsection (a) of this section; 325
405	405	(2) The factual basis for the executive director's identification of such 326
406	406	entity or payer pursuant to subdivision (1) of subsection (a) of this 327
407	407	section; and 328
408	408	(3) That such entity or payer shall file a proposed performance 329
409	409	improvement plan pursuant to subdivision (1) of subsection (e) of this 330
410	410	section, provided such entity or payer may: 331
411	411	(A) File a request for an extension of time, or a waiver, pursuant to 332
412	412	subdivision (1) of subsection (c) of this section; and 333
413	413	(B) Request a hearing pursuant to subsection (d) of this section. 334
414	414	(c) (1) (A) Each health care entity or payer identified by the executive 335
415	415	director pursuant to subdivision (1) of subsection (a) of this section may, 336
416	416	not later than thirty days after the executive director sends a notice to 337
417	417	such entity or payer pursuant to subsection (b) of this section, file with 338
418	418	the executive director, in a form and manner prescribed by the executive 339
419	419	director, a request seeking: 340
420	420	(i) An extension of time to file a proposed performance improvement 341
421	421	plan pursuant to subdivision (1) of subsection (e) of this section; or 342
422	422	(ii) A waiver from the requirement that such entity or payer file a 343
423	423	proposed performance improvement plan pursuant to subdivision (1) 344
424	424	of subsection (e) of this section. 345 Raised Bill No. 328
425	425
426	426
427	427
428	428	LCO No. 1988 13 of 40
429	429
430	430	(B) Each health care entity or payer that files a request pursuant to 346
431	431	subparagraph (A) of this subdivision shall set forth in such request the 347
432	432	reasons for such request. 348
433	433	(2) Not later than thirty days after a health care entity or payer files a 349
434	434	request pursuant to subdivision (1) of this subsection, the executive 350
435	435	director shall: 351
436	436	(A) Examine the reasons set forth in the request and decide, on the 352
437	437	basis of such reasons, whether to approve or deny such request; and 353
438	438	(B) Send a notice, in a form and manner prescribed by the executive 354
439	439	director, to the entity or payer that filed such request disclosing, at a 355
440	440	minimum: 356
441	441	(i) The executive director's decision concerning such request and the 357
442	442	reasons therefor; 358
443	443	(ii) If the executive director denies such entity's or payer's request, 359
444	444	that such entity or payer may file a request for a hearing pursuant to 360
445	445	subsection (d) of this section; and 361
446	446	(iii) If such entity's or payer's request is a request for an extension of 362
447	447	time to file a proposed performance improvement plan pursuant to 363
448	448	subdivision (1) of subsection (e) of this section and the executive director 364
449	449	approves such request, the date by which such entity or payer shall file 365
450	450	such proposed performance improvement plan. 366
451	451	(d) Each health care entity or payer identified by the executive 367
452	452	director pursuant to subsection (a) of this section may, not later than 368
453	453	thirty days after the executive director sends a notice to such entity or 369
454	454	payer pursuant to subsection (b) of this section or subparagraph (B) of 370
455	455	subdivision (2) of subsection (c) of this section, as applicable, file with 371
456	456	the executive director a request for a hearing. Each hearing conducted 372
457	457	pursuant to this subsection shall be conducted in accordance with the 373
458	458	procedures for hearings on contested cases established in chapter 54 of 374
459	459	the general statutes. 375 Raised Bill No. 328
460	460
461	461
462	462
463	463	LCO No. 1988 14 of 40
464	464
465	465	(e) (1) Each health care entity or payer identified by the executive 376
466	466	director pursuant to subdivision (1) of subsection (a) of this section, or 377
467	467	required by the executive director pursuant to subparagraph (C)(ii)(III) 378
468	468	of subdivision (4) of subsection (f) of this section, shall, subject to the 379
469	469	provisions of subsections (b) to (d), inclusive, of this section, file with 380
470	470	the executive director a proposed performance improvement plan. Such 381
471	471	entity or payer shall file such proposed performance improvement plan, 382
472	472	which shall include an implementation timetable, with the executive 383
473	473	director, in a form and manner prescribed by the executive director, not 384
474	474	later than whichever of the following dates first occurs: 385
475	475	(A) The date that is thirty days after the date on which the executive 386
476	476	director sent a notice to such entity or payer pursuant to subsection (b) 387
477	477	of this section; 388
478	478	(B) The date that the executive director disclosed to such entity or 389
479	479	payer pursuant to subparagraph (B)(iii) of subdivision (2) of subsection 390
480	480	(c) of this section; or 391
481	481	(C) The date that is thirty days after the date on which the notice of a 392
482	482	final decision is issued following a hearing conducted pursuant to 393
483	483	subsection (d) of this section. 394
484	484	(2) (A) The executive director shall review each health care entity's 395
485	485	and payer's proposed performance improvement plan filed pursuant to 396
486	486	subdivision (1) of this subsection to determine whether, in the executive 397
487	487	director's judgment, it is reasonably likely that: 398
488	488	(i) Such proposed performance improvement plan will address the 399
489	489	cause of such entity's or payer's excessive cost growth; and 400
490	490	(ii) Such entity or payer will successfully implement such proposed 401
491	491	performance improvement plan. 402
492	492	(B) After the executive director reviews a proposed performance 403
493	493	improvement plan pursuant to subparagraph (A) of this subdivision, 404
494	494	the executive director shall: 405 Raised Bill No. 328
495	495
496	496
497	497
498	498	LCO No. 1988 15 of 40
499	499
500	500	(i) Approve such proposed performance improvement plan if the 406
501	501	executive director determines, in the executive director's judgment, that 407
502	502	such proposed plan satisfies the criteria established in subparagraph (A) 408
503	503	of this subdivision; or 409
504	504	(ii) Deny such proposed performance improvement plan if the 410
505	505	executive director determines, in the executive director's judgment, that 411
506	506	such proposed performance improvement plan does not satisfy the 412
507	507	criteria established in subparagraph (A) of this subdivision. 413
508	508	(C) (i) Not later than thirty days after the executive director approves 414
509	509	or denies a proposed performance improvement plan pursuant to 415
510	510	subparagraph (B) of this subdivision, the executive director shall send a 416
511	511	notice to the health care entity or payer that filed such proposed 417
512	512	performance improvement plan disclosing, at a minimum, that: 418
513	513	(I) The executive director approved such proposed performance 419
514	514	improvement plan; or 420
515	515	(II) The executive director denied such proposed performance 421
516	516	improvement plan, the reasons for such denial and that such entity or 422
517	517	payer shall file with the executive director such amendments as are 423
518	518	necessary for such proposed performance improvement plan to satisfy 424
519	519	the criteria established in subparagraph (A) of this subdivision. 425
520	520	(ii) The executive director shall post a notice on the office's Internet 426
521	521	web site disclosing: 427
522	522	(I) The name of each health care entity or payer that files, and receives 428
