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General Assembly Raised Bill No. 346
February Session, 2020
LCO No. 2213
Referred to Committee on INSURANCE AND REAL ESTATE
Introduced by:
(INS)
AN ACT CONCERNING PU BLIC OPTIONS FOR HEALTH CARE IN
CONNECTICUT.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. (NEW) (Effective July 1, 2020) For the purposes of this 1
section and sections 2 to 5, inclusive, of this act: 2
(1) "Account" means the ConnectHealth Trust Account established 3
under section 4 of this act. 4
(2) "Advisory council" means the ConnectHealth Advisory Council 5
established under section 3 of this act. 6
(3) "Affordable Care Act" means the Patient Protection and 7
Affordable Care Act, P.L. 111-148, as amended by the Health Care and 8
Education Reconciliation Act, P.L. 111-152, as both may be amended 9
from time to time, and regulations adopted thereunder. 10
(4) "ConnectHealth Plan" means the health benefit plan designed and 11
made available to individuals in this state as part of the program. 12
(5) "Essential health benefits" means benefits that are essential health 13 Raised Bill No. 346
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benefits within the meaning of (A) the Affordable Care Act, or (B) 14
section 38a-492q or 38a-518q of the general statutes. 15
(6) "Exchange" means the Connecticut Health Insurance Exchange 16
established under section 38a-1081 of the general statutes. 17
(7) "Health benefit plan" has the same meaning as provided in section 18
38a-1080 of the general statutes. 19
(8) "Internal Revenue Code" means the Internal Revenue Code of 20
1986, or any subsequent corresponding internal revenue code of the 21
United States, as amended from time to time. 22
(9) "Medical loss ratio" means the ratio, expressed as a percentage, of 23
incurred claims to earned premiums for the prior calendar year for the 24
ConnectHealth Plan, provided, for purposes of this subdivision, claims 25
shall be limited to medical expenses for services and supplies provided 26
to enrollees in the ConnectHealth Plan and shall not include expenses 27
for stop-loss coverage, reinsurance, enrollee educational programs or 28
other cost containment programs or features. 29
(10) "Program" means the ConnectHealth Program established by the 30
Comptroller pursuant to section 2 of this act. 31
(11) "Qualified health plan" has the same meaning as provided in 32
section 38a-1080 of the general statutes. 33
(12) "Third-party administrator" has the same meaning as provided 34
in section 38a-720 of the general statutes. 35
Sec. 2. (NEW) (Effective July 1, 2020) (a) The Comptroller shall, within 36
available appropriations and in consultation with the advisory council 37
and the Office of Health Strategy, establish a program to be known as 38
the "ConnectHealth Program". The purpose of the program shall be to 39
offer high-quality, low-cost health insurance coverage to enrollees in 40
this state under a ConnectHealth Plan. Under the program, the 41
Comptroller, in consultation with the advisory council and the Office of 42
Health Strategy, shall: 43 Raised Bill No. 346
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(1) Establish enrollment criteria for the ConnectHealth Plan; 44
(2) Design and offer the ConnectHealth Plan, which shall, at a 45
minimum: (A) Be made available to prospective enrollees in this state 46
not later than January 1, 2022; (B) provide coverage for essential health 47
benefits; (C) provide a level of covered benefits that meets or exceeds 48
the level of covered benefits provided under qualified health plans; (D) 49
impose premiums, deductibles and enrollee cost-sharing in amounts 50
that do not exceed the amounts imposed under qualified health plans; 51
(E) include an affordability scale for premiums, deductibles and enrollee 52
cost-sharing that varies according to an enrollee's household income; 53
and (F) have a medical loss ratio of not less than ninety per cent; 54
(3) Determine whether to offer the ConnectHealth Plan through the 55
exchange as a qualified health plan; 56
(4) Subject to the provisions of subsection (c) of this section: (A) 57
Establish a schedule of payments and reimbursement rates for the 58
ConnectHealth Plan; (B) provide, within available appropriations, state-59
financed cost-sharing subsidies to enrollees in the ConnectHealth Plan 60
who do not qualify for cost-sharing subsidies under the Affordable Care 61
Act; and (C) seek a waiver from the United States Department of the 62
Treasury or the United States Department of Health and Human 63
Services, as applicable, pursuant to Section 1332 of the Affordable Care 64
Act; 65
(5) Use any data submitted to the all-payer claims database program 66
established under section 19a-755a of the general statutes to evaluate, 67
on an ongoing basis, the impact of the ConnectHealth Plan on: (A) 68
Individuals in this state; (B) health care providers and health care 69
facilities in this state; and (C) the individual and group health insurance 70
markets in this state; and 71
(6) Implement a competitive process to select, and enter into a 72
