Connecticut 2020 Regular Session

Connecticut Senate Bill SB00346 Compare Versions

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55 General Assembly Raised Bill No. 346
66 February Session, 2020
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1010 Referred to Committee on INSURANCE AND REAL ESTATE
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1919 AN ACT CONCERNING PU BLIC OPTIONS FOR HEALTH CARE IN
2020 CONNECTICUT.
2121 Be it enacted by the Senate and House of Representatives in General
2222 Assembly convened:
2323
2424 Section 1. (NEW) (Effective July 1, 2020) For the purposes of this 1
2525 section and sections 2 to 5, inclusive, of this act: 2
2626 (1) "Account" means the ConnectHealth Trust Account established 3
2727 under section 4 of this act. 4
2828 (2) "Advisory council" means the ConnectHealth Advisory Council 5
2929 established under section 3 of this act. 6
3030 (3) "Affordable Care Act" means the Patient Protection and 7
3131 Affordable Care Act, P.L. 111-148, as amended by the Health Care and 8
3232 Education Reconciliation Act, P.L. 111-152, as both may be amended 9
3333 from time to time, and regulations adopted thereunder. 10
3434 (4) "ConnectHealth Plan" means the health benefit plan designed and 11
3535 made available to individuals in this state as part of the program. 12
3636 (5) "Essential health benefits" means benefits that are essential health 13 Raised Bill No. 346
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4242 benefits within the meaning of (A) the Affordable Care Act, or (B) 14
4343 section 38a-492q or 38a-518q of the general statutes. 15
4444 (6) "Exchange" means the Connecticut Health Insurance Exchange 16
4545 established under section 38a-1081 of the general statutes. 17
4646 (7) "Health benefit plan" has the same meaning as provided in section 18
4747 38a-1080 of the general statutes. 19
4848 (8) "Internal Revenue Code" means the Internal Revenue Code of 20
4949 1986, or any subsequent corresponding internal revenue code of the 21
5050 United States, as amended from time to time. 22
5151 (9) "Medical loss ratio" means the ratio, expressed as a percentage, of 23
5252 incurred claims to earned premiums for the prior calendar year for the 24
5353 ConnectHealth Plan, provided, for purposes of this subdivision, claims 25
5454 shall be limited to medical expenses for services and supplies provided 26
5555 to enrollees in the ConnectHealth Plan and shall not include expenses 27
5656 for stop-loss coverage, reinsurance, enrollee educational programs or 28
5757 other cost containment programs or features. 29
5858 (10) "Program" means the ConnectHealth Program established by the 30
5959 Comptroller pursuant to section 2 of this act. 31
6060 (11) "Qualified health plan" has the same meaning as provided in 32
6161 section 38a-1080 of the general statutes. 33
6262 (12) "Third-party administrator" has the same meaning as provided 34
6363 in section 38a-720 of the general statutes. 35
6464 Sec. 2. (NEW) (Effective July 1, 2020) (a) The Comptroller shall, within 36
6565 available appropriations and in consultation with the advisory council 37
6666 and the Office of Health Strategy, establish a program to be known as 38
6767 the "ConnectHealth Program". The purpose of the program shall be to 39
6868 offer high-quality, low-cost health insurance coverage to enrollees in 40
6969 this state under a ConnectHealth Plan. Under the program, the 41
7070 Comptroller, in consultation with the advisory council and the Office of 42
7171 Health Strategy, shall: 43 Raised Bill No. 346
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7777 (1) Establish enrollment criteria for the ConnectHealth Plan; 44
7878 (2) Design and offer the ConnectHealth Plan, which shall, at a 45
7979 minimum: (A) Be made available to prospective enrollees in this state 46
8080 not later than January 1, 2022; (B) provide coverage for essential health 47
8181 benefits; (C) provide a level of covered benefits that meets or exceeds 48
8282 the level of covered benefits provided under qualified health plans; (D) 49
8383 impose premiums, deductibles and enrollee cost-sharing in amounts 50
8484 that do not exceed the amounts imposed under qualified health plans; 51
8585 (E) include an affordability scale for premiums, deductibles and enrollee 52
8686 cost-sharing that varies according to an enrollee's household income; 53
8787 and (F) have a medical loss ratio of not less than ninety per cent; 54
8888 (3) Determine whether to offer the ConnectHealth Plan through the 55
8989 exchange as a qualified health plan; 56
9090 (4) Subject to the provisions of subsection (c) of this section: (A) 57
