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General Assembly Raised Bill No. 842
January Session, 2021
LCO No. 2814
Referred to Committee on INSURANCE AND REAL ESTATE
Introduced by:
(INS)
AN ACT CONCERNING HE ALTH INSURANCE AND H EALTH CARE IN
CONNECTICUT.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. Section 3-123rrr of the general statutes is repealed and the 1
following is substituted in lieu thereof (Effective July 1, 2021): 2
As used in this section, [and] sections 3-123sss to 3-123vvv, inclusive, 3
[and] as amended by this act, section 3-123xxx and section 2 of this act: 4
(1) "Health Care Cost Containment Committee" means the committee 5
established in accordance with the ratified agreement between the state 6
and the State Employees Bargaining Agent Coalition pursuant to 7
subsection (f) of section 5-278. 8
(2) "Health enhancement program" means the program established in 9
accordance with the provisions of the Revised State Employees 10
Bargaining Agent Coalition agreement, approved by the General 11
Assembly on August 22, 2011, for state employees, as amended by 12
stipulated agreements. 13 Raised Bill No. 842
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(3) "Multiemployer plan" has the same meaning as provided in 14
Section 3 of the Employee Retirement Income Security Act of 1974, as 15
amended from time to time. 16
[(2)] (4) "Nonstate public employee" means any employee or elected 17
officer of a nonstate public employer. 18
[(3)] (5) "Nonstate public employer" means a municipality or other 19
political subdivision of the state, including a board of education, quasi-20
public agency or public library. A municipality and a board of education 21
may be considered separate employers. 22
(6) "Nonprofit employer" means a nonprofit, nonstock corporation, 23
other than a nonstate public employer, that employs at least one 24
employee on the first day that such employer receives coverage under a 25
group hospitalization, medical, pharmacy and surgical insurance plan 26
offered by the Comptroller pursuant to this part. 27
(7) "Small employer" means an employer, other than a nonstate public 28
employer, that employed an average of at least one but not more than 29
fifty employees on business days during the preceding calendar year, 30
and employs at least one employee on the first day that such employer 31
receives coverage under a group hospitalization, medical, pharmacy 32
and surgical insurance plan offered by the Comptroller pursuant to this 33
part. 34
[(4)] (8) "State employee plan" means the group hospitalization, 35
medical, pharmacy and surgical insurance plan offered to state 36
employees and retirees pursuant to section 5-259. 37
[(5) "Health enhancement program" means the program established 38
in accordance with the provisions of the Revised State Employees 39
Bargaining Agent Coalition agreement, approved by the General 40
Assembly on August 22, 2011, for state employees, as may be amended 41
by stipulated agreements.] 42
[(6)] (9) "Value-based insurance design" means health benefit designs 43 Raised Bill No. 842
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that lower or remove financial barriers to essential, high-value clinical 44
services. 45
[(7) "Health care coverage type" means the type of health care 46
coverage offered by nonstate public employers, including, but not 47
limited to, coverage for a nonstate public employee, nonstate public 48
employee plus spouse and nonstate public employee plus family.] 49
Sec. 2. (NEW) (Effective July 1, 2021) (a) (1) Notwithstanding any 50
provision of title 38a of the general statutes, the Comptroller shall offer 51
to plan participants and beneficiaries in this state under a 52
multiemployer plan, nonprofit employers and their employees and 53
small employers and their employees coverage under the state 54
employee plan or another group hospitalization, medical, pharmacy 55
and surgical insurance plan developed by the Comptroller to provide 56
coverage for plan participants and beneficiaries in this state under a 57
multiemployer plan, nonprofit employers and their employees and 58
small employers and their employees. Plan participants and 59
beneficiaries in this state under a multiemployer plan, nonprofit 60
employers and their employees and small employers and their 61
employees receiving coverage provided pursuant to this section shall be 62
pooled with state employees and retirees under the state employee plan, 63
provided the administrator of the multiemployer plan, the nonprofit 64
employer or the small employer files an application with the 65
Comptroller for coverage pursuant to this section and the Comptroller 66
approves such application. The administrators of multiemployer plans, 67
nonprofit employers or small employers shall remit to the Comptroller 68
payments for coverage provided pursuant to this section. Such 69
payments shall be equal to the payments paid by the state for state 70
employees covered under the state employee plan, inclusive of any 71
premiums paid by state employees pursuant to the state employee plan, 72
except premium payments may be adjusted to reflect: 73
(A) Age, in accordance with a uniform age rating curve that satisfies 74
the requirements established under the Patient Protection and 75
Affordable Care Act, P.L. 111-148, as amended from time to time, and 76 Raised Bill No. 842
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regulations adopted thereunder; 77
(B) Geographic area; 78
(C) Family size, provided premium payments for family coverage 79
shall not exceed the lesser of: 80
(i) The sum of the premium payments for all covered family 81
members; or 82
(ii) The sum of the premium payments for: 83
(I) All covered family members who are twenty-one years of age or 84
older; and 85
(II) The eldest three covered children who are younger than twenty-86
one years of age; 87
(D) Actuarially justified differences in: 88
(i) Plan design; 89
(ii) A plan's health care provider network; or 90
(iii) Administrative costs that can be reasonably attributed to a plan; 91
and 92
(E) The actual performance of a multiemployer plan, nonprofit 93
employer or small employer receiving coverage provided pursuant to 94
this section, provided such adjustment shall not cause the premiums 95
charged for such multiemployer plan, nonprofit employer or small 96
employer to increase or decrease by an amount that is greater than three 97
per cent of the premiums that would otherwise be charged for such 98
multiemployer plan, nonprofit employer or small employer under this 99
subdivision. 100
(2) Coverage provided pursuant to this section shall: 101
(A) Include the health enhancement program; 102 Raised Bill No. 842
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(B) Be consistent with value-based insurance design principles; 103
(C) Be approved by the Health Care Cost Containment Committee 104
during a public meeting; and 105
(D) Include coverage for: 106
(i) All health care services and benefits that each group health 107
insurance policy providing coverage of the type specified in 108
subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general 109
statutes delivered, issued for delivery, renewed, amended or continued 110
in this state is required to cover under chapter 700c of the general 111
statutes; and 112
(ii) All health care services and benefits that are essential health 113
benefits, as defined in the Patient Protection and Affordable Care Act, 114
P.L. 111-148, as amended from time to time, and regulations adopted 115
thereunder. 116
(3) The Comptroller may charge each multiemployer plan, nonprofit 117
employer and small employer receiving coverage provided pursuant to 118
this section an administrative fee calculated on a per member, per 119
month basis. Such administrative fee may include brokers' fees. 120
(b) (1) The Comptroller shall offer coverage under this section for 121
intervals lasting not less than: 122
(A) Three years for: 123
(i) Multiemployer plans; and 124
(ii) Nonprofit employers that are not small employers; or 125
(B) One year for small employers. 126
(2) The administrator of each multiemployer plan, nonprofit 127
employer or small employer receiving coverage pursuant to this section 128
may apply to renew such coverage before the interval applicable to such 129
multiemployer plan, nonprofit employer or small employer under 130 Raised Bill No. 842
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subdivision (1) of this subsection expires. 131
