Connecticut 2021 Regular Session

Connecticut Senate Bill SB00842 Compare Versions

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7	7		General Assembly Substitute Bill No. 842
8	8		January Session, 2021
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14	14		AN ACT CONCERNING HE ALTH INSURANCE AND H EALTH CARE IN
15	15		CONNECTICUT.
16	16		Be it enacted by the Senate and House of Representatives in General
17	17		Assembly convened:
18	18
19	19		Section 1. Section 3-123rrr of the general statutes is repealed and the 1
20	20		following is substituted in lieu thereof (Effective July 1, 2021): 2
21	21		As used in this section, [and] sections 3-123sss to 3-123vvv, inclusive, 3
22	22		[and] section 3-123xxx, and sections 2 and 3 of this act: 4
23	23		(1) "Health Care Cost Containment Committee" means the committee 5
24	24		established in accordance with the ratified agreement between the state 6
25	25		and the State Employees Bargaining Agent Coalition pursuant to 7
26	26		subsection (f) of section 5-278. 8
27	27		(2) "Health enhancement program" means the program established in 9
28	28		accordance with the provisions of the Revised State Employees 10
29	29		Bargaining Agent Coalition agreement, approved by the General 11
30	30		Assembly on August 22, 2011, for state employees, as may be amended 12
31	31		by stipulated agreements. 13
32	32		(3) "Multiemployer plan" has the same meaning as provided in 14
33	33		Section 3 of the Employee Retirement Income Security Act of 1974, as 15
34	34		amended from time to time. 16 Substitute Bill No. 842
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41	41		[(2)] (4) "Nonstate public employee" means any employee or elected 17
42	42		officer of a nonstate public employer. 18
43	43		[(3)] (5) "Nonstate public employer" means a municipality or other 19
44	44		political subdivision of the state, including a board of education, quasi-20
45	45		public agency or public library. A municipality and a board of education 21
46	46		may be considered separate employers. 22
47	47		(6) "Nonprofit employer" means a nonprofit, nonstock corporation, 23
48	48		other than a nonstate public employer, that employs at least one 24
49	49		employee on the first day that such employer receives coverage under a 25
50	50		group hospitalization, medical, pharmacy and surgical insurance plan 26
51	51		offered by the Comptroller pursuant to this part. 27
52	52		(7) "Small employer" means an employer, other than a nonstate public 28
53	53		employer, that employed an average of at least one but not more than 29
54	54		fifty employees on business days during the preceding calendar year, 30
55	55		and employs at least one employee on the first day that such employer 31
56	56		receives coverage under a group hospitalization, medical, pharmacy 32
57	57		and surgical insurance plan offered by the Comptroller pursuant to this 33
58	58		part. 34
59	59		[(4)] (8) "State employee plan" means the group hospitalization, 35
60	60		medical, pharmacy and surgical insurance plan offered to state 36
61	61		employees and retirees pursuant to section 5-259. 37
62	62		[(5) "Health enhancement program" means the program established 38
63	63		in accordance with the provisions of the Revised State Employees 39
64	64		Bargaining Agent Coalition agreement, approved by the General 40
65	65		Assembly on August 22, 2011, for state employees, as may be amended 41
66		-	by stipulated agreements.] 42
67		-	[(6)] (9) "Value-based insurance design" means health benefit designs 43
	66	+	by stipulated agreements. 42
	67	+	(6)] (9) "Value-based insurance design" means health benefit designs 43
68	68		that lower or remove financial barriers to essential, high-value clinical 44
69	69		services. 45
70	70		[(7) "Health care coverage type" means the type of health care 46 Substitute Bill No. 842
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77	77		coverage offered by nonstate public employers, including, but not 47
78	78		limited to, coverage for a nonstate public employee, nonstate public 48
79	79		employee plus spouse and nonstate public employee plus family.] 49
80	80		Sec. 2. (NEW) (Effective July 1, 2021) (a) The Comptroller shall offer to 50
81	81		plan participants and beneficiaries in this state under a multiemployer 51
82	82		plan, nonprofit employers in this state, their employees and their 52
83	83		employees' dependents and small employers in this state, their 53
84	84		employees and their employees' dependents coverage under a fully 54
85	85		insured group hospitalization, medical, pharmacy and surgical 55
86	86		insurance plan developed by the Comptroller to provide coverage for 56
87	87		such plan participants, beneficiaries, employers, employees and 57
88	88		dependents. Except as otherwise provided in this section, coverage 58
89	89		offered by the Comptroller pursuant to this section shall comply with 59
90	90		all applicable provisions of title 38a of the general statutes. The 60
91	91		administrators of multiemployer plans, nonprofit employers and small 61
92	92		employers shall remit to the Comptroller payments for coverage 62
93	93		provided pursuant to this section. Such payments shall be equal to the 63
94	94		payments paid by the state for state employees covered under the state 64
95	95		employee plan, inclusive of any premiums paid by state employees 65
96	96		pursuant to the state employee plan, except: 66
97	97		(1) Premium payments may be adjusted to reflect: 67
98	98		(A) Age, in accordance with a uniform age rating curve that satisfies 68
99	99		the requirements established under the Patient Protection and 69
100	100		Affordable Care Act, P.L. 111-148, as amended from time to time, and 70
101	101		regulations adopted thereunder; 71
102	102		(B) Geographic area; 72
103	103		(C) Family size, provided premium payments for family coverage 73
104	104		shall not exceed the lesser of: 74
105	105		(i) The sum of the premium payments for all covered family 75
106	106		members; or 76 Substitute Bill No. 842
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113	113		(ii) The sum of the premium payments for all covered family 77
114	114		members who are twenty-one years of age or older and the eldest three 78
115	115		covered dependents who are younger than twenty-one years of age; 79
116	116		(D) Actuarially justified differences in: 80
117	117		(i) Plan design; 81
118	118		(ii) A plan's health care provider network; or 82
119	119		(iii) Administrative costs that can be reasonably attributed to a plan; 83
120	120		and 84
121	121		(E) The actual performance of a multiemployer plan, nonprofit 85
122	122		employer or small employer receiving coverage provided by the 86
123	123		Comptroller pursuant to this section, provided such adjustment shall 87
124	124		not cause the premiums charged for such multiemployer plan, nonprofit 88
125	125		employer or small employer to increase or decrease by an amount that 89
126	126		is greater than three per cent of the premiums that would otherwise be 90
127	127		charged for such multiemployer plan, nonprofit employer or small 91
128	128		employer under this subdivision; 92
129	129		(2) Such payments shall be adjusted to include: 93
130	130		(A) The fee assessed by the Comptroller against multiemployer plans, 94
131	131		nonprofit employers and small employers pursuant to section 3 of this 95
132	132		act; 96
133	133		(B) The health and welfare fee assessed by the Insurance 97
134	134		Commissioner against multiemployer plans, nonprofit employers and 98
135	135		small employers pursuant to section 19a-7j of the general statutes, as 99
136	136		amended by this act, which the Comptroller shall annually collect from 100
137	137		the administrators of multiemployer plans, nonprofit employers and 101
138	138		small employers, and pay to the Insurance Commissioner, pursuant to 102
139	139		section 19a-7j of the general statutes, as amended by this act; 103
140	140		(C) The public health fee assessed by the Insurance Commissioner 104 Substitute Bill No. 842
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147	147		against multiemployer plans, nonprofit employers and small employers 105
148	148		pursuant to section 19a-7p of the general statutes, as amended by this 106
149	149		act, which the Comptroller shall annually collect from the 107
150	150		administrators of multiemployer plans, nonprofit employers and small 108
151	151		employers, and pay to the Insurance Commissioner, pursuant to section 109
152	152		19a-7p of the general statutes, as amended by this act; 110
153	153		(D) The administrative fee assessed by the Comptroller pursuant to 111
154	154		subdivision (4) of subsection (c) of this section; and 112
155	155		(E) Any risk fund fee assessed by the Comptroller pursuant to 113
156	156		subdivision (2) of subsection (d) of this section; and 114
157	157		(3) Such payments may be adjusted to include a general 115
158	158		administrative fee assessed by the Comptroller against multiemployer 116
159	159		plans, nonprofit employers and small employers receiving coverage 117
160	160		provided by the Comptroller pursuant to this section which, if assessed, 118
161	161		shall be calculated on a per member, per month basis and may include 119
162	162		brokers' fees. 120
163	163		(b) (1) The coverage provided by the Comptroller pursuant to this 121
164	164		section shall: 122
165	165		(A) Be available to all plan participants and beneficiaries in this state 123
166	166		under a multiemployer plan, nonprofit employers in this state, their 124
167	167		employees and their employees' dependents and small employers in 125
168	168		this state, their employees and their employees' dependents regardless 126
169	169		of age, gender, health status or any other factor that might be predictive 127
170	170		of health care service usage; 128
171	171		(B) Include the health enhancement program; 129
172	172		(C) Be consistent with value-based insurance design principles; 130
173	173		(D) Be approved by the Insurance Department and Health Care Cost 131
174	174		Containment Committee during public meetings of the Insurance 132
175	175		Department and Health Care Cost Containment Committee; 133 Substitute Bill No. 842
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182	182		(E) Include coverage for: 134
183	183		(i) All health care services and benefits that each group health 135
184	184		insurance policy providing coverage of the types specified in 136
185	185		subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general 137
186	186		statutes delivered, issued for delivery, renewed, amended or continued 138
187	187		in this state is required to cover under chapter 700c of the general 139
188	188		statutes; and 140
189	189		(ii) All health care services and benefits that are essential health 141
190	190		benefits, as defined in the Patient Protection and Affordable Care Act, 142
191	191		P.L. 111-148, as amended from time to time, and regulations adopted 143
192	192		thereunder; 144
193	193		(F) Include a process that enables entities that conduct independent 145
194	194		external reviews of adverse determinations and final adverse 146
195	195		determinations, as both terms are defined in section 38a-591a of the 147
196	196		general statutes, to review determinations made for benefits covered 148
197	197		pursuant to this section that are equivalent to adverse determinations 149
198	198		and final adverse determinations; and 150
199	199		(G) Enable plan participants and beneficiaries in this state under a 151
200	200		multiemployer plan, nonprofit employers in this state, their employees 152
201	201		and their employees' dependents and small employers in this state, their 153
202	202		employees and their employees' dependents receiving coverage 154
203	203		provided by the Comptroller pursuant to this section to access 155
204	204		assistance offered by the Office of the Healthcare Advocate under 156
205	205		section 38a-1041 of the general statutes, as amended by this act. 157
206	206		(2) (A) The Comptroller shall provide coverage pursuant to this 158
207	207		section for intervals lasting not less than: 159
208	208		(i) Three years for: 160
209	209		(I) Multiemployer plans; and 161
210	210		(II) Nonprofit employers that are not small employers; or 162 Substitute Bill No. 842
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217	217		(ii) One year for small employers. 163
218	218		(B) The administrator of each multiemployer plan, nonprofit 164
219	219		employer or small employer receiving coverage provided by the 165
220	220		Comptroller pursuant to this section may apply to renew such coverage 166
221	221		before the interval applicable to such multiemployer plan, nonprofit 167
222	222		employer or small employer under subparagraph (A) of this subdivision 168
223	223		expires. 169
224	224		(3) The Comptroller shall require each administrator of a 170
