LCO \\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-R02-
SB.docx
1 of 59
General Assembly Substitute Bill No. 842
January Session, 2021
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 Section 3-123rrr of the general statutes is repealed and the 1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] section 3-123xxx, and sections 2 and 3 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 may be amended 12
by stipulated agreements. 13
(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 Substitute Bill No. 842
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
R02-SB.docx }
2 of 59
[(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
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 Substitute Bill No. 842
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
R02-SB.docx }
3 of 59
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) The Comptroller shall offer to 50
plan participants and beneficiaries in this state under a multiemployer 51
plan, nonprofit employers in this state, their employees and their 52
employees' dependents and small employers in this state, their 53
employees and their employees' dependents coverage under a fully 54
insured group hospitalization, medical, pharmacy and surgical 55
insurance plan developed by the Comptroller to provide coverage for 56
such plan participants, beneficiaries, employers, employees and 57
dependents. Except as otherwise provided in this section, coverage 58
offered by the Comptroller pursuant to this section shall comply with 59
all applicable provisions of title 38a of the general statutes. The 60
administrators of multiemployer plans, nonprofit employers and small 61
employers shall remit to the Comptroller payments for coverage 62
provided pursuant to this section. Such payments shall be equal to the 63
payments paid by the state for state employees covered under the state 64
employee plan, inclusive of any premiums paid by state employees 65
pursuant to the state employee plan, except: 66
(1) Premium payments may be adjusted to reflect: 67
(A) Age, in accordance with a uniform age rating curve that satisfies 68
the requirements established under the Patient Protection and 69
Affordable Care Act, P.L. 111-148, as amended from time to time, and 70
regulations adopted thereunder; 71
(B) Geographic area; 72
(C) Family size, provided premium payments for family coverage 73
shall not exceed the lesser of: 74
(i) The sum of the premium payments for all covered family 75
members; or 76 Substitute Bill No. 842
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
R02-SB.docx }
4 of 59
(ii) The sum of the premium payments for all covered family 77
members who are twenty-one years of age or older and the eldest three 78
covered dependents who are younger than twenty-one years of age; 79
(D) Actuarially justified differences in: 80
(i) Plan design; 81
(ii) A plan's health care provider network; or 82
(iii) Administrative costs that can be reasonably attributed to a plan; 83
and 84
(E) The actual performance of a multiemployer plan, nonprofit 85
employer or small employer receiving coverage provided by the 86
Comptroller pursuant to this section, provided such adjustment shall 87
not cause the premiums charged for such multiemployer plan, nonprofit 88
employer or small employer to increase or decrease by an amount that 89
is greater than three per cent of the premiums that would otherwise be 90
charged for such multiemployer plan, nonprofit employer or small 91
employer under this subdivision; 92
(2) Such payments shall be adjusted to include: 93
(A) The fee assessed by the Comptroller against multiemployer plans, 94
nonprofit employers and small employers pursuant to section 3 of this 95
act; 96
(B) The health and welfare fee assessed by the Insurance 97
Commissioner against multiemployer plans, nonprofit employers and 98
small employers pursuant to section 19a-7j of the general statutes, as 99
amended by this act, which the Comptroller shall annually collect from 100
the administrators of multiemployer plans, nonprofit employers and 101
small employers, and pay to the Insurance Commissioner, pursuant to 102
section 19a-7j of the general statutes, as amended by this act; 103
(C) The public health fee assessed by the Insurance Commissioner 104 Substitute Bill No. 842
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
R02-SB.docx }
5 of 59
against multiemployer plans, nonprofit employers and small employers 105
pursuant to section 19a-7p of the general statutes, as amended by this 106
act, which the Comptroller shall annually collect from the 107
administrators of multiemployer plans, nonprofit employers and small 108
employers, and pay to the Insurance Commissioner, pursuant to section 109
19a-7p of the general statutes, as amended by this act; 110
(D) The administrative fee assessed by the Comptroller pursuant to 111
subdivision (4) of subsection (c) of this section; and 112
(E) Any risk fund fee assessed by the Comptroller pursuant to 113
subdivision (2) of subsection (d) of this section; and 114
(3) Such payments may be adjusted to include a general 115
administrative fee assessed by the Comptroller against multiemployer 116
plans, nonprofit employers and small employers receiving coverage 117
provided by the Comptroller pursuant to this section which, if assessed, 118
shall be calculated on a per member, per month basis and may include 119
brokers' fees. 120
(b) (1) The coverage provided by the Comptroller pursuant to this 121
section shall: 122
(A) Be available to all plan participants and beneficiaries in this state 123
under a multiemployer plan, nonprofit employers in this state, their 124
employees and their employees' dependents and small employers in 125
this state, their employees and their employees' dependents regardless 126
of age, gender, health status or any other factor that might be predictive 127
of health care service usage; 128
(B) Include the health enhancement program; 129
(C) Be consistent with value-based insurance design principles; 130
(D) Be approved by the Insurance Department and Health Care Cost 131
Containment Committee during public meetings of the Insurance 132
Department and Health Care Cost Containment Committee; 133 Substitute Bill No. 842
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
R02-SB.docx }
6 of 59
(E) Include coverage for: 134
(i) All health care services and benefits that each group health 135
insurance policy providing coverage of the types specified in 136
subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general 137
statutes delivered, issued for delivery, renewed, amended or continued 138
in this state is required to cover under chapter 700c of the general 139
statutes; and 140
(ii) All health care services and benefits that are essential health 141
benefits, as defined in the Patient Protection and Affordable Care Act, 142
P.L. 111-148, as amended from time to time, and regulations adopted 143
thereunder; 144
(F) Include a process that enables entities that conduct independent 145
external reviews of adverse determinations and final adverse 146
determinations, as both terms are defined in section 38a-591a of the 147
general statutes, to review determinations made for benefits covered 148
pursuant to this section that are equivalent to adverse determinations 149
and final adverse determinations; and 150
(G) Enable plan participants and beneficiaries in this state under a 151
multiemployer plan, nonprofit employers in this state, their employees 152
and their employees' dependents and small employers in this state, their 153
employees and their employees' dependents receiving coverage 154
provided by the Comptroller pursuant to this section to access 155
assistance offered by the Office of the Healthcare Advocate under 156
section 38a-1041 of the general statutes, as amended by this act. 157
(2) (A) The Comptroller shall provide coverage pursuant to this 158
section for intervals lasting not less than: 159
(i) Three years for: 160
(I) Multiemployer plans; and 161
(II) Nonprofit employers that are not small employers; or 162 Substitute Bill No. 842
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
R02-SB.docx }
7 of 59
(ii) One year for small employers. 163
(B) The administrator of each multiemployer plan, nonprofit 164
employer or small employer receiving coverage provided by the 165
Comptroller pursuant to this section may apply to renew such coverage 166
before the interval applicable to such multiemployer plan, nonprofit 167
employer or small employer under subparagraph (A) of this subdivision 168
expires. 169
(3) The Comptroller shall require each administrator of a 170
multiemployer plan, nonprofit employer in this state and small 171
employer in this state receiving coverage provided by the Comptroller 172
pursuant to this section to offer such coverage to all of such 173
multiemployer plan's participants and beneficiaries in this state, 174
nonprofit employer's employees and their employees' dependents and 175
small employer's employees and their employees' dependents who are 176
eligible for health coverage. The administrator of such multiemployer 177
plan, nonprofit employer or small employer shall not offer coverage 178
under this section in addition to, or in conjunction with, any other health 179
coverage option, except active employees and retirees may be treated as 180
independent groups for the purposes of this subdivision. 181
(c) (1) The Comptroller shall develop and establish: 182
(A) Procedures by which the administrator of a multiemployer plan, 183
nonprofit employer or small employer may initially apply for, renew 184
and withdraw from coverage provided by the Comptroller pursuant to 185
this section; 186
(B) Rules of participation that the Comptroller, in the Comptroller's 187
discretion, deems necessary; 188
(C) Accounting procedures to track the premium payments paid by, 189
and claims paid for, multiemployer plans, nonprofit employers and 190
small employers receiving coverage provided by the Comptroller 191
pursuant to this section; and 192 Substitute Bill No. 842
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
R02-SB.docx }
8 of 59
(D) Procedures to collect demographic data, including, but not 193
limited to, self-reported ethnic and racial data, concerning the plan 194
participants and beneficiaries in this state under a multiemployer plan, 195
nonprofit employers in this state, their employees and their employees' 196
dependents and small employers in this state, their employees and their 197
employees' dependents receiving coverage provided by the 198
Comptroller pursuant to this section. Such procedures shall, at a 199
minimum, utilize standardized categories developed by the Office of 200
Health Strategy pursuant to subdivision (9) of subsection (b) of section 201
19a-754a of the general statutes, as amended by this act, include an 202
"other" category and allow an individual who is self-reporting ethnic or 203
racial data to write in such individual's ethnicity or race, and select 204
multiple ethnicities and races, on any form provided by the Comptroller 205
to collect such ethnic or racial data. Not later than November 1, 2022, 206
and annually thereafter, the Comptroller shall submit a report to the 207
joint standing committee of the General Assembly having cognizance of 208
matters relating to insurance, in accordance with the provisions of 209
section 11-4a of the general statutes, disclosing, in the aggregate, the 210
demographic data collected using the procedures developed and 211
established by the Comptroller pursuant to this subparagraph during 212
the immediately preceding fiscal year. 213
(2) The Comptroller shall: 214
(A) Retain an independent actuarial firm to: 215
(i) Set premium payments for coverage provided by the Comptroller 216
pursuant to this section that satisfy the requirements established in this 217
section and actuarial best practices; and 218
(ii) Not later than November 1, 2022, and annually thereafter, 219
examine the books and records maintained by the Comptroller in 220
providing coverage pursuant to this section, and any person engaged 221
by the Comptroller to provide services to the Comptroller in connection 222
with providing such coverage, and prepare a report concerning such 223
examination, which shall disclose: 224 Substitute Bill No. 842
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
R02-SB.docx }
9 of 59
(I) The number of multiemployer plans, nonprofit employers and 225
small employers that received coverage provided by the Comptroller 226
pursuant to this section during the immediately preceding fiscal year; 227
(II) The number of multiemployer plan participants and beneficiaries 228
in this state, nonprofit employers' employees and their employees' 229
dependents and small employers' employees and their employees' 230
dependents who received coverage provided by the Comptroller 231
pursuant to this section during the immediately preceding fiscal year; 232
(III) The aggregate amount of premiums collected, claims paid and 233
administrative costs incurred by the Comptroller in providing coverage 234
pursuant to this section for the immediately preceding fiscal year; 235
(IV) The most recent medical loss ratio available for coverage 236
provided by the Comptroller pursuant to this section; 237
(V) The balance of the account in which the Comptroller deposited 238
premiums, and from which the Comptroller paid claims, for coverage 239
provided by the Comptroller pursuant to this section at the beginning 240
and the end of the immediately preceding fiscal year, and a comparison 241
of such balance to the amount that the independent actuarial firm 242
recommends that the Comptroller maintain as a reserve for such 243
coverage; 244
(VI) A description, and the cost, of each risk mitigation strategy that 245
the Comptroller employed for the immediately preceding fiscal year to 246
minimize the risk that coverage provided by the Comptroller pursuant 247
to this section for such fiscal year poses to this state's finances; and 248
(VII) The independent actuarial firm's recommendations, if any, to 249
improve or update the risk mitigation strategies employed by the 250
Comptroller to minimize the risk that coverage provided by the 251
Comptroller pursuant to this section poses to this state's finances; and 252
(B) Such services, including, but not limited to, any services to ensure 253
compliance with the Employee Retirement Income Security Act of 1974, 254 Substitute Bill No. 842
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
R02-SB.docx }
10 of 59
as amended from time to time, and regulations adopted thereunder, that 255
the Comptroller deems necessary to administer coverage provided by 256
the Comptroller pursuant to this section. 257
(3) The independent actuarial firm retained by the Comptroller 258
pursuant to subparagraph (A) of subdivision (2) of this subsection shall, 259
not later than November 1, 2022, and annually thereafter, submit the 260
report that the independent actuarial firm prepared pursuant to 261