(c) The Comptroller shall require each administrator of a 132
multiemployer plan, nonprofit employer and small employer receiving 133
coverage under this section to offer coverage under this section to all of 134
such multiemployer plan's participants and beneficiaries in this state, 135
nonprofit employer's employees in this state and small employer's 136
employees in this state who are eligible for health coverage. The 137
administrator of such multiemployer plan, nonprofit employer or small 138
employer shall not offer coverage under this section in addition to, or in 139
conjunction with, any other health coverage option, except an 140
employer's active employees and retirees may be treated as independent 141
groups for the purposes of this subsection. 142
(d) (1) The Comptroller shall develop and establish: 143
(A) Procedures by which the administrator of a multiemployer plan, 144
nonprofit employer or small employer may initially apply for, renew 145
and withdraw from coverage provided pursuant to this section; 146
(B) Rules of participation that the Comptroller, in the Comptroller's 147
discretion, deems necessary; and 148
(C) Accounting procedures to track claims and premium payments 149
paid by multiemployer plans, nonprofit employers and small employers 150
receiving coverage provided pursuant to this section. 151
(2) The Comptroller shall procure such services, including, but not 152
limited to, services necessary to ensure compliance with the Employee 153
Retirement Income Security Act of 1974, as amended from time to time, 154
and regulations adopted thereunder, that the Comptroller deems 155
necessary to administer coverage provided pursuant to this section. The 156
Comptroller shall make an assessment against the multiemployer plans, 157
nonprofit employers and small employers receiving coverage provided 158
pursuant to this section to recover the cost of such services. Such 159
assessment shall be made on a per employee, per month basis and shall 160
be considered an administrative fee. 161 Raised Bill No. 842
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(e) The Comptroller shall make reasonable efforts to minimize the 162
risk that coverage provided pursuant to this section poses to the state's 163
finances. In making such reasonable efforts, the Comptroller may, 164
among other things: 165
(1) Purchase an aggregate stop-loss insurance policy on behalf of all 166
multiemployer plans, nonprofit employers and small employers 167
receiving coverage provided pursuant to this section; 168
(2) Purchase a stop-loss insurance policy on behalf of an individual 169
multiemployer plan, nonprofit employer or small employer receiving 170
coverage provided pursuant to this section; and 171
(3) Establish a risk fund to pay claims that exceed the premiums 172
collected for a multiemployer plan, nonprofit employer or small 173
employer receiving coverage provided pursuant to this section, fund 174
such risk fund through a charge levied on such multiemployer plans, 175
nonprofit employers and small employers and establish operating 176
procedures for use of such fund. 177
(f) (1) Nothing in this section shall be construed to: 178
(A) Require the Comptroller to offer coverage under the state 179
employee plan to every multiemployer plan, nonprofit employer and 180
small employer seeking coverage under the state employee plan 181
pursuant to this section; or 182
(B) Prevent the Comptroller from: 183
(i) Procuring coverage for nonstate public employees from vendors 184
other than the vendors providing coverage to state employees; or 185
(ii) Offering plan designs or benefit coverage levels pursuant to this 186
section that differ from the plan designs and benefit coverage levels 187
offered to state employees, provided the Comptroller shall not offer any 188
coverage pursuant to this section that imposes a deductible that is 189
greater than the minimum deductible required by the Internal Revenue 190
Service for such coverage to qualify as a high deductible health plan, as 191 Raised Bill No. 842
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defined in Section 220(c)(2) or Section 223(c)(2) of the Internal Revenue 192
Code of 1986, or any subsequent corresponding internal revenue code 193
of the United States, as amended from time to time. 194
(2) No coverage offered by the Comptroller pursuant to this section 195
shall be deemed to constitute a multiple employer welfare arrangement, 196
as defined in Section 3 of the Employee Retirement Income Security Act 197
of 1974, as amended from time to time. 198
Sec. 3. Section 3-123vvv of the general statutes is repealed and the 199
following is substituted in lieu thereof (Effective July 1, 2021): 200
The Comptroller shall not offer coverage under the state employee 201
plan pursuant to sections 3-123rrr to 3-123uuu, inclusive, as amended 202
by this act, or section 2 of this act until the State Employees' Bargaining 203
Agent Coalition has provided its consent to the clerks of both houses of 204
the General Assembly to incorporate the terms of sections 3-123rrr to 3-205
123uuu, inclusive, as amended by this act, and section 2 of this act into 206
its collective bargaining agreement. 207
Sec. 4. (NEW) (Effective July 1, 2021) (a) For the purposes of this 208
section: 209
(1) "Exchange" has the same meaning as provided in section 38a-1080 210
of the general statutes, as amended by this act; 211
(2) "Exempt insurer" means an insurer that administers self-insured 212
health benefit plans and is exempt from third-party administrator 213
licensure under subparagraph (C) of subdivision (11) of section 38a-720 214
of the general statutes and section 38a-720a of the general statutes; and 215
(3) "Office of Health Strategy" means the Office of Health Strategy 216
established under section 19a-754a of the general statutes. 217
(b) (1) Subject to the approval required under subsection (d) of section 218
10 of this act and, with respect to the matters for which the exchange 219
seeks a state innovation waiver pursuant to subparagraph (B) of 220
subdivision (28) of section 38a-1084 of the general statutes, issuance of 221 Raised Bill No. 842
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such state innovation waiver, the Office of Health Strategy, not later 222
than September 1, 2021, for plan year 2022 and annually thereafter for 223
the succeeding plan year, shall: 224
(A) Determine the amount, not to exceed fifty million dollars, that the 225
exchange requires to perform its duties under subparagraph (C) of 226
subdivision (28) of section 38a-1084 of the general statutes, as amended 227
by this act; and 228
(B) Inform the Office of Policy and Management of the amount 229
determined pursuant to subparagraph (A) of this subdivision. 230
(2) The Office of Policy and Management shall disclose the amount 231
determined pursuant to subparagraph (A) of subdivision (1) of this 232
subsection to the Insurance Commissioner and the exchange. 233
(c) (1) Each insurer and health care center doing health insurance 234
business in this state, and each exempt insurer, shall annually pay to the 235
Insurance Commissioner, for deposit in the Connecticut Health 236
Insurance Exchange account established under section 7 of this act, a fee 237
assessed by the commissioner pursuant to this section. 238
(2) Not later than September 1, 2021, and annually thereafter, each 239
insurer, health care center and exempt insurer described in subdivision 240
(1) of this subsection shall report to the commissioner, on a form 241
designated by said commissioner, the number of insured or enrolled 242
lives in this state as of the May first immediately preceding for which 243
such insurer, health care center or exempt insurer was providing health 244
insurance coverage, or administering a self-insured health benefit plan 245
providing coverage, of the types specified in subdivisions (1), (2), (4), 246
(11) and (12) of section 38a-469 of the general statutes. Such number 247
shall not include lives enrolled in Medicare, any medical assistance 248
program administered by the Department of Social Services, workers' 249
compensation insurance or Medicare Part C plans. 250
(3) Not later than November 1, 2021, and annually thereafter, the 251
commissioner shall determine the fee to be assessed for the succeeding 252 Raised Bill No. 842
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plan year against each insurer, health care center and exempt insurer 253