225	225		multiemployer plan, nonprofit employer in this state and small 171
226	226		employer in this state receiving coverage provided by the Comptroller 172
227	227		pursuant to this section to offer such coverage to all of such 173
228	228		multiemployer plan's participants and beneficiaries in this state, 174
229	229		nonprofit employer's employees and their employees' dependents and 175
230	230		small employer's employees and their employees' dependents who are 176
231	231		eligible for health coverage. The administrator of such multiemployer 177
232	232		plan, nonprofit employer or small employer shall not offer coverage 178
233	233		under this section in addition to, or in conjunction with, any other health 179
234	234		coverage option, except active employees and retirees may be treated as 180
235	235		independent groups for the purposes of this subdivision. 181
236	236		(c) (1) The Comptroller shall develop and establish: 182
237	237		(A) Procedures by which the administrator of a multiemployer plan, 183
238	238		nonprofit employer or small employer may initially apply for, renew 184
239	239		and withdraw from coverage provided by the Comptroller pursuant to 185
240	240		this section; 186
241	241		(B) Rules of participation that the Comptroller, in the Comptroller's 187
242	242		discretion, deems necessary; 188
243	243		(C) Accounting procedures to track the premium payments paid by, 189
244	244		and claims paid for, multiemployer plans, nonprofit employers and 190
245	245		small employers receiving coverage provided by the Comptroller 191
246	246		pursuant to this section; and 192 Substitute Bill No. 842
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253	253		(D) Procedures to collect demographic data, including, but not 193
254	254		limited to, self-reported ethnic and racial data, concerning the plan 194
255	255		participants and beneficiaries in this state under a multiemployer plan, 195
256	256		nonprofit employers in this state, their employees and their employees' 196
257	257		dependents and small employers in this state, their employees and their 197
258	258		employees' dependents receiving coverage provided by the 198
259	259		Comptroller pursuant to this section. Such procedures shall, at a 199
260	260		minimum, utilize standardized categories developed by the Office of 200
261	261		Health Strategy pursuant to subdivision (9) of subsection (b) of section 201
262	262		19a-754a of the general statutes, as amended by this act, include an 202
263	263		"other" category and allow an individual who is self-reporting ethnic or 203
264	264		racial data to write in such individual's ethnicity or race, and select 204
265	265		multiple ethnicities and races, on any form provided by the Comptroller 205
266	266		to collect such ethnic or racial data. Not later than November 1, 2022, 206
267	267		and annually thereafter, the Comptroller shall submit a report to the 207
268	268		joint standing committee of the General Assembly having cognizance of 208
269	269		matters relating to insurance, in accordance with the provisions of 209
270	270		section 11-4a of the general statutes, disclosing, in the aggregate, the 210
271	271		demographic data collected using the procedures developed and 211
272	272		established by the Comptroller pursuant to this subparagraph during 212
273	273		the immediately preceding fiscal year. 213
274	274		(2) The Comptroller shall: 214
275	275		(A) Retain an independent actuarial firm to: 215
276	276		(i) Set premium payments for coverage provided by the Comptroller 216
277	277		pursuant to this section that satisfy the requirements established in this 217
278	278		section and actuarial best practices; and 218
279	279		(ii) Not later than November 1, 2022, and annually thereafter, 219
280	280		examine the books and records maintained by the Comptroller in 220
281	281		providing coverage pursuant to this section, and any person engaged 221
282	282		by the Comptroller to provide services to the Comptroller in connection 222
283	283		with providing such coverage, and prepare a report concerning such 223
284	284		examination, which shall disclose: 224 Substitute Bill No. 842
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291	291		(I) The number of multiemployer plans, nonprofit employers and 225
292	292		small employers that received coverage provided by the Comptroller 226
293	293		pursuant to this section during the immediately preceding fiscal year; 227
294	294		(II) The number of multiemployer plan participants and beneficiaries 228
295	295		in this state, nonprofit employers' employees and their employees' 229
296	296		dependents and small employers' employees and their employees' 230
297	297		dependents who received coverage provided by the Comptroller 231
298	298		pursuant to this section during the immediately preceding fiscal year; 232
299	299		(III) The aggregate amount of premiums collected, claims paid and 233
300	300		administrative costs incurred by the Comptroller in providing coverage 234
301	301		pursuant to this section for the immediately preceding fiscal year; 235
302	302		(IV) The most recent medical loss ratio available for coverage 236
303	303		provided by the Comptroller pursuant to this section; 237
304	304		(V) The balance of the account in which the Comptroller deposited 238
305	305		premiums, and from which the Comptroller paid claims, for coverage 239
306	306		provided by the Comptroller pursuant to this section at the beginning 240
307	307		and the end of the immediately preceding fiscal year, and a comparison 241
308	308		of such balance to the amount that the independent actuarial firm 242
309	309		recommends that the Comptroller maintain as a reserve for such 243
310	310		coverage; 244
311	311		(VI) A description, and the cost, of each risk mitigation strategy that 245
312	312		the Comptroller employed for the immediately preceding fiscal year to 246
313	313		minimize the risk that coverage provided by the Comptroller pursuant 247
314	314		to this section for such fiscal year poses to this state's finances; and 248
315	315		(VII) The independent actuarial firm's recommendations, if any, to 249
316	316		improve or update the risk mitigation strategies employed by the 250
317	317		Comptroller to minimize the risk that coverage provided by the 251
318	318		Comptroller pursuant to this section poses to this state's finances; and 252
319	319		(B) Such services, including, but not limited to, any services to ensure 253
320	320		compliance with the Employee Retirement Income Security Act of 1974, 254 Substitute Bill No. 842
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327	327		as amended from time to time, and regulations adopted thereunder, that 255
328	328		the Comptroller deems necessary to administer coverage provided by 256
329	329		the Comptroller pursuant to this section. 257
330	330		(3) The independent actuarial firm retained by the Comptroller 258
331	331		pursuant to subparagraph (A) of subdivision (2) of this subsection shall, 259
332	332		not later than November 1, 2022, and annually thereafter, submit the 260
333	333		report that the independent actuarial firm prepared pursuant to 261
334	334		subparagraph (A)(ii) of subdivision (2) of this subsection for the 262
335	335		immediately preceding fiscal year to the Comptroller and the Office of 263
336	336		Policy and Management and to the joint standing committees of the 264
337	337		General Assembly having cognizance of matters relating to 265
338	338		appropriations and insurance in accordance with the provisions of 266
339	339		section 11-4a of the general statutes. 267
340	340		(4) The Comptroller shall assess an administrative fee on a per 268
341	341		member, per month basis against the multiemployer plans, nonprofit 269
342	342		employers and small employers receiving coverage provided by the 270
343	343		Comptroller pursuant to this section to recover the cost of the services 271
344	344		described in subdivisions (2) and (3) of this subsection. 272
345	345		(d) The Comptroller shall make reasonable efforts to minimize the 273
346	346		risk that coverage provided by the Comptroller pursuant to this section 274
347	347		poses to this state's finances. In making such reasonable efforts, the 275
348	348		Comptroller shall, at a minimum: 276
349	349		(1) Purchase: 277
350	350		(A) An aggregate stop-loss insurance policy for all multiemployer 278
351	351		plans, nonprofit employers and small employers receiving coverage 279
352	352		provided by the Comptroller pursuant to this section; or 280
353	353		(B) A stop-loss insurance policy for each individual multiemployer 281
354	354		plan, nonprofit employer or small employer receiving coverage 282
355	355		provided by the Comptroller pursuant to this section; and 283
356	356		(2) Establish a risk fund to pay claims that exceed the premiums 284 Substitute Bill No. 842
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363	363		collected for a multiemployer plan, nonprofit employer or small 285
364	364		employer receiving coverage provided by the Comptroller pursuant to 286
365	365		this section, fund such risk fund through a risk fund fee assessed by the 287
366	366		Comptroller against such multiemployer plan, nonprofit employer or 288
367	367		small employer and establish operating procedures for use of such fund. 289
368	368		(e) (1) Not later than October 15, 2021, and annually thereafter, the 290
369	369		Comptroller shall prepare, in consultation with the Commissioner of 291
370	370		Public Health and the Insurance Commissioner, a report card for the 292
371	371		coverage offered by the Comptroller pursuant to this section. The report 293
372	372		card shall enable the administrators of multiemployer plans, nonprofit 294
373	373		employers and small employers that are eligible for the coverage offered 295
374	374		by the Comptroller pursuant to this section to compare such coverage 296
375	375		to private group health coverage that is available to such multiemployer 297
376	376		plans, nonprofit employers and small employers in this state to the same 298
377	377		extent that the consumer report card developed and distributed by the 299
378	378		Insurance Commissioner pursuant to section 38a-478l of the general 300
379	379		statutes permits consumer comparison across managed care 301
380	380		organizations. 302
381	381		(2) Each report card prepared by the Comptroller pursuant to 303
382	382		subdivision (1) of this subsection shall disclose: 304
383	383		(A) The medical loss ratio for the fully insured group hospitalization, 305
384	384		medical, pharmacy and surgical insurance plan developed and offered 306
385	385		by the Comptroller pursuant to this section; 307
386	386		(B) The medical loss ratio for private group health coverage that is 308
387	387		available to the multiemployer plans, nonprofit employers and small 309
388	388		employers that are eligible for the coverage offered by the Comptroller 310
389	389		pursuant to this section; and 311
390	390		(C) Any other information that the Comptroller deems relevant for 312
391	391		the purposes of this subsection. 313
392	392		(3) The Comptroller shall prominently display a link to each report 314
393	393		card prepared pursuant to subdivision (1) of this subsection on the 315 Substitute Bill No. 842
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400	400		Comptroller's Internet web site. 316
401	401		(f) Any administrator of a multiemployer plan, nonprofit employer 317
402	402		or small employer that files an application with the Comptroller for the 318
403	403		coverage offered by the Comptroller pursuant to this section may 319
404	404		submit a request to the Comptroller, in a form and manner prescribed 320
405	405		by the Comptroller, for a provider disruption report. The Comptroller 321
406	406		shall provide the provider disruption report to such administrator, 322
407	407		nonprofit employer or small employer not later than thirty days after 323
408	408		such administrator, nonprofit employer or small employer submits such 324
409	409		request to the Comptroller. 325
410	410		(g) (1) Nothing in this section shall be construed to preclude the 326
411	411		Comptroller from: 327
412	412		(A) Procuring coverage for nonstate public employees from vendors 328
413	413		other than the vendors providing coverage to state employees; or 329
414	414		(B) Offering plan designs or benefit coverage levels pursuant to this 330
415	415		section that differ from the plan designs and benefit coverage levels 331
416	416		offered to state employees, provided the Comptroller shall not offer any 332
417	417		coverage pursuant to this section that imposes a deductible that is equal 333
418	418		to or greater than the minimum deductible required by the Internal 334
419	419		Revenue Service for such coverage to qualify as a high deductible health 335