523	523	approval for, a proposed performance improvement plan; and 429
524	524	(II) That such health care entity or payer is implementing such 430
525	525	performance improvement plan. 431
526	526	(D) Each health care entity or payer that receives a notice from the 432
527	527	executive director pursuant to subparagraph (C)(i) of this subdivision 433
528	528	notifying such entity or payer that the executive director has denied 434
529	529	such entity's or payer's proposed performance improvement plan shall 435 Raised Bill No. 328
530	530
531	531
532	532
533	533	LCO No. 1988 16 of 40
534	534
535	535	file with the executive director, in a form and manner prescribed by the 436
536	536	executive director and not later than thirty days after the date that the 437
537	537	executive director sends such notice to such entity or payer, such 438
538	538	amendments as are necessary for such proposed performance 439
539	539	improvement plan to satisfy the criteria established in subparagraph (A) 440
540	540	of this subdivision. 441
541	541	(f) (1) Each health care entity or payer that receives a notice from the 442
542	542	executive director pursuant to subparagraph (C)(i) of subdivision (2) of 443
543	543	subsection (e) of this section notifying such entity or payer that the 444
544	544	executive director has approved such entity's or payer's proposed 445
545	545	performance improvement plan: 446
546	546	(A) Shall immediately make good faith efforts to implement such 447
547	547	performance improvement plan; and 448
548	548	(B) May amend such plan at any time during the implementation 449
549	549	timetable included in such performance improvement plan, provided 450
550	550	the executive director approves such amendment. 451
551	551	(2) The office may provide such assistance to each health care entity 452
552	552	or payer that the executive director, in the executive director's 453
553	553	discretion, deems necessary and appropriate to ensure that such entity 454
554	554	or payer successfully implements such entity's or payer's performance 455
555	555	improvement plan. 456
556	556	(3) Each health care entity or payer shall be subject to such additional 457
557	557	reporting requirements that the executive director, in the executive 458
558	558	director's discretion, deems necessary to ensure that such entity or payer 459
559	559	successfully implements such entity's or payer's performance 460
560	560	improvement plan. 461
561	561	(4) (A) Each health care entity or payer that files, and receives 462
562	562	approval for, a performance improvement plan pursuant to this section 463
563	563	shall, not later than thirty days after the last date specified in the 464
564	564	implementation timetable included in such performance improvement 465
565	565	plan, submit to the executive director, in a form and manner prescribed 466 Raised Bill No. 328
566	566
567	567
568	568
569	569	LCO No. 1988 17 of 40
570	570
571	571	by the executive director, a report regarding the outcome of such entity's 467
572	572	or payer's implementation of such performance improvement plan. 468
573	573	(B) If the executive director determines, on the basis of the report 469
574	574	submitted by a health care entity or payer pursuant to subparagraph (A) 470
575	575	of this subdivision, that such entity or payer successfully implemented 471
576	576	such entity's or payer's performance improvement plan, the executive 472
577	577	director shall: 473
578	578	(i) Send a notice to such entity or payer, in a form and manner 474
579	579	prescribed by the executive director, disclosing such determination; and 475
580	580	(ii) Remove from the office's Internet web site the notice concerning 476
581	581	such entity or payer that the executive director posted on such Internet 477
582	582	web site pursuant to subparagraph (C)(ii) of subdivision (2) of 478
583	583	subsection (e) of this section. 479
584	584	(C) If the executive director determines, on the basis of the report 480
585	585	submitted by a health care entity or payer pursuant to subparagraph (A) 481
586	586	of this subdivision, that such entity or payer failed to successfully 482
587	587	implement such entity's or payer's performance improvement plan, the 483
588	588	executive director shall: 484
589	589	(i) Send a notice to such entity or payer, in a form and manner 485
590	590	prescribed by the executive director, disclosing such determination and 486
591	591	any action taken by the executive director pursuant to clause (ii) of this 487
592	592	subparagraph; and 488
593	593	(ii) In the executive director's discretion: 489
594	594	(I) Extend the implementation timetable included in such 490
595	595	performance improvement plan; 491
596	596	(II) Require such entity or payer to file with the executive director, in 492
597	597	a form and manner prescribed by the executive director, such 493
598	598	amendments to such performance improvement plan as are, in the 494
599	599	executive director's judgment, necessary to ensure that such entity or 495
600	600	payer successfully implements such performance improvement plan; 496 Raised Bill No. 328
601	601
602	602
603	603
604	604	LCO No. 1988 18 of 40
605	605
606	606	(III) Require such entity or payer to file a new proposed performance 497
607	607	improvement plan pursuant to subdivision (1) of subsection (e) of this 498
608	608	section; or 499
609	609	(IV) Waive or delay the requirement that such entity or payer file any 500
610	610	future proposed performance improvement plan until the executive 501
611	611	director determines, in the executive director's discretion, that such 502
612	612	entity or payer has successfully implemented its current performance 503
613	613	improvement plan. 504
614	614	(g) The executive director shall keep confidential all nonpublic 505
615	615	clinical, financial, operational or strategic documents and information 506
616	616	filed with, or submitted to, the executive director pursuant to this 507
617	617	section. The executive director shall not disclose any such document or 508
618	618	information to any person without the consent of the health care entity 509
619	619	or payer that filed such document or information with, or submitted 510
620	620	such document or information to, the executive director pursuant to this 511
621	621	section, except in summary form as part of an evaluative report if the 512
622	622	executive director determines that such disclosure should be made in 513
623	623	the public interest after taking into account any privacy, trade secret or 514
624	624	anti-competitive considerations. Notwithstanding any provision of the 515
625	625	general statutes, no document or information filed with, or submitted 516
626	626	to, the executive director pursuant to this section shall be deemed to be 517
627	627	a public record or subject to disclosure under the Freedom of 518
628	628	Information Act, as defined in section 1-200 of the general statutes. 519
629	629	Sec. 7. (NEW) (Effective July 1, 2020) (a) (1) For each calendar year 520
630	630	beginning on or after January 1, 2022, if the executive director 521
631	631	determines that the average annual percentage change in total health 522
632	632	care expenditures for the preceding calendar year exceeded the health 523
633	633	care cost growth benchmark for such year, the executive director shall 524
634	634	identify each other entity that significantly contributed to exceeding 525
635	635	such benchmark. Each identification shall be based on: 526
636	636	(A) The report, if any, prepared by the executive director pursuant to 527
637	637	subsection (c) of section 5 of this act for such calendar year; 528 Raised Bill No. 328
638	638
639	639
640	640
641	641	LCO No. 1988 19 of 40
642	642
643	643	(B) The report filed pursuant to section 38a-479ppp of the general 529