contract with, one or more third-party administrators to administer the 73
ConnectHealth Plan, and permit such third-party administrator or 74
third-party administrators to directly receive individual premiums and 75 Raised Bill No. 346
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federal premium tax credits in accordance with all applicable provisions 76
of the Affordable Care Act and the Internal Revenue Code. 77
(b) The Comptroller may, in the Comptroller's discretion and within 78
available appropriations, engage the services of such third-party 79
actuaries, professionals and specialists that the Comptroller deems 80
necessary to assist the Comptroller in performing the Comptroller's 81
duties under subsection (a) of this section. 82
(c) (1) Not later than March 1, 2021, the Comptroller, in consultation 83
with the advisory council and the Office of Health Strategy, shall 84
submit, in accordance with the provisions of section 11-4a of the general 85
statutes, to the joint standing committee of the General Assembly 86
having cognizance of matters relating to insurance: 87
(A) A plan to make the ConnectHealth Plan available to prospective 88
enrollees in this state not later than January 1, 2022; 89
(B) Strategies to ensure that health care providers and health care 90
facilities in this state participate in the ConnectHealth Plan; 91
(C) An analysis of the likely impact of the ConnectHealth Plan on the 92
individual and group health insurance markets in this state; 93
(D) A proposed schedule of the initial payments and reimbursement 94
rates for the ConnectHealth Plan; 95
(E) A proposal to implement state-financed cost-sharing subsidies for 96
enrollees in the ConnectHealth Plan who do not qualify for cost-sharing 97
subsidies under the Affordable Care Act, which proposal shall include, 98
but need not be limited to, (i) eligibility criteria for enrollees to receive 99
such subsidies, (ii) the recommended amount or amounts of such 100
subsidies, and (iii) a plan to administer and disburse such subsidies; and 101
(F) A proposed application for a waiver from the United States 102
Department of the Treasury or the United States Department of Health 103
and Human Services, as applicable, pursuant to Section 1332 of the 104
Affordable Care Act. 105 Raised Bill No. 346
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(2) If the committee does not act within sixty days after receiving a 106
submittal under subdivision (1) of this subsection, each proposal 107
described in subparagraphs (D) to (F), inclusive, of said subdivision 108
shall be deemed to be denied by the committee. 109
Sec. 3. (NEW) (Effective July 1, 2020) (a) (1) There is established the 110
ConnectHealth Advisory Council. The council shall consist of ten 111
members, as follows: 112
(A) Two appointed by the speaker of the House of Representatives, 113
one of whom shall represent the interests of hospitals in this state and 114
one of whom shall represent the interests of community-based health 115
care providers in this state; 116
(B) Two appointed by the president pro tempore of the Senate, one of 117
whom shall represent the interests of consumers in this state and one of 118
whom shall represent the interests of nurses practicing in this state; 119
(C) One appointed by the majority leader of the House of 120
Representatives, who shall represent the interests of patients in this 121
state; 122
(D) One appointed by the majority leader of the Senate, who shall 123
have expertise in health policy; 124
(E) Two appointed by the minority leader of the House of 125
Representatives, one of whom shall represent the interests of health 126
insurers offering individual health insurance policies in this state and 127
one of whom shall represent the interests of physicians practicing in this 128
state; and 129
(F) Two appointed by the minority leader of the Senate, one of whom 130
shall represent the interests of health insurers offering small group 131
health insurance policies in this state and one of whom shall represent 132
the interests of insurance producers licensed in this state. 133
(2) The members of the advisory council shall select a chairperson 134
from the membership of the advisory council, and the advisory council 135 Raised Bill No. 346
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may establish rules governing the advisory council's internal 136
procedures. 137
(3) The Governor, Lieutenant Governor, Comptroller, Secretary of the 138
Office of Policy and Management, Insurance Commissioner and 139
Commissioner of Social Services shall serve as ex-officio, nonvoting 140
members of the advisory council. 141
(b) Initial appointments to the advisory council shall be made on or 142
before October 1, 2020. If an appointing authority fails to appoint an 143
advisory council member on or before October 1, 2020, the president pro 144
tempore of the Senate and the speaker of the House of Representatives 145
shall jointly appoint an advisory council member who meets the 146