subparagraph (A)(ii) of subdivision (2) of this subsection for the 262
immediately preceding fiscal year to the Comptroller and the Office of 263
Policy and Management and to the joint standing committees of the 264
General Assembly having cognizance of matters relating to 265
appropriations and insurance in accordance with the provisions of 266
section 11-4a of the general statutes. 267
(4) The Comptroller shall assess an administrative fee on a per 268
member, per month basis against the multiemployer plans, nonprofit 269
employers and small employers receiving coverage provided by the 270
Comptroller pursuant to this section to recover the cost of the services 271
described in subdivisions (2) and (3) of this subsection. 272
(d) The Comptroller shall make reasonable efforts to minimize the 273
risk that coverage provided by the Comptroller pursuant to this section 274
poses to this state's finances. In making such reasonable efforts, the 275
Comptroller shall, at a minimum: 276
(1) Purchase: 277
(A) An aggregate stop-loss insurance policy for all multiemployer 278
plans, nonprofit employers and small employers receiving coverage 279
provided by the Comptroller pursuant to this section; or 280
(B) A stop-loss insurance policy for each individual multiemployer 281
plan, nonprofit employer or small employer receiving coverage 282
provided by the Comptroller pursuant to this section; and 283
(2) Establish a risk fund to pay claims that exceed the premiums 284 Substitute Bill No. 842
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
R02-SB.docx }
11 of 59
collected for a multiemployer plan, nonprofit employer or small 285
employer receiving coverage provided by the Comptroller pursuant to 286
this section, fund such risk fund through a risk fund fee assessed by the 287
Comptroller against such multiemployer plan, nonprofit employer or 288
small employer and establish operating procedures for use of such fund. 289
(e) (1) Not later than October 15, 2021, and annually thereafter, the 290
Comptroller shall prepare, in consultation with the Commissioner of 291
Public Health and the Insurance Commissioner, a report card for the 292
coverage offered by the Comptroller pursuant to this section. The report 293
card shall enable the administrators of multiemployer plans, nonprofit 294
employers and small employers that are eligible for the coverage offered 295
by the Comptroller pursuant to this section to compare such coverage 296
to private group health coverage that is available to such multiemployer 297
plans, nonprofit employers and small employers in this state to the same 298
extent that the consumer report card developed and distributed by the 299
Insurance Commissioner pursuant to section 38a-478l of the general 300
statutes permits consumer comparison across managed care 301
organizations. 302
(2) Each report card prepared by the Comptroller pursuant to 303
subdivision (1) of this subsection shall disclose: 304
(A) The medical loss ratio for the fully insured group hospitalization, 305
medical, pharmacy and surgical insurance plan developed and offered 306
by the Comptroller pursuant to this section; 307
(B) The medical loss ratio for private group health coverage that is 308
available to the multiemployer plans, nonprofit employers and small 309
employers that are eligible for the coverage offered by the Comptroller 310
pursuant to this section; and 311
(C) Any other information that the Comptroller deems relevant for 312
the purposes of this subsection. 313
(3) The Comptroller shall prominently display a link to each report 314
card prepared pursuant to subdivision (1) of this subsection on the 315 Substitute Bill No. 842
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
R02-SB.docx }
12 of 59
Comptroller's Internet web site. 316
(f) Any administrator of a multiemployer plan, nonprofit employer 317
or small employer that files an application with the Comptroller for the 318
coverage offered by the Comptroller pursuant to this section may 319
submit a request to the Comptroller, in a form and manner prescribed 320
by the Comptroller, for a provider disruption report. The Comptroller 321
shall provide the provider disruption report to such administrator, 322
nonprofit employer or small employer not later than thirty days after 323
such administrator, nonprofit employer or small employer submits such 324
request to the Comptroller. 325
(g) (1) Nothing in this section shall be construed to preclude the 326
Comptroller from: 327
(A) Procuring coverage for nonstate public employees from vendors 328
other than the vendors providing coverage to state employees; or 329
(B) Offering plan designs or benefit coverage levels pursuant to this 330
section that differ from the plan designs and benefit coverage levels 331
offered to state employees, provided the Comptroller shall not offer any 332
coverage pursuant to this section that imposes a deductible that is equal 333
to or greater than the minimum deductible required by the Internal 334
Revenue Service for such coverage to qualify as a high deductible health 335
plan, as defined in Section 220(c)(2) or Section 223(c)(2) of the Internal 336
Revenue Code of 1986, or any subsequent corresponding internal 337
revenue code of the United States, as amended from time to time. 338
(2) No coverage offered by the Comptroller pursuant to this section 339
shall be deemed to constitute a multiple employer welfare arrangement, 340
as defined in Section 3 of the Employee Retirement Income Security Act 341
of 1974, as amended from time to time. 342
(h) The Comptroller may adopt regulations, in accordance with 343
chapter 54 of the general statutes, to carry out the purposes of this 344
section. 345 Substitute Bill No. 842
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
R02-SB.docx }
13 of 59
Sec. 3. (NEW) (Effective July 1, 2021) (a) For each fiscal year beginning 346
on or after July 1, 2021, the Comptroller shall assess a fee against all 347
multiemployer plans, nonprofit employers and small employers 348
receiving coverage provided by the Comptroller pursuant to section 2 349
of this act, and the administrator of each such multiemployer plan and 350
each such nonprofit employer and small employer shall pay such 351
assessment to the Comptroller pursuant to this section for deposit in the 352
Connecticut Health Insurance Exchange account established under 353
section 13 of this act. 354
(b) Not later than July 15, 2021, and annually thereafter, the 355
Comptroller shall consult with the Insurance Commissioner to 356
determine the aggregate amount of the assessments due from the 357
multiemployer plans, nonprofit employers and small employers 358
receiving coverage provided by the Comptroller pursuant to section 2 359
of this act for the then current fiscal year. The aggregate amount of 360
assessments due for any fiscal year shall be equal to the amount that 361
would be due from the Comptroller for such fiscal year if the 362
Comptroller were a domestic insurance company under sections 38a-47 363
and 38a-48 of the general statutes during such fiscal year. 364
(c) Not later than July 31, 2021, and annually thereafter, the 365
Comptroller shall render to the administrator of each multiemployer 366
plan and each nonprofit employer and small employer that is liable for 367
the fee assessed by the Comptroller pursuant to subsection (a) of this 368
section the proposed assessment against such multiemployer plan, 369
nonprofit employer or small employer in the amount described in 370
subsection (b) of this section. 371
(d) On or before September first, annually, for each fiscal year 372
beginning on or after July 1, 2021, the Comptroller, after receiving any 373
objections to the proposed assessments made by the Comptroller 374
pursuant to this section and making such adjustments as in the 375
Comptroller's opinion may be indicated, shall assess against each 376
multiemployer plan, nonprofit employer or small employer an amount 377
equal to the proposed assessment as so adjusted. The administrator of 378 Substitute Bill No. 842
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
R02-SB.docx }
14 of 59
each multiemployer plan and each such nonprofit employer and small 379
employer shall pay to the Comptroller, on or before the following 380
December thirty-first and March thirty-first, annually, the proposed 381
assessment due from such multiemployer plan, nonprofit employer or 382
small employer in two equal installments. 383
(e) The administrator of any multiemployer plan, nonprofit employer 384
or small employer aggrieved because of a fee assessed by the 385
Comptroller pursuant to this section may appeal therefrom in 386
accordance with the provisions of section 38a-52 of the general statutes, 387
as amended by this act. 388
(f) If the administrator of a multiemployer plan, or a nonprofit 389
employer or small employer, that is liable for the fee assessed by the 390
Comptroller pursuant to this section fails to pay an assessment when 391
due under this section, the Comptroller shall add a penalty of twenty-392
five dollars to such fee, and interest at the rate of six per cent per annum 393
shall be paid thereafter on such assessment and penalty, until such 394
assessment and penalty are paid. 395
(g) The Comptroller shall deposit all payments made pursuant to this 396
section in the Connecticut Health Insurance Exchange account 397
established under section 13 of this act. 398
(h) The Comptroller may adopt regulations, in accordance with 399
chapter 54 of the general statutes, to carry out the purposes of this 400
section. 401
Sec. 4. (NEW) (Effective July 1, 2021) (a) As used in this section: 402
(1) "Nonprofit employer" has the same meaning as provided in 403
section 3-123aaa of the general statutes; 404
(2) "Nonstate public employee" has the same meaning as provided in 405
sections 3-123aaa and 3-123rrr of the general statutes, as amended by 406
this act; 407 Substitute Bill No. 842
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
R02-SB.docx }
15 of 59
(3) "Nonstate public employer" has the same meaning as provided in 408
sections 3-123aaa and 3-123rrr of the general statutes, as amended by 409
this act; 410
(4) "Partnership plan" means (A) a health care benefit plan offered by 411
the Comptroller to (i) nonstate public employers or nonprofit employers 412
pursuant to section 3-123bbb of the general statutes, (ii) graduate 413
assistants at The University of Connecticut and The University of 414
Connecticut Health Center, (iii) postdoctoral trainees at The University 415
of Connecticut and The University of Connecticut Health Center, (iv) 416
graduate fellows at The University of Connecticut and The University 417
of Connecticut Health Center, and (v) graduate students of The 418
University of Connecticut participating in university-funded 419
internships as part of their graduate program, and (B) a group 420
hospitalization, medical, pharmacy and surgical insurance plan 421
developed by the Comptroller pursuant to (i) subsection (a) of section 3-422
123sss of the general statutes, or (ii) section 2 of this act; 423
(5) "State employee plan" means the group hospitalization, medical, 424
pharmacy and surgical insurance plan offered to (A) state employees 425
and retirees pursuant to section 5-259 of the general statutes, and (B) 426
nonstate public employers, their nonstate public employees and, if 427
applicable, their retirees if the Comptroller offers coverage under such 428
plan to nonstate public employers, their nonstate public employees and, 429
if applicable, retirees under sections 3-123rrr to 3-123www, inclusive, of 430
the general statutes, as amended by this act; and 431
(6) "Third-party administrator" means any person who directly or 432
indirectly underwrites, collects premiums or charges from, or adjusts or 433
settles claims on, residents of this state in connection with health 434
coverage offered or provided by the Comptroller. 435
(b) Beginning on July 1, 2021, the Auditors of Public Accounts shall 436
audit the books and accounts of the State Comptroller, and any third-437
party administrator engaged by the State Comptroller, maintained for 438
the partnership plan or plans or the state employee plan and certify the 439 Substitute Bill No. 842
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
R02-SB.docx }
16 of 59
results to the Governor. 440
Sec. 5. Section 19a-7j of the general statutes is repealed and the 441
following is substituted in lieu thereof (Effective July 1, 2021): 442
(a) As used in this section: 443
(1) "Exempt insurer" means a domestic insurer that administers self-444
insured health benefit plans and is exempt from third -party 445
administrator licensure under subparagraph (C) of subdivision (11) of 446
section 38a-720 and section 38a-720a; 447
(2) "Health insurance" means health insurance providing coverage of 448
the types specified in subdivisions (1), (2), (4), (11) and (12) of section 449
38a-469; 450
(3) "Multiemployer plan" has the same meaning as provided in 451
Section 3 of the Employee Retirement Income Security Act of 1974, as 452
amended from time to time; 453
(4) "Nonprofit employer" has the same meaning as provided in 454
section 3-123rrr, as amended by this act; and 455
(5) "Small employer" has the same meaning as provided in section 3-456
123rrr, as amended by this act. 457
[(a)] (b) Not later than September first, annually, the Secretary of the 458
Office of Policy and Management, in consultation with the 459
Commissioner of Public Health, shall: 460
(1) [determine] Determine the amount appropriated for the following 461
purposes: 462
(A) To purchase, store and distribute vaccines for routine 463
immunizations included in the schedule for active immunization 464
required by section 19a-7f; 465
(B) [to] To purchase, store and distribute: 466 Substitute Bill No. 842
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
R02-SB.docx }
17 of 59
(i) [vaccines] Vaccines to prevent hepatitis A and B in persons of all 467
ages, as recommended by the schedule for immunizations published by 468
the National Advisory Committee for Immunization Practices; [,] 469
(ii) [antibiotics] Antibiotics necessary for: [the] 470
(I) The treatment of tuberculosis and biologics; and [antibiotics 471
necessary for the] 472
(II) The detection and treatment of tuberculosis infections; [,] and 473
(iii) [antibiotics] Antibiotics to support treatment of patients in 474
communicable disease control clinics, as defined in section 19a-216a; 475
(C) [to] To administer the immunization program described in 476
section 19a-7f; and 477
(D) [to] To provide services needed to collect up-to-date information 478
on childhood immunizations for all children enrolled in Medicaid who 479
reach two years of age during the year preceding the current fiscal year, 480
to incorporate such information into the childhood immunization 481
registry, as defined in section 19a-7h; [,] 482
(2) [calculate] Calculate the difference between the amount expended 483