described in subdivision (1) of this subsection. Such fee shall be 254
calculated by multiplying the number of insured or enrolled lives 255
reported to the commissioner pursuant to subdivision (2) of this 256
subsection by a factor, determined annually by the commissioner, to 257
fully fund the amount determined by the Office of Health Strategy 258
under subparagraph (A) of subdivision (1) of subsection (b) of this 259
section, adjusted by subtracting, if the amount appropriated was more 260
than the amount expended, or by adding, if the amount expended was 261
more than the amount appropriated, the amount determined by the 262
Office of Health Strategy under subparagraph (A) of subdivision (1) of 263
subsection (b) of this section, less the amount of any federal pass-264
through savings available pursuant to the waiver described in 265
subdivision (1) of subsection (b) of this section. The commissioner shall 266
determine the factor by dividing the adjusted amount by the total 267
number of insured or enrolled lives reported to the commissioner 268
pursuant to subdivision (2) of this subsection. 269
(4) (A) Not later than December 1, 2021, and annually thereafter, the 270
commissioner shall submit a statement to each insurer, health care 271
center and exempt insurer described in subdivision (1) of this subsection 272
that includes the proposed fee imposed under this section for such 273
insurer, health care center or exempt insurer calculated in accordance 274
with this subsection. Each such insurer, health care center and exempt 275
insurer shall pay such fee to the commissioner not later than February 276
first of the succeeding calendar year. 277
(B) Any insurer, health care center or exempt insurer described in 278
subdivision (1) of this subsection that is aggrieved by an assessment 279
levied under this subsection may appeal therefrom in the same manner 280
as provided for appeals under section 38a-52 of the general statutes. 281
(5) Any insurer, health care center or exempt insurer that fails to file 282
the report required under subdivision (2) of this subsection shall pay a 283
late filing fee of one hundred dollars per day for each day from the date 284
such report was due. The commissioner may require an insurer, health 285 Raised Bill No. 842
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care center or exempt insurer subject to this subsection to produce any 286
records in its possession, and may require any other person to produce 287
any records in such other person's possession, that were used to prepare 288
such report for examination by the commissioner or the commissioner's 289
designee. If the commissioner determines there exists anything other 290
than a good faith discrepancy between the actual number of insured or 291
enrolled lives that should have been reported pursuant to subdivision 292
(2) of this subsection and the number actually reported, such insurer, 293
health care center or exempt insurer shall pay a civil penalty of not more 294
than fifteen thousand dollars for each report filed for which the 295
commissioner determines there is such a discrepancy. 296
(6) (A) The commissioner shall apply an overpayment of the fee 297
imposed under this section by an insurer, health care center or exempt 298
insurer for any plan year as a credit against the fee due from such 299
insurer, health care center or exempt insurer under this section for the 300
succeeding plan year, subject to an adjustment under subdivision (3) of 301
this subsection, if: 302
(i) The amount of the overpayment exceeds five thousand dollars; 303
and 304
(ii) On or before June first of the calendar year of the overpayment, 305
the insurer, health care center, or exempt insurer: 306
(I) Notifies the commissioner of the amount of the overpayment; and 307
(II) Provides the commissioner with evidence sufficient to prove the 308
amount of the overpayment. 309
(B) Not later than ninety days following receipt of notice and 310
supporting evidence under subparagraph (A) of this subdivision, the 311
commissioner shall: 312
(i) Determine whether the insurer, health care center or exempt 313
insurer made an overpayment; and 314
(ii) Notify the insurer, health care center or exempt insurer of the 315 Raised Bill No. 842
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commissioner's determination under subparagraph (B)(i) of this 316
subdivision. 317
(C) Failure of an insurer, health care center or exempt insurer to 318
notify the commissioner of the amount of an overpayment within the 319
time prescribed in subparagraph (A)(ii) of this subdivision constitutes a 320
waiver of any demand of the insurer, health care center or exempt 321
insurer against this state on account of such overpayment. 322
(D) Nothing in this subdivision shall be construed to prohibit or limit 323
the right of an insurer, health care center or exempt insurer to appeal 324
pursuant to subparagraph (B) of subdivision (4) of this subsection. 325
(d) The exchange shall use the assessment imposed under this section 326
to perform the exchange's duties under subparagraph (C) of subdivision 327
(28) of section 38a-1084 of the general statutes, as amended by this act. 328
(e) If another state, territory or district of the United States, or a 329
foreign country, imposes on a Connecticut domiciled insurer, fraternal 330
benefit society, hospital service corporation, medical service 331
corporation, health care center or other domestic entity a retaliatory 332
charge for the fee imposed under this section, such domestic entity may, 333
not later than sixty days after receipt of notice of the imposition of the 334
retaliatory charge for such fee, appeal to the Insurance Commissioner 335
for a verification that the fee imposed under this section is subject to 336
retaliation by another state, territory or district of the United States, or a 337
foreign country. If the commissioner verifies, upon appeal to and 338
certification by the commissioner, that the fee imposed under this 339
section is the subject of a retaliatory tax, fee, assessment or other 340
obligation by another state, territory or district of the United States, or a 341
foreign country, such fee shall not be assessed against nondomestic 342
insurers and nondomestic exempt insurers pursuant to this section. Any 343
such domestic insurer, fraternal benefit society, hospital service 344
corporation, medical service corporation, health care center or other 345
entity aggrieved by the commissioner's decision issued under this 346
subsection may appeal therefrom in the same manner as provided 347 Raised Bill No. 842
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under section 38a-52 of the general statutes. 348
(f) The Insurance Commissioner may adopt regulatio ns, in 349
accordance with chapter 54 of the general statutes, to implement the 350
provisions of this section. 351
Sec. 5. Section 38a-1080 of the general statutes is repealed and the 352
following is substituted in lieu thereof (Effective July 1, 2021): 353
For purposes of sections 38a-1080 to 38a-1093, inclusive, as amended 354
by this act, and sections 7 and 8 of this act: 355
(1) "Board" means the board of directors of the Connecticut Health 356
Insurance Exchange; 357
(2) "Commissioner" means the Insurance Commissioner; 358
(3) "Exchange" means the Connecticut Health Insurance Exchange 359
established pursuant to section 38a-1081; 360
(4) "Affordable Care Act" means the Patient Protection and 361
Affordable Care Act, P.L. 111-148, as amended by the Health Care and 362
Education Reconciliation Act, P.L. 111-152, as both may be amended 363
from time to time, and regulations adopted thereunder; 364
(5) (A) "Health benefit plan" means an insurance policy or contract 365
offered, delivered, issued for delivery, renewed, amended or continued 366
in the state by a health carrier to provide, deliver, pay for or reimburse 367
any of the costs of health care services. 368
(B) "Health benefit plan" does not include: 369
(i) Coverage of the type specified in subdivisions (5), (6), (7), (8), (9), 370
(14), (15) and (16) of section 38a-469 or any combination thereof; 371
(ii) Coverage issued as a supplement to liability insurance; 372
(iii) Liability insurance, including general liability insurance and 373
automobile liability insurance; 374 Raised Bill No. 842
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(iv) Workers' compensation insurance; 375
(v) Automobile medical payment insurance; 376