required specifications on behalf of such appointing authority and such 147
advisory council member shall serve for the duration of the initial term 148
for such advisory council member. The presence of not less than six 149
advisory council members shall constitute a quorum for the transaction 150
of business. The initial term for advisory council members appointed by 151
the minority leader of the House of Representatives and the minority 152
leader of the Senate shall be three years. The initial term for advisory 153
council members appointed by the majority leader of the House of 154
Representatives and the majority leader of the Senate shall be four years. 155
The initial term for the advisory council members appointed by the 156
speaker of the House of Representatives and the president pro tempore 157
of the Senate shall be five years. Terms pursuant to this subsection shall 158
expire on June thirtieth in accordance with the provisions of this 159
subsection. Any vacancy shall be filled by the appointing authority for 160
the balance of the unexpired term. Not later than thirty days prior to the 161
expiration of a term as provided for in this subsection, the appointing 162
authority may reappoint the current advisory council member or shall 163
appoint a new member to the advisory council. Other than an initial 164
term, an advisory council member shall serve for a term of five years 165
and until a successor advisory council member is appointed. Each 166
member of the advisory council shall be eligible for reappointment. Any 167
member of the advisory council may be removed by the appropriate 168
appointing authority for misfeasance, malfeasance or wilful neglect of 169 Raised Bill No. 346
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duty. 170
(c) The advisory council shall advise the Comptroller and the Office 171
of Health Strategy on matters concerning the program and the 172
ConnectHealth Plan, including, but not limited to: 173
(1) Implementation of the ConnectHealth Plan; 174
(2) Affordability of the ConnectHealth Plan; 175
(3) Marketing of the ConnectHealth Plan to prospective enrollees; 176
(4) Outreach to prospective enrollees and enrollees in the 177
ConnectHealth Plan; and 178
(5) Periodic evaluations of the ConnectHealth Plan. 179
(d) The advisory council shall not be construed to be a department, 180
institution or agency of this state. The staff of the joint standing 181
committee of the General Assembly having cognizance of matters 182
relating to insurance shall provide administrative support to the 183
advisory council. 184
Sec. 4. (NEW) (Effective July 1, 2020) There is established an account 185
to be known as the "ConnectHealth Trust Account", which shall be a 186
separate, nonlapsing account within the General Fund. The account 187
shall contain all moneys required by law to be deposited in the account. 188
Investment earnings from any moneys in the account shall be credited 189
to the account and shall become part of the assets of the account. Any 190
balance remaining in the account at the end of any fiscal year shall be 191
carried forward in the account for the fiscal year next succeeding. The 192
moneys in the account shall be allocated to the Comptroller for the 193
purposes of lowering the cost of the ConnectHealth Plan and providing 194
state-financed cost-sharing subsidies to enrollees in such plan who do 195
not qualify for cost-sharing subsidies under the Affordable Care Act. 196
Sec. 5. (NEW) (Effective July 1, 2020) The Comptroller may adopt 197
regulations, in accordance with chapter 54 of the general statutes, to 198 Raised Bill No. 346
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implement the provisions of sections 1 to 4, inclusive, of this act. 199
Sec. 6. Section 3-123rrr of the 2020 supplement to the general statutes 200
is repealed and the following is substituted in lieu thereof (Effective July 201
1, 2020): 202
As used in this section, section 7 of this act and sections 3-123sss to 3-203
123vvv, inclusive, as amended by this act, and section 3-123xxx: 204
(1) "Health Care Cost Containment Committee" means the committee 205
established in accordance with the ratified agreement between the state 206
and the State Employees Bargaining Agent Coalition pursuant to 207
subsection (f) of section 5-278. 208
(2) "Health enhancement program" means the program established in 209
accordance with the provisions of the Revised State Employees 210
Bargaining Agent Coalition agreement, approved by the General 211
Assembly on August 22, 2011, for state employees, as amended by 212
stipulated agreements. 213
(3) "Multiemployer plan" has the same meaning as provided in 214
Section 3 of the Employee Retirement Income Security Act of 1974, as 215
amended from time to time; 216
[(2)] (4) "Nonstate public employee" means any employee or elected 217
officer of a nonstate public employer. 218
[(3)] (5) "Nonstate public employer" means a municipality or other 219
political subdivision of the state, including a board of education, quasi-220
public agency or public library. A municipality and a board of education 221