9191 Establish a schedule of payments and reimbursement rates for the 58
9292 ConnectHealth Plan; (B) provide, within available appropriations, state-59
9393 financed cost-sharing subsidies to enrollees in the ConnectHealth Plan 60
9494 who do not qualify for cost-sharing subsidies under the Affordable Care 61
9595 Act; and (C) seek a waiver from the United States Department of the 62
9696 Treasury or the United States Department of Health and Human 63
9797 Services, as applicable, pursuant to Section 1332 of the Affordable Care 64
9898 Act; 65
9999 (5) Use any data submitted to the all-payer claims database program 66
100100 established under section 19a-755a of the general statutes to evaluate, 67
101101 on an ongoing basis, the impact of the ConnectHealth Plan on: (A) 68
102102 Individuals in this state; (B) health care providers and health care 69
103103 facilities in this state; and (C) the individual and group health insurance 70
104104 markets in this state; and 71
105105 (6) Implement a competitive process to select, and enter into a 72
106106 contract with, one or more third-party administrators to administer the 73
107107 ConnectHealth Plan, and permit such third-party administrator or 74
108108 third-party administrators to directly receive individual premiums and 75 Raised Bill No. 346
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114114 federal premium tax credits in accordance with all applicable provisions 76
115115 of the Affordable Care Act and the Internal Revenue Code. 77
116116 (b) The Comptroller may, in the Comptroller's discretion and within 78
117117 available appropriations, engage the services of such third-party 79
118118 actuaries, professionals and specialists that the Comptroller deems 80
119119 necessary to assist the Comptroller in performing the Comptroller's 81
120120 duties under subsection (a) of this section. 82
121121 (c) (1) Not later than March 1, 2021, the Comptroller, in consultation 83
122122 with the advisory council and the Office of Health Strategy, shall 84
123123 submit, in accordance with the provisions of section 11-4a of the general 85
124124 statutes, to the joint standing committee of the General Assembly 86
125125 having cognizance of matters relating to insurance: 87
126126 (A) A plan to make the ConnectHealth Plan available to prospective 88
127127 enrollees in this state not later than January 1, 2022; 89
128128 (B) Strategies to ensure that health care providers and health care 90
129129 facilities in this state participate in the ConnectHealth Plan; 91
130130 (C) An analysis of the likely impact of the ConnectHealth Plan on the 92
131131 individual and group health insurance markets in this state; 93
132132 (D) A proposed schedule of the initial payments and reimbursement 94
133133 rates for the ConnectHealth Plan; 95
134134 (E) A proposal to implement state-financed cost-sharing subsidies for 96
135135 enrollees in the ConnectHealth Plan who do not qualify for cost-sharing 97
136136 subsidies under the Affordable Care Act, which proposal shall include, 98
137137 but need not be limited to, (i) eligibility criteria for enrollees to receive 99
138138 such subsidies, (ii) the recommended amount or amounts of such 100
139139 subsidies, and (iii) a plan to administer and disburse such subsidies; and 101
140140 (F) A proposed application for a waiver from the United States 102
141141 Department of the Treasury or the United States Department of Health 103
142142 and Human Services, as applicable, pursuant to Section 1332 of the 104
143143 Affordable Care Act. 105 Raised Bill No. 346
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149149 (2) If the committee does not act within sixty days after receiving a 106
150150 submittal under subdivision (1) of this subsection, each proposal 107
151151 described in subparagraphs (D) to (F), inclusive, of said subdivision 108
152152 shall be deemed to be denied by the committee. 109
153153 Sec. 3. (NEW) (Effective July 1, 2020) (a) (1) There is established the 110
154154 ConnectHealth Advisory Council. The council shall consist of ten 111
155155 members, as follows: 112
156156 (A) Two appointed by the speaker of the House of Representatives, 113
157157 one of whom shall represent the interests of hospitals in this state and 114
158158 one of whom shall represent the interests of community-based health 115
159159 care providers in this state; 116
160160 (B) Two appointed by the president pro tempore of the Senate, one of 117
161161 whom shall represent the interests of consumers in this state and one of 118
162162 whom shall represent the interests of nurses practicing in this state; 119
163163 (C) One appointed by the majority leader of the House of 120