644	644	statutes for such calendar year; 530
645	645	(C) The information and data reported to the office pursuant to 531
646	646	section 19a-754b of the general statutes for such calendar year; 532
647	647	(D) Information obtained from the all-payer claims database 533
648	648	established under section 19a-755a of the general statutes; and 534
649	649	(E) Any other information that the executive director, in the executive 535
650	650	director's discretion, deems relevant for the purposes of this section. 536
651	651	(2) The executive director shall account for costs, net of rebates and 537
652	652	discounts, when identifying other entities pursuant to this section. 538
653	653	(b) The executive director may require that any other entity that is 539
654	654	found to be a significant contributor to health care cost growth in this 540
655	655	state during the preceding calendar year participate in the informational 541
656	656	public hearing held pursuant to subsection (a) of section 4 of this act. 542
657	657	Each such other entity that is required to participate in such hearing 543
658	658	shall provide testimony on issues identified by the executive director, 544
659	659	and provide additional information on actions taken to reduce such 545
660	660	other entity's contribution to future state-wide health care costs. If such 546
661	661	other entity is a drug manufacturer, and the executive director requires 547
662	662	that such drug manufacturer participate in such hearing with respect to 548
663	663	a specific drug or class of drugs, such hearing may, to the extent 549
664	664	possible, include representatives from at least one brand-name 550
665	665	manufacturer, one generic manufacturer and one innovator company 551
666	666	that is less than ten years old. 552
667	667	Sec. 8. (NEW) (Effective July 1, 2020) (a) (1) For each calendar year 553
668	668	beginning on or after January 1, 2022, the executive director shall 554
669	669	develop and adopt annual health care quality benchmarks for health 555
670	670	care entities and payers that: 556
671	671	(A) Enable health care entities and payers to report to the executive 557
672	672	director a standard set of information concerning health care quality for 558 Raised Bill No. 328
673	673
674	674
675	675
676	676	LCO No. 1988 20 of 40
677	677
678	678	such year; and 559
679	679	(B) Include measures concerning clinical health outcomes, 560
680	680	overutilization, underutilization and safety measures. 561
681	681	(2) In developing annual health care quality benchmarks pursuant to 562
682	682	subdivision (1) of this subsection, the executive director shall: 563
683	683	(A) Consider: 564
684	684	(i) Nationally recognized quality measures that are recommended by 565
685	685	medical groups or provider organizations concerning appropriate 566
686	686	quality measures for such groups' or organizations' specialties; and 567
687	687	(ii) Measures, including, but not limited to, newly developed 568
688	688	measures, that: 569
689	689	(I) Concern health outcomes, overutilization, underutilization and 570
690	690	patient safety; and 571
691	691	(II) Meet standards of patient-centeredness and ensure consideration 572
692	692	of important differences in preferences and clinical characteristics 573
693	693	within patient subpopulations; 574
694	694	(B) Provide stakeholders with an opportunity to engage with the 575
695	695	executive director in developing such benchmarks; and 576
696	696	(C) Ensure that the processes the executive director uses to develop, 577
697	697	and any research that the executive director relies upon in developing, 578
698	698	such benchmarks is transparent. 579
699	699	(b) Not later than October 1, 2021, and annually thereafter, the 580
700	700	executive director shall, prior to adopting health care quality 581
701	701	benchmarks pursuant to subdivision (1) of subsection (a) of this section 582
702	702	for the calendar year next succeeding, hold an informational public 583
703	703	hearing concerning the quality measures the executive director 584
704	704	proposes to adopt as health care quality benchmarks for the calendar 585
705	705	year next succeeding. 586 Raised Bill No. 328
706	706
707	707
708	708
709	709	LCO No. 1988 21 of 40
710	710
711	711	(c) Not later than November 1, 2021, and annually thereafter, the 587
712	712	executive director shall send a notice to each health care entity, payer 588
713	713	and other entity disclosing the health care quality benchmarks that the 589
714	714	executive director has adopted for the calendar year next succeeding. 590
715	715	Sec. 9. (NEW) (Effective July 1, 2020) The executive director may adopt 591
716	716	regulations, in accordance with chapter 54 of the general statutes, to 592
717	717	implement the provisions of sections 2 to 8, inclusive, of this act. 593
718	718	Sec. 10. (NEW) (Effective July 1, 2020) For the purposes of this section 594
719	719	and sections 11 to 15, inclusive, of this act unless the context otherwise 595
720	720	requires: 596
721	721	(1) "Drug" means an article that is (A) recognized in the official United 597
722	722	States Pharmacopoeia, official Homeopathic Pharmacopoeia of the 598
723	723	United States or official National Formulary, or any supplement thereto, 599
724	724	(B) intended for use in the diagnosis, cure, mitigation, treatment or 600
725	725	prevention of disease in humans, (C) not food and intended to affect the 601
726	726	structure or any function of the human body, and (D) not a device and 602
727	727	intended for use as a component of any other article specified in 603
728	728	subparagraphs (A) to (C), inclusive, of this subdivision; 604
729	729	(2) "Drug Quality and Security Act" means the federal Drug Quality 605
730	730	and Security Act, 21 USC 351, et seq., as amended from time to time; 606
731	731	(3) "Food, Drug and Cosmetic Act" means the Federal Food, Drug and 607
732	732	Cosmetic Act, 21 USC 301, et seq., as amended by the Drug Quality and 608
733	733	Security Act, as both may be amended from time to time; 609
734	734	(4) "Laboratory testing" means a quantitative and qualitative analysis 610
735	735	of a prescription drug consistent with the official United States 611
736	736	Pharmacopoeia; 612
737	737	(5) "Legend drug" means a drug that (A) any applicable federal or 613
738	738	state law requires to be (i) dispensed pursuant to a prescription, or (ii) 614
739	739	used by a prescribing practitioner, or (B) applicable federal law requires 615
740	740	to bear the following legend: "RX ONLY" IN ACCORDANCE WITH 616 Raised Bill No. 328
741	741
742	742
743	743
744	744	LCO No. 1988 22 of 40
745	745
746	746	GUIDELINES ESTABLISHED IN THE FEDERAL FOO D, DRUG AND 617
747	747	COSMETIC ACT; 618
748	748	(6) "Participating Canadian supplier" means a manufacturer or 619
749	749	wholesale drug distributor that is (A) licensed or permitted under 620
750	750	applicable Canadian law to manufacture or distribute prescription 621
751	751	drugs, (B) exporting legend drugs, in the manufacturer's original 622
752	752	container, to a participating wholesaler for distribution in this state 623
753	753	under the program, and (C) properly registered, if such Canadian 624
754	754	supplier is required to be registered, with the United States Food and 625
755	755	Drug Administration, or any successor agency; 626
756	756	(7) "Participating wholesaler" means a wholesaler, as defined in 627
757	757	section 21a-70 of the general statutes, that (A) has received a certificate 628
758	758	of registration from the Commissioner of Consumer Protection 629
759	759	pursuant to said section, and (B) is designated by the commissioner to 630
760	760	participate in the program; 631
761	761	(8) "Prescription" means a lawful verbal, written or electronic order 632