may be considered separate employers. 222
(6) "Nonprofit employer" means a nonprofit, nonstock corporation, 223
other than a nonstate public employer, that employs at least one 224
employee on the first day that such employer receives coverage under a 225
group hospitalization, medical, pharmacy and surgical insurance plan 226
offered by the Comptroller pursuant to this part. 227 Raised Bill No. 346
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(7) "Small employer" means an employer, other than a nonstate public 228
employer, that employed an average of at least one but not more than 229
fifty employees on business days during the preceding calendar year, 230
and employs at least one employee on the first day that such employer 231
receives coverage under a group hospitalization, medical, pharmacy 232
and surgical insurance plan offered by the Comptroller pursuant to this 233
part. 234
[(4)] (8) "State employee plan" means the group hospitalization, 235
medical, pharmacy and surgical insurance plan offered to state 236
employees and retirees pursuant to section 5-259. 237
[(5) "Health enhancement program" means the program established 238
in accordance with the provisions of the Revised State Employees 239
Bargaining Agent Coalition agreement, approved by the General 240
Assembly on August 22, 2011, for state employees, as may be amended 241
by stipulated agreements.] 242
[(6)] (9) "Value-based insurance design" means health benefit designs 243
that lower or remove financial barriers to essential, high-value clinical 244
services. 245
[(7) "Health care coverage type" means the type of health care 246
coverage offered by nonstate public employers, including, but not 247
limited to, coverage for a nonstate public employee, nonstate public 248
employee plus spouse and nonstate public employee plus family.] 249
Sec. 7. (NEW) (Effective July 1, 2020) (a) (1) Notwithstanding any 250
provision of title 38a of the general statutes, the Comptroller shall offer 251
to plan participants and beneficiaries in this state under a 252
multiemployer plan, nonprofit employers and their employees and 253
small employers and their employees coverage under the state 254
employee plan or another group hospitalization, medical, pharmacy 255
and surgical insurance plan developed by the Comptroller to provide 256
coverage for plan participants and beneficiaries in this state under a 257
multiemployer plan, nonprofit employers and their employees and 258
small employers and their employees. Plan participants and 259 Raised Bill No. 346
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beneficiaries in this state under a multiemployer plan, nonprofit 260
employers and their employees and small employers and their 261
employees receiving coverage provided pursuant to this section shall be 262
pooled with state employees and retirees under the state employee plan, 263
provided the administrator of the multiemployer plan, the nonprofit 264
employer or the small employer files an application with the 265
Comptroller for coverage pursuant to this section and the Comptroller 266
approves such application. The administrators of multiemployer plans, 267
nonprofit employers or small employers shall remit to the Comptroller 268
payments for coverage provided pursuant to this section. Such 269
payments shall be equal to the payments paid by the state for state 270
employees covered under the state employee plan, inclusive of any 271
premiums paid by state employees pursuant to the state employee plan, 272
except that premium payments may be adjusted to reflect the cost of 273
health care in the geographic area in which the majority of a 274
multiemployer plan's plan participants and beneficiaries, a nonprofit 275
employer's employees or a small employer's employees work, 276
differences from the benefits and networks provided to state employees, 277
the demographic makeup of the multiemployer plan's plan participants 278
and beneficiaries, nonprofit employer's employees or small employer's 279
employees or as otherwise provided in this section. The Comptroller 280
shall phase in the geographic adjustment established in this subsection 281
over a two-year period for existing participants. Beginning on July 1, 282
2021, the Comptroller may charge each multiemployer plan, nonprofit 283
employer and small employer participating in the state employee plan 284
an administrative fee calculated on a per member, per month basis. 285
(2) Any group hospitalization, medical, pharmacy and surgical 286
insurance plan developed by the Comptroller pursuant to subdivision 287
(1) of this subsection shall (A) include the health enhancement program, 288
(B) be consistent with value-based insurance design principles, and (C) 289
be approved by the Health Care Cost Containment Committee prior to 290
being offered to small employers and their employees. 291
(b) The Comptroller shall offer participation in each plan described 292
in subsection (a) of this section for intervals lasting not less than three 293 Raised Bill No. 346