(vi) Credit insurance; 377
(vii) Coverage for on-site medical clinics; or 378
(viii) Other similar insurance coverage specified in regulations issued 379
pursuant to the Health Insurance Portability and Accountability Act of 380
1996, P.L. 104-191, as amended from time to time, under which benefits 381
for health care services are secondary or incidental to other insurance 382
benefits. 383
(C) "Health benefit plan" does not include the following benefits if 384
they are provided under a separate insurance policy, certificate or 385
contract or are otherwise not an integral part of the plan: 386
(i) Limited scope dental or vision benefits; 387
(ii) Benefits for long-term care, nursing home care, home health care, 388
community-based care or any combination thereof; or 389
(iii) Other similar, limited benefits specified in regulations issued 390
pursuant to the Health Insurance Portability and Accountability Act of 391
1996, P.L. 104-191, as amended from time to time; 392
(iv) Other supplemental coverage, similar to coverage of the type 393
specified in subdivisions (9) and (14) of section 38a-469, provided under 394
a group health plan. 395
(D) "Health benefit plan" does not include coverage of the type 396
specified in subdivisions (3) and (13) of section 38a-469 or other fixed 397
indemnity insurance if (i) such coverage is provided under a separate 398
insurance policy, certificate or contract, (ii) there is no coordination 399
between the provision of the benefits and any exclusion of benefits 400
under any group health plan maintained by the same plan sponsor, and 401
(iii) the benefits are paid with respect to an event without regard to 402 Raised Bill No. 842
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whether benefits were also provided under any group health plan 403
maintained by the same plan sponsor; 404
(6) "Health care services" has the same meaning as provided in 405
section 38a-478; 406
(7) "Health carrier" means an insurance company, fraternal benefit 407
society, hospital service corporation, medical service corporation, health 408
care center or other entity subject to the insurance laws and regulations 409
of the state or the jurisdiction of the commissioner that contracts or 410
offers to contract to provide, deliver, pay for or reimburse any of the 411
costs of health care services; 412
(8) "Internal Revenue Code" means the Internal Revenue Code of 413
1986, or any subsequent corresponding internal revenue code of the 414
United States, as amended from time to time; 415
(9) "Person" has the same meaning as provided in section 38a-1; 416
(10) "Qualified dental plan" means a limited scope dental plan that 417
has been certified in accordance with subsection (e) of section 38a-1086; 418
(11) "Qualified employer" has the same meaning as provided in 419
Section 1312 of the Affordable Care Act; 420
(12) "Qualified health plan" means a health benefit plan that has in 421
effect a certification that the plan meets the criteria for certification 422
described in Section 1311(c) of the Affordable Care Act and section 38a-423
1086; 424
(13) "Qualified individual" has the same meaning as provided in 425
Section 1312 of the Affordable Care Act; 426
(14) "Secretary" means the Secretary of the United States Department 427
of Health and Human Services; and 428
(15) "Small employer" has the same meaning as provided in section 429
38a-564. 430 Raised Bill No. 842
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Sec. 6. Section 38a-1084 of the general statutes is repealed and the 431
following is substituted in lieu thereof (Effective July 1, 2021): 432
The exchange shall: 433
(1) Administer the exchange for both qualified individuals and 434
qualified employers; 435
(2) Commission surveys of individuals, small employers and health 436
care providers on issues related to health care and health care coverage; 437
(3) Implement procedures for the certification, recertification and 438
decertification, consistent with guidelines developed by the Secretary 439
under Section 1311(c) of the Affordable Care Act, and section 38a-1086, 440
of health benefit plans as qualified health plans; 441
(4) Provide for the operation of a toll-free telephone hotline to 442
respond to requests for assistance; 443
(5) Provide for enrollment periods, as provided under Section 444
1311(c)(6) of the Affordable Care Act; 445
(6) Maintain an Internet web site through which enrollees and 446
prospective enrollees of qualified health plans may obtain standardized 447
comparative information on such plans including, but not limited to, the 448
enrollee satisfaction survey information under Section 1311(c)(4) of the 449
Affordable Care Act and any other information or tools to assist 450
enrollees and prospective enrollees evaluate qualified health plans 451
offered through the exchange; 452
(7) Publish the average costs of licensing, regulatory fees and any 453
other payments required by the exchange and the administrative costs 454
of the exchange, including information on moneys lost to waste, fraud 455
and abuse, on an Internet web site to educate individuals on such costs; 456
(8) On or before the open enrollment period for plan year 2017, assign 457
a rating to each qualified health plan offered through the exchange in 458
accordance with the criteria developed by the Secretary under Section 459 Raised Bill No. 842
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1311(c)(3) of the Affordable Care Act, and determine each qualified 460
health plan's level of coverage in accordance with regulations issued by 461
the Secretary under Section 1302(d)(2)(A) of the Affordable Care Act; 462
(9) Use a standardized format for presenting health benefit options in 463
the exchange, including the use of the uniform outline of coverage 464
established under Section 2715 of the Public Health Service Act, 42 USC 465
300gg-15, as amended from time to time; 466
(10) Inform individuals, in accordance with Section 1413 of the 467
Affordable Care Act, of eligibility requirements for the Medicaid 468
program under Title XIX of the Social Security Act, as amended from 469
time to time, the Children's Health Insurance Program (CHIP) under 470
Title XXI of the Social Security Act, as amended from time to time, or 471
any applicable state or local public program, and enroll an individual in 472
such program if the exchange determines, through screening of the 473
application by the exchange, that such individual is eligible for any such 474
program; 475
(11) Collaborate with the Department of Social Services, to the extent 476
possible, to allow an enrollee who loses premium tax credit eligibility 477
under Section 36B of the Internal Revenue Code and is eligible for 478
HUSKY A or any other state or local public program, to remain enrolled 479
in a qualified health plan; 480
(12) Establish and make available by electronic means a calculator to 481
determine the actual cost of coverage after application of any premium 482
tax credit under Section 36B of the Internal Revenue Code and any cost-483
sharing reduction under Section 1402 of the Affordable Care Act; 484
(13) Establish a program for small employers through which 485
qualified employers may access coverage for their employees and that 486
shall enable any qualified employer to specify a level of coverage so that 487
any of its employees may enroll in any qualified health plan offered 488
through the exchange at the specified level of coverage; 489
(14) Offer enrollees and small employers the option of having the 490 Raised Bill No. 842
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exchange collect and administer premiums, including through 491
allocation of premiums among the various insurers and qualified health 492
plans chosen by individual employers; 493
(15) Grant a certification, subject to Section 1411 of the Affordable 494
Care Act, attesting that, for purposes of the individual responsibility 495
penalty under Section 5000A of the Internal Revenue Code, an 496
individual is exempt from the individual responsibility requirement or 497
from the penalty imposed by said Section 5000A because: 498
(A) There is no affordable qualified health plan available through the 499
exchange, or the individual's employer, covering the individual; or 500
(B) The individual meets the requirements for any other such 501
exemption from the individual responsibility requirement or penalty; 502
(16) Provide to the Secretary of the Treasury of the United States the 503