in the prior fiscal year for the purposes set forth in subdivision (1) of this 484
subsection and the amount of the appropriation used for the purpose of 485
the health and welfare fee established in [subparagraph (A) of] 486
subdivision [(2)] (1) of subsection [(b)] (c) of this section in that same 487
year; [,] and 488
(3) [inform] Inform the Insurance Commissioner of such amounts. 489
[(b) (1) As used in this subsection, (A) "health insurance" means 490
health insurance of the types specified in subdivisions (1), (2), (4), (11) 491
and (12) of section 38a-469, and (B) "exempt insurer" means a domestic 492
insurer that administers self-insured health benefit plans and is exempt 493
from third-party administrator licensure under subparagraph (C) of 494 Substitute Bill No. 842
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
R02-SB.docx }
18 of 59
subdivision (11) of section 38a-720 and section 38a-720a.] 495
[(2)] (c) (1) (A) Each domestic insurer [or] and domestic health care 496
center doing health insurance business in this state shall annually pay 497
to the Insurance Commissioner, for deposit in the Insurance Fund 498
established under section 38a-52a, a health and welfare fee assessed by 499
the Insurance Commissioner pursuant to this section. 500
(B) Each third-party administrator licensed pursuant to section 38a-501
720a that provides administrative services for self-insured health benefit 502
plans and each exempt insurer shall, on behalf of the self-insured health 503
benefit plans for which such third-party administrator or exempt 504
insurer provides administrative services, annually pay to the Insurance 505
Commissioner, for deposit in the Insurance Fund established under 506
section 38a-52a, a health and welfare fee assessed by the Insurance 507
Commissioner pursuant to this section. 508
(C) The Comptroller shall, on behalf of each multiemployer plan, 509
nonprofit employer and small employer receiving coverage provided 510
by the Comptroller pursuant to section 2 of this act, annually pay to the 511
Insurance Commissioner, for deposit in the Insurance Fund established 512
under section 38a-52a, a health and welfare fee assessed by the 513
Insurance Commissioner pursuant to this section. 514
[(3)] (2) Not later than September first, annually: [, each such] 515
(A) Each domestic insurer [,] and domestic health care center [,] 516
described in subparagraph (A) of subdivision (1) of this subsection, and 517
each third-party administrator and exempt insurer described in 518
subparagraph (B) of subdivision (1) of this subsection, shall report to the 519
Insurance Commissioner, on a form designated by [said commissioner] 520
the Insurance Commissioner, the number of insured or enrolled lives in 521
this state as of the May first immediately preceding for which such 522
domestic insurer, domestic health care center, third-party administrator 523
or exempt insurer [is] was providing health insurance or administering 524
a self-insured health benefit plan [that provides] providing coverage of 525 Substitute Bill No. 842
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
R02-SB.docx }
19 of 59
the types specified in subdivisions (1), (2), (4), (11) and (12) of section 526
38a-469, [. Such number shall not include] excluding any lives enrolled 527
in Medicare, any medical assistance program administered by the 528
Department of Social Services, workers' compensation insurance or 529
Medicare Part C plans; and 530
(B) The Comptroller shall report to the Insurance Commissioner, in 531
the form and manner prescribed by the Insurance Commissioner: 532
(i) For each multiemployer plan described in subparagraph (C) of 533
subdivision (1) of this subsection, the number of such multiemployer 534
plan's plan participants and beneficiaries in this state for whom the 535
Comptroller was providing coverage pursuant to section 2 of this act as 536
of the May first immediately preceding; 537
(ii) For each nonprofit employer described in subparagraph (C) of 538
subdivision (1) of this subsection, the number of such nonprofit 539
employer's employees and their dependents in this state for whom the 540
Comptroller was providing coverage pursuant to section 2 of this act as 541
of the May first immediately preceding; and 542
(iii) For each small employer described in subparagraph (C) of 543
subdivision (1) of this subsection, the number of such small employer's 544
employees and their dependents in this state for whom the Comptroller 545
was providing coverage pursuant to section 2 of this act as of the May 546
first immediately preceding. 547
[(4)] (3) Not later than November first, annually, the Insurance 548
Commissioner shall determine the fee to be assessed for the current 549
fiscal year against each [such] domestic insurer [,] and domestic health 550
care center described in subparagraph (A) of subdivision (1) of this 551
subsection, third-party administrator and exempt insurer described in 552
subparagraph (B) of subdivision (1) of this subsection and 553
multiemployer plan, nonprofit employer and small employer described 554
in subparagraph (C) of subdivision (1) of this subsection. Such fee shall 555
be calculated by multiplying the number of lives reported to [said 556 Substitute Bill No. 842
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
R02-SB.docx }
20 of 59
commissioner] the Insurance Commissioner pursuant to subparagraph 557
(A) of subdivision [(3)] (2) of this subsection, and the number of plan 558
participants, beneficiaries, employees and dependents reported to the 559
Insurance Commissioner pursuant to subparagraph (B) of subdivision 560
(2) of this subsection, by a factor, determined annually by [said 561
commissioner] the Insurance Commissioner as set forth in this 562
subdivision, to fully fund the amount determined under subdivision (1) 563
of subsection [(a)] (b) of this section, adjusted for a health and welfare 564
fee, by subtracting, if the amount appropriated was more than the 565
amount expended or by adding, if the amount expended was more than 566
the amount appropriated, the amount calculated under subdivision (2) 567
of subsection [(a)] (b) of this section. The Insurance Commissioner shall 568
determine the factor by dividing the adjusted amount by the sum of the 569
total number of lives reported to [said commissioner] the Insurance 570
Commissioner pursuant to subparagraph (A) of subdivision [(3)] (2) of 571
this subsection and the number of plan participants, beneficiaries, 572
employees and dependents reported to the Insurance Commissioner 573
pursuant to subparagraph (B) of subdivision (2) of this subsection. 574
[(5)] (4) (A) Not later than December first, annually, the Insurance 575
Commissioner shall submit a statement to each [such] domestic insurer 576
[,] and domestic health care center [,] described in subparagraph (A) of 577
subdivision (1) of this subsection, each third-party administrator and 578
exempt insurer described in subparagraph (B) of subdivision (1) of this 579
subsection and the Comptroller for each multiemployer plan, nonprofit 580
employer or small employer described in subparagraph (C) of 581
subdivision (1) of this subsection that includes the proposed fee, 582
identified on such statement as the "Health and Welfare fee", for [the] 583
such domestic insurer, domestic health care center, third-party 584
administrator, [or] exempt insurer, multiemployer plan, nonprofit 585
employer or small employer calculated in accordance with this 586
subsection. [Each] The Comptroller shall collect such fee from each such 587
multiemployer plan, nonprofit employer and small employer described 588
in subparagraph (C) of subdivision (1) of this subsection and pay such 589
fee to the Insurance Commissioner, and each such domestic insurer, 590 Substitute Bill No. 842
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
R02-SB.docx }
21 of 59
domestic health care center, third-party administrator and exempt 591
insurer shall pay such fee to the Insurance Commissioner, not later than 592
February first, annually. 593
(B) Any [such] domestic insurer [,] or domestic health care center 594
described in subparagraph (A) of subdivision (1) of this subsection, 595
third-party administrator or exempt insurer described in subparagraph 596
(B) of subdivision (1) of this subsection or the administrator of a 597
multiemployer plan, a nonprofit employer or a small employer 598
described in subparagraph (C) of subdivision (1) of this subsection that 599
is aggrieved by an assessment levied under this subsection may appeal 600
therefrom in the same manner as provided for appeals under section 601
38a-52, as amended by this act. 602
[(6)] (5) Any domestic insurer, domestic health care center, third-603
party administrator or exempt insurer that fails to file the report 604
required under subparagraph (A) of subdivision [(3)] (2) of this 605
subsection shall pay a late filing fee of one hundred dollars per day for 606
each day from the date such report was due. The Insurance 607
Commissioner may require [an] a domestic insurer, domestic health 608
care center, third-party administrator or exempt insurer subject to this 609
subsection to produce the records in its possession, and may require any 610
other person to produce the records in such person's possession, that 611
were used to prepare such report, for [said commissioner's] the 612
Insurance Commissioner's or [said commissioner's] the Insurance 613
Commissioner's designee's examination. If [said commissioner] the 614
Insurance Commissioner determines there is other than a good faith 615
discrepancy between the actual number of insured or enrolled lives that 616
should have been reported under subparagraph (A) of subdivision [(3)] 617
(2) of this subsection and the number actually reported, such domestic 618
insurer, domestic health care center, third-party administrator or 619
exempt insurer shall pay a civil penalty of not more than fifteen 620
thousand dollars for each report filed for which [said commissioner] the 621
Insurance Commissioner determines there is such a discrepancy. 622
[(7)] (6) (A) The Insurance Commissioner shall apply an overpayment 623 Substitute Bill No. 842
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
R02-SB.docx }
22 of 59
of the health and welfare fee by [an] a domestic insurer, domestic health 624
care center, third-party administrator or exempt insurer, or by the 625
Comptroller on behalf of a multiemployer plan, nonprofit employer or 626
small employer described in subparagraph (C) of subdivision (1) of this 627
subsection, for any fiscal year as a credit against the health and welfare 628
fee due from such domestic insurer, domestic health care center, third-629
party administrator, [or] exempt insurer, multiemployer plan, nonprofit 630
employer or small employer for the succeeding fiscal year, subject to an 631
adjustment under subdivision [(4)] (3) of this subsection: [, if:] 632
(i) [The] If the amount of the overpayment exceeds five thousand 633
dollars; and 634
(ii) If, on or before June first of the calendar year of the overpayment, 635
[the] such domestic insurer, domestic health care center, third-party 636
administrator, [or] exempt insurer, multiemployer plan, nonprofit 637
employer or small employer: 638
(I) [notifies] Notifies the [commissioner] Insurance Commissioner of 639
the amount of the overpayment; [,] and 640
(II) [provides] Provides the [commissioner] Insurance Commissioner 641
with evidence sufficient to prove the amount of the overpayment. 642
(B) Not later than ninety days following receipt of notice and 643
supporting evidence under subparagraph [(A)] (A)(ii) of this 644
subdivision, the [commissioner] Insurance Commissioner shall: 645
(i) [determine] Determine whether the domestic insurer, domestic 646
health care center, third-party administrator, [or] exempt insurer, 647
multiemployer plan, nonprofit employer or small employer made an 648
overpayment; [,] and 649
(ii) [notify] Notify the domestic insurer, domestic health care center, 650
third-party administrator, [or] exempt insurer, multiemployer plan, 651
nonprofit employer or small employer of such determination. 652 Substitute Bill No. 842
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
R02-SB.docx }
23 of 59
(C) Failure of [an] a domestic insurer, domestic health care center, 653
third-party administrator, [or] exempt insurer, multiemployer plan, 654
nonprofit employer or small employer to notify the commissioner of the 655
amount of an overpayment within the time prescribed in subparagraph 656
[(A)] (A)(ii) of this subdivision constitutes a waiver of any demand of 657
the domestic insurer, domestic health care center, third-party 658
administrator, [or] exempt insurer, multiemployer plan, nonprofit 659
employer or small employer against the state on account of such 660
overpayment. 661
(D) Nothing in this subdivision shall be construed to prohibit or limit 662
the right of [an] a domestic insurer, domestic health care center, third-663
party administrator, [or] exempt insurer, multiemployer plan, nonprofit 664
employer or small employer to appeal pursuant to subparagraph (B) of 665
subdivision [(5)] (4) of this [section] subsection. 666
Sec. 6. Section 19a-7p of the general statutes is repealed and the 667
following is substituted in lieu thereof (Effective July 1, 2021): 668
(a) As used in this section: 669
(1) "Health care center" has the same meaning as provided in section 670
38a-175; 671
(2) "Health insurance" means health insurance providing coverage of 672
the types specified in subdivisions (1), (2), (4), (11) and (12) of section 673
38a-469; 674
(3) "Multiemployer plan" has the same meaning as provided in 675
Section 3 of the Employee Retirement Income Security Act of 1974, as 676
amended from time to time; 677
(4) "Nonprofit employer" has the same meaning as provided in 678
section 3-123rrr, as amended by this act; and 679
(5) "Small employer" has the same meaning as provided in section 3-680
123rrr, as amended by this act. 681 Substitute Bill No. 842
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
R02-SB.docx }
24 of 59
[(a)] (b) Not later than September first, annually, the Secretary of the 682
Office of Policy and Management, in consultation with the 683
Commissioner of Public Health, shall: 684
(1) [determine] Determine the amounts appropriated for the syringe 685
services program, AIDS services, breast and cervical cancer detection 686
and treatment, x-ray screening and tuberculosis care, sexually 687
transmitted disease control and children's health initiatives; and 688
(2) [inform] Inform the Insurance Commissioner of such amounts. 689
[(b) (1) As used in this section: (A) "Health insurance" means health 690
insurance of the types specified in subdivisions (1), (2), (4), (11) and (12) 691
of section 38a-469; and (B) "health care center" has the same meaning as 692
provided in section 38a-175.] 693
[(2)] (c) (1) Each domestic insurer [or] and domestic health care center 694