762	762	by a prescribing practitioner for a drug for a specific patient; 633
763	763	(9) "Program" means the Canadian legend drug importation program 634
764	764	established by the Commissioner of Consumer Protection pursuant to 635
765	765	section 11 of this act; 636
766	766	(10) "Qualified laboratory" means a laboratory that is (A) adequately 637
767	767	equipped and staffed to properly perform laboratory testing on legend 638
768	768	drugs, and (B) accredited to International Organization for 639
769	769	Standardization (ISO) 17025; and 640
770	770	(11) "Track-and-trace" means the product tracing process for the 641
771	771	components of the pharmaceutical distribution supply chain, as 642
772	772	described in Title II of the Drug Quality and Security Act. 643
773	773	Sec. 11. (NEW) (Effective July 1, 2020) (a) The Commissioner of 644
774	774	Consumer Protection shall establish a program to be known as the 645
775	775	"Canadian legend drug importation program". Under such program, 646 Raised Bill No. 328
776	776
777	777
778	778
779	779	LCO No. 1988 23 of 40
780	780
781	781	the commissioner shall, notwithstanding any contrary provision of the 647
782	782	general statutes: 648
783	783	(1) Provide for the importation of safe and effective legend drugs 649
784	784	from Canada that have the highest potential for cost savings in this state; 650
785	785	and 651
786	786	(2) Designate one or more participating wholesalers to distribute 652
787	787	legend drugs in this state: 653
788	788	(A) In the manufacturer's original container; 654
789	789	(B) From a participating Canadian supplier; and 655
790	790	(C) To a pharmacy or institutional pharmacy, as both terms are 656
791	791	defined in section 20-571 of the general statutes, or a qualified 657
792	792	laboratory. 658
793	793	(b) (1) Not later than July 1, 2021, the Commissioner of Consumer 659
794	794	Protection shall submit a request to the federal Secretary of Health and 660
795	795	Human Services seeking approval for the program under 21 USC 384, 661
796	796	as amended from time to time. Such request shall, at a minimum: 662
797	797	(A) Describe the commissioner's plans for operating the program; 663
798	798	(B) Demonstrate that the legend drugs that will be imported and 664
799	799	distributed in this state under the program shall: 665
800	800	(i) Meet all applicable federal and state standards for safety and 666
801	801	effectiveness; and 667
802	802	(ii) Comply with all federal tracing procedures; and 668
803	803	(C) Disclose the costs of implementing the program. 669
804	804	(2) (A) If the federal Secretary of Health and Human Services 670
805	805	approves the commissioner's request, the commissioner shall: 671
806	806	(i) Submit to the Commissioner of Public Health a notice disclosing 672 Raised Bill No. 328
807	807
808	808
809	809
810	810	LCO No. 1988 24 of 40
811	811
812	812	that the federal Secretary of Health and Human Services has approved 673
813	813	such request; 674
814	814	(ii) Submit to the joint standing committees of the General Assembly 675
815	815	having cognizance of matters relating to appropriations, general law, 676
816	816	human services and public health a notice disclosing that the federal 677
817	817	Secretary of Health and Human Services has approved such request; 678
818	818	and 679
819	819	(iii) Begin operating the program not later than one hundred eighty 680
820	820	days after the date of such approval. 681
821	821	(B) Except as otherwise provided in this subsection, the 682
822	822	Commissioner of Consumer Protection shall not operate the program 683
823	823	unless the federal Secretary of Health and Human Services approves the 684
824	824	commissioner's request. 685
825	825	Sec. 12. (NEW) (Effective July 1, 2020) (a) Each participating 686
826	826	wholesaler may, subject to the provisions of this section and sections 11 687
827	827	and 14 of this act, import into this state a legend drug from a 688
828	828	participating Canadian supplier, and distribute such legend drug to a 689
829	829	pharmacy or institutional pharmacy, as both terms are defined in 690
830	830	section 20-571 of the general statutes, or a qualified laboratory in this 691
831	831	state, under the program if: 692
832	832	(1) Such participating wholesaler: 693
833	833	(A) Is registered with the federal Secretary of Health and Human 694
834	834	Services pursuant to Section 510(b) of the Food, Drug and Cosmetic Act, 695
835	835	21 USC 360(b), as amended from time to time; and 696
836	836	(B) Holds a valid labeler code that has been issued to such 697
837	837	participating wholesaler by the United States Food and Drug 698
838	838	Administration, or any successor agency; and 699
839	839	(2) Such legend drug: 700
840	840	(A) May be imported into this state in accordance with applicable 701 Raised Bill No. 328
841	841
842	842
843	843
844	844	LCO No. 1988 25 of 40
845	845
846	846	federal patent laws; 702
847	847	(B) Meets the United States Food and Drug Administration's, or any 703
848	848	successor agency's, standards concerning drug safety, effectiveness, 704
849	849	misbranding and adulteration; and 705
850	850	(C) Is not: 706
851	851	(i) A controlled substance, as defined in 21 USC 802, as amended from 707
852	852	time to time; 708
853	853	(ii) A biological product, as defined in 42 USC 262, as amended from 709
854	854	time to time; 710
855	855	(iii) An infused drug; 711
856	856	(iv) An intravenously injected drug; 712
857	857	(v) A drug that is inhaled during surgery; or 713
858	858	(vi) A drug that is a parenteral drug, the importation of which is 714
859	859	determined by the federal Secretary of Health and Human Services to 715
860	860	pose a threat to the public health. 716
861	861	(b) Each participating wholesaler shall: 717
862	862	(1) Comply with all applicable track-and-trace requirements, and 718
863	863	make available to the Commissioner of Consumer Protection all track-719
864	864	and-trace records not later than forty-eight hours after the commissioner 720
865	865	requests such records; 721
866	866	(2) Not import, distribute, dispense or sell in this state any legend 722
867	867	drugs under the program except in accordance with the provisions of 723
868	868	this section and sections 11 and 14 of this act; 724
869	869	(3) Not distribute, dispense or sell outside of this state any legend 725
870	870	drugs that are imported into this state under the program; 726
871	871	(4) Ensure the safety and quality of the legend drugs that are 727 Raised Bill No. 328
872	872
873	873
874	874
875	875	LCO No. 1988 26 of 40
876	876
877	877	imported and distributed in this state under the program; 728
878	878	(5) For each initial shipment of a legend drug that is imported into 729
879	879	this state by such participating wholesaler, ensure that a qualified 730
880	880	laboratory engaged by such participating wholesaler tests a statistically 731
881	881	valid sample size for each batch of such legend drug in such shipment 732
882	882	for authenticity and degradation in a manner that is consistent with the 733
883	883	Food, Drug and Cosmetic Act; 734
884	884	(6) For each shipment of a legend drug that is imported into this state 735
885	885	by such participating wholesaler, and sampled and tested pursuant to 736
886	886	subdivision (5) of this subsection, ensure that a qualified laboratory 737
887	887	engaged by such participating wholesaler tests a statistically valid 738
888	888	sample of such legend drug in such shipment for authenticity and 739
889	889	degradation in a manner that is consistent with the Food, Drug and 740
890	890	Cosmetic Act; 741
891	891	(7) Certify to the Commissioner of Consumer Protection that each 742
892	892	legend drug imported into this state under the program: 743
893	893	(A) Is approved for marketing in the United States and not 744