420	420		plan, as defined in Section 220(c)(2) or Section 223(c)(2) of the Internal 336
421	421		Revenue Code of 1986, or any subsequent corresponding internal 337
422	422		revenue code of the United States, as amended from time to time. 338
423	423		(2) No coverage offered by the Comptroller pursuant to this section 339
424	424		shall be deemed to constitute a multiple employer welfare arrangement, 340
425	425		as defined in Section 3 of the Employee Retirement Income Security Act 341
426	426		of 1974, as amended from time to time. 342
427	427		(h) The Comptroller may adopt regulations, in accordance with 343
428	428		chapter 54 of the general statutes, to carry out the purposes of this 344
429	429		section. 345 Substitute Bill No. 842
430	430
431	431
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435	435
436	436		Sec. 3. (NEW) (Effective July 1, 2021) (a) For each fiscal year beginning 346
437	437		on or after July 1, 2021, the Comptroller shall assess a fee against all 347
438	438		multiemployer plans, nonprofit employers and small employers 348
439	439		receiving coverage provided by the Comptroller pursuant to section 2 349
440	440		of this act, and the administrator of each such multiemployer plan and 350
441	441		each such nonprofit employer and small employer shall pay such 351
442	442		assessment to the Comptroller pursuant to this section for deposit in the 352
443	443		Connecticut Health Insurance Exchange account established under 353
444	444		section 13 of this act. 354
445	445		(b) Not later than July 15, 2021, and annually thereafter, the 355
446	446		Comptroller shall consult with the Insurance Commissioner to 356
447	447		determine the aggregate amount of the assessments due from the 357
448	448		multiemployer plans, nonprofit employers and small employers 358
449	449		receiving coverage provided by the Comptroller pursuant to section 2 359
450	450		of this act for the then current fiscal year. The aggregate amount of 360
451	451		assessments due for any fiscal year shall be equal to the amount that 361
452	452		would be due from the Comptroller for such fiscal year if the 362
453	453		Comptroller were a domestic insurance company under sections 38a-47 363
454	454		and 38a-48 of the general statutes during such fiscal year. 364
455	455		(c) Not later than July 31, 2021, and annually thereafter, the 365
456	456		Comptroller shall render to the administrator of each multiemployer 366
457	457		plan and each nonprofit employer and small employer that is liable for 367
458	458		the fee assessed by the Comptroller pursuant to subsection (a) of this 368
459	459		section the proposed assessment against such multiemployer plan, 369
460	460		nonprofit employer or small employer in the amount described in 370
461	461		subsection (b) of this section. 371
462	462		(d) On or before September first, annually, for each fiscal year 372
463	463		beginning on or after July 1, 2021, the Comptroller, after receiving any 373
464	464		objections to the proposed assessments made by the Comptroller 374
465	465		pursuant to this section and making such adjustments as in the 375
466	466		Comptroller's opinion may be indicated, shall assess against each 376
467	467		multiemployer plan, nonprofit employer or small employer an amount 377
468	468		equal to the proposed assessment as so adjusted. The administrator of 378 Substitute Bill No. 842
469	469
470	470
471	471		LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
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474	474
475	475		each multiemployer plan and each such nonprofit employer and small 379
476	476		employer shall pay to the Comptroller, on or before the following 380
477	477		December thirty-first and March thirty-first, annually, the proposed 381
478	478		assessment due from such multiemployer plan, nonprofit employer or 382
479	479		small employer in two equal installments. 383
480	480		(e) The administrator of any multiemployer plan, nonprofit employer 384
481	481		or small employer aggrieved because of a fee assessed by the 385
482	482		Comptroller pursuant to this section may appeal therefrom in 386
483	483		accordance with the provisions of section 38a-52 of the general statutes, 387
484	484		as amended by this act. 388
485	485		(f) If the administrator of a multiemployer plan, or a nonprofit 389
486	486		employer or small employer, that is liable for the fee assessed by the 390
487	487		Comptroller pursuant to this section fails to pay an assessment when 391
488	488		due under this section, the Comptroller shall add a penalty of twenty-392
489	489		five dollars to such fee, and interest at the rate of six per cent per annum 393
490	490		shall be paid thereafter on such assessment and penalty, until such 394
491	491		assessment and penalty are paid. 395
492	492		(g) The Comptroller shall deposit all payments made pursuant to this 396
493	493		section in the Connecticut Health Insurance Exchange account 397
494	494		established under section 13 of this act. 398
495	495		(h) The Comptroller may adopt regulations, in accordance with 399
496	496		chapter 54 of the general statutes, to carry out the purposes of this 400
497	497		section. 401
498	498		Sec. 4. (NEW) (Effective July 1, 2021) (a) As used in this section: 402
499	499		(1) "Nonprofit employer" has the same meaning as provided in 403
500	500		section 3-123aaa of the general statutes; 404
501	501		(2) "Nonstate public employee" has the same meaning as provided in 405
502	502		sections 3-123aaa and 3-123rrr of the general statutes, as amended by 406
503	503		this act; 407 Substitute Bill No. 842
504	504
505	505
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509	509
510	510		(3) "Nonstate public employer" has the same meaning as provided in 408
511	511		sections 3-123aaa and 3-123rrr of the general statutes, as amended by 409
512	512		this act; 410
513	513		(4) "Partnership plan" means (A) a health care benefit plan offered by 411
514	514		the Comptroller to (i) nonstate public employers or nonprofit employers 412
515	515		pursuant to section 3-123bbb of the general statutes, (ii) graduate 413
516	516		assistants at The University of Connecticut and The University of 414
517	517		Connecticut Health Center, (iii) postdoctoral trainees at The University 415
518	518		of Connecticut and The University of Connecticut Health Center, (iv) 416
519	519		graduate fellows at The University of Connecticut and The University 417
520	520		of Connecticut Health Center, and (v) graduate students of The 418
521	521		University of Connecticut participating in university-funded 419
522	522		internships as part of their graduate program, and (B) a group 420
523	523		hospitalization, medical, pharmacy and surgical insurance plan 421
524	524		developed by the Comptroller pursuant to (i) subsection (a) of section 3-422
525	525		123sss of the general statutes, or (ii) section 2 of this act; 423
526	526		(5) "State employee plan" means the group hospitalization, medical, 424
527	527		pharmacy and surgical insurance plan offered to (A) state employees 425
528	528		and retirees pursuant to section 5-259 of the general statutes, and (B) 426
529	529		nonstate public employers, their nonstate public employees and, if 427
530	530		applicable, their retirees if the Comptroller offers coverage under such 428
531	531		plan to nonstate public employers, their nonstate public employees and, 429
532	532		if applicable, retirees under sections 3-123rrr to 3-123www, inclusive, of 430
533	533		the general statutes, as amended by this act; and 431
534	534		(6) "Third-party administrator" means any person who directly or 432
535	535		indirectly underwrites, collects premiums or charges from, or adjusts or 433
536	536		settles claims on, residents of this state in connection with health 434
537	537		coverage offered or provided by the Comptroller. 435
538	538		(b) Beginning on July 1, 2021, the Auditors of Public Accounts shall 436
539	539		audit the books and accounts of the State Comptroller, and any third-437
540	540		party administrator engaged by the State Comptroller, maintained for 438
541	541		the partnership plan or plans or the state employee plan and certify the 439 Substitute Bill No. 842
542	542
543	543
544	544		LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
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546	546		16 of 59
547	547
548	548		results to the Governor. 440
549	549		Sec. 5. Section 19a-7j of the general statutes is repealed and the 441
550	550		following is substituted in lieu thereof (Effective July 1, 2021): 442
551	551		(a) As used in this section: 443
552	552		(1) "Exempt insurer" means a domestic insurer that administers self-444
553	553		insured health benefit plans and is exempt from third -party 445
554	554		administrator licensure under subparagraph (C) of subdivision (11) of 446
555	555		section 38a-720 and section 38a-720a; 447
556	556		(2) "Health insurance" means health insurance providing coverage of 448
557	557		the types specified in subdivisions (1), (2), (4), (11) and (12) of section 449
558	558		38a-469; 450
559	559		(3) "Multiemployer plan" has the same meaning as provided in 451
560	560		Section 3 of the Employee Retirement Income Security Act of 1974, as 452
561	561		amended from time to time; 453
562	562		(4) "Nonprofit employer" has the same meaning as provided in 454
563	563		section 3-123rrr, as amended by this act; and 455
564	564		(5) "Small employer" has the same meaning as provided in section 3-456
565	565		123rrr, as amended by this act. 457
566		-	~~[(a)]~~ (b) Not later than September first, annually, the Secretary of the 458
567		-	~~Office~~ of Policy and Management, in consultation with the 459
568		-	~~Commissioner of~~ Public Health, shall: 460
	566	+	(b) Not later than September first, annually, the Secretary of the Office 458
	567	+	of Policy and Management, in consultation with the Commissioner of 459
	568	+	Public Health, shall: 460
569	569		(1) [determine] Determine the amount appropriated for the following 461
570	570		purposes: 462
571	571		(A) To purchase, store and distribute vaccines for routine 463
572	572		immunizations included in the schedule for active immunization 464
573	573		required by section 19a-7f; 465
574	574		(B) [to] To purchase, store and distribute: 466 Substitute Bill No. 842
575	575
576	576
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579	579		17 of 59
580	580
581	581		(i) [vaccines] Vaccines to prevent hepatitis A and B in persons of all 467
582	582		ages, as recommended by the schedule for immunizations published by 468
583	583		the National Advisory Committee for Immunization Practices; [,] 469
584	584		(ii) [antibiotics] Antibiotics necessary for: [the] 470
585	585		(I) The treatment of tuberculosis and biologics; and [antibiotics 471
586	586		necessary for the] 472
587	587		(II) The detection and treatment of tuberculosis infections; [,] and 473
588	588		(iii) [antibiotics] Antibiotics to support treatment of patients in 474
589	589		communicable disease control clinics, as defined in section 19a-216a; 475
590	590		(C) [to] To administer the immunization program described in 476
591	591		section 19a-7f; and 477
592	592		(D) [to] To provide services needed to collect up-to-date information 478
593	593		on childhood immunizations for all children enrolled in Medicaid who 479
594	594		reach two years of age during the year preceding the current fiscal year, 480
595	595		to incorporate such information into the childhood immunization 481
596	596		registry, as defined in section 19a-7h; [,] 482
597	597		(2) [calculate] Calculate the difference between the amount expended 483
598	598		in the prior fiscal year for the purposes set forth in subdivision (1) of this 484
599	599		subsection and the amount of the appropriation used for the purpose of 485
600	600		the health and welfare fee established in [subparagraph (A) of] 486
601	601		subdivision [(2)] (1) of subsection [(b)] (c) of this section in that same 487
602	602		year; [,] and 488
603	603		(3) [inform] Inform the Insurance Commissioner of such amounts. 489
604	604		[(b) (1) As used in this subsection, (A) "health insurance" means 490
605	605		health insurance of the types specified in subdivisions (1), (2), (4), (11) 491
606	606		and (12) of section 38a-469, and (B) "exempt insurer" means a domestic 492
607	607		insurer that administers self-insured health benefit plans and is exempt 493
608	608		from third-party administrator licensure under subparagraph (C) of 494 Substitute Bill No. 842
609	609
610	610
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614	614
615	615		subdivision (11) of section 38a-720 and section 38a-720a.] 495
616	616		[(2)] (c) (1) (A) Each domestic insurer [or] and domestic health care 496
617	617		center doing health insurance business in this state shall annually pay 497
618	618		to the Insurance Commissioner, for deposit in the Insurance Fund 498