doing health insurance business in this state, and the Comptroller on 695
behalf of each multiemployer plan, nonprofit employer and small 696
employer receiving coverage provided by the Comptroller pursuant to 697
section 2 of this act, shall annually pay to the Insurance Commissioner, 698
for deposit in the Insurance Fund established under section 38a-52a, a 699
public health fee assessed by the Insurance Commissioner pursuant to 700
this section. 701
[(3)] (2) Not later than September first, annually: [, each such] 702
(A) Each domestic insurer [or] and domestic health care center 703
described in subdivision (1) of this subsection shall report to the 704
Insurance Commissioner, in the form and manner prescribed by [said 705
commissioner] the Insurance Commissioner, the number of insured or 706
enrolled lives in this state as of the May first immediately preceding [the 707
date] for which such domestic insurer or domestic health care center [is] 708
was providing health insurance [that provides] coverage, [of the types 709
specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469. 710
Such number shall not include] excluding any lives enrolled in 711
Medicare, any medical assistance program administered by the 712 Substitute Bill No. 842
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
R02-SB.docx }
25 of 59
Department of Social Services, workers' compensation insurance or 713
Medicare Part C plans; and 714
(B) The Comptroller shall report to the Insurance Commissioner, in 715
the form and manner prescribed by the Insurance Commissioner: 716
(i) For each multiemployer plan described in subdivision (1) of this 717
subsection, the number of such multiemployer plan's plan participants 718
and beneficiaries in this state for whom the Comptroller was providing 719
coverage pursuant to section 2 of this act as of the May first immediately 720
preceding; 721
(ii) For each nonprofit employer described in subdivision (1) of this 722
subsection, the number of such nonprofit employer's employees and 723
their dependents in this state for whom the Comptroller was providing 724
coverage pursuant to section 2 of this act as of the May first immediately 725
preceding; and 726
(iii) For each small employer described in subdivision (1) of this 727
subsection, the number of such small employer's employees and their 728
dependents in this state for whom the Comptroller was providing 729
coverage pursuant to section 2 of this act as of the May first immediately 730
preceding. 731
[(c)] (d) Not later than November first, annually, the Insurance 732
Commissioner shall determine the fee to be assessed for the current 733
fiscal year against each [such] domestic insurer, [and] domestic health 734
care center, multiemployer plan, nonprofit employer or small employer 735
described in subdivision (1) of subsection (c) of this section. Such fee 736
shall be calculated by multiplying the number of lives reported to [said 737
commissioner] the Insurance Commissioner pursuant to subparagraph 738
(A) of subdivision [(3)] (2) of subsection [(b)] (c) of this section, and the 739
number of plan participants, beneficiaries, employees and dependents 740
reported to the Insurance Commissioner pursuant to subparagraph (B) 741
of subdivision (2) of subsection (c) of this section, by a factor, 742
determined annually by [said commissioner] the Insurance 743 Substitute Bill No. 842
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
R02-SB.docx }
26 of 59
Commissioner as set forth in this subsection, to fully fund the aggregate 744
amount determined under subdivision (1) of subsection [(a)] (b) of this 745
section. The Insurance Commissioner shall determine the factor by 746
dividing the aggregate amount by the sum of the total number of lives 747
reported to [said commissioner] the Insurance Commissioner pursuant 748
to subparagraph (A) of subdivision [(3)] (2) of subsection [(b)] (c) of this 749
section and the number of plan participants, beneficiaries, employees 750
and dependents reported to the Insurance Commissioner pursuant to 751
subparagraph (B) of subdivision (2) of subsection (c) of this section. 752
[(d)] (e) Not later than December first, annually, the Insurance 753
Commissioner shall submit a statement to each [such] domestic insurer 754
and domestic health care center described in subdivision (1) of 755
subsection (c) of this section, and to the Comptroller for each 756
multiemployer plan, nonprofit employer or small employer described 757
in subdivision (1) of subsection (c) of this section, that includes the 758
proposed fee, identified on such statement as the "Public Health fee", for 759
[the] such domestic insurer, [or] domestic health care center, 760
multiemployer plan, nonprofit employer or small employer, calculated 761
in accordance with this section. Not later than December twentieth, 762
annually, [any] a domestic insurer, [or] domestic health care center, or 763
the Comptroller acting on behalf of a multiemployer plan, nonprofit 764
employer or small employer, may submit an objection to the Insurance 765
Commissioner concerning the proposed public health fee. The 766
Insurance Commissioner, after making any adjustment that [said 767
commissioner] the Insurance Commissioner deems necessary, shall, not 768
later than January first, annually, submit a final statement to the 769
Comptroller for each multiemployer plan, nonprofit employer and 770
small employer described in subdivision (1) of subsection (c) of this 771
section that includes the final fee for such multiemployer plan, nonprofit 772
employer or small employer and to each domestic insurer and domestic 773
health care center that includes the final fee for [the] such domestic 774
insurer or domestic health care center. [Each such] The Comptroller 775
shall collect such fee from each such multiemployer plan, nonprofit 776
employer and small employer and pay such fee to the Insurance 777 Substitute Bill No. 842
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
R02-SB.docx }
27 of 59
Commissioner, and each such domestic insurer and domestic health 778
care center shall pay such fee to the Insurance Commissioner, not later 779
than February first, annually. 780
[(e)] (f) Any [such] domestic insurer, [or] domestic health care center, 781
multiemployer plan, nonprofit employer or small employer described 782
in subdivision (1) of subsection (c) of this section that is aggrieved by an 783
assessment levied under this section may appeal therefrom in the same 784
manner as provided for appeals under section 38a-52, as amended by 785
this act. 786
[(f)] (g) (1) The Insurance Commissioner shall apply an overpayment 787
of the public health fee by [an] a domestic insurer or domestic health 788
care center, or by the Comptroller on behalf of a multiemployer plan, 789
nonprofit employer or small employer described in subdivision (1) of 790
subsection (c) of this section, for any fiscal year as a credit against the 791
public health fee due from such domestic insurer, [or] domestic health 792
care center, multiemployer plan, nonprofit employer or small employer 793
for the succeeding fiscal year, subject to an adjustment under subsection 794
[(c)] (d) of this section: [, if:] 795
(A) [The] If the amount of the overpayment exceeds five thousand 796
dollars; and 797
(B) If, on or before June first of the calendar year of the overpayment, 798
[the] such domestic insurer, [or] domestic health care center, 799
multiemployer plan, nonprofit employer or small employer: 800
(i) [notifies] Notifies the [commissioner] Insurance Commissioner of 801
the amount of the overpayment; [,] and 802
(ii) [provides] Provides the [commissioner] Insurance Commissioner 803
with evidence sufficient to prove the amount of the overpayment. 804
(2) Not later than ninety days following receipt of notice and 805
supporting evidence under subdivision (1) of this subsection, the 806
[commissioner] Insurance Commissioner shall: 807 Substitute Bill No. 842
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
R02-SB.docx }
28 of 59
(A) [determine] Determine whether the domestic insurer, [or] 808
domestic health care center, multiemployer plan, nonprofit employer or 809
small employer made an overpayment; [,] and 810
(B) [notify] Notify the domestic insurer, [or] domestic health care 811
center, multiemployer plan, nonprofit employer or small employer of 812
such determination. 813
(3) Failure of [an] a domestic insurer, [or] domestic health care center, 814
multiemployer plan, nonprofit employer or small employer to notify the 815
commissioner of the amount of an overpayment within the time 816
prescribed in subparagraph (B) of subdivision (1) of this subsection 817
constitutes a waiver of any demand of the domestic insurer, [or] 818
domestic health care center, multiemployer plan, nonprofit employer or 819
small employer against the state on account of such overpayment. 820
(4) Nothing in this subsection shall be construed to prohibit or limit 821
the right of [an] a domestic insurer, [or] domestic health care center, 822
multiemployer plan, nonprofit employer or small employer to appeal 823
pursuant to subsection [(e)] (f) of this section. 824
Sec. 7. Section 38a-52 of the general statutes is repealed and the 825
following is substituted in lieu thereof (Effective July 1, 2021): 826
Any (1) domestic insurance company or other domestic entity 827
aggrieved because of any assessment levied under section 38a-48, (2) 828
fraternal benefit society or foreign or alien insurance company or other 829
entity aggrieved because of any assessment levied under the provisions 830
of sections 38a-49 to 38a-51, inclusive, [or] (3) domestic insurer, domestic 831
health care center [,] or third-party administrator licensed pursuant to 832
section 38a-720a, or exempt insurer, administrator of a multiemployer 833
plan, nonprofit employer or small employer as defined in [subdivision 834
(1) of] subsection [(b)] (a) of section 19a-7j, as amended by this act, 835
aggrieved because of any assessment levied under said section 19a-7j, 836
as amended by this act, or (4) domestic insurer or domestic health care 837
center, or administrator of a multiemployer plan, nonprofit employer or 838 Substitute Bill No. 842
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
R02-SB.docx }
29 of 59
small employer as defined in subsection (a) of section 19a-7p, as 839
amended by this act, aggrieved because of any assessment levied under 840
said section 19a-7p, as amended by this act, may, within one month from 841
the time provided for the payment of such assessment, appeal therefrom 842
to the superior court for the judicial district of New Britain, which 843
appeal shall be accompanied by a citation to the commissioner to appear 844
before said court. Such citation shall be signed by the same authority, 845
and such appeal shall be returnable at the same time and served and 846
returned in the same manner, as is required in case of a summons in a 847
civil action. The authority issuing the citation shall take from the 848
appellant a bond or recognizance to the state, with surety to prosecute 849
the appeal to effect and to comply with the orders and decrees of the 850
court in the premises. Such appeals shall be preferred cases, to be heard, 851
unless cause appears to the contrary, at the first session, by the court or 852
by a committee appointed by the court. Said court may grant such relief 853
as may be equitable, and, if such assessment has been paid prior to the 854
granting of such relief, may order the Treasurer to pay the amount of 855
such relief, with interest at the rate of six per cent per annum, to the 856
aggrieved company. If the appeal has been taken without probable 857
cause, the court may tax double or triple costs, as the case demands; and, 858
upon all such appeals which may be denied, costs may be taxed against 859
the appellant at the discretion of the court, but no costs shall be taxed 860
against the state. 861
Sec. 8. Section 38a-1041 of the general statutes is repealed and the 862
following is substituted in lieu thereof (Effective July 1, 2021): 863
(a) There is established an Office of the Healthcare Advocate which 864
shall be within the Insurance Department for administrative purposes 865
only. 866
(b) The Office of the Healthcare Advocate may: 867
(1) Assist health insurance consumers with managed care plan 868
selection by providing information, referral and assistance to 869
individuals about means of obtaining health insurance coverage and 870 Substitute Bill No. 842
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
R02-SB.docx }
30 of 59
services; 871
(2) Assist health insurance consumers to understand their rights and 872
responsibilities under managed care plans; 873
(3) Provide information to the public, agencies, legislators and others 874
regarding problems and concerns of health insurance consumers and 875
make recommendations for resolving those problems and concerns; 876
(4) Assist consumers with the filing of complaints and appeals, 877
including filing appeals with a managed care organization's internal 878
appeal or grievance process and the external appeal process established 879
under sections 38a-591d to 38a-591g, inclusive; 880
(5) Analyze and monitor the development and implementation of 881
federal, state and local laws, regulations and policies relating to health 882
insurance consumers and recommend changes it deems necessary; 883
(6) Facilitate public comment on laws, regulations and policies, 884
including policies and actions of health insurers; 885
(7) Ensure that health insurance consumers have timely access to the 886
services provided by the office; 887
(8) Review the health insurance records of a consumer who has 888
provided written consent for such review; 889
(9) Create and make available to employers a notice, suitable for 890
posting in the workplace, concerning the services that the Healthcare 891
Advocate provides; 892
(10) Establish a toll-free number, or any other free calling option, to 893
allow customer access to the services provided by the Healthcare 894
Advocate; 895
(11) Pursue administrative remedies on behalf of and with the 896
consent of any health insurance consumers; 897 Substitute Bill No. 842
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
R02-SB.docx }
31 of 59
(12) Adopt regulations, pursuant to chapter 54, to carry out the 898
provisions of sections 38a-1040 to 38a-1050, inclusive; and 899
(13) Take any other actions necessary to fulfill the purposes of 900
sections 38a-1040 to 38a-1050, inclusive. 901
(c) The Office of the Healthcare Advocate shall make a referral to the 902
Insurance Commissioner if the Healthcare Advocate finds that a 903
preferred provider network may have engaged in a pattern or practice 904
that may be in violation of sections 38a-479aa to 38a-479gg, inclusive, or 905
38a-815 to 38a-819, inclusive. 906
(d) The Healthcare Advocate and the Insurance Commissioner shall 907