894	894	adulterated or misbranded; and 745
895	895	(B) Meets all labeling requirements under 21 USC 352, as amended 746
896	896	from time to time; 747
897	897	(8) Maintain laboratory records, including, but not limited to, 748
898	898	complete data derived from all tests necessary to ensure that each 749
899	899	legend drug imported into this state under the program satisfies the 750
900	900	requirements of subdivisions (5) and (6) of this subsection; 751
901	901	(9) Maintain documentation demonstrating that the testing required 752
902	902	by subdivisions (5) and (6) of this subsection was conducted at a 753
903	903	qualified laboratory in accordance with the Food, Drug and Cosmetic 754
904	904	Act and all other applicable federal and state laws and regulations 755
905	905	concerning laboratory qualifications; 756
906	906	(10) Maintain the following information for each legend drug that 757 Raised Bill No. 328
907	907
908	908
909	909
910	910	LCO No. 1988 27 of 40
911	911
912	912	such participating wholesaler imports and distributes in this state under 758
913	913	the program, and submit such information to the Commissioner of 759
914	914	Consumer Protection upon request by the commissioner: 760
915	915	(A) The name and quantity of the active ingredient of such legend 761
916	916	drug; 762
917	917	(B) A description of the dosage form of such legend drug; 763
918	918	(C) The date on which such participating wholesaler received such 764
919	919	legend drug; 765
920	920	(D) The quantity of such legend drug that such participating 766
921	921	wholesaler received; 767
922	922	(E) The point of origin and destination of such legend drug; 768
923	923	(F) The price paid by such participating wholesaler for such legend 769
924	924	drug; 770
925	925	(G) A report for any legend drug that fails laboratory testing under 771
926	926	subdivision (5) or (6) of this subsection; and 772
927	927	(H) Such additional information and documentation that the 773
928	928	commissioner deems necessary to ensure the protection of the public 774
929	929	health; and 775
930	930	(11) Maintain all information and documentation that is submitted to 776
931	931	the Commissioner of Consumer Protection pursuant to this subsection 777
932	932	for a period of not less than three years. 778
933	933	Sec. 13. (NEW) (Effective July 1, 2020) Each participating Canadian 779
934	934	supplier shall: 780
935	935	(1) Comply with all applicable track-and-trace requirements; 781
936	936	(2) Not distribute, dispense or sell outside of this state any legend 782
937	937	drugs that are imported into this state under the program; and 783 Raised Bill No. 328
938	938
939	939
940	940
941	941	LCO No. 1988 28 of 40
942	942
943	943	(3) Maintain the following information and documentation and, 784
944	944	upon request by the Commissioner of Consumer Protection, submit 785
945	945	such information and documentation to the commissioner for each 786
946	946	legend drug that such participating Canadian supplier exports into this 787
947	947	state under the program: 788
948	948	(A) The original source of such legend drug, including, but not 789
949	949	limited to: 790
950	950	(i) The name of the manufacturer of such legend drug; 791
951	951	(ii) The date on which such legend drug was manufactured; and 792
952	952	(iii) The location where such legend drug was manufactured; 793
953	953	(B) The date on which such legend drug was shipped to a 794
954	954	participating wholesaler; 795
955	955	(C) The quantity of such legend drug that was shipped to a 796
956	956	participating wholesaler; 797
957	957	(D) The quantity of each lot of such legend drug that such 798
958	958	participating Canadian supplier originally received and the source of 799
959	959	such lot; 800
960	960	(E) The lot or control number and the batch number assigned to such 801
961	961	legend drug by the manufacturer; and 802
962	962	(F) Such additional information and documentation that the 803
963	963	commissioner deems necessary to ensure the protection of the public 804
964	964	health. 805
965	965	Sec. 14. (NEW) (Effective July 1, 2020) (a) The Commissioner of 806
966	966	Consumer Protection shall issue a written order: 807
967	967	(1) Suspending importation and distribution of a legend drug under 808
968	968	the program if the commissioner discovers that such distribution or 809
969	969	importation violates any provision of sections 11 to 13, inclusive, of this 810
970	970	act or any other applicable state or federal law or regulation; 811 Raised Bill No. 328
971	971
972	972
973	973
974	974	LCO No. 1988 29 of 40
975	975
976	976	(2) Suspending all importation and distribution of legend drugs by a 812
977	977	participating wholesaler under the program if the commissioner 813
978	978	discovers that the participating wholesaler has violated any provision 814
979	979	of section 11 or 12 of this act or any other applicable state or federal law 815
980	980	or regulation; 816
981	981	(3) Suspending all importation and distribution of legend drugs by a 817
982	982	participating Canadian supplier under the program if the commissioner 818
983	983	discovers that the participating Canadian supplier has violated any 819
984	984	provision of section 11 or 13 of this act or any other applicable state or 820
985	985	federal law or regulation; or 821
986	986	(4) Requiring the recall or seizure of any legend drug that was 822
987	987	imported and distributed under the program and has been identified as 823
988	988	adulterated, within the meaning of section 21a-105 of the general 824
989	989	statutes, or misbranded. 825
990	990	(b) The Commissioner of Consumer Protection shall send a notice to 826
991	991	each participating Canadian supplier and participating wholesaler 827
992	992	affected by an order issued pursuant to subsection (a) of this section 828
993	993	notifying such participating Canadian supplier or participating 829
994	994	wholesaler that: 830
995	995	(1) The commissioner has issued such order, and providing the legal 831
996	996	and factual basis for such order; and 832
997	997	(2) Such participating Canadian supplier or participating wholesaler 833
998	998	may request, in writing, a hearing before the commissioner, provided 834
999	999	such request is received by the commissioner not later than thirty days 835
1000	1000	after the date of such notice. 836
1001	1001	(c) If a participating Canadian supplier or participating wholesaler 837
1002	1002	timely requests a hearing pursuant to subsection (b) of this section, the 838
1003	1003	Commissioner of Consumer Protection shall, not later than thirty days 839
1004	1004	after the receipt of the request, convene the hearing as a contested case 840
1005	1005	in accordance with the provisions of chapter 54 of the general statutes. 841
1006	1006	Not later than sixty days after the receipt of such request, the 842 Raised Bill No. 328
1007	1007
1008	1008
1009	1009
1010	1010	LCO No. 1988 30 of 40
1011	1011
1012	1012	commissioner shall issue a final decision vacating, modifying or 843
1013	1013	affirming the commissioner's order. A participating Canadian supplier 844
1014	1014	or participating wholesaler aggrieved by a final decision may appeal 845
1015	1015	such decision in accordance with the provisions of section 4-183 of the 846
1016	1016	general statutes. 847
1017	1017	Sec. 15. (NEW) (Effective July 1, 2020) The Commissioner of Consumer 848
1018	1018	Protection may, in consultation with the Commissioner of Public 849
1019	1019	Health, adopt regulations in accordance with the provisions of chapter 850
1020	1020	54 of the general statutes to implement the provisions of sections 10 to 851
1021	1021	14, inclusive, of this act. 852
1022	1022	Sec. 16. Section 38a-8b of the general statutes is repealed and the 853