619	619		established under section 38a-52a, a health and welfare fee assessed by 499
620	620		the Insurance Commissioner pursuant to this section. 500
621	621		(B) Each third-party administrator licensed pursuant to section 38a-501
622	622		720a that provides administrative services for self-insured health benefit 502
623	623		plans and each exempt insurer shall, on behalf of the self-insured health 503
624	624		benefit plans for which such third-party administrator or exempt 504
625	625		insurer provides administrative services, annually pay to the Insurance 505
626	626		Commissioner, for deposit in the Insurance Fund established under 506
627	627		section 38a-52a, a health and welfare fee assessed by the Insurance 507
628	628		Commissioner pursuant to this section. 508
629	629		(C) The Comptroller shall, on behalf of each multiemployer plan, 509
630	630		nonprofit employer and small employer receiving coverage provided 510
631	631		by the Comptroller pursuant to section 2 of this act, annually pay to the 511
632	632		Insurance Commissioner, for deposit in the Insurance Fund established 512
633	633		under section 38a-52a, a health and welfare fee assessed by the 513
634	634		Insurance Commissioner pursuant to this section. 514
635	635		[(3)] (2) Not later than September first, annually: [, each such] 515
636	636		(A) Each domestic insurer [,] and domestic health care center [,] 516
637	637		described in subparagraph (A) of subdivision (1) of this subsection, and 517
638	638		each third-party administrator and exempt insurer described in 518
639	639		subparagraph (B) of subdivision (1) of this subsection, shall report to the 519
640	640		Insurance Commissioner, on a form designated by [said commissioner] 520
641	641		the Insurance Commissioner, the number of insured or enrolled lives in 521
642	642		this state as of the May first immediately preceding for which such 522
643	643		domestic insurer, domestic health care center, third-party administrator 523
644	644		or exempt insurer [is] was providing health insurance or administering 524
645	645		a self-insured health benefit plan [that provides] providing coverage of 525 Substitute Bill No. 842
646	646
647	647
648	648		LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
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651	651
652	652		the types specified in subdivisions (1), (2), (4), (11) and (12) of section 526
653	653		38a-469, [. Such number shall not include] excluding any lives enrolled 527
654	654		in Medicare, any medical assistance program administered by the 528
655	655		Department of Social Services, workers' compensation insurance or 529
656	656		Medicare Part C plans; and 530
657	657		(B) The Comptroller shall report to the Insurance Commissioner, in 531
658	658		the form and manner prescribed by the Insurance Commissioner: 532
659	659		(i) For each multiemployer plan described in subparagraph (C) of 533
660	660		subdivision (1) of this subsection, the number of such multiemployer 534
661	661		plan's plan participants and beneficiaries in this state for whom the 535
662	662		Comptroller was providing coverage pursuant to section 2 of this act as 536
663	663		of the May first immediately preceding; 537
664	664		(ii) For each nonprofit employer described in subparagraph (C) of 538
665	665		subdivision (1) of this subsection, the number of such nonprofit 539
666	666		employer's employees and their dependents in this state for whom the 540
667	667		Comptroller was providing coverage pursuant to section 2 of this act as 541
668	668		of the May first immediately preceding; and 542
669	669		(iii) For each small employer described in subparagraph (C) of 543
670	670		subdivision (1) of this subsection, the number of such small employer's 544
671	671		employees and their dependents in this state for whom the Comptroller 545
672	672		was providing coverage pursuant to section 2 of this act as of the May 546
673	673		first immediately preceding. 547
674	674		[(4)] (3) Not later than November first, annually, the Insurance 548
675	675		Commissioner shall determine the fee to be assessed for the current 549
676	676		fiscal year against each [such] domestic insurer [,] and domestic health 550
677	677		care center described in subparagraph (A) of subdivision (1) of this 551
678	678		subsection, third-party administrator and exempt insurer described in 552
679	679		subparagraph (B) of subdivision (1) of this subsection and 553
680	680		multiemployer plan, nonprofit employer and small employer described 554
681	681		in subparagraph (C) of subdivision (1) of this subsection. Such fee shall 555
682	682		be calculated by multiplying the number of lives reported to [said 556 Substitute Bill No. 842
683	683
684	684
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688	688
689	689		commissioner] the Insurance Commissioner pursuant to subparagraph 557
690	690		(A) of subdivision [(3)] (2) of this subsection, and the number of plan 558
691	691		participants, beneficiaries, employees and dependents reported to the 559
692	692		Insurance Commissioner pursuant to subparagraph (B) of subdivision 560
693	693		(2) of this subsection, by a factor, determined annually by [said 561
694	694		commissioner] the Insurance Commissioner as set forth in this 562
695	695		subdivision, to fully fund the amount determined under subdivision (1) 563
696	696		of subsection [(a)] (b) of this section, adjusted for a health and welfare 564
697	697		fee, by subtracting, if the amount appropriated was more than the 565
698	698		amount expended or by adding, if the amount expended was more than 566
699	699		the amount appropriated, the amount calculated under subdivision (2) 567
700	700		of subsection [(a)] (b) of this section. The Insurance Commissioner shall 568
701	701		determine the factor by dividing the adjusted amount by the sum of the 569
702	702		total number of lives reported to [said commissioner] the Insurance 570
703	703		Commissioner pursuant to subparagraph (A) of subdivision [(3)] (2) of 571
704	704		this subsection and the number of plan participants, beneficiaries, 572
705	705		employees and dependents reported to the Insurance Commissioner 573
706	706		pursuant to subparagraph (B) of subdivision (2) of this subsection. 574
707	707		[(5)] (4) (A) Not later than December first, annually, the Insurance 575
708	708		Commissioner shall submit a statement to each [such] domestic insurer 576
709	709		[,] and domestic health care center [,] described in subparagraph (A) of 577
710	710		subdivision (1) of this subsection, each third-party administrator and 578
711	711		exempt insurer described in subparagraph (B) of subdivision (1) of this 579
712	712		subsection and the Comptroller for each multiemployer plan, nonprofit 580
713	713		employer or small employer described in subparagraph (C) of 581
714	714		subdivision (1) of this subsection that includes the proposed fee, 582
715	715		identified on such statement as the "Health and Welfare fee", for [the] 583
716	716		such domestic insurer, domestic health care center, third-party 584
717	717		administrator, [or] exempt insurer, multiemployer plan, nonprofit 585
718	718		employer or small employer calculated in accordance with this 586
719	719		subsection. [Each] The Comptroller shall collect such fee from each such 587
720	720		multiemployer plan, nonprofit employer and small employer described 588
721	721		in subparagraph (C) of subdivision (1) of this subsection and pay such 589
722	722		fee to the Insurance Commissioner, and each such domestic insurer, 590 Substitute Bill No. 842
723	723
724	724
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728	728
729	729		domestic health care center, third-party administrator and exempt 591
730	730		insurer shall pay such fee to the Insurance Commissioner, not later than 592
731	731		February first, annually. 593
732	732		(B) Any [such] domestic insurer [,] or domestic health care center 594
733	733		described in subparagraph (A) of subdivision (1) of this subsection, 595
734	734		third-party administrator or exempt insurer described in subparagraph 596
735	735		(B) of subdivision (1) of this subsection or the administrator of a 597
736	736		multiemployer plan, a nonprofit employer or a small employer 598
737	737		described in subparagraph (C) of subdivision (1) of this subsection that 599
738	738		is aggrieved by an assessment levied under this subsection may appeal 600
739	739		therefrom in the same manner as provided for appeals under section 601
740	740		38a-52, as amended by this act. 602
741	741		[(6)] (5) Any domestic insurer, domestic health care center, third-603
742	742		party administrator or exempt insurer that fails to file the report 604
743	743		required under subparagraph (A) of subdivision [(3)] (2) of this 605
744	744		subsection shall pay a late filing fee of one hundred dollars per day for 606
745	745		each day from the date such report was due. The Insurance 607
746	746		Commissioner may require [an] a domestic insurer, domestic health 608
747	747		care center, third-party administrator or exempt insurer subject to this 609
748	748		subsection to produce the records in its possession, and may require any 610
749	749		other person to produce the records in such person's possession, that 611
750	750		were used to prepare such report, for [said commissioner's] the 612
751	751		Insurance Commissioner's or [said commissioner's] the Insurance 613
752	752		Commissioner's designee's examination. If [said commissioner] the 614
753	753		Insurance Commissioner determines there is other than a good faith 615
754	754		discrepancy between the actual number of insured or enrolled lives that 616
755	755		should have been reported under subparagraph (A) of subdivision [(3)] 617
756	756		(2) of this subsection and the number actually reported, such domestic 618
757	757		insurer, domestic health care center, third-party administrator or 619
758	758		exempt insurer shall pay a civil penalty of not more than fifteen 620
759	759		thousand dollars for each report filed for which [said commissioner] the 621
760	760		Insurance Commissioner determines there is such a discrepancy. 622
761	761		[(7)] (6) (A) The Insurance Commissioner shall apply an overpayment 623 Substitute Bill No. 842
762	762
763	763
764	764		LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
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767	767
768	768		of the health and welfare fee by [an] a domestic insurer, domestic health 624
769	769		care center, third-party administrator or exempt insurer, or by the 625
770	770		Comptroller on behalf of a multiemployer plan, nonprofit employer or 626
771	771		small employer described in subparagraph (C) of subdivision (1) of this 627
772	772		subsection, for any fiscal year as a credit against the health and welfare 628
773	773		fee due from such domestic insurer, domestic health care center, third-629
774	774		party administrator, [or] exempt insurer, multiemployer plan, nonprofit 630
775	775		employer or small employer for the succeeding fiscal year, subject to an 631
776	776		adjustment under subdivision [(4)] (3) of this subsection: [, if:] 632
777	777		(i) [The] If the amount of the overpayment exceeds five thousand 633
778	778		dollars; and 634
779	779		(ii) If, on or before June first of the calendar year of the overpayment, 635
780	780		[the] such domestic insurer, domestic health care center, third-party 636
781	781		administrator, [or] exempt insurer, multiemployer plan, nonprofit 637
782	782		employer or small employer: 638
783	783		(I) [notifies] Notifies the [commissioner] Insurance Commissioner of 639
784	784		the amount of the overpayment; [,] and 640
785	785		(II) [provides] Provides the [commissioner] Insurance Commissioner 641
786	786		with evidence sufficient to prove the amount of the overpayment. 642
787	787		(B) Not later than ninety days following receipt of notice and 643
788	788		supporting evidence under subparagraph [(A)] (A)(ii) of this 644
789	789		subdivision, the [commissioner] Insurance Commissioner shall: 645
790	790		(i) [determine] Determine whether the domestic insurer, domestic 646
791	791		health care center, third-party administrator, [or] exempt insurer, 647
792	792		multiemployer plan, nonprofit employer or small employer made an 648
793	793		overpayment; [,] and 649
794	794		(ii) [notify] Notify the domestic insurer, domestic health care center, 650
795	795		third-party administrator, [or] exempt insurer, multiemployer plan, 651
796	796		nonprofit employer or small employer of such determination. 652 Substitute Bill No. 842
797	797
798	798
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802	802
803	803		(C) Failure of [an] a domestic insurer, domestic health care center, 653
804	804		third-party administrator, [or] exempt insurer, multiemployer plan, 654
805	805		nonprofit employer or small employer to notify the commissioner of the 655