jointly compile a list of complaints received against managed care 908
organizations and preferred provider networks and the commissioner 909
shall maintain the list, except the names of complainants shall not be 910
disclosed if such disclosure would violate the provisions of section 4-911
61dd or 38a-1045. 912
(e) On or before October 1, 2005, the Managed Care Ombudsman 913
shall establish a process to provide ongoing communication among 914
mental health care providers, patients, state-wide and regional business 915
organizations, managed care companies and other health insurers to 916
assure: (1) Best practices in mental health treatment and recovery; (2) 917
compliance with the provisions of sections 38a-476a, 38a-476b, 38a-488a 918
and 38a-489; and (3) the relative costs and benefits of providing effective 919
mental health care coverage to employees and their families. On or 920
before January 1, 2006, and annually thereafter, the Healthcare 921
Advocate shall report, in accordance with the provisions of section 11-922
4a, on the implementation of this subsection to the joint standing 923
committees of the General Assembly having cognizance of matters 924
relating to public health and insurance. 925
(f) On or before October 1, 2008, the Office of the Healthcare Advocate 926
shall, within available appropriations, establish and maintain a 927
healthcare consumer information web site on the Internet for use by the 928 Substitute Bill No. 842
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
R02-SB.docx }
32 of 59
public in obtaining healthcare information, including but not limited to: 929
(1) The availability of wellness programs in various regions of 930
Connecticut, such as disease prevention and health promotion 931
programs; (2) quality and experience data from hospitals licensed in this 932
state; and (3) a link to the consumer report card developed and 933
distributed by the Insurance Commissioner pursuant to section 38a-934
478l. 935
(g) Not later than January 1, 2015, the Office of the Healthcare 936
Advocate shall establish an information and referral service to help 937
residents and providers receive behavioral health care information, 938
timely referrals and access to behavioral health care providers. In 939
developing and implementing such service, the Healthcare Advocate, 940
or the Healthcare Advocate's designee, shall: (1) Collaborate with 941
stakeholders, including, but not limited to, (A) state agencies, (B) the 942
Behavioral Health Partnership established pursuant to section 17a-22h, 943
(C) community collaboratives, (D) the United Way's 2-1-1 Infoline 944
program, and (E) providers; (2) identify any basis that prevents 945
residents from obtaining adequate and timely behavioral health care 946
services, including, but not limited to, (A) gaps in private behavioral 947
health care services and coverage, and (B) barriers to access to care; (3) 948
coordinate a public awareness and educational campaign directing 949
residents to the information and referral service; and (4) develop data 950
reporting mechanisms to determine the effectiveness of the service, 951
including, but not limited to, tracking (A) the number of referrals to 952
providers by type and location of providers, (B) waiting time for 953
services, and (C) the number of providers who accept or reject requests 954
for service based on type of health care coverage. Not later than 955
February 1, 2016, and annually thereafter, the Office of the Healthcare 956
Advocate shall submit a report, in accordance with the provisions of 957
section 11-4a, to the joint standing committees of the General Assembly 958
having cognizance of matters relating to children, human services, 959
public health and insurance. The report shall identify gaps in services 960
and the resources needed to improve behavioral health care options for 961
residents. 962 Substitute Bill No. 842
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
R02-SB.docx }
33 of 59
(h) The Office of the Healthcare Advocate shall provide assistance to 963
the plan participants and beneficiaries in this state under multiemployer 964
plans, nonprofit employers' employees and their dependents and small 965
employers' employees and their dependents receiving coverage 966
provided by the Comptroller pursuant to section 2 of this act that is 967
equivalent to the assistance that the Office of the Healthcare Advocate 968
provides to other health insurance consumers. 969
Sec. 9. (NEW) (Effective July 1, 2021) (a) For the purposes of this 970
section: 971
(1) "Connecticut Health Insurance Exchange account" means the 972
Connecticut Health Insurance Exchange account established under 973
section 13 of this act; 974
(2) "Exchange" has the same meaning as provided in section 38a-1080 975
of the general statutes, as amended by this act; 976
(3) "Exempt insurer" means an insurer that administers self-insured 977
health benefit plans and is exempt from third-party administrator 978
licensure under subparagraph (C) of subdivision (11) of section 38a-720 979
of the general statutes and section 38a-720a of the general statutes; and 980
(4) "Office of Health Strategy" means the Office of Health Strategy 981
established under section 19a-754a of the general statutes, as amended 982
by this act. 983
(b) (1) Subject to the approval required under subsection (d) of section 984
16 of this act and, with respect to the matters for which the exchange 985
seeks a state innovation waiver pursuant to subparagraph (B) of 986
subdivision (28) of section 38a-1084 of the general statutes, as amended 987
by this act, issuance of such state innovation waiver, the Office of Health 988
Strategy shall: 989
(A) Not later than July 1, 2022, and annually thereafter: 990
(i) Determine the amount that the exchange requires to perform its 991 Substitute Bill No. 842
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
R02-SB.docx }
34 of 59
duties under subparagraph (C) of subdivision (28) of section 38a-1084 of 992
the general statutes, as amended by this act; and 993
(ii) Report the amount determined pursuant to subparagraph (A)(i) 994
of this subdivision to the Insurance Commissioner; and 995
(B) Not later than July 1, 2021, report to the Insurance Commissioner 996
that the amount described in subparagraph (A)(i) of this subdivision is 997
fifty million dollars for the year 2022. 998
(2) The amount determined pursuant to subparagraph (A)(i) of 999
subdivision (1) of this subsection shall not exceed fifty million dollars 1000
for any year. 1001
(c) (1) Each insurer and health care center doing health insurance 1002
business in this state, and each exempt insurer, shall annually pay to the 1003
Insurance Commissioner, for deposit in the Connecticut Health 1004
Insurance Exchange account, a fee assessed by the commissioner 1005
pursuant to this section. 1006
(2) Not later than July 1, 2021, and annually thereafter, each insurer, 1007
health care center and exempt insurer described in subdivision (1) of 1008
this subsection shall report to the commissioner, on a form designated 1009
by the commissioner, the number of insured or enrolled lives in this 1010
state as of the May first immediately preceding for which such insurer, 1011
health care center or exempt insurer was providing health insurance 1012
coverage, or administering a self-insured health benefit plan providing 1013
coverage, of the types specified in subdivisions (1), (2), (4), (11) and (12) 1014
of section 38a-469 of the general statutes. Such number shall not include 1015
insured or enrolled lives covered under fully insured group health 1016
insurance policies sold in the small group market, Medicare, any 1017
medical assistance program administered by the Department of Social 1018
Services, workers' compensation insurance or Medicare Part C plans. 1019
(3) Not later than August 1, 2021, and annually thereafter, the 1020
commissioner shall determine the fee to be assessed for that year against 1021
each insurer, health care center and exempt insurer described in 1022 Substitute Bill No. 842
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
R02-SB.docx }
35 of 59
subdivision (1) of this subsection. Such fee shall be determined by 1023
multiplying the number of insured or enrolled lives reported to the 1024
commissioner pursuant to subdivision (2) of this subsection by a factor, 1025
determined annually by the commissioner, to fully fund the amount 1026
reported by the Office of Health Strategy to the commissioner pursuant 1027
to subparagraph (A)(ii) or (B) of subdivision (1) of subsection (b) of this 1028
section. The commissioner shall determine the factor by dividing the 1029
amount reported by the Office of Health Strategy to the commissioner 1030
pursuant to subparagraph (A)(ii) or (B) of subdivision (1) of subsection 1031
(b) of this section by the total number of insured or enrolled lives 1032
reported to the commissioner pursuant to subdivision (2) of this 1033
subsection. 1034
(4) (A) Not later than August 1, 2021, and annually thereafter, the 1035
commissioner shall submit a statement to each insurer, health care 1036
center and exempt insurer described in subdivision (1) of this subsection 1037
that includes the proposed fee imposed under this section for such 1038
insurer, health care center or exempt insurer determined in accordance 1039
with this subsection. Each such insurer, health care center and exempt 1040
insurer shall pay such fee to the commissioner not later than November 1041
first of that year. 1042
(B) Any insurer, health care center or exempt insurer described in 1043
subdivision (1) of this subsection that is aggrieved by an assessment 1044
levied under this subsection may appeal therefrom in the same manner 1045
as provided for appeals under section 38a-52 of the general statutes, as 1046
amended by this act. 1047
(5) Any insurer, health care center or exempt insurer that fails to file 1048
the report required under subdivision (2) of this subsection, or pay the 1049
fee assessed under subdivision (1) of this subsection, shall pay a late 1050
filing or payment fee, as applicable, of one hundred dollars per day for 1051
each day from the date such report or payment was due. The 1052
commissioner shall deposit all late fees paid pursuant to this 1053
subdivision in the Connecticut Health Insurance Exchange account. The 1054
commissioner may require an insurer, health care center or exempt 1055 Substitute Bill No. 842
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
R02-SB.docx }
36 of 59
insurer subject to this subsection to produce any records in its 1056
possession, and may require any other person to produce any records 1057
in such other person's possession, that were used to prepare such report 1058
for examination by the commissioner or the commissioner's designee. If 1059
the commissioner determines there exists anything other than a good 1060
faith discrepancy between the actual number of insured or enrolled lives 1061
that should have been reported to the commissioner pursuant to 1062
subdivision (2) of this subsection and the number actually reported, 1063
such insurer, health care center or exempt insurer shall be liable to this 1064
state for a civil penalty of not more than fifteen thousand dollars for each 1065
report filed for which the commissioner determines there is such a 1066
discrepancy. 1067
(6) (A) The commissioner shall apply any overpayment of the fee 1068
imposed under this section by an insurer, health care center or exempt 1069
insurer for a given year as a credit against the fee due from such insurer, 1070
health care center or exempt insurer under this section for the 1071
succeeding year if: 1072
(i) The amount of the overpayment exceeds five thousand dollars; 1073
and 1074
(ii) On or before April first of the year of the overpayment, the 1075
insurer, health care center or exempt insurer: 1076
(I) Notifies the commissioner of the amount of the overpayment; and 1077
(II) Provides the commissioner with evidence sufficient to prove the 1078
amount of the overpayment. 1079
(B) Not later than ninety days after the commissioner receives the 1080
notice and supporting evidence under subparagraph (A)(ii) of this 1081
subdivision, the commissioner shall: 1082
(i) Determine whether the insurer, health care center or exempt 1083
insurer made an overpayment; and 1084 Substitute Bill No. 842
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
R02-SB.docx }
37 of 59
(ii) Notify the insurer, health care center or exempt insurer of the 1085
commissioner's determination under subparagraph (B)(i) of this 1086
subdivision. 1087
(C) Failure of an insurer, health care center or exempt insurer to 1088
notify the commissioner of the amount of an overpayment within the 1089
time prescribed in subparagraph (A)(ii) of this subdivision constitutes a 1090
waiver of any demand of the insurer, health care center or exempt 1091
insurer against this state on account of such overpayment. 1092
(D) Nothing in this subdivision shall be construed to prohibit or limit 1093
the right of an insurer, health care center or exempt insurer to appeal 1094
pursuant to subparagraph (B) of subdivision (4) of this subsection. 1095
(d) If another state, territory or district of the United States, or a 1096
foreign country, imposes on a Connecticut domiciled insurer, fraternal 1097
benefit society, hospital service corporation, medical service 1098
corporation, health care center or other domestic entity a retaliatory 1099
charge for the fee imposed under this section, such domestic entity may, 1100
not later than sixty days after receipt of notice of the imposition of the 1101
retaliatory charge for such fee, appeal to the Insurance Commissioner 1102
for a verification that the fee imposed under this section is subject to 1103
retaliation by another state, territory or district of the United States, or a 1104
foreign country. If the commissioner verifies, upon appeal to and 1105
certification by the commissioner, that the fee imposed under this 1106
section is the subject of a retaliatory tax, fee, assessment or other 1107
obligation by another state, territory or district of the United States, or a 1108
foreign country, such fee shall not be assessed against nondomestic 1109
insurers and nondomestic exempt insurers pursuant to this section. Any 1110
such domestic insurer, fraternal benefit society, hospital service 1111
corporation, medical service corporation, health care center or other 1112
entity aggrieved by the commissioner's decision issued under this 1113
subsection may appeal therefrom in the same manner as provided 1114
under section 38a-52 of the general statutes, as amended by this act. 1115
(e) The Insurance Commissioner may adopt regulations, in 1116 Substitute Bill No. 842
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
R02-SB.docx }
38 of 59
accordance with chapter 54 of the general statutes, to implement the 1117
provisions of this section. 1118
Sec. 10. Section 38a-1080 of the general statutes is repealed and the 1119