1023	1023	following is substituted in lieu thereof (Effective January 1, 2021): 854
1024	1024	(a) For the purposes of this section: 855
1025	1025	(1) "Attachment point" means the dollar value of claims incurred by 856
1026	1026	a policyholder at which the insurer that issues or delivers a medical 857
1027	1027	stop-loss insurance policy to the policyholder incurs liability to such 858
1028	1028	policyholder for payment under such medical stop-loss insurance 859
1029	1029	policy; 860
1030	1030	(2) "Employee" has the same meaning as provided in section 38a-564; 861
1031	1031	(3) "Expected claims" means the dollar value of claims that, in the 862
1032	1032	absence of a medical stop-loss insurance policy, the policyholder of a 863
1033	1033	medical stop-loss insurance policy is projected to incur under such 864
1034	1034	policyholder's health benefit plan; 865
1035	1035	(4) "Lasering" means assigning a different attachment point or 866
1036	1036	deductible, or denying coverage altogether, under a medical stop-loss 867
1037	1037	insurance policy for an enrollee or a dependent because the enrollee or 868
1038	1038	dependent has a high-cost preexisting condition or another identified 869
1039	1039	risk; 870
1040	1040	(5) "Medical stop-loss insurance" means stop-loss insurance 871
1041	1041	purchased by a person, other than a health carrier or health care 872 Raised Bill No. 328
1042	1042
1043	1043
1044	1044
1045	1045	LCO No. 1988 31 of 40
1046	1046
1047	1047	provider, and providing coverage for catastrophic, excess or unexpected 873
1048	1048	losses incurred by the policyholder, and due and owing to a third party, 874
1049	1049	under a health benefit plan not providing coverage for retirees; 875
1050	1050	(6) "Medical stop-loss insurer" means an insurer that is licensed 876
1051	1051	pursuant to section 38a-41 to sell, issue and deliver medical stop-loss 877
1052	1052	insurance in this state; 878
1053	1053	(7) "Retiree stop-loss insurance" means stop-loss insurance purchased 879
1054	1054	by a person, other than a health carrier or health care provider, and 880
1055	1055	providing coverage for catastrophic, excess or unexpected losses 881
1056	1056	incurred by the policyholder, and due and owing to a third party, under 882
1057	1057	a health benefit plan providing coverage for retirees; and 883
1058	1058	(8) "Stop-loss insurance" means insurance, other than reinsurance, 884
1059	1059	providing coverage for catastrophic, excess or unexpected losses 885
1060	1060	incurred by the policyholder, and due and owing to a third party, under 886
1061	1061	another insurance policy or a health benefit plan. 887
1062	1062	(b) No [stop loss] stop-loss insurance policy [may] shall be issued or 888
1063	1063	delivered in this state unless a copy of the [stop loss] stop-loss insurance 889
1064	1064	policy form has been submitted to, and approved by, the Insurance 890
1065	1065	Commissioner. [pursuant to regulations that the commissioner may 891
1066	1066	adopt in accordance with chapter 54. Such regulations, if adopted, shall 892
1067	1067	include, but need not be limited to, a definition of a stop loss policy and 893
1068	1068	the standards for filing and review of stop loss policies.] 894
1069	1069	(c) (1) Except as provided in subdivision (4) of subsection (d) of this 895
1070	1070	section, no medical stop-loss insurer shall issue or deliver, and the 896
1071	1071	Insurance Commissioner shall not approve, a medical stop-loss 897
1072	1072	insurance policy in this state on or after January 1, 2021, if the medical 898
1073	1073	stop-loss insurance policy: 899
1074	1074	(A) Imposes an annual attachment point that is less than twenty 900
1075	1075	thousand dollars for claims incurred per enrolled employee or 901
1076	1076	dependent; 902 Raised Bill No. 328
1077	1077
1078	1078
1079	1079
1080	1080	LCO No. 1988 32 of 40
1081	1081
1082	1082	(B) Imposes an annual aggregate attachment point: 903
1083	1083	(i) That is less than the greatest of the following amounts for an 904
1084	1084	insured group consisting of not more than fifty employees, as calculated 905
1085	1085	in the manner set forth in subdivision (2) of this subsection: 906
1086	1086	(I) Four thousand dollars multiplied by the number of employees in 907
1087	1087	such insured group; 908
1088	1088	(II) One hundred twenty per cent of the expected claims for such 909
1089	1089	insured group; or 910
1090	1090	(III) Twenty thousand dollars; or 911
1091	1091	(ii) That is less than one hundred ten per cent of the expected claims 912
1092	1092	for an insured group consisting of more than fifty employees, as 913
1093	1093	calculated in the manner set forth in subdivision (2) of this subsection; 914
1094	1094	(C) Provides direct coverage for an enrollee's or dependent's health 915
1095	1095	care expenses; 916
1096	1096	(D) Provides for a determination regarding whether a benefit is: 917
1097	1097	(i) Medically necessary; 918
1098	1098	(ii) Usual or customary; or 919
1099	1099	(iii) Experimental or investigational; 920
1100	1100	(E) Imposes a case management requirement or an annual dollar 921
1101	1101	limitation for an enrolled employee, dependent or benefit; 922
1102	1102	(F) Requires an enrolled employee or dependent to use a provider 923
1103	1103	network or provides a benefit incentive for an enrolled employee or 924
1104	1104	dependent to use a provider participating in a provider network; 925
1105	1105	(G) Provides the medical stop-loss insurer with a right to examine an 926
1106	1106	enrolled employee or dependent; 927
1107	1107	(H) Permits the medical stop-loss insurer to: 928 Raised Bill No. 328
1108	1108
1109	1109
1110	1110
1111	1111	LCO No. 1988 33 of 40
1112	1112
1113	1113	(i) Deny a claim if the policyholder is legally obligated to pay the 929
1114	1114	claim under such policyholder's health benefit plan; 930
1115	1115	(ii) Rescind such medical stop-loss insurance policy for any reason 931
1116	1116	other than fraud or intentional misrepresentation; 932
1117	1117	(iii) Terminate such medical stop-loss insurance policy, in the sole 933
1118	1118	discretion of such medical stop-loss insurer, in any manner that is 934
1119	1119	inconsistent with applicable laws concerning cancellation or 935
1120	1120	nonrenewal of medical stop-loss insurance policies; or 936
1121	1121	(iv) Increase the rates imposed under such medical stop-loss 937
1122	1122	insurance policy, in the sole discretion of such medical stop-loss insurer, 938
1123	1123	during the term of such medical stop-loss insurance policy; 939
1124	1124	(I) Requires an enrolled employee to be actively at work; or 940
1125	1125	(J) Contains any provision that is misleading, deceptive or contrary 941
1126	1126	to any provision of the general statutes or the public interest. 942
1127	1127	(2) (A) For the purposes of subparagraph (B) of subdivision (1) of this 943
1128	1128	subsection, the number of employees in an insured group shall be 944
1129	1129	determined by adding: 945
1130	1130	(i) The number of the policyholder's full-time employees for each 946
1131	1131	month who work a normal work week of thirty hours or more; and 947
1132	1132	(ii) The number of the policyholder's full-time equivalent employees, 948
1133	1133	calculated for each month by dividing by one hundred twenty the 949
1134	1134	aggregate number of hours worked for such month by employees who 950
1135	1135	work a normal work week of less than thirty hours, and averaging such 951
1136	1136	total for the calendar year. 952
1137	1137	(B) If a policyholder was not in existence throughout the preceding 953
1138	1138	calendar year, the number of employees shall be based on the average 954
1139	1139	number of employees that such policyholder reasonably expects to 955
1140	1140	employ in the current calendar year. 956 Raised Bill No. 328
1141	1141