806	806		amount of an overpayment within the time prescribed in subparagraph 656
807	807		[(A)] (A)(ii) of this subdivision constitutes a waiver of any demand of 657
808	808		the domestic insurer, domestic health care center, third-party 658
809	809		administrator, [or] exempt insurer, multiemployer plan, nonprofit 659
810	810		employer or small employer against the state on account of such 660
811	811		overpayment. 661
812	812		(D) Nothing in this subdivision shall be construed to prohibit or limit 662
813	813		the right of [an] a domestic insurer, domestic health care center, third-663
814	814		party administrator, [or] exempt insurer, multiemployer plan, nonprofit 664
815	815		employer or small employer to appeal pursuant to subparagraph (B) of 665
816	816		subdivision [(5)] (4) of this [section] subsection. 666
817	817		Sec. 6. Section 19a-7p of the general statutes is repealed and the 667
818	818		following is substituted in lieu thereof (Effective July 1, 2021): 668
819	819		(a) As used in this section: 669
820	820		(1) "Health care center" has the same meaning as provided in section 670
821	821		38a-175; 671
822	822		(2) "Health insurance" means health insurance providing coverage of 672
823	823		the types specified in subdivisions (1), (2), (4), (11) and (12) of section 673
824	824		38a-469; 674
825	825		(3) "Multiemployer plan" has the same meaning as provided in 675
826	826		Section 3 of the Employee Retirement Income Security Act of 1974, as 676
827	827		amended from time to time; 677
828	828		(4) "Nonprofit employer" has the same meaning as provided in 678
829	829		section 3-123rrr, as amended by this act; and 679
830	830		(5) "Small employer" has the same meaning as provided in section 3-680
831	831		123rrr, as amended by this act. 681 Substitute Bill No. 842
832	832
833	833
834	834		LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
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836	836		24 of 59
837	837
838	838		[(a)] (b) Not later than September first, annually, the Secretary of the 682
839	839		Office of Policy and Management, in consultation with the 683
840	840		Commissioner of Public Health, shall: 684
841	841		(1) [determine] Determine the amounts appropriated for the syringe 685
842	842		services program, AIDS services, breast and cervical cancer detection 686
843	843		and treatment, x-ray screening and tuberculosis care, sexually 687
844	844		transmitted disease control and children's health initiatives; and 688
845	845		(2) [inform] Inform the Insurance Commissioner of such amounts. 689
846	846		[(b) (1) As used in this section: (A) "Health insurance" means health 690
847	847		insurance of the types specified in subdivisions (1), (2), (4), (11) and (12) 691
848	848		of section 38a-469; and (B) "health care center" has the same meaning as 692
849	849		provided in section 38a-175.] 693
850	850		[(2)] (c) (1) Each domestic insurer [or] and domestic health care center 694
851	851		doing health insurance business in this state, and the Comptroller on 695
852	852		behalf of each multiemployer plan, nonprofit employer and small 696
853	853		employer receiving coverage provided by the Comptroller pursuant to 697
854	854		section 2 of this act, shall annually pay to the Insurance Commissioner, 698
855	855		for deposit in the Insurance Fund established under section 38a-52a, a 699
856	856		public health fee assessed by the Insurance Commissioner pursuant to 700
857	857		this section. 701
858	858		[(3)] (2) Not later than September first, annually: [, each such] 702
859	859		(A) Each domestic insurer [or] and domestic health care center 703
860	860		described in subdivision (1) of this subsection shall report to the 704
861	861		Insurance Commissioner, in the form and manner prescribed by [said 705
862	862		commissioner] the Insurance Commissioner, the number of insured or 706
863	863		enrolled lives in this state as of the May first immediately preceding [the 707
864	864		date] for which such domestic insurer or domestic health care center [is] 708
865	865		was providing health insurance [that provides] coverage, [of the types 709
866	866		specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469. 710
867	867		Such number shall not include] excluding any lives enrolled in 711
868	868		Medicare, any medical assistance program administered by the 712 Substitute Bill No. 842
869	869
870	870
871	871		LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
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873	873		25 of 59
874	874
875	875		Department of Social Services, workers' compensation insurance or 713
876	876		Medicare Part C plans; and 714
877	877		(B) The Comptroller shall report to the Insurance Commissioner, in 715
878	878		the form and manner prescribed by the Insurance Commissioner: 716
879	879		(i) For each multiemployer plan described in subdivision (1) of this 717
880	880		subsection, the number of such multiemployer plan's plan participants 718
881	881		and beneficiaries in this state for whom the Comptroller was providing 719
882	882		coverage pursuant to section 2 of this act as of the May first immediately 720
883	883		preceding; 721
884	884		(ii) For each nonprofit employer described in subdivision (1) of this 722
885	885		subsection, the number of such nonprofit employer's employees and 723
886	886		their dependents in this state for whom the Comptroller was providing 724
887	887		coverage pursuant to section 2 of this act as of the May first immediately 725
888	888		preceding; and 726
889	889		(iii) For each small employer described in subdivision (1) of this 727
890	890		subsection, the number of such small employer's employees and their 728
891	891		dependents in this state for whom the Comptroller was providing 729
892	892		coverage pursuant to section 2 of this act as of the May first immediately 730
893	893		preceding. 731
894	894		[(c)] (d) Not later than November first, annually, the Insurance 732
895	895		Commissioner shall determine the fee to be assessed for the current 733
896	896		fiscal year against each [such] domestic insurer, [and] domestic health 734
897	897		care center, multiemployer plan, nonprofit employer or small employer 735
898	898		described in subdivision (1) of subsection (c) of this section. Such fee 736
899	899		shall be calculated by multiplying the number of lives reported to [said 737
900	900		commissioner] the Insurance Commissioner pursuant to subparagraph 738
901	901		(A) of subdivision [(3)] (2) of subsection [(b)] (c) of this section, and the 739
902	902		number of plan participants, beneficiaries, employees and dependents 740
903	903		reported to the Insurance Commissioner pursuant to subparagraph (B) 741
904	904		of subdivision (2) of subsection (c) of this section, by a factor, 742
905	905		determined annually by [said commissioner] the Insurance 743 Substitute Bill No. 842
906	906
907	907
908	908		LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
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910	910		26 of 59
911	911
912	912		Commissioner as set forth in this subsection, to fully fund the aggregate 744
913	913		amount determined under subdivision (1) of subsection [(a)] (b) of this 745
914	914		section. The Insurance Commissioner shall determine the factor by 746
915	915		dividing the aggregate amount by the sum of the total number of lives 747
916	916		reported to [said commissioner] the Insurance Commissioner pursuant 748
917	917		to subparagraph (A) of subdivision [(3)] (2) of subsection [(b)] (c) of this 749
918	918		section and the number of plan participants, beneficiaries, employees 750
919	919		and dependents reported to the Insurance Commissioner pursuant to 751
920	920		subparagraph (B) of subdivision (2) of subsection (c) of this section. 752
921	921		[(d)] (e) Not later than December first, annually, the Insurance 753
922	922		Commissioner shall submit a statement to each [such] domestic insurer 754
923	923		and domestic health care center described in subdivision (1) of 755
924	924		subsection (c) of this section, and to the Comptroller for each 756
925	925		multiemployer plan, nonprofit employer or small employer described 757
926	926		in subdivision (1) of subsection (c) of this section, that includes the 758
927	927		proposed fee, identified on such statement as the "Public Health fee", for 759
928	928		[the] such domestic insurer, [or] domestic health care center, 760
929	929		multiemployer plan, nonprofit employer or small employer, calculated 761
930	930		in accordance with this section. Not later than December twentieth, 762
931	931		annually, [any] a domestic insurer, [or] domestic health care center, or 763
932	932		the Comptroller acting on behalf of a multiemployer plan, nonprofit 764
933	933		employer or small employer, may submit an objection to the Insurance 765
934	934		Commissioner concerning the proposed public health fee. The 766
935	935		Insurance Commissioner, after making any adjustment that [said 767
936	936		commissioner] the Insurance Commissioner deems necessary, shall, not 768
937	937		later than January first, annually, submit a final statement to the 769
938	938		Comptroller for each multiemployer plan, nonprofit employer and 770
939	939		small employer described in subdivision (1) of subsection (c) of this 771
940	940		section that includes the final fee for such multiemployer plan, nonprofit 772
941	941		employer or small employer and to each domestic insurer and domestic 773
942	942		health care center that includes the final fee for [the] such domestic 774
943	943		insurer or domestic health care center. [Each such] The Comptroller 775
944	944		shall collect such fee from each such multiemployer plan, nonprofit 776
945	945		employer and small employer and pay such fee to the Insurance 777 Substitute Bill No. 842
946	946
947	947
948	948		LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
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950	950		27 of 59
951	951
952	952		Commissioner, and each such domestic insurer and domestic health 778
953	953		care center shall pay such fee to the Insurance Commissioner, not later 779
954	954		than February first, annually. 780
955	955		[(e)] (f) Any [such] domestic insurer, [or] domestic health care center, 781
956	956		multiemployer plan, nonprofit employer or small employer described 782
957	957		in subdivision (1) of subsection (c) of this section that is aggrieved by an 783
958	958		assessment levied under this section may appeal therefrom in the same 784
959	959		manner as provided for appeals under section 38a-52, as amended by 785
960	960		this act. 786
961	961		[(f)] (g) (1) The Insurance Commissioner shall apply an overpayment 787
962	962		of the public health fee by [an] a domestic insurer or domestic health 788
963	963		care center, or by the Comptroller on behalf of a multiemployer plan, 789
964	964		nonprofit employer or small employer described in subdivision (1) of 790
965	965		subsection (c) of this section, for any fiscal year as a credit against the 791
966	966		public health fee due from such domestic insurer, [or] domestic health 792
967	967		care center, multiemployer plan, nonprofit employer or small employer 793
968	968		for the succeeding fiscal year, subject to an adjustment under subsection 794
969	969		[(c)] (d) of this section: [, if:] 795
970	970		(A) [The] If the amount of the overpayment exceeds five thousand 796
971	971		dollars; and 797
972	972		(B) If, on or before June first of the calendar year of the overpayment, 798
973	973		[the] such domestic insurer, [or] domestic health care center, 799
974	974		multiemployer plan, nonprofit employer or small employer: 800
975	975		(i) [notifies] Notifies the [commissioner] Insurance Commissioner of 801
976	976		the amount of the overpayment; [,] and 802
977	977		(ii) [provides] Provides the [commissioner] Insurance Commissioner 803
978	978		with evidence sufficient to prove the amount of the overpayment. 804
979	979		(2) Not later than ninety days following receipt of notice and 805
980	980		supporting evidence under subdivision (1) of this subsection, the 806
981	981		[commissioner] Insurance Commissioner shall: 807 Substitute Bill No. 842
982	982
983	983
984	984		LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
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986	986		28 of 59
987	987
988	988		(A) [determine] Determine whether the domestic insurer, [or] 808
989	989		domestic health care center, multiemployer plan, nonprofit employer or 809
990	990		small employer made an overpayment; [,] and 810
991	991		(B) [notify] Notify the domestic insurer, [or] domestic health care 811
992	992		center, multiemployer plan, nonprofit employer or small employer of 812
993	993		such determination. 813
994	994		(3) Failure of [an] a domestic insurer, [or] domestic health care center, 814
995	995		multiemployer plan, nonprofit employer or small employer to notify the 815