following is substituted in lieu thereof (Effective July 1, 2021): 1120
For purposes of this section, sections [38a-1080] 38a-1081 to 38a-1093, 1121
inclusive, and sections 13 and 14 of this act: 1122
(1) "Affordable Care Act" means the Patient Protection and 1123
Affordable Care Act, P.L. 111-148, as amended by the Health Care and 1124
Education Reconciliation Act, P.L. 111-152, as both may be amended 1125
from time to time, and regulations adopted thereunder; 1126
[(1)] (2) "Board" means the board of directors of the Connecticut 1127
Health Insurance Exchange; 1128
[(2)] (3) "Commissioner" means the Insurance Commissioner; 1129
[(3)] (4) "Exchange" means the Connecticut Health Insurance 1130
Exchange established pursuant to section 38a-1081; 1131
[(4) "Affordable Care Act" means the Patient Protection and 1132
Affordable Care Act, P.L. 111-148, as amended by the Health Care and 1133
Education Reconciliation Act, P.L. 111-152, as both may be amended 1134
from time to time, and regulations adopted thereunder;] 1135
(5) (A) "Health benefit plan" means an insurance policy or contract 1136
offered, delivered, issued for delivery, renewed, amended or continued 1137
in the state by a health carrier to provide, deliver, pay for or reimburse 1138
any of the costs of health care services. 1139
(B) "Health benefit plan" does not include: 1140
(i) Coverage of the type specified in subdivisions (5), (6), (7), (8), (9), 1141
(14), (15) and (16) of section 38a-469 or any combination thereof; 1142
(ii) Coverage issued as a supplement to liability insurance; 1143 Substitute Bill No. 842
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
R02-SB.docx }
39 of 59
(iii) Liability insurance, including general liability insurance and 1144
automobile liability insurance; 1145
(iv) Workers' compensation insurance; 1146
(v) Automobile medical payment insurance; 1147
(vi) Credit insurance; 1148
(vii) Coverage for on-site medical clinics; or 1149
(viii) Other similar insurance coverage specified in regulations issued 1150
pursuant to the Health Insurance Portability and Accountability Act of 1151
1996, P.L. 104-191, as amended from time to time, under which benefits 1152
for health care services are secondary or incidental to other insurance 1153
benefits. 1154
(C) "Health benefit plan" does not include the following benefits if 1155
they are provided under a separate insurance policy, certificate or 1156
contract or are otherwise not an integral part of the plan: 1157
(i) Limited scope dental or vision benefits; 1158
(ii) Benefits for long-term care, nursing home care, home health care, 1159
community-based care or any combination thereof; or 1160
(iii) Other similar, limited benefits specified in regulations issued 1161
pursuant to the Health Insurance Portability and Accountability Act of 1162
1996, P.L. 104-191, as amended from time to time; 1163
(iv) Other supplemental coverage, similar to coverage of the type 1164
specified in subdivisions (9) and (14) of section 38a-469, provided under 1165
a group health plan. 1166
(D) "Health benefit plan" does not include coverage of the type 1167
specified in subdivisions (3) and (13) of section 38a-469 or other fixed 1168
indemnity insurance if (i) such coverage is provided under a separate 1169
insurance policy, certificate or contract, (ii) there is no coordination 1170 Substitute Bill No. 842
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
R02-SB.docx }
40 of 59
between the provision of the benefits and any exclusion of benefits 1171
under any group health plan maintained by the same plan sponsor, and 1172
(iii) the benefits are paid with respect to an event without regard to 1173
whether benefits were also provided under any group health plan 1174
maintained by the same plan sponsor; 1175
(6) "Health care services" has the same meaning as provided in 1176
section 38a-478; 1177
(7) "Health carrier" means an insurance company, fraternal benefit 1178
society, hospital service corporation, medical service corporation, health 1179
care center or other entity subject to the insurance laws and regulations 1180
of the state or the jurisdiction of the commissioner that contracts or 1181
offers to contract to provide, deliver, pay for or reimburse any of the 1182
costs of health care services; 1183
(8) "Internal Revenue Code" means the Internal Revenue Code of 1184
1986, or any subsequent corresponding internal revenue code of the 1185
United States, as amended from time to time; 1186
[(9) "Person" has the same meaning as provided in section 38a-1; 1187
(10)] (9) "Qualified dental plan" means a limited scope dental plan 1188
that has been certified in accordance with subsection (e) of section 38a-1189
1086; 1190
[(11)] (10) "Qualified employer" has the same meaning as provided in 1191
Section 1312 of the Affordable Care Act; 1192
[(12)] (11) "Qualified health plan" means a health benefit plan that has 1193
in effect a certification that the plan meets the criteria for certification 1194
described in Section 1311(c) of the Affordable Care Act and section 38a-1195
1086; 1196
[(13)] (12) "Qualified individual" has the same meaning as provided 1197
in Section 1312 of the Affordable Care Act; 1198 Substitute Bill No. 842
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
R02-SB.docx }
41 of 59
[(14)] (13) "Secretary" means the Secretary of the United States 1199
Department of Health and Human Services; and 1200
[(15)] (14) "Small employer" has the same meaning as provided in 1201
section 38a-564. 1202
Sec. 11. Section 38a-1084 of the general statutes is repealed and the 1203
following is substituted in lieu thereof (Effective July 1, 2021): 1204
The exchange shall: 1205
(1) Administer the exchange for both qualified individuals and 1206
qualified employers; 1207
(2) Commission surveys of individuals, small employers and health 1208
care providers on issues related to health care and health care coverage; 1209
(3) Implement procedures for the certification, recertification and 1210
decertification, consistent with guidelines developed by the Secretary 1211
under Section 1311(c) of the Affordable Care Act, and section 38a-1086, 1212
of health benefit plans as qualified health plans; 1213
(4) Provide for the operation of a toll-free telephone hotline to 1214
respond to requests for assistance; 1215
(5) Provide for enrollment periods, as provided under Section 1216
1311(c)(6) of the Affordable Care Act; 1217
(6) Maintain an Internet web site through which enrollees and 1218
prospective enrollees of qualified health plans may obtain standardized 1219
comparative information on such plans including, but not limited to, the 1220
enrollee satisfaction survey information under Section 1311(c)(4) of the 1221
Affordable Care Act and any other information or tools to assist 1222
enrollees and prospective enrollees evaluate qualified health plans 1223
offered through the exchange; 1224
(7) Publish the average costs of licensing, regulatory fees and any 1225
other payments required by the exchange and the administrative costs 1226 Substitute Bill No. 842
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
R02-SB.docx }
42 of 59
of the exchange, including information on moneys lost to waste, fraud 1227
and abuse, on an Internet web site to educate individuals on such costs; 1228
(8) On or before the open enrollment period for plan year 2017, assign 1229
a rating to each qualified health plan offered through the exchange in 1230
accordance with the criteria developed by the Secretary under Section 1231
1311(c)(3) of the Affordable Care Act, and determine each qualified 1232
health plan's level of coverage in accordance with regulations issued by 1233
the Secretary under Section 1302(d)(2)(A) of the Affordable Care Act; 1234
(9) Use a standardized format for presenting health benefit options in 1235
the exchange, including the use of the uniform outline of coverage 1236
established under Section 2715 of the Public Health Service Act, 42 USC 1237
300gg-15, as amended from time to time; 1238
(10) Inform individuals, in accordance with Section 1413 of the 1239
Affordable Care Act, of eligibility requirements for the Medicaid 1240
program under Title XIX of the Social Security Act, as amended from 1241
time to time, the Children's Health Insurance Program (CHIP) under 1242
Title XXI of the Social Security Act, as amended from time to time, or 1243
any applicable state or local public program, and enroll an individual in 1244
such program if the exchange determines, through screening of the 1245
application by the exchange, that such individual is eligible for any such 1246
program; 1247
(11) Collaborate with the Department of Social Services, to the extent 1248
possible, to allow an enrollee who loses premium tax credit eligibility 1249
under Section 36B of the Internal Revenue Code and is eligible for 1250
HUSKY A or any other state or local public program, to remain enrolled 1251
in a qualified health plan; 1252
(12) Establish and make available by electronic means a calculator to 1253
determine the actual cost of coverage after application of any premium 1254
tax credit under Section 36B of the Internal Revenue Code and any cost-1255
sharing reduction under Section 1402 of the Affordable Care Act; 1256
(13) Establish a program for small employers through which 1257 Substitute Bill No. 842
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
R02-SB.docx }
43 of 59
qualified employers may access coverage for their employees and that 1258
shall enable any qualified employer to specify a level of coverage so that 1259
any of its employees may enroll in any qualified health plan offered 1260
through the exchange at the specified level of coverage; 1261
(14) Offer enrollees and small employers the option of having the 1262
exchange collect and administer premiums, including through 1263
allocation of premiums among the various insurers and qualified health 1264
plans chosen by individual employers; 1265
(15) Grant a certification, subject to Section 1411 of the Affordable 1266
Care Act, attesting that, for purposes of the individual responsibility 1267
penalty under Section 5000A of the Internal Revenue Code, an 1268
individual is exempt from the individual responsibility requirement or 1269
from the penalty imposed by said Section 5000A because: 1270
(A) There is no affordable qualified health plan available through the 1271
exchange, or the individual's employer, covering the individual; or 1272
(B) The individual meets the requirements for any other such 1273
exemption from the individual responsibility requirement or penalty; 1274
(16) Provide to the Secretary of the Treasury of the United States the 1275
following: 1276
(A) A list of the individuals granted a certification under subdivision 1277
(15) of this section, including the name and taxpayer identification 1278
number of each individual; 1279
(B) The name and taxpayer identification number of each individual 1280
who was an employee of an employer but who was determined to be 1281
eligible for the premium tax credit under Section 36B of the Internal 1282
Revenue Code because: 1283
(i) The employer did not provide minimum essential health benefits 1284
coverage; or 1285 Substitute Bill No. 842
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
R02-SB.docx }
44 of 59
(ii) The employer provided the minimum essential coverage but it 1286
was determined under Section 36B(c)(2)(C) of the Internal Revenue 1287
Code to be unaffordable to the employee or not provide the required 1288
minimum actuarial value; and 1289
(C) The name and taxpayer identification number of: 1290
(i) Each individual who notifies the exchange under Section 1291
1411(b)(4) of the Affordable Care Act that such individual has changed 1292
employers; and 1293
(ii) Each individual who ceases coverage under a qualified health 1294
plan during a plan year and the effective date of that cessation; 1295
(17) Provide to each employer the name of each employee, as 1296
described in subparagraph (B) of subdivision (16) of this section, of the 1297
employer who ceases coverage under a qualified health plan during a 1298
plan year and the effective date of the cessation; 1299
(18) Perform duties required of, or delegated to, the exchange by the 1300
Secretary or the Secretary of the Treasury of the United States related to 1301
determining eligibility for premium tax credits, reduced cost-sharing or 1302
individual responsibility requirement exemptions; 1303
(19) Select entities qualified to serve as Navigators in accordance with 1304
Section 1311(i) of the Affordable Care Act and award grants to enable 1305
Navigators to: 1306
(A) Conduct public education activities to raise awareness of the 1307
availability of qualified health plans; 1308
(B) Distribute fair and impartial information concerning enrollment 1309
in qualified health plans and the availability of premium tax credits 1310
under Section 36B of the Internal Revenue Code and cost-sharing 1311
reductions under Section 1402 of the Affordable Care Act; 1312
(C) Facilitate enrollment in qualified health plans; 1313 Substitute Bill No. 842
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
R02-SB.docx }
45 of 59
(D) Provide referrals to the Office of the Healthcare Advocate or 1314
health insurance ombudsman established under Section 2793 of the 1315
Public Health Service Act, 42 USC 300gg-93, as amended from time to 1316
time, or any other appropriate state agency or agencies, for any enrollee 1317
with a grievance, complaint or question regarding the enrollee's health 1318
benefit plan, coverage or a determination under that plan or coverage; 1319
and 1320
(E) Provide information in a manner that is culturally and 1321
linguistically appropriate to the needs of the population being served by 1322
the exchange; 1323
(20) Review the rate of premium growth within and outside the 1324
exchange and consider such information in developing 1325
recommendations on whether to continue limiting qualified employer 1326
status to small employers; 1327
(21) Credit the amount, in accordance with Section 10108 of the 1328
Affordable Care Act, of any free choice voucher to the monthly 1329
premium of the plan in which a qualified employee is enrolled and 1330
collect the amount credited from the offering employer; 1331
(22) Consult with stakeholders relevant to carrying out the activities 1332
required under sections 38a-1080 to 38a-1090, inclusive, as amended by 1333
this act, including, but not limited to: 1334
(A) Individuals who are knowledgeable about the health care system, 1335
have background or experience in making informed decisions regarding 1336
health, medical and scientific matters and are enrollees in qualified 1337
health plans; 1338
(B) Individuals and entities with experience in facilitating enrollment 1339
in qualified health plans; 1340
(C) Representatives of small employers and s elf-employed 1341
individuals; 1342 Substitute Bill No. 842
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
R02-SB.docx }
46 of 59