164164 Representatives, who shall represent the interests of patients in this 121
165165 state; 122
166166 (D) One appointed by the majority leader of the Senate, who shall 123
167167 have expertise in health policy; 124
168168 (E) Two appointed by the minority leader of the House of 125
169169 Representatives, one of whom shall represent the interests of health 126
170170 insurers offering individual health insurance policies in this state and 127
171171 one of whom shall represent the interests of physicians practicing in this 128
172172 state; and 129
173173 (F) Two appointed by the minority leader of the Senate, one of whom 130
174174 shall represent the interests of health insurers offering small group 131
175175 health insurance policies in this state and one of whom shall represent 132
176176 the interests of insurance producers licensed in this state. 133
177177 (2) The members of the advisory council shall select a chairperson 134
178178 from the membership of the advisory council, and the advisory council 135 Raised Bill No. 346
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184184 may establish rules governing the advisory council's internal 136
185185 procedures. 137
186186 (3) The Governor, Lieutenant Governor, Comptroller, Secretary of the 138
187187 Office of Policy and Management, Insurance Commissioner and 139
188188 Commissioner of Social Services shall serve as ex-officio, nonvoting 140
189189 members of the advisory council. 141
190190 (b) Initial appointments to the advisory council shall be made on or 142
191191 before October 1, 2020. If an appointing authority fails to appoint an 143
192192 advisory council member on or before October 1, 2020, the president pro 144
193193 tempore of the Senate and the speaker of the House of Representatives 145
194194 shall jointly appoint an advisory council member who meets the 146
195195 required specifications on behalf of such appointing authority and such 147
196196 advisory council member shall serve for the duration of the initial term 148
197197 for such advisory council member. The presence of not less than six 149
198198 advisory council members shall constitute a quorum for the transaction 150
199199 of business. The initial term for advisory council members appointed by 151
200200 the minority leader of the House of Representatives and the minority 152
201201 leader of the Senate shall be three years. The initial term for advisory 153
202202 council members appointed by the majority leader of the House of 154
203203 Representatives and the majority leader of the Senate shall be four years. 155
204204 The initial term for the advisory council members appointed by the 156
205205 speaker of the House of Representatives and the president pro tempore 157
206206 of the Senate shall be five years. Terms pursuant to this subsection shall 158
207207 expire on June thirtieth in accordance with the provisions of this 159
208208 subsection. Any vacancy shall be filled by the appointing authority for 160
209209 the balance of the unexpired term. Not later than thirty days prior to the 161
210210 expiration of a term as provided for in this subsection, the appointing 162
211211 authority may reappoint the current advisory council member or shall 163
212212 appoint a new member to the advisory council. Other than an initial 164
213213 term, an advisory council member shall serve for a term of five years 165
214214 and until a successor advisory council member is appointed. Each 166
215215 member of the advisory council shall be eligible for reappointment. Any 167
216216 member of the advisory council may be removed by the appropriate 168
217217 appointing authority for misfeasance, malfeasance or wilful neglect of 169 Raised Bill No. 346
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223223 duty. 170
224224 (c) The advisory council shall advise the Comptroller and the Office 171
225225 of Health Strategy on matters concerning the program and the 172
226226 ConnectHealth Plan, including, but not limited to: 173
227227 (1) Implementation of the ConnectHealth Plan; 174
228228 (2) Affordability of the ConnectHealth Plan; 175
229229 (3) Marketing of the ConnectHealth Plan to prospective enrollees; 176
230230 (4) Outreach to prospective enrollees and enrollees in the 177
231231 ConnectHealth Plan; and 178
232232 (5) Periodic evaluations of the ConnectHealth Plan. 179
233233 (d) The advisory council shall not be construed to be a department, 180
234234 institution or agency of this state. The staff of the joint standing 181
235235 committee of the General Assembly having cognizance of matters 182
236236 relating to insurance shall provide administrative support to the 183