996	996		commissioner of the amount of an overpayment within the time 816
997	997		prescribed in subparagraph (B) of subdivision (1) of this subsection 817
998	998		constitutes a waiver of any demand of the domestic insurer, [or] 818
999	999		domestic health care center, multiemployer plan, nonprofit employer or 819
1000	1000		small employer against the state on account of such overpayment. 820
1001	1001		(4) Nothing in this subsection shall be construed to prohibit or limit 821
1002	1002		the right of [an] a domestic insurer, [or] domestic health care center, 822
1003	1003		multiemployer plan, nonprofit employer or small employer to appeal 823
1004	1004		pursuant to subsection [(e)] (f) of this section. 824
1005	1005		Sec. 7. Section 38a-52 of the general statutes is repealed and the 825
1006	1006		following is substituted in lieu thereof (Effective July 1, 2021): 826
1007	1007		Any (1) domestic insurance company or other domestic entity 827
1008	1008		aggrieved because of any assessment levied under section 38a-48, (2) 828
1009	1009		fraternal benefit society or foreign or alien insurance company or other 829
1010	1010		entity aggrieved because of any assessment levied under the provisions 830
1011	1011		of sections 38a-49 to 38a-51, inclusive, [or] (3) domestic insurer, domestic 831
1012	1012		health care center [,] or third-party administrator licensed pursuant to 832
1013	1013		section 38a-720a, or exempt insurer, administrator of a multiemployer 833
1014	1014		plan, nonprofit employer or small employer as defined in [subdivision 834
1015	1015		(1) of] subsection [(b)] (a) of section 19a-7j, as amended by this act, 835
1016	1016		aggrieved because of any assessment levied under said section 19a-7j, 836
1017	1017		as amended by this act, or (4) domestic insurer or domestic health care 837
1018	1018		center, or administrator of a multiemployer plan, nonprofit employer or 838 Substitute Bill No. 842
1019	1019
1020	1020
1021	1021		LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
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1023	1023		29 of 59
1024	1024
1025	1025		small employer as defined in subsection (a) of section 19a-7p, as 839
1026	1026		amended by this act, aggrieved because of any assessment levied under 840
1027	1027		said section 19a-7p, as amended by this act, may, within one month from 841
1028	1028		the time provided for the payment of such assessment, appeal therefrom 842
1029	1029		to the superior court for the judicial district of New Britain, which 843
1030	1030		appeal shall be accompanied by a citation to the commissioner to appear 844
1031	1031		before said court. Such citation shall be signed by the same authority, 845
1032	1032		and such appeal shall be returnable at the same time and served and 846
1033	1033		returned in the same manner, as is required in case of a summons in a 847
1034	1034		civil action. The authority issuing the citation shall take from the 848
1035	1035		appellant a bond or recognizance to the state, with surety to prosecute 849
1036	1036		the appeal to effect and to comply with the orders and decrees of the 850
1037	1037		court in the premises. Such appeals shall be preferred cases, to be heard, 851
1038	1038		unless cause appears to the contrary, at the first session, by the court or 852
1039	1039		by a committee appointed by the court. Said court may grant such relief 853
1040	1040		as may be equitable, and, if such assessment has been paid prior to the 854
1041	1041		granting of such relief, may order the Treasurer to pay the amount of 855
1042	1042		such relief, with interest at the rate of six per cent per annum, to the 856
1043	1043		aggrieved company. If the appeal has been taken without probable 857
1044	1044		cause, the court may tax double or triple costs, as the case demands; and, 858
1045	1045		upon all such appeals which may be denied, costs may be taxed against 859
1046	1046		the appellant at the discretion of the court, but no costs shall be taxed 860
1047	1047		against the state. 861
1048	1048		Sec. 8. Section 38a-1041 of the general statutes is repealed and the 862
1049	1049		following is substituted in lieu thereof (Effective July 1, 2021): 863
1050	1050		(a) There is established an Office of the Healthcare Advocate which 864
1051	1051		shall be within the Insurance Department for administrative purposes 865
1052	1052		only. 866
1053	1053		(b) The Office of the Healthcare Advocate may: 867
1054	1054		(1) Assist health insurance consumers with managed care plan 868
1055	1055		selection by providing information, referral and assistance to 869
1056	1056		individuals about means of obtaining health insurance coverage and 870 Substitute Bill No. 842
1057	1057
1058	1058
1059	1059		LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
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1061	1061		30 of 59
1062	1062
1063	1063		services; 871
1064	1064		(2) Assist health insurance consumers to understand their rights and 872
1065	1065		responsibilities under managed care plans; 873
1066	1066		(3) Provide information to the public, agencies, legislators and others 874
1067	1067		regarding problems and concerns of health insurance consumers and 875
1068	1068		make recommendations for resolving those problems and concerns; 876
1069	1069		(4) Assist consumers with the filing of complaints and appeals, 877
1070	1070		including filing appeals with a managed care organization's internal 878
1071	1071		appeal or grievance process and the external appeal process established 879
1072	1072		under sections 38a-591d to 38a-591g, inclusive; 880
1073	1073		(5) Analyze and monitor the development and implementation of 881
1074	1074		federal, state and local laws, regulations and policies relating to health 882
1075	1075		insurance consumers and recommend changes it deems necessary; 883
1076	1076		(6) Facilitate public comment on laws, regulations and policies, 884
1077	1077		including policies and actions of health insurers; 885
1078	1078		(7) Ensure that health insurance consumers have timely access to the 886
1079	1079		services provided by the office; 887
1080	1080		(8) Review the health insurance records of a consumer who has 888
1081	1081		provided written consent for such review; 889
1082	1082		(9) Create and make available to employers a notice, suitable for 890
1083	1083		posting in the workplace, concerning the services that the Healthcare 891
1084	1084		Advocate provides; 892
1085	1085		(10) Establish a toll-free number, or any other free calling option, to 893
1086	1086		allow customer access to the services provided by the Healthcare 894
1087	1087		Advocate; 895
1088	1088		(11) Pursue administrative remedies on behalf of and with the 896
1089	1089		consent of any health insurance consumers; 897 Substitute Bill No. 842
1090	1090
1091	1091
1092	1092		LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
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1094	1094		31 of 59
1095	1095
1096	1096		(12) Adopt regulations, pursuant to chapter 54, to carry out the 898
1097	1097		provisions of sections 38a-1040 to 38a-1050, inclusive; and 899
1098	1098		(13) Take any other actions necessary to fulfill the purposes of 900
1099	1099		sections 38a-1040 to 38a-1050, inclusive. 901
1100	1100		(c) The Office of the Healthcare Advocate shall make a referral to the 902
1101	1101		Insurance Commissioner if the Healthcare Advocate finds that a 903
1102	1102		preferred provider network may have engaged in a pattern or practice 904
1103	1103		that may be in violation of sections 38a-479aa to 38a-479gg, inclusive, or 905
1104	1104		38a-815 to 38a-819, inclusive. 906
1105	1105		(d) The Healthcare Advocate and the Insurance Commissioner shall 907
1106	1106		jointly compile a list of complaints received against managed care 908
1107	1107		organizations and preferred provider networks and the commissioner 909
1108	1108		shall maintain the list, except the names of complainants shall not be 910
1109	1109		disclosed if such disclosure would violate the provisions of section 4-911
1110	1110		61dd or 38a-1045. 912
1111	1111		(e) On or before October 1, 2005, the Managed Care Ombudsman 913
1112	1112		shall establish a process to provide ongoing communication among 914
1113	1113		mental health care providers, patients, state-wide and regional business 915
1114	1114		organizations, managed care companies and other health insurers to 916
1115	1115		assure: (1) Best practices in mental health treatment and recovery; (2) 917
1116	1116		compliance with the provisions of sections 38a-476a, 38a-476b, 38a-488a 918
1117	1117		and 38a-489; and (3) the relative costs and benefits of providing effective 919
1118	1118		mental health care coverage to employees and their families. On or 920
1119	1119		before January 1, 2006, and annually thereafter, the Healthcare 921
1120	1120		Advocate shall report, in accordance with the provisions of section 11-922
1121	1121		4a, on the implementation of this subsection to the joint standing 923
1122	1122		committees of the General Assembly having cognizance of matters 924
1123	1123		relating to public health and insurance. 925
1124	1124		(f) On or before October 1, 2008, the Office of the Healthcare Advocate 926
1125	1125		shall, within available appropriations, establish and maintain a 927
1126	1126		healthcare consumer information web site on the Internet for use by the 928 Substitute Bill No. 842
1127	1127
1128	1128
1129	1129		LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
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1131	1131		32 of 59
1132	1132
1133	1133		public in obtaining healthcare information, including but not limited to: 929
1134	1134		(1) The availability of wellness programs in various regions of 930
1135	1135		Connecticut, such as disease prevention and health promotion 931
1136	1136		programs; (2) quality and experience data from hospitals licensed in this 932
1137	1137		state; and (3) a link to the consumer report card developed and 933
1138	1138		distributed by the Insurance Commissioner pursuant to section 38a-934
1139	1139		478l. 935
1140	1140		(g) Not later than January 1, 2015, the Office of the Healthcare 936
1141	1141		Advocate shall establish an information and referral service to help 937
1142	1142		residents and providers receive behavioral health care information, 938
1143	1143		timely referrals and access to behavioral health care providers. In 939
1144	1144		developing and implementing such service, the Healthcare Advocate, 940
1145	1145		or the Healthcare Advocate's designee, shall: (1) Collaborate with 941
1146	1146		stakeholders, including, but not limited to, (A) state agencies, (B) the 942
1147	1147		Behavioral Health Partnership established pursuant to section 17a-22h, 943
1148	1148		(C) community collaboratives, (D) the United Way's 2-1-1 Infoline 944
1149	1149		program, and (E) providers; (2) identify any basis that prevents 945
1150	1150		residents from obtaining adequate and timely behavioral health care 946
1151	1151		services, including, but not limited to, (A) gaps in private behavioral 947
1152	1152		health care services and coverage, and (B) barriers to access to care; (3) 948
1153	1153		coordinate a public awareness and educational campaign directing 949
1154	1154		residents to the information and referral service; and (4) develop data 950
1155	1155		reporting mechanisms to determine the effectiveness of the service, 951
1156	1156		including, but not limited to, tracking (A) the number of referrals to 952
1157	1157		providers by type and location of providers, (B) waiting time for 953
1158	1158		services, and (C) the number of providers who accept or reject requests 954
1159	1159		for service based on type of health care coverage. Not later than 955
1160	1160		February 1, 2016, and annually thereafter, the Office of the Healthcare 956
1161	1161		Advocate shall submit a report, in accordance with the provisions of 957
1162	1162		section 11-4a, to the joint standing committees of the General Assembly 958
1163	1163		having cognizance of matters relating to children, human services, 959
1164	1164		public health and insurance. The report shall identify gaps in services 960
1165	1165		and the resources needed to improve behavioral health care options for 961
1166	1166		residents. 962 Substitute Bill No. 842
1167	1167
1168	1168
1169	1169		LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
1170		-	~~R02~~-SB.docx }
	1170	+	R01-SB.docx }
1171	1171		33 of 59
1172	1172
1173	1173		(h) The Office of the Healthcare Advocate shall provide assistance to 963
1174	1174		the plan participants and beneficiaries in this state under multiemployer 964
1175	1175		plans, nonprofit employers' employees and their dependents and small 965
1176	1176		employers' employees and their dependents receiving coverage 966
1177	1177		provided by the Comptroller pursuant to section 2 of this act that is 967