following: 504
(A) A list of the individuals granted a certification under subdivision 505
(15) of this section, including the name and taxpayer identification 506
number of each individual; 507
(B) The name and taxpayer identification number of each individual 508
who was an employee of an employer but who was determined to be 509
eligible for the premium tax credit under Section 36B of the Internal 510
Revenue Code because: 511
(i) The employer did not provide minimum essential health benefits 512
coverage; or 513
(ii) The employer provided the minimum essential coverage but it 514
was determined under Section 36B(c)(2)(C) of the Internal Revenue 515
Code to be unaffordable to the employee or not provide the required 516
minimum actuarial value; and 517
(C) The name and taxpayer identification number of: 518 Raised Bill No. 842
LCO No. 2814 19 of 34
(i) Each individual who notifies the exchange under Section 519
1411(b)(4) of the Affordable Care Act that such individual has changed 520
employers; and 521
(ii) Each individual who ceases coverage under a qualified health 522
plan during a plan year and the effective date of that cessation; 523
(17) Provide to each employer the name of each employee, as 524
described in subparagraph (B) of subdivision (16) of this section, of the 525
employer who ceases coverage under a qualified health plan during a 526
plan year and the effective date of the cessation; 527
(18) Perform duties required of, or delegated to, the exchange by the 528
Secretary or the Secretary of the Treasury of the United States related to 529
determining eligibility for premium tax credits, reduced cost-sharing or 530
individual responsibility requirement exemptions; 531
(19) Select entities qualified to serve as Navigators in accordance with 532
Section 1311(i) of the Affordable Care Act and award grants to enable 533
Navigators to: 534
(A) Conduct public education activities to raise awareness of the 535
availability of qualified health plans; 536
(B) Distribute fair and impartial information concerning enrollment 537
in qualified health plans and the availability of premium tax credits 538
under Section 36B of the Internal Revenue Code and cost-sharing 539
reductions under Section 1402 of the Affordable Care Act; 540
(C) Facilitate enrollment in qualified health plans; 541
(D) Provide referrals to the Office of the Healthcare Advocate or 542
health insurance ombudsman established under Section 2793 of the 543
Public Health Service Act, 42 USC 300gg-93, as amended from time to 544
time, or any other appropriate state agency or agencies, for any enrollee 545
with a grievance, complaint or question regarding the enrollee's health 546
benefit plan, coverage or a determination under that plan or coverage; 547
and 548 Raised Bill No. 842
LCO No. 2814 20 of 34
(E) Provide information in a manner that is culturally and 549
linguistically appropriate to the needs of the population being served by 550
the exchange; 551
(20) Review the rate of premium growth within and outside the 552
exchange and consider such information in developing 553
recommendations on whether to continue limiting qualified employer 554
status to small employers; 555
(21) Credit the amount, in accordance with Section 10108 of the 556
Affordable Care Act, of any free choice voucher to the monthly 557
premium of the plan in which a qualified employee is enrolled and 558
collect the amount credited from the offering employer; 559
(22) Consult with stakeholders relevant to carrying out the activities 560
required under sections 38a-1080 to 38a-1090, inclusive, as amended by 561
this act, including, but not limited to: 562
(A) Individuals who are knowledgeable about the health care system, 563
have background or experience in making informed decisions regarding 564
health, medical and scientific matters and are enrollees in qualified 565
health plans; 566
(B) Individuals and entities with experience in facilitating enrollment 567
in qualified health plans; 568
(C) Representatives of small employers and self-employed 569
individuals; 570
(D) The Department of Social Services; and 571
(E) Advocates for enrolling hard-to-reach populations; 572
(23) Meet the following financial integrity requirements: 573
(A) Keep an accurate accounting of all activities, receipts and 574
expenditures and annually submit to the Secretary, the Governor, the 575
Insurance Commissioner and the General Assembly a report concerning 576 Raised Bill No. 842
LCO No. 2814 21 of 34
such accountings; 577
(B) Fully cooperate with any investigation conducted by the Secretary 578
pursuant to the Secretary's authority under the Affordable Care Act and 579
allow the Secretary, in coordination with the Inspector General of the 580
United States Department of Health and Human Services, to: 581
(i) Investigate the affairs of the exchange; 582
(ii) Examine the properties and records of the exchange; and 583
(iii) Require periodic reports in relation to the activities undertaken 584
by the exchange; and 585
(C) Not use any funds in carrying out its activities under sections 38a-586
1080 to 38a-1089, inclusive, as amended by this act, that are intended for 587
the administrative and operational expenses of the exchange, for staff 588
retreats, promotional giveaways, excessive executive compensation or 589
promotion of federal or state legislative and regulatory modifications; 590
(24) (A) Seek to include the most comprehensive health benefit plans 591
that offer high quality benefits at the most affordable price in the 592
exchange, (B) encourage health carriers to offer tiered health care 593
provider network plans that have different cost-sharing rates for 594
different health care provider tiers and reward enrollees for choosing 595
low-cost, high-quality health care providers by offering lower 596
copayments, deductibles or other out-of-pocket expenses, and (C) offer 597
any such tiered health care provider network plans through the 598
exchange; [and] 599
(25) Report at least annually to the General Assembly on the effect of 600
adverse selection on the operations of the exchange and make legislative 601
recommendations, if necessary, to reduce the negative impact from any 602
such adverse selection on the sustainability of the exchange, including 603
recommendations to ensure that regulation of insurers and health 604
benefit plans are similar for qualified health plans offered through the 605
exchange and health benefit plans offered outside the exchange. The 606 Raised Bill No. 842
LCO No. 2814 22 of 34
exchange shall evaluate whether adverse selection is occurring with 607
respect to health benefit plans that are grandfathered under the 608
Affordable Care Act, self-insured plans, plans sold through the 609
exchange and plans sold outside the exchange; [.] 610
(26) Administer the Connecticut Health Insurance Exchange account 611
established under section 7 of this act; 612
(27) Consult with the Office of Health Strategy established under 613
section 19a-754a, as amended by this act, for the purposes set forth in 614
subsection (b) of section 10 of this act; 615
(28) Subject to the approval required under subsection (d) of section 616
10 of this act: 617
(A) Establish the subsidiary described in subdivision (1) of subsection 618
(b) of section 10 of this act not later than November 1, 2021; 619
(B) Seek the state innovation waiver described in subdivision (2) of 620
subsection (b) of section 10 of this act not later than November 1, 2021; 621
and 622
(C) Use the moneys deposited in the Connecticut Health Insurance 623
Exchange account established under section 7 of this act for the 624
purposes set forth in subdivision (3) of subsection (b) of section 10 of 625
this act; 626
(29) Consult with the Commissioner of Social Services for the 627
purposes set forth in subsection (b) of section 17b-597, as amended by 628
this act; 629
(30) Implement, with assistance from the Commissioner of Social 630
Services, the policies and procedures necessary to carry out the 631
provisions of section 17b-597, as amended by this act; and 632
(31) Determine whether individuals referred to the exchange by the 633
Labor Commissioner pursuant to section 14 of this act are eligible for 634
free or subsidized health coverage or other assistance or benefits, 635 Raised Bill No. 842
LCO No. 2814 23 of 34
including, but not limited to, assistance under the supplemental 636
nutrition assistance program, and, if such individuals are eligible for 637