237237 advisory council. 184
238238 Sec. 4. (NEW) (Effective July 1, 2020) There is established an account 185
239239 to be known as the "ConnectHealth Trust Account", which shall be a 186
240240 separate, nonlapsing account within the General Fund. The account 187
241241 shall contain all moneys required by law to be deposited in the account. 188
242242 Investment earnings from any moneys in the account shall be credited 189
243243 to the account and shall become part of the assets of the account. Any 190
244244 balance remaining in the account at the end of any fiscal year shall be 191
245245 carried forward in the account for the fiscal year next succeeding. The 192
246246 moneys in the account shall be allocated to the Comptroller for the 193
247247 purposes of lowering the cost of the ConnectHealth Plan and providing 194
248248 state-financed cost-sharing subsidies to enrollees in such plan who do 195
249249 not qualify for cost-sharing subsidies under the Affordable Care Act. 196
250250 Sec. 5. (NEW) (Effective July 1, 2020) The Comptroller may adopt 197
251251 regulations, in accordance with chapter 54 of the general statutes, to 198 Raised Bill No. 346
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257257 implement the provisions of sections 1 to 4, inclusive, of this act. 199
258258 Sec. 6. Section 3-123rrr of the 2020 supplement to the general statutes 200
259259 is repealed and the following is substituted in lieu thereof (Effective July 201
260260 1, 2020): 202
261261 As used in this section, section 7 of this act and sections 3-123sss to 3-203
262262 123vvv, inclusive, as amended by this act, and section 3-123xxx: 204
263263 (1) "Health Care Cost Containment Committee" means the committee 205
264264 established in accordance with the ratified agreement between the state 206
265265 and the State Employees Bargaining Agent Coalition pursuant to 207
266266 subsection (f) of section 5-278. 208
267267 (2) "Health enhancement program" means the program established in 209
268268 accordance with the provisions of the Revised State Employees 210
269269 Bargaining Agent Coalition agreement, approved by the General 211
270270 Assembly on August 22, 2011, for state employees, as amended by 212
271271 stipulated agreements. 213
272272 (3) "Multiemployer plan" has the same meaning as provided in 214
273273 Section 3 of the Employee Retirement Income Security Act of 1974, as 215
274274 amended from time to time; 216
275275 [(2)] (4) "Nonstate public employee" means any employee or elected 217
276276 officer of a nonstate public employer. 218
277277 [(3)] (5) "Nonstate public employer" means a municipality or other 219
278278 political subdivision of the state, including a board of education, quasi-220
279279 public agency or public library. A municipality and a board of education 221
280280 may be considered separate employers. 222
281281 (6) "Nonprofit employer" means a nonprofit, nonstock corporation, 223
282282 other than a nonstate public employer, that employs at least one 224
283283 employee on the first day that such employer receives coverage under a 225
284284 group hospitalization, medical, pharmacy and surgical insurance plan 226
285285 offered by the Comptroller pursuant to this part. 227 Raised Bill No. 346
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291291 (7) "Small employer" means an employer, other than a nonstate public 228
292292 employer, that employed an average of at least one but not more than 229
293293 fifty employees on business days during the preceding calendar year, 230
294294 and employs at least one employee on the first day that such employer 231
295295 receives coverage under a group hospitalization, medical, pharmacy 232
296296 and surgical insurance plan offered by the Comptroller pursuant to this 233
297297 part. 234
298298 [(4)] (8) "State employee plan" means the group hospitalization, 235
299299 medical, pharmacy and surgical insurance plan offered to state 236
300300 employees and retirees pursuant to section 5-259. 237
301301 [(5) "Health enhancement program" means the program established 238
302302 in accordance with the provisions of the Revised State Employees 239
303303 Bargaining Agent Coalition agreement, approved by the General 240
304304 Assembly on August 22, 2011, for state employees, as may be amended 241
305305 by stipulated agreements.] 242
306306 [(6)] (9) "Value-based insurance design" means health benefit designs 243
307307 that lower or remove financial barriers to essential, high-value clinical 244
308308 services. 245
309309 [(7) "Health care coverage type" means the type of health care 246
310310 coverage offered by nonstate public employers, including, but not 247