1178	1178		equivalent to the assistance that the Office of the Healthcare Advocate 968
1179	1179		provides to other health insurance consumers. 969
1180	1180		Sec. 9. (NEW) (Effective July 1, 2021) (a) For the purposes of this 970
1181	1181		section: 971
1182	1182		(1) "Connecticut Health Insurance Exchange account" means the 972
1183	1183		Connecticut Health Insurance Exchange account established under 973
1184	1184		section 13 of this act; 974
1185	1185		(2) "Exchange" has the same meaning as provided in section 38a-1080 975
1186	1186		of the general statutes, as amended by this act; 976
1187	1187		(3) "Exempt insurer" means an insurer that administers self-insured 977
1188	1188		health benefit plans and is exempt from third-party administrator 978
1189	1189		licensure under subparagraph (C) of subdivision (11) of section 38a-720 979
1190	1190		of the general statutes and section 38a-720a of the general statutes; and 980
1191	1191		(4) "Office of Health Strategy" means the Office of Health Strategy 981
1192	1192		established under section 19a-754a of the general statutes, as amended 982
1193	1193		by this act. 983
1194	1194		(b) (1) Subject to the approval required under subsection (d) of section 984
1195	1195		16 of this act and, with respect to the matters for which the exchange 985
1196	1196		seeks a state innovation waiver pursuant to subparagraph (B) of 986
1197	1197		subdivision (28) of section 38a-1084 of the general statutes, as amended 987
1198	1198		by this act, issuance of such state innovation waiver, the Office of Health 988
1199	1199		Strategy shall: 989
1200	1200		(A) Not later than July 1, 2022, and annually thereafter: 990
1201	1201		(i) Determine the amount that the exchange requires to perform its 991 Substitute Bill No. 842
1202	1202
1203	1203
1204	1204		LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
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1206	1206		34 of 59
1207	1207
1208	1208		duties under subparagraph (C) of subdivision (28) of section 38a-1084 of 992
1209	1209		the general statutes, as amended by this act; and 993
1210	1210		(ii) Report the amount determined pursuant to subparagraph (A)(i) 994
1211	1211		of this subdivision to the Insurance Commissioner; and 995
1212	1212		(B) Not later than July 1, 2021, report to the Insurance Commissioner 996
1213	1213		that the amount described in subparagraph (A)(i) of this subdivision is 997
1214	1214		fifty million dollars for the year 2022. 998
1215	1215		(2) The amount determined pursuant to subparagraph (A)(i) of 999
1216	1216		subdivision (1) of this subsection shall not exceed fifty million dollars 1000
1217	1217		for any year. 1001
1218	1218		(c) (1) Each insurer and health care center doing health insurance 1002
1219	1219		business in this state, and each exempt insurer, shall annually pay to the 1003
1220	1220		Insurance Commissioner, for deposit in the Connecticut Health 1004
1221	1221		Insurance Exchange account, a fee assessed by the commissioner 1005
1222	1222		pursuant to this section. 1006
1223	1223		(2) Not later than July 1, 2021, and annually thereafter, each insurer, 1007
1224	1224		health care center and exempt insurer described in subdivision (1) of 1008
1225	1225		this subsection shall report to the commissioner, on a form designated 1009
1226	1226		by the commissioner, the number of insured or enrolled lives in this 1010
1227	1227		state as of the May first immediately preceding for which such insurer, 1011
1228	1228		health care center or exempt insurer was providing health insurance 1012
1229	1229		coverage, or administering a self-insured health benefit plan providing 1013
1230	1230		coverage, of the types specified in subdivisions (1), (2), (4), (11) and (12) 1014
1231	1231		of section 38a-469 of the general statutes. Such number shall not include 1015
1232	1232		insured or enrolled lives covered under fully insured group health 1016
1233	1233		insurance policies sold in the small group market, Medicare, any 1017
1234	1234		medical assistance program administered by the Department of Social 1018
1235	1235		Services, workers' compensation insurance or Medicare Part C plans. 1019
1236	1236		(3) Not later than August 1, 2021, and annually thereafter, the 1020
1237	1237		commissioner shall determine the fee to be assessed for that year against 1021
1238	1238		each insurer, health care center and exempt insurer described in 1022 Substitute Bill No. 842
1239	1239
1240	1240
1241	1241		LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
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1243	1243		35 of 59
1244	1244
1245	1245		subdivision (1) of this subsection. Such fee shall be determined by 1023
1246	1246		multiplying the number of insured or enrolled lives reported to the 1024
1247	1247		commissioner pursuant to subdivision (2) of this subsection by a factor, 1025
1248	1248		determined annually by the commissioner, to fully fund the amount 1026
1249	1249		reported by the Office of Health Strategy to the commissioner pursuant 1027
1250	1250		to subparagraph (A)(ii) or (B) of subdivision (1) of subsection (b) of this 1028
1251	1251		section. The commissioner shall determine the factor by dividing the 1029
1252	1252		amount reported by the Office of Health Strategy to the commissioner 1030
1253	1253		pursuant to subparagraph (A)(ii) or (B) of subdivision (1) of subsection 1031
1254	1254		(b) of this section by the total number of insured or enrolled lives 1032
1255	1255		reported to the commissioner pursuant to subdivision (2) of this 1033
1256	1256		subsection. 1034
1257	1257		(4) (A) Not later than August 1, 2021, and annually thereafter, the 1035
1258	1258		commissioner shall submit a statement to each insurer, health care 1036
1259	1259		center and exempt insurer described in subdivision (1) of this subsection 1037
1260	1260		that includes the proposed fee imposed under this section for such 1038
1261	1261		insurer, health care center or exempt insurer determined in accordance 1039
1262	1262		with this subsection. Each such insurer, health care center and exempt 1040
1263	1263		insurer shall pay such fee to the commissioner not later than November 1041
1264	1264		first of that year. 1042
1265	1265		(B) Any insurer, health care center or exempt insurer described in 1043
1266	1266		subdivision (1) of this subsection that is aggrieved by an assessment 1044
1267	1267		levied under this subsection may appeal therefrom in the same manner 1045
1268	1268		as provided for appeals under section 38a-52 of the general statutes, as 1046
1269	1269		amended by this act. 1047
1270	1270		(5) Any insurer, health care center or exempt insurer that fails to file 1048
1271	1271		the report required under subdivision (2) of this subsection, or pay the 1049
1272	1272		fee assessed under subdivision (1) of this subsection, shall pay a late 1050
1273	1273		filing or payment fee, as applicable, of one hundred dollars per day for 1051
1274	1274		each day from the date such report or payment was due. The 1052
1275	1275		commissioner shall deposit all late fees paid pursuant to this 1053
1276	1276		subdivision in the Connecticut Health Insurance Exchange account. The 1054
1277	1277		commissioner may require an insurer, health care center or exempt 1055 Substitute Bill No. 842
1278	1278
1279	1279
1280	1280		LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
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1282	1282		36 of 59
1283	1283
1284	1284		insurer subject to this subsection to produce any records in its 1056
1285	1285		possession, and may require any other person to produce any records 1057
1286	1286		in such other person's possession, that were used to prepare such report 1058
1287	1287		for examination by the commissioner or the commissioner's designee. If 1059
1288	1288		the commissioner determines there exists anything other than a good 1060
1289	1289		faith discrepancy between the actual number of insured or enrolled lives 1061
1290	1290		that should have been reported to the commissioner pursuant to 1062
1291	1291		subdivision (2) of this subsection and the number actually reported, 1063
1292	1292		such insurer, health care center or exempt insurer shall be liable to this 1064
1293	1293		state for a civil penalty of not more than fifteen thousand dollars for each 1065
1294	1294		report filed for which the commissioner determines there is such a 1066
1295	1295		discrepancy. 1067
1296	1296		(6) (A) The commissioner shall apply any overpayment of the fee 1068
1297	1297		imposed under this section by an insurer, health care center or exempt 1069
1298	1298		insurer for a given year as a credit against the fee due from such insurer, 1070
1299	1299		health care center or exempt insurer under this section for the 1071
1300	1300		succeeding year if: 1072
1301	1301		(i) The amount of the overpayment exceeds five thousand dollars; 1073
1302	1302		and 1074
1303	1303		(ii) On or before April first of the year of the overpayment, the 1075
1304	1304		insurer, health care center or exempt insurer: 1076
1305	1305		(I) Notifies the commissioner of the amount of the overpayment; and 1077
1306	1306		(II) Provides the commissioner with evidence sufficient to prove the 1078
1307	1307		amount of the overpayment. 1079
1308	1308		(B) Not later than ninety days after the commissioner receives the 1080
1309	1309		notice and supporting evidence under subparagraph (A)(ii) of this 1081
1310	1310		subdivision, the commissioner shall: 1082
1311	1311		(i) Determine whether the insurer, health care center or exempt 1083
1312	1312		insurer made an overpayment; and 1084 Substitute Bill No. 842
1313	1313
1314	1314
1315	1315		LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
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1317	1317		37 of 59
1318	1318
1319	1319		(ii) Notify the insurer, health care center or exempt insurer of the 1085
1320	1320		commissioner's determination under subparagraph (B)(i) of this 1086
1321	1321		subdivision. 1087
1322	1322		(C) Failure of an insurer, health care center or exempt insurer to 1088
1323	1323		notify the commissioner of the amount of an overpayment within the 1089
1324	1324		time prescribed in subparagraph (A)(ii) of this subdivision constitutes a 1090
1325	1325		waiver of any demand of the insurer, health care center or exempt 1091
1326	1326		insurer against this state on account of such overpayment. 1092
1327	1327		(D) Nothing in this subdivision shall be construed to prohibit or limit 1093
1328	1328		the right of an insurer, health care center or exempt insurer to appeal 1094
1329	1329		pursuant to subparagraph (B) of subdivision (4) of this subsection. 1095
1330	1330		(d) If another state, territory or district of the United States, or a 1096
1331	1331		foreign country, imposes on a Connecticut domiciled insurer, fraternal 1097
1332	1332		benefit society, hospital service corporation, medical service 1098
1333	1333		corporation, health care center or other domestic entity a retaliatory 1099
1334	1334		charge for the fee imposed under this section, such domestic entity may, 1100
1335	1335		not later than sixty days after receipt of notice of the imposition of the 1101
1336	1336		retaliatory charge for such fee, appeal to the Insurance Commissioner 1102
1337	1337		for a verification that the fee imposed under this section is subject to 1103
1338	1338		retaliation by another state, territory or district of the United States, or a 1104
1339	1339		foreign country. If the commissioner verifies, upon appeal to and 1105
1340	1340		certification by the commissioner, that the fee imposed under this 1106
1341	1341		section is the subject of a retaliatory tax, fee, assessment or other 1107
1342	1342		obligation by another state, territory or district of the United States, or a 1108
1343	1343		foreign country, such fee shall not be assessed against nondomestic 1109
1344	1344		insurers and nondomestic exempt insurers pursuant to this section. Any 1110
1345	1345		such domestic insurer, fraternal benefit society, hospital service 1111
1346	1346		corporation, medical service corporation, health care center or other 1112
1347	1347		entity aggrieved by the commissioner's decision issued under this 1113
1348	1348		subsection may appeal therefrom in the same manner as provided 1114
1349	1349		under section 38a-52 of the general statutes, as amended by this act. 1115
1350	1350		(e) The Insurance Commissioner may adopt regulations, in 1116 Substitute Bill No. 842
1351	1351
1352	1352
1353	1353		LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
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1355	1355		38 of 59
1356	1356
1357	1357		accordance with chapter 54 of the general statutes, to implement the 1117
1358	1358		provisions of this section. 1118
1359	1359		Sec. 10. Section 38a-1080 of the general statutes is repealed and the 1119