(D) The Department of Social Services; and 1343
(E) Advocates for enrolling hard-to-reach populations; 1344
(23) Meet the following financial integrity requirements: 1345
(A) Keep an accurate accounting of all activities, receipts and 1346
expenditures and annually submit to the Secretary, the Governor, the 1347
Insurance Commissioner and the General Assembly a report concerning 1348
such accountings; 1349
(B) Fully cooperate with any investigation conducted by the Secretary 1350
pursuant to the Secretary's authority under the Affordable Care Act and 1351
allow the Secretary, in coordination with the Inspector General of the 1352
United States Department of Health and Human Services, to: 1353
(i) Investigate the affairs of the exchange; 1354
(ii) Examine the properties and records of the exchange; and 1355
(iii) Require periodic reports in relation to the activities undertaken 1356
by the exchange; and 1357
(C) Not use any funds in carrying out its activities under sections 38a-1358
1080 to 38a-1089, inclusive, as amended by this act, that are intended for 1359
the administrative and operational expenses of the exchange, for staff 1360
retreats, promotional giveaways, excessive executive compensation or 1361
promotion of federal or state legislative and regulatory modifications; 1362
(24) (A) Seek to include the most comprehensive health benefit plans 1363
that offer high quality benefits at the most affordable price in the 1364
exchange, (B) encourage health carriers to offer tiered health care 1365
provider network plans that have different cost-sharing rates for 1366
different health care provider tiers and reward enrollees for choosing 1367
low-cost, high-quality health care providers by offering lower 1368
copayments, deductibles or other out-of-pocket expenses, and (C) offer 1369
any such tiered health care provider network plans through the 1370 Substitute Bill No. 842
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
R02-SB.docx }
47 of 59
exchange; [and] 1371
(25) Report at least annually to the General Assembly on the effect of 1372
adverse selection on the operations of the exchange and make legislative 1373
recommendations, if necessary, to reduce the negative impact from any 1374
such adverse selection on the sustainability of the exchange, including 1375
recommendations to ensure that regulation of insurers and health 1376
benefit plans are similar for qualified health plans offered through the 1377
exchange and health benefit plans offered outside the exchange. The 1378
exchange shall evaluate whether adverse selection is occurring with 1379
respect to health benefit plans that are grandfathered under the 1380
Affordable Care Act, self-insured plans, plans sold through the 1381
exchange and plans sold outside the exchange; [.] 1382
(26) Administer the Connecticut Health Insurance Exchange account 1383
established under section 13 of this act; 1384
(27) Consult with the Office of Health Strategy established under 1385
section 19a-754a, as amended by this act, for the purposes set forth in 1386
subsection (b) of section 16 of this act; 1387
(28) Subject to the approval required under subsection (d) of section 1388
16 of this act: 1389
(A) Establish the subsidiary described in subdivision (1) of subsection 1390
(b) of section 16 of this act not later than November 1, 2021, which, if 1391
established, shall: 1392
(i) Require each health carrier offering coverage through such 1393
subsidiary to: 1394
(I) Collect demographic data, including, but not limited to, self-1395
reported ethnic and racial data, concerning the individuals receiving 1396
such coverage by, at a minimum, utilizing standardized categories 1397
developed by the Office of Health Strategy pursuant to subdivision (9) 1398
of subsection (b) of section 19a-754a of the general statutes, as amended 1399
by this act, including an "other" category and allowing any individual 1400 Substitute Bill No. 842
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
R02-SB.docx }
48 of 59
who is self-reporting ethnic or racial data to write in such individual's 1401
ethnicity or race, and select multiple ethnicities and races, on any form 1402
provided by such health carrier to collect such ethnic or racial data; and 1403
(II) Not later than February 1, 2022, and annually thereafter, submit a 1404
report to such subsidiary disclosing, in the aggregate, the demographic 1405
data collected by such health carrier pursuant to subparagraph (A)(i)(I) 1406
of this subdivision; and 1407
(ii) Not later than March 1, 2022, and annually thereafter, submit a 1408
report to the exchange disclosing, in the aggregate, the demographic 1409
data that health carriers submitted to such subsidiary pursuant to 1410
subparagraph (A)(i)(II) of this subdivision for the preceding calendar 1411
year; 1412
(B) Seek the state innovation waiver described in subdivision (2) of 1413
subsection (b) of section 16 of this act not later than November 1, 2021; 1414
and 1415
(C) Use the moneys deposited in the Connecticut Health Insurance 1416
Exchange account established under section 13 of this act for the 1417
purposes set forth in subdivision (3) of subsection (b) of section 16 of 1418
this act and, if the exchange uses any funds deposited in said account to 1419
provide premium and cost -sharing subsidies described in 1420
subparagraph (B) of subdivision (3) of subsection (b) of section 16 of this 1421
act, collect, at least annually, demographic data, including, but not 1422
limited to, self-reported ethnic and racial data, concerning the 1423
individuals receiving such subsidies by, at a minimum: 1424
(i) Utilizing standardized categories developed by the Office of 1425
Health Strategy pursuant to subdivision (9) of subsection (b) of section 1426
19a-754a of the general statutes, as amended by this act; and 1427
(ii) Including an "other" category and allowing any individual who is 1428
self-reporting ethnic or racial data to write in such individual's ethnicity 1429
or race and select multiple ethnicities and races on any form provided 1430
by the exchange to collect such ethnic or racial data; and 1431 Substitute Bill No. 842
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
R02-SB.docx }
49 of 59
(29) Determine whether individuals referred to the exchange by the 1432
Labor Commissioner pursuant to section 18 of this act are eligible for 1433
free or subsidized health coverage or other assistance or benefits, 1434
including, but not limited to, assistance under the supplemental 1435
nutrition assistance program, and, if such individuals are eligible for 1436
such coverage, assistance or benefits, enroll such individuals in such 1437
coverage, assistance or benefits. 1438
Sec. 12. Section 38a-1089 of the general statutes is repealed and the 1439
following is substituted in lieu thereof (Effective July 1, 2021): 1440
(a) Not later than January 1, 2012, and annually thereafter until 1441
January 1, 2014, the chief executive officer of the exchange shall report, 1442
in accordance with section 11-4a, to the Governor and the General 1443
Assembly on a plan, and any revisions or amendments to such plan, to 1444
establish a health insurance exchange in the state. Such report shall 1445
address: 1446
(1) Whether to establish two separate exchanges, one for the 1447
individual health insurance market and one for the small employer 1448
health insurance market, or to establish a single exchange; 1449
(2) Whether to merge the individual and small employer health 1450
insurance markets; 1451
(3) Whether to revise the definition of "small employer" from not 1452
more than fifty employees to not more than one hundred employees; 1453
(4) Whether to allow large employers to participate in the exchange 1454
beginning in 2017; 1455
(5) Whether to require qualified health plans to provide the essential 1456
health benefits package, as described in Section 1302(a) of the 1457
Affordable Care Act, or include additional state mandated benefits; 1458
(6) Whether to list dental benefits separately on the exchange's 1459
Internet web site where a qualified health plan includes dental benefits; 1460 Substitute Bill No. 842
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
R02-SB.docx }
50 of 59
(7) The relationship of the exchange to insurance producers; 1461
(8) The capacity of the exchange to award Navigator grants pursuant 1462
to section 38a-1087; 1463
(9) Ways to ensure that the exchange is financially sustainable by 1464
2015, as required by the Affordable Care Act including, but not limited 1465
to, assessments or user fees charged to carriers; 1466
(10) Methods to independently evaluate consumers' experience, 1467
including, but not limited to, hiring consultants to act as secret shoppers; 1468
and 1469
(11) The status of the implementation and administration of the all-1470
payer claims database program established under section 19a-755a. 1471
(b) Not later than January 1, 2012, and annually thereafter, the chief 1472
executive officer of the exchange shall report, in accordance with section 1473
11-4a, to the Governor and the General Assembly on: 1474
(1) Any private or federal funds received during the preceding 1475
calendar year and, if applicable, how such funds were expended; 1476
(2) The adequacy of federal funds for the exchange prior to January 1477
1, 2015; 1478
(3) The amount and recipients of any grants awarded; and 1479
(4) The current financial status of the exchange. 1480
(c) Not later than April 1, 2022, and annually thereafter, the chief 1481
executive officer of the exchange shall submit a report, in accordance 1482
with section 11-4a, to the joint standing committee of the General 1483
Assembly having cognizance of matters relating to insurance disclosing, 1484
in the aggregate, the demographic data, if any, that: 1485
(1) The subsidiary established pursuant to subparagraph (A) of 1486
subdivision (28) of section 38a-1084, as amended by this act, reported to 1487 Substitute Bill No. 842
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
R02-SB.docx }
51 of 59
the exchange pursuant to subparagraph (A)(ii) of subdivision (28) of 1488
section 38a-1084, as amended by this act, for the preceding calendar 1489
year; and 1490
(2) The exchange collected pursuant to subparagraph (C) of 1491
subdivision (28) of section 38a-1084, as amended by this act, for the 1492
preceding calendar year. 1493
(d) Not later than January 1, 2023, and annually thereafter, the chief 1494
executive officer of the exchange shall submit a report, in accordance 1495
with section 11-4a, to the joint standing committees of the General 1496
Assembly having cognizance of matters relating to appropriations, 1497
human services and insurance regarding expenditures from the 1498
Connecticut Health Insurance Exchange account established under 1499
section 13 of this act for the preceding calendar year and disclosing 1500
whether such funds were sufficient to carry out the purposes set forth 1501
in subdivision (3) of subsection (b) of section 16 of this act for such 1502
preceding calendar year. 1503
Sec. 13. (NEW) (Effective July 1, 2021) There is established an account 1504
to be known as the "Connecticut Health Insurance Exchange account" 1505
which shall be a separate, nonlapsing account within the General Fund. 1506
The account shall contain any moneys required by law to be deposited 1507
in the account. Moneys in the account shall be expended by the 1508
exchange for the purposes set forth in subparagraph (C) of subdivision 1509
(28) of section 38a-1084 of the general statutes, as amended by this act. 1510
Sec. 14. (NEW) (Effective July 1, 2021) (a) For the purposes of this 1511
section, "individual market" has the same meaning as provided in 1512
Section 1304 of the Affordable Care Act. 1513
(b) Notwithstanding any provision of the general statutes and to the 1514
extent permitted by federal law, each qualified health plan that is 1515
offered through the exchange, in the individual market and at a silver 1516
level of coverage for plan year 2022 or any subsequent plan year shall 1517
provide coverage for the following benefits: 1518 Substitute Bill No. 842
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
R02-SB.docx }
52 of 59
(1) Angiotensin converting enzyme inhibitors for an enrollee who is 1519
diagnosed with congestive heart failure, diabetes or coronary artery 1520
disease by a licensed health care provider who is acting within such 1521
health care provider's scope of practice; 1522
(2) Anti-resorptive therapy for an enrollee who is diagnosed with 1523
osteoporosis or osteopenia by a licensed health care provider who is 1524
acting within such health care provider's scope of practice; 1525
(3) Beta-adrenergic blocking agents for an enrollee who is diagnosed 1526
with congestive heart failure or coronary artery disease by a licensed 1527
health care provider who is acting within such health care provider's 1528
scope of practice; 1529
(4) Blood pressure monitors for an enrollee who is diagnosed with 1530
hypertension by a licensed health care provider who is acting within 1531
such health care provider's scope of practice; 1532
(5) Inhaled corticosteroids and peak flow meters for an enrollee who 1533
is diagnosed with asthma by a licensed health care provider who is 1534
acting within such health care provider's scope of practice; 1535
(6) Insulin and other glucose lowering agents, retinopathy screening, 1536
glucometers and hemoglobin A1C testing for an enrollee who is 1537
diagnosed with diabetes by a licensed health care provider who is acting 1538
within such health care provider's scope of practice; 1539
(7) International normalized ratio testing for an enrollee who is 1540
diagnosed with liver disease or a bleeding disorder by a licensed health 1541
care provider who is acting within such health care provider's scope of 1542
practice; 1543
(8) Low density lipoprotein testing for an enrollee who is diagnosed 1544
with heart disease by a licensed health care provider who is acting 1545
within such health care provider's scope of practice; 1546
(9) Selective serotonin reuptake inhibitors for an enrollee who is 1547 Substitute Bill No. 842
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
R02-SB.docx }
53 of 59
diagnosed with depression by a licensed health care provider who is 1548
acting within such health care provider's scope of practice; and 1549
(10) Statins for an enrollee who is diagnosed with heart disease or 1550
diabetes by a licensed health care provider who is acting within such 1551
health care provider's scope of practice. 1552
(c) Notwithstanding any provision of the general statutes and to the 1553
extent permitted by federal law, each qualified health plan described in 1554
subsection (b) of this section shall: 1555
(1) Have a minimum actuarial value of at least seventy per cent; and 1556
(2) Provide enrollees with access to the broadest provider network 1557
available under the qualified health plans offered by the health carrier 1558
through the exchange. 1559