311311 limited to, coverage for a nonstate public employee, nonstate public 248
312312 employee plus spouse and nonstate public employee plus family.] 249
313313 Sec. 7. (NEW) (Effective July 1, 2020) (a) (1) Notwithstanding any 250
314314 provision of title 38a of the general statutes, the Comptroller shall offer 251
315315 to plan participants and beneficiaries in this state under a 252
316316 multiemployer plan, nonprofit employers and their employees and 253
317317 small employers and their employees coverage under the state 254
318318 employee plan or another group hospitalization, medical, pharmacy 255
319319 and surgical insurance plan developed by the Comptroller to provide 256
320320 coverage for plan participants and beneficiaries in this state under a 257
321321 multiemployer plan, nonprofit employers and their employees and 258
322322 small employers and their employees. Plan participants and 259 Raised Bill No. 346
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328328 beneficiaries in this state under a multiemployer plan, nonprofit 260
329329 employers and their employees and small employers and their 261
330330 employees receiving coverage provided pursuant to this section shall be 262
331331 pooled with state employees and retirees under the state employee plan, 263
332332 provided the administrator of the multiemployer plan, the nonprofit 264
333333 employer or the small employer files an application with the 265
334334 Comptroller for coverage pursuant to this section and the Comptroller 266
335335 approves such application. The administrators of multiemployer plans, 267
336336 nonprofit employers or small employers shall remit to the Comptroller 268
337337 payments for coverage provided pursuant to this section. Such 269
338338 payments shall be equal to the payments paid by the state for state 270
339339 employees covered under the state employee plan, inclusive of any 271
340340 premiums paid by state employees pursuant to the state employee plan, 272
341341 except that premium payments may be adjusted to reflect the cost of 273
342342 health care in the geographic area in which the majority of a 274
343343 multiemployer plan's plan participants and beneficiaries, a nonprofit 275
344344 employer's employees or a small employer's employees work, 276
345345 differences from the benefits and networks provided to state employees, 277
346346 the demographic makeup of the multiemployer plan's plan participants 278
347347 and beneficiaries, nonprofit employer's employees or small employer's 279
348348 employees or as otherwise provided in this section. The Comptroller 280
349349 shall phase in the geographic adjustment established in this subsection 281
350350 over a two-year period for existing participants. Beginning on July 1, 282
351351 2021, the Comptroller may charge each multiemployer plan, nonprofit 283
352352 employer and small employer participating in the state employee plan 284
353353 an administrative fee calculated on a per member, per month basis. 285
354354 (2) Any group hospitalization, medical, pharmacy and surgical 286
355355 insurance plan developed by the Comptroller pursuant to subdivision 287
356356 (1) of this subsection shall (A) include the health enhancement program, 288
357357 (B) be consistent with value-based insurance design principles, and (C) 289
358358 be approved by the Health Care Cost Containment Committee prior to 290
359359 being offered to small employers and their employees. 291
360360 (b) The Comptroller shall offer participation in each plan described 292
361361 in subsection (a) of this section for intervals lasting not less than three 293 Raised Bill No. 346
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367367 years. The administrator of the multiemployer plan, nonprofit employer 294
368368 or small employer may apply for renewal of coverage prior to expiration 295
369369 of each interval. 296
370370 (c) The Comptroller shall develop procedures by which 297
371371 administrators of multiemployer plans, nonprofit employers and small 298
372372 employers may initially apply for, renew and withdraw from coverage 299
373373 provided pursuant to this section, as well as rules of participation that 300
374374 the Comptroller, in the Comptroller's discretion, deems necessary. 301
375375 (d) The Comptroller shall establish accounting procedures to track 302
376376 claims and premium payments paid by multiemployer plans, nonprofit 303
377377 employers and small employers receiving coverage provided pursuant 304
378378 to this section. 305
379379 Sec. 8. Section 3-123vvv of the 2020 supplement to the general statutes 306
380380 is repealed and the following is substituted in lieu thereof (Effective July 307