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years. The administrator of the multiemployer plan, nonprofit employer 294
or small employer may apply for renewal of coverage prior to expiration 295
of each interval. 296
(c) The Comptroller shall develop procedures by which 297
administrators of multiemployer plans, nonprofit employers and small 298
employers may initially apply for, renew and withdraw from coverage 299
provided pursuant to this section, as well as rules of participation that 300
the Comptroller, in the Comptroller's discretion, deems necessary. 301
(d) The Comptroller shall establish accounting procedures to track 302
claims and premium payments paid by multiemployer plans, nonprofit 303
employers and small employers receiving coverage provided pursuant 304
to this section. 305
Sec. 8. Section 3-123vvv of the 2020 supplement to the general statutes 306
is repealed and the following is substituted in lieu thereof (Effective July 307
1, 2020): 308
The Comptroller shall not offer coverage under the state employee 309
plan pursuant to sections 3-123rrr to 3-123uuu, inclusive, as amended 310
by this act, or section 7 of this act until the State Employees' Bargaining 311
Agent Coalition has provided its consent to the clerks of both houses of 312
the General Assembly to incorporate the terms of sections 3-123rrr to 3-313
123uuu, inclusive, as amended by this act, and section 7 of this act into 314
its collective bargaining agreement. 315
Sec. 9. Section 17b-282b of the general statutes is repealed and the 316
following is substituted in lieu thereof (Effective from passage): 317
(a) Not later than July 1, 2004, and prior to the implementation of a 318
state-wide dental plan that provides for the administration of the dental 319
services portion of the department's medical assistance, the 320
Commissioner of Social Services shall amend the federal waiver 321
approved pursuant to Section 1915(b) of the Social Security Act. Such 322
waiver amendment shall be submitted to the joint standing committees 323
of the General Assembly having cognizance of matters relating to 324 Raised Bill No. 346
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human services and appropriations and the budgets of state agencies in 325
accordance with the provisions of section 17b-8. 326
(b) (1) Not later than July 1, 2020, the Commissioner of Social Services 327
shall seek to amend the federal waiver described in subsection (a) of this 328
section to provide the state-wide dental plan, which provides for the 329
administration of the dental services portion of the department's 330
medical assistance, to: 331
(A) Enable each individual in this state who is insured under an 332
individual health insurance policy or a group health insurance policy 333
for a small employer, as defined in section 3-123rrr, as amended by this 334
act, or a nonprofit employer, as defined in section 3-123rrr or who is a 335
plan participant or beneficiary in this state under a multiemployer plan, 336
as defined in Section 3 of the Employee Retirement Income Security Act 337
of 1974, as amended from time to time, to receive coverage for the dental 338
services portion of such medical assistance; and 339
(B) Enable the Commissioner of Social Services to prescribe premium 340
and underwriting standards for the dental services portion of such 341
medical assistance for individuals described in subparagraph (A) of this 342
subdivision. 343
(2) Such waiver amendment shall be submitted to the joint standing 344
committees of the General Assembly having cognizance of matters 345
relating to human services and appropriations and the budgets of state 346
agencies in accordance with the provisions of section 17b-8. 347
This act shall take effect as follows and shall amend the following
sections:
Section 1 July 1, 2020 New section
Sec. 2 July 1, 2020 New section
Sec. 3 July 1, 2020 New section
Sec. 4 July 1, 2020 New section
Sec. 5 July 1, 2020 New section
Sec. 6 July 1, 2020 3-123rrr
Sec. 7 July 1, 2020 New section Raised Bill No. 346
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Sec. 8 July 1, 2020 3-123vvv
Sec. 9 from passage 17b-282b
Statement of Purpose:
To: (1) Establish the ConnectHealth Program, the ConnectHealth Trust
Account and the ConnectHealth Advisory Board; (2) require the
Comptroller, in consultation with the ConnectHealth Advisory Board
and the Office of Health Strategy, to establish the ConnectHealth Plan;
(3) authorize the Comptroller to offer coverage to plan participants and
beneficiaries in this state under a multiemployer plan, nonprofit
employers and their employees, and small employers and their
employees; and (4) require the Commissioner of Social Services to seek
to amend the federal waiver for the state-wide dental plan that provides
for the administration of the dental services portion of the department's
medical assistance to expand coverage to include additional individuals
in this state.
[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except
that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not
underlined.]