such coverage, assistance or benefits, enroll such individuals in such 638
coverage, assistance or benefits. 639
Sec. 7. (NEW) (Effective July 1, 2021) There is established an account 640
to be known as the "Connecticut Health Insurance Exchange account" 641
which shall be a separate, nonlapsing account within the General Fund. 642
The account shall contain any moneys required by law to be deposited 643
in the account. Moneys in the account shall be expended by the 644
exchange for the purposes set forth in subparagraph (C) of subdivision 645
(28) of section 38a-1084 of the general statutes, as amended by this act. 646
Sec. 8. (NEW) (Effective July 1, 2021) (a) Notwithstanding any 647
provision of the general statutes and to the extent permitted by federal 648
law, each qualified health plan that is offered through the exchange at a 649
silver level of coverage for a plan year beginning on or after January 1, 650
2022, shall provide coverage for the following benefits: 651
(1) Angiotensin converting enzyme inhibitors for an enrollee who is 652
diagnosed with congestive heart failure, diabetes or coronary artery 653
disease by a licensed health care provider who is acting within such 654
health care provider's scope of practice; 655
(2) Anti-resorptive therapy for an enrollee who is diagnosed with 656
osteoporosis or osteopenia by a licensed health care provider who is 657
acting within such health care provider's scope of practice; 658
(3) Beta-adrenergic blocking agents for an enrollee who is diagnosed 659
with congestive heart failure or coronary artery disease by a licensed 660
health care provider who is acting within such health care provider's 661
scope of practice; 662
(4) Blood pressure monitors for an enrollee who is diagnosed with 663
hypertension by a licensed health care provider who is acting within 664
such health care provider's scope of practice; 665 Raised Bill No. 842
LCO No. 2814 24 of 34
(5) Inhaled corticosteroids and peak flow meters for an enrollee who 666
is diagnosed with asthma by a licensed health care provider who is 667
acting within such health care provider's scope of practice; 668
(6) Insulin and other glucose lowering agents, retinopathy screening, 669
glucometers and hemoglobin A1C testing for an enrollee who is 670
diagnosed with diabetes by a licensed health care provider who is acting 671
within such health care provider's scope of practice; 672
(7) International normalized ratio testing for an enrollee who is 673
diagnosed with liver disease or a bleeding disorder by a licensed health 674
care provider who is acting within such health care provider's scope of 675
practice; 676
(8) Low density lipoprotein testing for an enrollee who is diagnosed 677
with heart disease by a licensed health care provider who is acting 678
within such health care provider's scope of practice; 679
(9) Selective serotonin reuptake inhibitors for an enrollee who is 680
diagnosed with depression by a licensed health care provider who is 681
acting within such health care provider's scope of practice; and 682
(10) Statins for an enrollee who is diagnosed with heart disease or 683
diabetes by a licensed health care provider who is acting within such 684
health care provider's scope of practice. 685
(b) Notwithstanding any provision of the general statutes and to the 686
extent permitted by federal law, each qualified health plan described in 687
subsection (a) of this section shall: 688
(1) Have a minimum actuarial value of at least seventy per cent; and 689
(2) Provide enrollees with access to the broadest provider network 690
available under the qualified health plans offered by the health carrier 691
through the exchange. 692
Sec. 9. Subsections (a) and (b) of section 19a-754a of the general 693
statutes are repealed and the following is substituted in lieu thereof 694 Raised Bill No. 842
LCO No. 2814 25 of 34
(Effective July 1, 2021): 695
(a) There is established an Office of Health Strategy, which shall be 696
within the Department of Public Health for administrative purposes 697
only. The department head of said office shall be the executive director 698
of the Office of Health Strategy, who shall be appointed by the Governor 699
in accordance with the provisions of sections 4-5 to 4-8, inclusive, with 700
the powers and duties therein prescribed. 701
(b) The Office of Health Strategy shall be responsible for the 702
following: 703
(1) Developing and implementing a comprehensive and cohesive 704
health care vision for the state, including, but not limited to, a 705
coordinated state health care cost containment strategy; 706
(2) Promoting effective health planning and the provision of quality 707
health care in the state in a manner that ensures access for all state 708
residents to cost-effective health care services, avoids the duplication of 709
such services and improves the availability and financial stability of 710
such services throughout the state; 711
(3) Directing and overseeing the State Innovation Model Initiative 712
and related successor initiatives; 713
(4) (A) Coordinating the state's health information technology 714
initiatives, (B) seeking funding for and overseeing the planning, 715
implementation and development of policies and procedures for the 716
administration of the all-payer claims database program established 717
under section 19a-775a, (C) establishing and maintaining a consumer 718
health information Internet web site under section 19a-755b, and (D) 719
designating an unclassified individual from the office to perform the 720
duties of a health information technology officer as set forth in sections 721
17b-59f and 17b-59g; 722
(5) Directing and overseeing the Health Systems Planning Unit 723
established under section 19a-612 and all of its duties and 724 Raised Bill No. 842
LCO No. 2814 26 of 34
responsibilities as set forth in chapter 368z; [and] 725
(6) Convening forums and meetings with state government and 726
external stakeholders, including, but not limited to, the Connecticut 727
Health Insurance Exchange, to discuss health care issues designed to 728
develop effective health care cost and quality strategies; [.] 729
(7) Annually (A) determining the amount described in subparagraph 730
(A) of subdivision (1) of subsection (b) of section 4 of this act, and (B) 731
informing the Office of Policy and Management of such amount 732
pursuant to subparagraph (B) of subdivision (1) of subsection (b) of 733
section 4 of this act; and 734
(8) Developing a plan pursuant to subsection (b) of section 10 of this 735
act and submitting a report containing such plan pursuant to subsection 736
(c) of section 10 of this act. 737
Sec. 10. (Effective July 1, 2021) (a) For the purposes of this section: 738
(1) "Account" means the Connecticut Health Insurance Exchange 739
account established under section 7 of this act; 740
(2) "Affordable Care Act" has the same meaning as provided in 741
section 38a-1080 of the general statutes, as amended by this act; 742
(3) "Exchange" has the same meaning as provided in section 38a-1080 743
of the general statutes, as amended by this act; 744
(4) "Office of Health Strategy" means the Office of Health Strategy 745
established under section 19a-754a of the general statutes, as amended 746
by this act; and 747
(5) "Qualified health plan" has the same meaning as provided in 748
section 38a-1080 of the general statutes, as amended by this act. 749
(b) The Office of Health Strategy shall, in consultation with the 750
exchange, develop a plan for the exchange to: 751
(1) Establish a subsidiary, in the manner set forth in section 38a-1093 752 Raised Bill No. 842
LCO No. 2814 27 of 34
of the general statutes, to create a marketplace for health carriers to offer 753
affordable health insurance coverage to persons who are ineligible for 754
coverage under the qualified health plans offered through the exchange; 755
(2) Seek a state innovation waiver pursuant to Section 1332 of the 756
Affordable Care Act for the purpose of: 757
(A) Reducing the cost of health insurance coverage in this state, 758
including, but not limited to, premiums and cost-sharing for such 759
coverage; 760
(B) Making health insurance coverage available to persons in this 761
state who are ineligible for coverage under a qualified health plan 762
offered through the exchange; and 763
(C) Allowing persons specified in subsection (a) of section 17b-597 of 764
the general statutes, as amended by this act, to receive coverage for 765