381381 1, 2020): 308
382382 The Comptroller shall not offer coverage under the state employee 309
383383 plan pursuant to sections 3-123rrr to 3-123uuu, inclusive, as amended 310
384384 by this act, or section 7 of this act until the State Employees' Bargaining 311
385385 Agent Coalition has provided its consent to the clerks of both houses of 312
386386 the General Assembly to incorporate the terms of sections 3-123rrr to 3-313
387387 123uuu, inclusive, as amended by this act, and section 7 of this act into 314
388388 its collective bargaining agreement. 315
389389 Sec. 9. Section 17b-282b of the general statutes is repealed and the 316
390390 following is substituted in lieu thereof (Effective from passage): 317
391391 (a) Not later than July 1, 2004, and prior to the implementation of a 318
392392 state-wide dental plan that provides for the administration of the dental 319
393393 services portion of the department's medical assistance, the 320
394394 Commissioner of Social Services shall amend the federal waiver 321
395395 approved pursuant to Section 1915(b) of the Social Security Act. Such 322
396396 waiver amendment shall be submitted to the joint standing committees 323
397397 of the General Assembly having cognizance of matters relating to 324 Raised Bill No. 346
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403403 human services and appropriations and the budgets of state agencies in 325
404404 accordance with the provisions of section 17b-8. 326
405405 (b) (1) Not later than July 1, 2020, the Commissioner of Social Services 327
406406 shall seek to amend the federal waiver described in subsection (a) of this 328
407407 section to provide the state-wide dental plan, which provides for the 329
408408 administration of the dental services portion of the department's 330
409409 medical assistance, to: 331
410410 (A) Enable each individual in this state who is insured under an 332
411411 individual health insurance policy or a group health insurance policy 333
412412 for a small employer, as defined in section 3-123rrr, as amended by this 334
413413 act, or a nonprofit employer, as defined in section 3-123rrr or who is a 335
414414 plan participant or beneficiary in this state under a multiemployer plan, 336
415415 as defined in Section 3 of the Employee Retirement Income Security Act 337
416416 of 1974, as amended from time to time, to receive coverage for the dental 338
417417 services portion of such medical assistance; and 339
418418 (B) Enable the Commissioner of Social Services to prescribe premium 340
419419 and underwriting standards for the dental services portion of such 341
420420 medical assistance for individuals described in subparagraph (A) of this 342
421421 subdivision. 343
422422 (2) Such waiver amendment shall be submitted to the joint standing 344
423423 committees of the General Assembly having cognizance of matters 345
424424 relating to human services and appropriations and the budgets of state 346
425425 agencies in accordance with the provisions of section 17b-8. 347
426426 This act shall take effect as follows and shall amend the following
427427 sections:
428428
429429 Section 1 July 1, 2020 New section
430430 Sec. 2 July 1, 2020 New section
431431 Sec. 3 July 1, 2020 New section
432432 Sec. 4 July 1, 2020 New section
433433 Sec. 5 July 1, 2020 New section
434434 Sec. 6 July 1, 2020 3-123rrr
435435 Sec. 7 July 1, 2020 New section Raised Bill No. 346
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441441 Sec. 8 July 1, 2020 3-123vvv
442442 Sec. 9 from passage 17b-282b
443443
444444 Statement of Purpose:
445445 To: (1) Establish the ConnectHealth Program, the ConnectHealth Trust
446446 Account and the ConnectHealth Advisory Board; (2) require the
447447 Comptroller, in consultation with the ConnectHealth Advisory Board
448448 and the Office of Health Strategy, to establish the ConnectHealth Plan;
449449 (3) authorize the Comptroller to offer coverage to plan participants and
450450 beneficiaries in this state under a multiemployer plan, nonprofit
451451 employers and their employees, and small employers and their
452452 employees; and (4) require the Commissioner of Social Services to seek
453453 to amend the federal waiver for the state-wide dental plan that provides
454454 for the administration of the dental services portion of the department's
455455 medical assistance to expand coverage to include additional individuals
456456 in this state.
457457 [Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except
458458 that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not
459459 underlined.]
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