Sec. 15. Subsections (a) and (b) of section 19a-754a of the general 1560
statutes are repealed and the following is substituted in lieu thereof 1561
(Effective July 1, 2021): 1562
(a) There is established an Office of Health Strategy, which shall be 1563
within the Department of Public Health for administrative purposes 1564
only. The department head of said office shall be the executive director 1565
of the Office of Health Strategy, who shall be appointed by the Governor 1566
in accordance with the provisions of sections 4-5 to 4-8, inclusive, with 1567
the powers and duties therein prescribed. 1568
(b) The Office of Health Strategy shall be responsible for the 1569
following: 1570
(1) Developing and implementing a comprehensive and cohesive 1571
health care vision for the state, including, but not limited to, a 1572
coordinated state health care cost containment strategy; 1573
(2) Promoting effective health planning and the provision of quality 1574
health care in the state in a manner that ensures access for all state 1575 Substitute Bill No. 842
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
R02-SB.docx }
54 of 59
residents to cost-effective health care services, avoids the duplication of 1576
such services and improves the availability and financial stability of 1577
such services throughout the state; 1578
(3) Directing and overseeing the State Innovation Model Initiative 1579
and related successor initiatives; 1580
(4) (A) Coordinating the state's health information technology 1581
initiatives, (B) seeking funding for and overseeing the planning, 1582
implementation and development of policies and procedures for the 1583
administration of the all-payer claims database program established 1584
under section 19a-775a, (C) establishing and maintaining a consumer 1585
health information Internet web site under section 19a-755b, and (D) 1586
designating an unclassified individual from the office to perform the 1587
duties of a health information technology officer as set forth in sections 1588
17b-59f and 17b-59g; 1589
(5) Directing and overseeing the Health Systems Planning Unit 1590
established under section 19a-612 and all of its duties and 1591
responsibilities as set forth in chapter 368z; [and] 1592
(6) Convening forums and meetings with state government and 1593
external stakeholders, including, but not limited to, the Connecticut 1594
Health Insurance Exchange, to discuss health care issues designed to 1595
develop effective health care cost and quality strategies; [.] 1596
(7) Annually (A) determining the amount described in subparagraph 1597
(A)(i) of subdivision (1) of subsection (b) of section 9 of this act, and (B) 1598
reporting such amount to the Insurance Commissioner pursuant to 1599
subparagraph (A)(ii) or (B) of subdivision (1) of subsection (b) of section 1600
9 of this act; 1601
(8) Developing a plan pursuant to subsection (b) of section 16 of this 1602
act and submitting a report containing such plan pursuant to subsection 1603
(c) of section 16 of this act; and 1604
(9) Developing standardized categories that enable (A) the 1605 Substitute Bill No. 842
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
R02-SB.docx }
55 of 59
Comptroller to collect demographic data pursuant to subparagraph (D) 1606
of subdivision (1) of subsection (c) of section 2 of this act, (B) health 1607
carriers to collect and submit demographic data pursuant to 1608
subparagraph (A) of subdivision (28) of section 38a-1084, as amended 1609
by this act, and (C) the exchange to collect demographic data pursuant 1610
to subparagraph (C) of subdivision (28) of section 38a-1084, as amended 1611
by this act. 1612
Sec. 16. (NEW) (Effective July 1, 2021) (a) For the purposes of this 1613
section: 1614
(1) "Account" means the Connecticut Health Insurance Exchange 1615
account established under section 13 of this act; 1616
(2) "Affordable Care Act" has the same meaning as provided in 1617
section 38a-1080 of the general statutes, as amended by this act; 1618
(3) "Exchange" has the same meaning as provided in section 38a-1080 1619
of the general statutes, as amended by this act; 1620
(4) "Office of Health Strategy" means the Office of Health Strategy 1621
established under section 19a-754a of the general statutes, as amended 1622
by this act; and 1623
(5) "Qualified health plan" has the same meaning as provided in 1624
section 38a-1080 of the general statutes, as amended by this act. 1625
(b) The Office of Health Strategy shall, in consultation with the 1626
exchange, develop a plan for the exchange to: 1627
(1) Establish a subsidiary, in the manner set forth in section 38a-1093 1628
of the general statutes, to create a marketplace for health carriers to offer 1629
affordable health insurance coverage to persons who are ineligible for 1630
coverage under the qualified health plans offered through the exchange; 1631
(2) Seek a state innovation waiver pursuant to Section 1332 of the 1632
Affordable Care Act for the purpose of: 1633 Substitute Bill No. 842
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
R02-SB.docx }
56 of 59
(A) Reducing the cost of health insurance coverage in this state, 1634
including, but not limited to, premiums and cost-sharing for such 1635
coverage; and 1636
(B) Making health insurance coverage available to persons in this 1637
state who are ineligible for coverage under a qualified health plan 1638
offered through the exchange; and 1639
(3) For plan year 2022 and subsequent plan years, use the moneys 1640
deposited in the account to: 1641
(A) Reduce the cost of qualified health plans offered through the 1642
exchange by, among other things: 1643
(i) Eliminating premiums for such qualified health plans for persons 1644
with a household income not exceeding two hundred one per cent of the 1645
federal poverty level; 1646
(ii) Reducing premiums and cost-sharing for such qualified health 1647
plans for persons with a household income exceeding two hundred one 1648
per cent of the federal poverty level; and 1649
(iii) Establishing a reinsurance program, provided the exchange shall 1650
not use more than twenty million dollars in the account to fund the 1651
reinsurance program for any fiscal year; 1652
(B) Make coverage affordable for persons who are ineligible for 1653
coverage under a qualified health plan offered through the exchange by, 1654
among other things, providing premium and cost-sharing subsidies to 1655
such persons which, in the aggregate for all such persons, shall not 1656
exceed twenty-five million dollars per year; and 1657
(C) Implement the provisions of the state innovation waiver 1658
described in subdivision (2) of this subsection if the federal government 1659
issues such waiver for this state. 1660
(c) Not later than August 1, 2021, the Office of Health Strategy shall 1661 Substitute Bill No. 842
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
R02-SB.docx }
57 of 59
submit a report, in accordance with section 11-4a of the general statutes, 1662
to the joint standing committee of the General Assembly having 1663
cognizance of matters relating to insurance. Such report shall contain 1664
the plan developed pursuant to subsection (b) of this section. 1665
(d) Not later than October 1, 2021, the joint standing committee of the 1666
General Assembly having cognizance of matters relating to insurance 1667
shall advise the Office of Health Strategy and the exchange of its 1668
approval or rejection of the plan contained in the report submitted by 1669
the Office of Health Strategy pursuant to subsection (c) of this section. If 1670
the committee does not act on or before said date, said plan shall be 1671
deemed rejected. 1672
(e) The Office of Health Strategy shall consult with the Department 1673
of Social Services and the exchange to determine whether this state 1674
should seek a waiver from the federal government under Section 1115 1675
of the Social Security Act, 42 USC 1315, as amended from time to time, 1676
to reduce costs to moderate and low income families. If, following such 1677
consultation, the Office of Health Strategy determines that this state 1678
should seek such waiver, the Office of Health Strategy may submit a 1679
report, in accordance with section 11-4a of the general statutes, to the 1680
joint standing committees of the General Assembly having cognizance 1681
of matters relating to appropriations, human services and insurance 1682
disclosing such determination and the reasons therefor. 1683
Sec. 17. Subsection (a) of section 17b-261 of the general statutes is 1684
repealed and the following is substituted in lieu thereof (Effective July 1, 1685
2021): 1686
(a) Medical assistance shall be provided for any otherwise eligible 1687
person whose income, including any available support from legally 1688
liable relatives and the income of the person's spouse or dependent 1689
child, is not more than one hundred forty-three per cent, pending 1690
approval of a federal waiver applied for pursuant to subsection (e) of 1691
this section, of the benefit amount paid to a person with no income 1692
under the temporary family assistance program in the appropriate 1693 Substitute Bill No. 842
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
R02-SB.docx }
58 of 59
region of residence and if such person is an institutionalized individual 1694
as defined in Section 1917 of the Social Security Act, 42 USC 1396p(h)(3), 1695
and has not made an assignment or transfer or other disposition of 1696
property for less than fair market value for the purpose of establishing 1697
eligibility for benefits or assistance under this section. Any such 1698
disposition shall be treated in accordance with Section 1917(c) of the 1699
Social Security Act, 42 USC 1396p(c). Any disposition of property made 1700
on behalf of an applicant or recipient or the spouse of an applicant or 1701
recipient by a guardian, conservator, person authorized to make such 1702
disposition pursuant to a power of attorney or other person so 1703
authorized by law shall be attributed to such applicant, recipient or 1704
spouse. A disposition of property ordered by a court shall be evaluated 1705
in accordance with the standards applied to any other such disposition 1706
for the purpose of determining eligibility. The commissioner shall 1707
establish the standards for eligibility for medical assistance at one 1708
hundred forty-three per cent of the benefit amount paid to a household 1709
of equal size with no income under the temporary family assistance 1710
program in the appropriate region of residence. In determining 1711
eligibility, the commissioner shall not consider as income Aid and 1712
Attendance pension benefits granted to a veteran, as defined in section 1713
27-103, or the surviving spouse of such veteran. Except as provided in 1714
section 17b-277 and section 17b-292, the medical assistance program 1715
shall provide coverage to persons under the age of nineteen with 1716
household income up to one hundred ninety-six per cent of the federal 1717
poverty level without an asset limit and to persons under the age of 1718
nineteen, who qualify for coverage under Section 1931 of the Social 1719
Security Act, with household income not exceeding one hundred 1720
ninety-six per cent of the federal poverty level without an asset limit, 1721
and their parents and needy caretaker relatives, who qualify for 1722
coverage under Section 1931 of the Social Security Act, with household 1723
income not exceeding [one hundred fifty-five] two hundred one per cent 1724
of the federal poverty level without an asset limit. Such levels shall be 1725
based on the regional differences in such benefit amount, if applicable, 1726
unless such levels based on regional differences are not in conformance 1727
with federal law. Any income in excess of the applicable amounts shall 1728 Substitute Bill No. 842
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
R02-SB.docx }
59 of 60
be applied as may be required by said federal law, and assistance shall 1729
be granted for the balance of the cost of authorized medical assistance. 1730
The Commissioner of Social Services shall provide applicants for 1731
assistance under this section, at the time of application, with a written 1732
statement advising them of (1) the effect of an assignment or transfer or 1733
other disposition of property on eligibility for benefits or assistance, (2) 1734
the effect that having income that exceeds the limits prescribed in this 1735
subsection will have with respect to program eligibility, and (3) the 1736
availability of, and eligibility for, services provided by the Nurturing 1737
Families Network established pursuant to section 17b-751b. For 1738
coverage dates on or after January 1, 2014, the department shall use the 1739
modified adjusted gross income financial eligibility rules set forth in 1740
Section 1902(e)(14) of the Social Security Act and the implementing 1741
regulations to determine eligibility for HUSKY A, HUSKY B and 1742
HUSKY D applicants, as defined in section 17b-290. Persons who are 1743
determined ineligible for assistance pursuant to this section shall be 1744
provided a written statement notifying such persons of their ineligibility 1745
and advising such persons of their potential eligibility for one of the 1746
other insurance affordability programs as defined in 42 CFR 435.4. 1747
Sec. 18. (NEW) (Effective July 1, 2021) The Labor Commissioner shall, 1748
within available appropriations, notify individuals applying for 1749
unemployment compensation benefits under chapter 567 of the general 1750
statutes that such individuals may be eligible for free or subsidized 1751
health coverage or other assistance or benefits, including, but not 1752
limited to, assistance under the supplemental nutrition assistance 1753
program. The commissioner shall refer such individuals to the exchange 1754
for the purpose of determining their eligibility for such coverage, 1755
assistance or benefits and, if such individuals are eligible for such 1756
coverage, assistance or benefits, enrolling such individuals in such 1757
coverage, assistance or benefits. For the purposes of this section, 1758
"exchange" and "qualified health plan" have the same meanings as 1759
provided in section 38a-1080 of the general statutes, as amended by this 1760
act. 1761 Substitute Bill No. 842
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
R02-SB.docx }
60 of 60
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 New section
Sec. 4 July 1, 2021 New section
Sec. 5 July 1, 2021 19a-7j
Sec. 6 July 1, 2021 19a-7p
Sec. 7 July 1, 2021 38a-52
Sec. 8 July 1, 2021 38a-1041
Sec. 9 July 1, 2021 New section
Sec. 10 July 1, 2021 38a-1080
Sec. 11 July 1, 2021 38a-1084
Sec. 12 July 1, 2021 38a-1089
Sec. 13 July 1, 2021 New section
Sec. 14 July 1, 2021 New section
Sec. 15 July 1, 2021 19a-754a(a) and (b)
Sec. 16 July 1, 2021 New section
Sec. 17 July 1, 2021 17b-261(a)
Sec. 18 July 1, 2021 New section
INS Joint Favorable Subst. C/R FIN
FIN Joint Favorable