medical assistance under section 17b-597 of the general statutes, as 766
amended by this act, through the exchange; and 767
(3) For plan year 2022 and subsequent plan years, use the moneys 768
deposited in the account to: 769
(A) Reduce the cost of qualified health plans offered through the 770
exchange by, among other things, eliminating premiums for such 771
qualified health plans for persons with a household income not 772
exceeding two hundred one per cent of the federal poverty level; 773
(B) Make coverage affordable for persons who are ineligible for 774
coverage under a qualified health plan offered through the exchange by, 775
among other things, providing premium and cost-sharing subsidies to 776
such persons which, in the aggregate for all such persons, shall not 777
exceed twenty-five million dollars per year; and 778
(C) Implement the provisions of the state innovation waiver 779
described in subdivision (2) of this subsection if the federal government 780
issues such waiver for this state. 781 Raised Bill No. 842
LCO No. 2814 28 of 34
(c) Not later than August 1, 2021, the Office of Health Strategy shall 782
submit a report, in accordance with section 11-4a of the general statutes, 783
to the joint standing committee of the General Assembly having 784
cognizance of matters relating to insurance. Such report shall contain 785
the plan developed pursuant to subsection (b) of this section. 786
(d) Not later than October 1, 2021, the joint standing committee of the 787
General Assembly having cognizance of matters relating to insurance 788
shall advise the Office of Health Strategy and the exchange of its 789
approval or rejection of the plan contained in the report submitted by 790
the Office of Health Strategy pursuant to subsection (c) of this section. If 791
the committee does not act on or before said date, said plan shall be 792
deemed rejected. 793
Sec. 11. Section 17b-597 of the general statutes is repealed and the 794
following is substituted in lieu thereof (Effective July 1, 2021): 795
(a) The Department of Social Services shall establish and implement 796
a working persons with disabilities program to provide medical 797
assistance as authorized under 42 USC 1396a(a)(10)(A)(ii), as amended 798
from time to time, to persons who are disabled and regularly employed. 799
(b) The Commissioner of Social Services shall amend the Medicaid 800
state plan to develop, in consultation with the Connecticut Health 801
Insurance Exchange established pursuant to section 38a-1081, a 802
methodology to determine eligibility for the program established and 803
implemented by the commissioner pursuant to subsection (a) of this 804
section and allow persons specified in said subsection [(a) of this 805
section] to qualify for medical assistance regardless of assets. The 806
amendment shall include the following requirements: (1) That the 807
person be engaged in a substantial and reasonable work effort as 808
determined by the commissioner, or, if the amendment is approved, the 809
exchange, and as permitted by federal law; and [have an annual 810
adjusted gross income, as defined in Section 62 of the Internal Revenue 811
Code of 1986, or any subsequent corresponding internal revenue code 812
of the United States, as amended from time to time, of no more than 813 Raised Bill No. 842
LCO No. 2814 29 of 34
seventy-five thousand dollars per year; (2) a disregard of all countable 814
income up to two hundred per cent of the federal poverty level; (3) for 815
an unmarried person, an asset limit of ten thousand dollars, and for a 816
married couple, an asset limit of fifteen thousand dollars; (4) a disregard 817
of any retirement and medical savings accounts established pursuant to 818
26 USC 220 and held by either the person or the person's spouse; (5) a 819
disregard of any moneys in accounts designated by the person or the 820
person's spouse for the purpose of purchasing goods or services that 821
will increase the employability of such person, subject to approval by 822
the commissioner; (6) a disregard of spousal income solely for purposes 823
of determination of eligibility; and (7)] (2) a contribution of any 824
countable income of the person or the person's spouse which exceeds 825
two hundred per cent of the federal poverty level, as adjusted for the 826
appropriate family size, equal to ten per cent of the excess minus any 827
premiums paid from income for health insurance by any family 828
member, but which does not exceed the maximum contribution 829
allowable under Section 201(a)(3) of Public Law 106-170, as amended 830
from time to time. 831
(c) The Commissioner of Social Services shall (1) not later than 832
August 1, 2021, seek federal approval for a Medicaid state plan 833
amendment to implement the provisions of subsection (b) of this 834
section; and (2) assist the Connecticut Health Insurance Exchange, 835
established pursuant to section 38a-1081, to implement the policies and 836
procedures necessary to carry out the provisions of this section while 837
the commissioner is in the process of adopting such policies and 838
procedures in regulation form, provided notice of intent to adopt the 839
regulations is published [in the Connecticut Law Journal within] on the 840
Internet web site of the Department of Social Services and the 841
eRegulations System not later than twenty days after implementation. 842
The commissioner and the exchange shall define "countable income" for 843
purposes of subsection (b) of this section which shall take into account 844
impairment-related work expenses as defined in the Social Security Act. 845
Such policies and procedures shall be valid until the time final 846
regulations are effective. 847 Raised Bill No. 842
LCO No. 2814 30 of 34
Sec. 12. Section 17b-598 of the general statutes is repealed and the 848
following is substituted in lieu thereof (Effective July 1, 2021): 849
The Commissioner of Social Services shall seek a waiver from federal 850
law to permit a person participating in the program established under 851
section 17b-597, as amended by this act, to remain eligible for medical 852
assistance under the Medicaid program in the event such person is 853
unable to maintain a work effort for involuntary reasons. No such 854
person shall be required to make another application to determine 855
continued eligibility for medical assistance under the Medicaid 856
program. In order to remain eligible for such medical assistance, such 857
person shall (1) request that such assistance be continued for a period 858
not to exceed twelve months from the date of the involuntary loss of 859
employment, and (2) maintain a connection to the workforce as 860
determined by the commissioner during such period. At the end of the 861
twelve-month period, such person shall meet the eligibility criteria for 862
the Medicaid program. [, except that the commissioner shall disregard 863
any assets specified in subdivisions (4) and (5) of subsection (b) of 864
section 17b-597.] 865
Sec. 13. Subsection (a) of section 17b-261 of the general statutes is 866
repealed and the following is substituted in lieu thereof (Effective July 1, 867
2021): 868
(a) Medical assistance shall be provided for any otherwise eligible 869
person whose income, including any available support from legally 870
liable relatives and the income of the person's spouse or dependent 871
child, is not more than one hundred forty-three per cent, pending 872
approval of a federal waiver applied for pursuant to subsection (e) of 873
this section, of the benefit amount paid to a person with no income 874
under the temporary family assistance program in the appropriate 875
region of residence and if such person is an institutionalized individual 876
as defined in Section 1917 of the Social Security Act, 42 USC 1396p(h)(3), 877
and has not made an assignment or transfer or other disposition of 878
property for less than fair market value for the purpose of establishing 879
eligibility for benefits or assistance under this section. Any such 880 Raised Bill No. 842
LCO No. 2814 31 of 34
disposition shall be treated in accordance with Section 1917(c) of the 881
Social Security Act, 42 USC 1396p(c). Any disposition of property made 882
on behalf of an applicant or recipient or the spouse of an applicant or 883
recipient by a guardian, conservator, person authorized to make such 884
disposition pursuant to a power of attorney or other person so 885
authorized by law shall be attributed to such applicant, recipient or 886