1142	1142
1143	1143
1144	1144	LCO No. 1988 34 of 40
1145	1145
1146	1146	(d) Each insurer that underwrites a medical stop-loss insurance 957
1147	1147	policy issued or delivered in this state on or after January 1, 2021, may 958
1148	1148	use lasering in underwriting such medical stop-loss insurance policy, 959
1149	1149	provided: 960
1150	1150	(1) If such insurer uses lasering in underwriting such medical stop-961
1151	1151	loss insurance policy, such insurer and any insurance producer who 962
1152	1152	sells, solicits or negotiates such medical stop-loss insurance policy on 963
1153	1153	behalf of such insurer includes in each application for coverage under 964
1154	1154	such medical stop-loss insurance policy: 965
1155	1155	(A) A statement disclosing the increased financial risk that each 966
1156	1156	prospective policyholder under such medical stop-loss insurance policy 967
1157	1157	will bear because such insurer intends to use lasering in underwriting 968
1158	1158	such medical stop-loss insurance policy, and any alternatives available 969
1159	1159	to each such prospective policyholder with respect to such insurer's 970
1160	1160	intended use of lasering in underwriting such medical stop-loss 971
1161	1161	insurance policy; 972
1162	1162	(B) A statement by such insurer or insurance producer, as applicable, 973
1163	1163	affirming that such insurer or insurance producer fully explained to 974
1164	1164	each prospective policyholder under such medical stop-loss insurance 975
1165	1165	policy the increased financial risk described in subparagraph (A) of this 976
1166	1166	subdivision and that each such prospective policyholder understands 977
1167	1167	such increased financial risk; and 978
1168	1168	(C) The signature of such insurer, insurance producer and each 979
1169	1169	prospective policyholder below the statement required under 980
1170	1170	subparagraph (B) of this subdivision; 981
1171	1171	(2) If such insurer uses lasering on the effective date of such medical 982
1172	1172	stop-loss insurance policy, such insurer shall not change such lasering 983
1173	1173	during the term of such medical stop-loss insurance policy; 984
1174	1174	(3) If such insurer does not use lasering on the effective date of such 985
1175	1175	medical stop-loss insurance policy, such insurer shall not use lasering 986
1176	1176	during the term of such medical stop-loss insurance policy; and 987 Raised Bill No. 328
1177	1177
1178	1178
1179	1179
1180	1180	LCO No. 1988 35 of 40
1181	1181
1182	1182	(4) The attachment point for an enrolled employee under such 988
1183	1183	medical stop-loss insurance policy shall not exceed an amount that is 989
1184	1184	equal to three hundred per cent of the attachment point for such medical 990
1185	1185	stop-loss insurance policy. 991
1186	1186	(e) No retiree stop-loss insurance policy issued or delivered in this 992
1187	1187	state on or after January 1, 2021, shall be subject to the provisions of 993
1188	1188	subsection (c) or (d) of this section, and the Insurance Commissioner 994
1189	1189	shall review and approve, on a case-by case basis, such retiree stop-loss 995
1190	1190	insurance policies for issuance and delivery in this state on or after said 996
1191	1191	date. 997
1192	1192	(f) The Insurance Commissioner may adopt regulations, in 998
1193	1193	accordance with chapter 54, to carry out the purposes of this section. 999
1194	1194	Sec. 17. Subparagraph (C) of subdivision (3) of subsection (m) of 1000
1195	1195	section 5-259 of the 2020 supplement to the general statutes is repealed 1001
1196	1196	and the following is substituted in lieu thereof (Effective January 1, 2021): 1002
1197	1197	(C) The Comptroller may offer to nonstate public employers that 1003
1198	1198	choose to purchase prescription drugs pursuant to subparagraph (A) of 1004
1199	1199	this subdivision the option to purchase [stop loss] stop-loss coverage 1005
1200	1200	from an insurer at a rate negotiated by the Comptroller. 1006
1201	1201	Sec. 18. Subdivision (1) of subsection (c) of section 7-464 of the general 1007
1202	1202	statutes is repealed and the following is substituted in lieu thereof 1008
1203	1203	(Effective January 1, 2021): 1009
1204	1204	(1) In no event shall any commercial insurance company which 1010
1205	1205	provides health insurance benefits to the employees of a town, city or 1011
1206	1206	borough and their covered dependents and family members, including, 1012
1207	1207	but not limited to, [stop loss] stop-loss insurance beyond a municipal 1013
1208	1208	self-funded medical expense amount, be entitled to any reimbursement 1014
1209	1209	from a tortfeasor recovery. The provisions of this subsection shall be 1015
1210	1210	construed to only permit a self-insured town, city or borough to recover 1016
1211	1211	medical expenses paid from its own revenues. The provisions of this 1017
1212	1212	subsection shall not be construed to permit a self-insured town, city or 1018 Raised Bill No. 328
1213	1213
1214	1214
1215	1215
1216	1216	LCO No. 1988 36 of 40
1217	1217
1218	1218	borough to recover medical expenses paid from an insured plan, 1019
1219	1219	whether insured in whole or in part. 1020
1220	1220	Sec. 19. Subparagraph (F) of subdivision (18) of section 38a-465 of the 1021
1221	1221	general statutes is repealed and the following is substituted in lieu 1022
1222	1222	thereof (Effective January 1, 2021): 1023
1223	1223	(F) An authorized or eligible insurer that provides [stop loss] stop-1024
1224	1224	loss coverage to a provider, purchaser, financing entity, special purpose 1025
1225	1225	entity or related provider trust; 1026
1226	1226	Sec. 20. Subsection (c) of section 38a-465d of the general statutes is 1027
1227	1227	repealed and the following is substituted in lieu thereof (Effective January 1028
1228	1228	1, 2021): 1029
1229	1229	(c) Except as otherwise required or permitted by law, no person, 1030
1230	1230	including, but not limited to, a provider, broker, insurance company, 1031
1231	1231	insurance producer, information bureau, rating agency or company, or 1032
1232	1232	any other person with actual knowledge of an insured's identity, shall 1033
1233	1233	disclose such identity or information where there is a reasonable basis 1034
1234	1234	to conclude such information could be used to identify the insured or 1035
1235	1235	the insured's financial or medical information to any other person unless 1036
1236	1236	such disclosure: (1) Is necessary to effect a life settlement contract 1037
1237	1237	between the owner and a provider and the owner and insured have 1038
1238	1238	provided prior written consent to such disclosure; (2) is provided in 1039
1239	1239	response to an investigation or examination by the commissioner or any 1040
1240	1240	other governmental office or agency or pursuant to the requirements of 1041
1241	1241	section 38a-465i; (3) is necessary to effectuate the sale of life settlement 1042
1242	1242	contracts or interests therein as investments, provided the sale is 1043
1243	1243	conducted in accordance with applicable state and federal securities 1044
1244	1244	laws, and provided further the owner and the insured have both 1045
1245	1245	provided prior written consent to the disclosure; (4) is a term of or 1046
1246	1246	condition to the transfer of a policy by one provider to another provider, 1047
1247	1247	in which case the provider receiving such information shall comply with 1048
1248	1248	the confidentiality requirements specified in this subsection; (5) is 1049
1249	1249	necessary to allow the provider or broker or their authorized 1050 Raised Bill No. 328
1250	1250
1251	1251
1252	1252
1253	1253	LCO No. 1988 37 of 40
1254	1254
1255	1255	representatives to make contacts for the purpose of determining health 1051
1256	1256	status. For the purpose of this section, "authorized representative" does 1052
1257	1257	not include any person who has or may have a financial interest in the 1053
1258	1258	settlement contract other than a provider, licensed broker, financing 1054
1259	1259	entity, related provider trust or special purpose entity. Each provider or 1055
1260	1260	broker shall require its authorized representative to agree in writing to 1056
1261	1261	comply with the privacy provisions of this part; or (6) is required to 1057
1262	1262	purchase [stop loss] stop-loss coverage. 1058
1263	1263	Sec. 21. Subparagraph (A) of subdivision (2) of subsection (b) of 1059
1264	1264	section 38a-478l of the general statutes is repealed and the following is 1060
1265	1265	substituted in lieu thereof (Effective January 1, 2021): 1061
1266	1266	(A) "State medical loss ratio" means the ratio of incurred claims to 1062
1267	1267	earned premiums for the prior calendar year for managed care plans 1063
1268	1268	issued in the state. Claims shall be limited to medical expenses for 1064
1269	1269	services and supplies provided to enrollees and shall not include 1065
1270	1270	expenses for [stop loss] stop-loss coverage, reinsurance, enrollee 1066
1271	1271	educational programs or other cost containment programs or features; 1067
1272	1272	Sec. 22. Subsection (c) of section 38a-720h of the general statutes is 1068
1273	1273	repealed and the following is substituted in lieu thereof (Effective January 1069
1274	1274	1, 2021): 1070
1275	1275	(c) The third-party administrator shall disclose to the insurer or other 1071
1276	1276	person utilizing the services of the third-party administrator all charges, 1072
1277	1277	fees and commissions that the third-party administrator receives arising 1073
1278	1278	from services it provides for the insurer or other person utilizing the 1074
1279	1279	services of the third-party administrator, including any fees or 1075
1280	1280	commissions paid by insurers providing reinsurance or [stop loss] stop-1076
1281	1281	loss coverage. 1077
1282	1282	Sec. 23. (NEW) (Effective from passage) (a) For the purposes of this 1078
1283	1283	section: 1079
1284	1284	(1) "Affordable Care Act" means the Patient Protection and 1080
1285	1285	Affordable Care Act, P.L. 111-148, as amended by the Health Care and 1081 Raised Bill No. 328
1286	1286
1287	1287
1288	1288
1289	1289	LCO No. 1988 38 of 40
1290	1290
1291	1291	Education Reconciliation Act, P.L. 111-152, as both may be amended 1082
1292	1292	from time to time, and regulations adopted thereunder; 1083
1293	1293	(2) "Exchange" means the Connecticut Health Insurance Exchange 1084
1294	1294	established under section 38a-1081 of the general statutes; and 1085
1295	1295	(3) "Office" means the Office of Health Strategy established under 1086
1296	1296	section 19a-754a of the general statutes, as amended by this act. 1087
1297	1297	(b) The office shall, in conjunction with the Office of Policy and 1088
1298	1298	Management, the Insurance Department and the Health Reinsurance 1089
1299	1299	Association created under section 38a-556 of the general statutes, seek a 1090
1300	1300	state innovation waiver from the United States Department of the 1091
1301	1301	Treasury or the United States Department of Health and Human 1092
1302	1302	Services, as applicable, pursuant to Section 1332 of the Affordable Care 1093
1303	1303	Act to establish a reinsurance program pursuant to subsection (d) of this 1094
1304	1304	section. 1095
1305	1305	(c) Subject to the approval of a waiver described in subsection (b) of 1096
1306	1306	this section, the office, not later than September 1, 2020, for plan year 1097
1307	1307	2021 and annually thereafter for the subsequent plan year, shall: 1098
1308	1308	(1) Determine the amount needed, not to exceed twenty-one million 1099
1309	1309	two hundred ten thousand dollars, annually, to fund the reinsurance 1100
1310	1310	program established pursuant to subsection (d) of this section; and 1101
1311	1311	(2) Inform the Office of Policy and Management of the amount 1102
1312	1312	determined pursuant to subdivision (1) of this subsection. 1103
1313	1313	(d) The amount described in subsection (c) of this section shall be 1104
1314	1314	utilized to establish a reinsurance program for the individual health 1105
1315	1315	insurance market designed to lower premiums on health benefit plans 1106
1316	1316	sold in such market, on and off the exchange, provided the United States 1107
1317	1317	Department of the Treasury or the United States Department of Health 1108
1318	1318	and Human Services, as applicable, approves the waiver described in 1109
1319	1319	subsection (b) of this section. Any such reinsurance program shall be 1110
1320	1320	administered by the Health Reinsurance Association. The Treasurer 1111 Raised Bill No. 328
1321	1321
1322	1322
1323	1323
1324	1324	LCO No. 1988 39 of 40
1325	1325
1326	1326	shall annually transmit the amount as described in subsection (c) of this 1112
1327	1327	section for the purpose of administering such reinsurance program. 1113
1328	1328	(e) If the waiver described in subsection (b) of this section terminates 1114
1329	1329	and the office does not obtain another waiver pursuant to subsection (a) 1115
1330	1330	of this section, the Treasurer shall cease transmitting the amount 1116
1331	1331	described in subsection (c) of this section for the purpose of 1117
1332	1332	administering the reinsurance program established pursuant to 1118
1333	1333	subsection (d) of this section. 1119
1334	1334	This act shall take effect as follows and shall amend the following
1335	1335	sections:
1336	1336
1337	1337	Section 1 July 1, 2020 19a-754a
1338	1338	Sec. 2 July 1, 2020 New section
1339	1339	Sec. 3 July 1, 2020 New section
1340	1340	Sec. 4 July 1, 2020 New section
1341	1341	Sec. 5 July 1, 2020 New section
1342	1342	Sec. 6 July 1, 2020 New section
1343	1343	Sec. 7 July 1, 2020 New section
1344	1344	Sec. 8 July 1, 2020 New section
1345	1345	Sec. 9 July 1, 2020 New section
1346	1346	Sec. 10 July 1, 2020 New section
1347	1347	Sec. 11 July 1, 2020 New section
1348	1348	Sec. 12 July 1, 2020 New section
1349	1349	Sec. 13 July 1, 2020 New section
1350	1350	Sec. 14 July 1, 2020 New section
1351	1351	Sec. 15 July 1, 2020 New section
1352	1352	Sec. 16 January 1, 2021 38a-8b
1353	1353	Sec. 17 January 1, 2021 5-259(m)(3)(C)
1354	1354	Sec. 18 January 1, 2021 7-464(c)(1)
1355	1355	Sec. 19 January 1, 2021 38a-465(18)(F)
1356	1356	Sec. 20 January 1, 2021 38a-465d(c)
1357	1357	Sec. 21 January 1, 2021 38a-478l(b)(2)(A)
1358	1358	Sec. 22 January 1, 2021 38a-720h(c)
1359	1359	Sec. 23 from passage New section
1360	1360	Raised Bill No. 328
1361	1361
1362	1362
1363	1363
1364	1364	LCO No. 1988 40 of 40
1365	1365
1366	1366	Statement of Purpose:
1367	1367	To: (1) Require the Office of Health Strategy to establish and implement
1368	1368	health care cost growth benchmarks in this state; (2) require the
1369	1369	Commissioner of Consumer Protection to submit a request to the federal
1370	1370	Secretary of Health and Human Services to implement a Canadian
1371	1371	prescription drug reimportation program in this state and, if the
1372	1372	secretary approves such request, implement such program in this state;
1373	1373	(3) implement the Insurance Commissioner's recommendations
1374	1374	regarding stop-loss insurance; and (4) require the Office of Health
1375	1375	Strategy to seek a state innovation waiver from the federal government
1376	1376	to establish a reinsurance program in this state and, if the federal
1377	1377	government approves such request, implement such program in this
1378	1378	state.
1379	1379	[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except
1380	1380	that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not
1381	1381	underlined.]
1382	1382