spouse. A disposition of property ordered by a court shall be evaluated 887
in accordance with the standards applied to any other such disposition 888
for the purpose of determining eligibility. The commissioner shall 889
establish the standards for eligibility for medical assistance at one 890
hundred forty-three per cent of the benefit amount paid to a household 891
of equal size with no income under the temporary family assistance 892
program in the appropriate region of residence. In determining 893
eligibility, the commissioner shall not consider as income Aid and 894
Attendance pension benefits granted to a veteran, as defined in section 895
27-103, or the surviving spouse of such veteran. Except as provided in 896
section 17b-277 and section 17b-292, the medical assistance program 897
shall provide coverage to persons under the age of nineteen with 898
household income up to one hundred ninety-six per cent of the federal 899
poverty level without an asset limit and to persons under the age of 900
nineteen, who qualify for coverage under Section 1931 of the Social 901
Security Act, with household income not exceeding one hundred 902
ninety-six per cent of the federal poverty level without an asset limit, 903
and their parents and needy caretaker relatives, who qualify for 904
coverage under Section 1931 of the Social Security Act, with household 905
income not exceeding [one hundred fifty-five] two hundred one per cent 906
of the federal poverty level without an asset limit. Such levels shall be 907
based on the regional differences in such benefit amount, if applicable, 908
unless such levels based on regional differences are not in conformance 909
with federal law. Any income in excess of the applicable amounts shall 910
be applied as may be required by said federal law, and assistance shall 911
be granted for the balance of the cost of authorized medical assistance. 912
The Commissioner of Social Services shall provide applicants for 913
assistance under this section, at the time of application, with a written 914
statement advising them of (1) the effect of an assignment or transfer or 915 Raised Bill No. 842
LCO No. 2814 32 of 34
other disposition of property on eligibility for benefits or assistance, (2) 916
the effect that having income that exceeds the limits prescribed in this 917
subsection will have with respect to program eligibility, and (3) the 918
availability of, and eligibility for, services provided by the Nurturing 919
Families Network established pursuant to section 17b-751b. For 920
coverage dates on or after January 1, 2014, the department shall use the 921
modified adjusted gross income financial eligibility rules set forth in 922
Section 1902(e)(14) of the Social Security Act and the implementing 923
regulations to determine eligibility for HUSKY A, HUSKY B and 924
HUSKY D applicants, as defined in section 17b-290. Persons who are 925
determined ineligible for assistance pursuant to this section shall be 926
provided a written statement notifying such persons of their ineligibility 927
and advising such persons of their potential eligibility for one of the 928
other insurance affordability programs as defined in 42 CFR 435.4. 929
Sec. 14. (NEW) (Effective July 1, 2021) The Labor Commissioner shall, 930
within available appropriations, notify individuals applying for 931
unemployment compensation benefits under chapter 567 of the general 932
statutes that such individuals may be eligible for free or subsidized 933
health coverage or other assistance or benefits, including, but not 934
limited to, assistance under the supplemental nutrition assistance 935
program. The commissioner shall refer such individuals to the exchange 936
for the purpose of determining their eligibility for such coverage, 937
assistance or benefits and, if such individuals are eligible for such 938
coverage, assistance or benefits, enrolling such individuals in such 939
coverage, assistance or benefits. For the purposes of this section, 940
"exchange" and "qualified health plan" have the same meanings as 941
provided in section 38a-1080 of the general statutes, as amended by this 942
act. 943
This act shall take effect as follows and shall amend the following
sections:
Section 1 July 1, 2021 3-123rrr
Sec. 2 July 1, 2021 New section
Sec. 3 July 1, 2021 3-123vvv
Sec. 4 July 1, 2021 New section Raised Bill No. 842
LCO No. 2814 33 of 34
Sec. 5 July 1, 2021 38a-1080
Sec. 6 July 1, 2021 38a-1084
Sec. 7 July 1, 2021 New section
Sec. 8 July 1, 2021 New section
Sec. 9 July 1, 2021 19a-754a(a) and (b)
Sec. 10 July 1, 2021 New section
Sec. 11 July 1, 2021 17b-597
Sec. 12 July 1, 2021 17b-598
Sec. 13 July 1, 2021 17b-261(a)
Sec. 14 July 1, 2021 New section
Statement of Purpose:
To: (1) Authorize the Comptroller to offer health coverage to plan
participants and beneficiaries in this state under a multiemployer plan,
nonprofit employers and their employees and small employers and
their employees; (2) assess an annual fee against certain insurers, health
care centers and exempt insurers; (3) require the Connecticut Health
Insurance Exchange to (A) administer the "Connecticut Health
Insurance Exchange account", (B) consult with the Office of Health
Strategy to develop and, if approved, implement a plan to (i) establish a
subsidiary, (ii) seek a state innovation waiver, and (iii) use the moneys
deposited in said account for the purposes set forth in the plan, (C)
consult with the Commissioner of Social Services to develop and, if
approved, implement a methodology to determine eligibility for the
working persons with disabilities program, and (D) determine whether
certain individuals referred to the exchange by the Labor Commissioner
are eligible for free or subsidized health coverage or other assistance or
benefits and, if such individuals are eligible for such coverage,
assistance or benefits, enroll such individuals in such coverage,
assistance or benefits; (4) establish the "Connecticut Health Insurance
Exchange account"; (5) require certain qualified health plans offered
through the exchange to (A) provide coverage for certain benefits, (B)
have a minimum actuarial value of at least seventy per cent, and (C)
provide enrollees with access to the broadest provider network
available under the qualified health plans offered by the health carrier
through the exchange; (6) require the Office of Health Strategy to (A)
annually determine, and disclose to the Office of Policy and
Management, the amount of an annual assessment against certain
insurers, health care centers and exempt insurers, and (B) develop, and
submit to the joint standing committee of the General Assembly having
cognizance of matters relating to insurance for approval, a plan for the
exchange to (i) establish a subsidiary to create a marketplace for health Raised Bill No. 842
LCO No. 2814 34 of 34
carriers to offer affordable health insurance coverage to persons who are
ineligible for coverage under the qualified health plans offered through
the exchange, (ii) seek a state innovation waiver to (I) reduce the cost of
health insurance in this state, (II) make health insurance coverage
available to persons in this state who are ineligible for coverage under a
qualified health plan offered through the exchange, and (III) allow
persons to receive coverage under the working persons with disabilities
program through the exchange, and (iii) use the moneys deposited in
the "Connecticut Health Insurance Exchange account" to (I) reduce the
cost of qualified health plans offered through the exchange, (II) make
coverage affordable for persons who are ineligible for coverage under a
qualified health plan offered through the exchange, and (III) implement
the state innovation waiver if the federal government issues such
waiver; (7) (A) require the Commissioner of Social Services to amend
the Medicaid state plan to develop a methodology to determine
eligibility for the working persons with disabilities program and
delegate authority to the exchange to determine eligibility for said
program, and (B) expand eligibility for said program; (8) expand
eligibility for medical assistance under the state's Medicaid program;
and (9) require the Labor Commissioner to (A) notify applicants for
unemployment compensation benefits that such applicants may be
eligible for free or subsidized health coverage or other assistance or
benefits, and (B) refer such applicants to the Connecticut Health
Insurance Exchange.
[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.]