1360	1360		following is substituted in lieu thereof (Effective July 1, 2021): 1120
1361	1361		For purposes of this section, sections [38a-1080] 38a-1081 to 38a-1093, 1121
1362	1362		inclusive, and sections 13 and 14 of this act: 1122
1363	1363		(1) "Affordable Care Act" means the Patient Protection and 1123
1364	1364		Affordable Care Act, P.L. 111-148, as amended by the Health Care and 1124
1365	1365		Education Reconciliation Act, P.L. 111-152, as both may be amended 1125
1366	1366		from time to time, and regulations adopted thereunder; 1126
1367	1367		[(1)] (2) "Board" means the board of directors of the Connecticut 1127
1368	1368		Health Insurance Exchange; 1128
1369	1369		[(2)] (3) "Commissioner" means the Insurance Commissioner; 1129
1370	1370		[(3)] (4) "Exchange" means the Connecticut Health Insurance 1130
1371	1371		Exchange established pursuant to section 38a-1081; 1131
1372	1372		[(4) "Affordable Care Act" means the Patient Protection and 1132
1373	1373		Affordable Care Act, P.L. 111-148, as amended by the Health Care and 1133
1374	1374		Education Reconciliation Act, P.L. 111-152, as both may be amended 1134
1375	1375		from time to time, and regulations adopted thereunder;] 1135
1376	1376		(5) (A) "Health benefit plan" means an insurance policy or contract 1136
1377	1377		offered, delivered, issued for delivery, renewed, amended or continued 1137
1378	1378		in the state by a health carrier to provide, deliver, pay for or reimburse 1138
1379	1379		any of the costs of health care services. 1139
1380	1380		(B) "Health benefit plan" does not include: 1140
1381	1381		(i) Coverage of the type specified in subdivisions (5), (6), (7), (8), (9), 1141
1382	1382		(14), (15) and (16) of section 38a-469 or any combination thereof; 1142
1383	1383		(ii) Coverage issued as a supplement to liability insurance; 1143 Substitute Bill No. 842
1384	1384
1385	1385
1386	1386		LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
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1389	1389
1390	1390		(iii) Liability insurance, including general liability insurance and 1144
1391	1391		automobile liability insurance; 1145
1392	1392		(iv) Workers' compensation insurance; 1146
1393	1393		(v) Automobile medical payment insurance; 1147
1394	1394		(vi) Credit insurance; 1148
1395	1395		(vii) Coverage for on-site medical clinics; or 1149
1396	1396		(viii) Other similar insurance coverage specified in regulations issued 1150
1397	1397		pursuant to the Health Insurance Portability and Accountability Act of 1151
1398	1398		1996, P.L. 104-191, as amended from time to time, under which benefits 1152
1399	1399		for health care services are secondary or incidental to other insurance 1153
1400	1400		benefits. 1154
1401	1401		(C) "Health benefit plan" does not include the following benefits if 1155
1402	1402		they are provided under a separate insurance policy, certificate or 1156
1403	1403		contract or are otherwise not an integral part of the plan: 1157
1404	1404		(i) Limited scope dental or vision benefits; 1158
1405	1405		(ii) Benefits for long-term care, nursing home care, home health care, 1159
1406	1406		community-based care or any combination thereof; or 1160
1407	1407		(iii) Other similar, limited benefits specified in regulations issued 1161
1408	1408		pursuant to the Health Insurance Portability and Accountability Act of 1162
1409	1409		1996, P.L. 104-191, as amended from time to time; 1163
1410	1410		(iv) Other supplemental coverage, similar to coverage of the type 1164
1411	1411		specified in subdivisions (9) and (14) of section 38a-469, provided under 1165
1412	1412		a group health plan. 1166
1413	1413		(D) "Health benefit plan" does not include coverage of the type 1167
1414	1414		specified in subdivisions (3) and (13) of section 38a-469 or other fixed 1168
1415	1415		indemnity insurance if (i) such coverage is provided under a separate 1169
1416	1416		insurance policy, certificate or contract, (ii) there is no coordination 1170 Substitute Bill No. 842
1417	1417
1418	1418
1419	1419		LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
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1421	1421		40 of 59
1422	1422
1423	1423		between the provision of the benefits and any exclusion of benefits 1171
1424	1424		under any group health plan maintained by the same plan sponsor, and 1172
1425	1425		(iii) the benefits are paid with respect to an event without regard to 1173
1426	1426		whether benefits were also provided under any group health plan 1174
1427	1427		maintained by the same plan sponsor; 1175
1428	1428		(6) "Health care services" has the same meaning as provided in 1176
1429	1429		section 38a-478; 1177
1430	1430		(7) "Health carrier" means an insurance company, fraternal benefit 1178
1431	1431		society, hospital service corporation, medical service corporation, health 1179
1432	1432		care center or other entity subject to the insurance laws and regulations 1180
1433	1433		of the state or the jurisdiction of the commissioner that contracts or 1181
1434	1434		offers to contract to provide, deliver, pay for or reimburse any of the 1182
1435	1435		costs of health care services; 1183
1436	1436		(8) "Internal Revenue Code" means the Internal Revenue Code of 1184
1437	1437		1986, or any subsequent corresponding internal revenue code of the 1185
1438	1438		United States, as amended from time to time; 1186
1439	1439		[(9) "Person" has the same meaning as provided in section 38a-1; 1187
1440	1440		(10)] (9) "Qualified dental plan" means a limited scope dental plan 1188
1441	1441		that has been certified in accordance with subsection (e) of section 38a-1189
1442	1442		1086; 1190
1443	1443		[(11)] (10) "Qualified employer" has the same meaning as provided in 1191
1444	1444		Section 1312 of the Affordable Care Act; 1192
1445	1445		[(12)] (11) "Qualified health plan" means a health benefit plan that has 1193
1446	1446		in effect a certification that the plan meets the criteria for certification 1194
1447	1447		described in Section 1311(c) of the Affordable Care Act and section 38a-1195
1448	1448		1086; 1196
1449	1449		[(13)] (12) "Qualified individual" has the same meaning as provided 1197
1450	1450		in Section 1312 of the Affordable Care Act; 1198 Substitute Bill No. 842
1451	1451
1452	1452
1453	1453		LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
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	1454	+	R01-SB.docx }
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1456	1456
1457	1457		[(14)] (13) "Secretary" means the Secretary of the United States 1199
1458	1458		Department of Health and Human Services; and 1200
1459	1459		[(15)] (14) "Small employer" has the same meaning as provided in 1201
1460	1460		section 38a-564. 1202
1461	1461		Sec. 11. Section 38a-1084 of the general statutes is repealed and the 1203
1462	1462		following is substituted in lieu thereof (Effective July 1, 2021): 1204
1463	1463		The exchange shall: 1205
1464	1464		(1) Administer the exchange for both qualified individuals and 1206
1465	1465		qualified employers; 1207
1466	1466		(2) Commission surveys of individuals, small employers and health 1208
1467	1467		care providers on issues related to health care and health care coverage; 1209
1468	1468		(3) Implement procedures for the certification, recertification and 1210
1469	1469		decertification, consistent with guidelines developed by the Secretary 1211
1470	1470		under Section 1311(c) of the Affordable Care Act, and section 38a-1086, 1212
1471	1471		of health benefit plans as qualified health plans; 1213
1472	1472		(4) Provide for the operation of a toll-free telephone hotline to 1214
1473	1473		respond to requests for assistance; 1215
1474	1474		(5) Provide for enrollment periods, as provided under Section 1216
1475	1475		1311(c)(6) of the Affordable Care Act; 1217
1476	1476		(6) Maintain an Internet web site through which enrollees and 1218
1477	1477		prospective enrollees of qualified health plans may obtain standardized 1219
1478	1478		comparative information on such plans including, but not limited to, the 1220
1479	1479		enrollee satisfaction survey information under Section 1311(c)(4) of the 1221
1480	1480		Affordable Care Act and any other information or tools to assist 1222
1481	1481		enrollees and prospective enrollees evaluate qualified health plans 1223
1482	1482		offered through the exchange; 1224
1483	1483		(7) Publish the average costs of licensing, regulatory fees and any 1225
1484	1484		other payments required by the exchange and the administrative costs 1226 Substitute Bill No. 842
1485	1485
1486	1486
1487	1487		LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
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1489	1489		42 of 59
1490	1490
1491	1491		of the exchange, including information on moneys lost to waste, fraud 1227
1492	1492		and abuse, on an Internet web site to educate individuals on such costs; 1228
1493	1493		(8) On or before the open enrollment period for plan year 2017, assign 1229
1494	1494		a rating to each qualified health plan offered through the exchange in 1230
1495	1495		accordance with the criteria developed by the Secretary under Section 1231
1496	1496		1311(c)(3) of the Affordable Care Act, and determine each qualified 1232
1497	1497		health plan's level of coverage in accordance with regulations issued by 1233
1498	1498		the Secretary under Section 1302(d)(2)(A) of the Affordable Care Act; 1234
1499	1499		(9) Use a standardized format for presenting health benefit options in 1235
1500	1500		the exchange, including the use of the uniform outline of coverage 1236
1501	1501		established under Section 2715 of the Public Health Service Act, 42 USC 1237
1502	1502		300gg-15, as amended from time to time; 1238
1503	1503		(10) Inform individuals, in accordance with Section 1413 of the 1239
1504	1504		Affordable Care Act, of eligibility requirements for the Medicaid 1240
1505	1505		program under Title XIX of the Social Security Act, as amended from 1241
1506	1506		time to time, the Children's Health Insurance Program (CHIP) under 1242
1507	1507		Title XXI of the Social Security Act, as amended from time to time, or 1243
1508	1508		any applicable state or local public program, and enroll an individual in 1244
1509	1509		such program if the exchange determines, through screening of the 1245
1510	1510		application by the exchange, that such individual is eligible for any such 1246
1511	1511		program; 1247
1512	1512		(11) Collaborate with the Department of Social Services, to the extent 1248
1513	1513		possible, to allow an enrollee who loses premium tax credit eligibility 1249
1514	1514		under Section 36B of the Internal Revenue Code and is eligible for 1250
1515	1515		HUSKY A or any other state or local public program, to remain enrolled 1251
1516	1516		in a qualified health plan; 1252
1517	1517		(12) Establish and make available by electronic means a calculator to 1253
1518	1518		determine the actual cost of coverage after application of any premium 1254
1519	1519		tax credit under Section 36B of the Internal Revenue Code and any cost-1255
1520	1520		sharing reduction under Section 1402 of the Affordable Care Act; 1256
1521	1521		(13) Establish a program for small employers through which 1257 Substitute Bill No. 842
1522	1522
1523	1523
1524	1524		LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
1525		-	~~R02~~-SB.docx }
	1525	+	R01-SB.docx }
1526	1526		43 of 59
1527	1527
1528	1528		qualified employers may access coverage for their employees and that 1258
1529	1529		shall enable any qualified employer to specify a level of coverage so that 1259
1530	1530		any of its employees may enroll in any qualified health plan offered 1260
1531	1531		through the exchange at the specified level of coverage; 1261
1532	1532		(14) Offer enrollees and small employers the option of having the 1262
1533	1533		exchange collect and administer premiums, including through 1263
1534	1534		allocation of premiums among the various insurers and qualified health 1264
1535	1535		plans chosen by individual employers; 1265
1536	1536		(15) Grant a certification, subject to Section 1411 of the Affordable 1266
1537	1537		Care Act, attesting that, for purposes of the individual responsibility 1267
1538	1538		penalty under Section 5000A of the Internal Revenue Code, an 1268
1539	1539		individual is exempt from the individual responsibility requirement or 1269
1540	1540		from the penalty imposed by said Section 5000A because: 1270
1541	1541		(A) There is no affordable qualified health plan available through the 1271
1542	1542		exchange, or the individual's employer, covering the individual; or 1272
1543	1543		(B) The individual meets the requirements for any other such 1273
1544	1544		exemption from the individual responsibility requirement or penalty; 1274
1545	1545		(16) Provide to the Secretary of the Treasury of the United States the 1275
1546	1546		following: 1276
1547	1547		(A) A list of the individuals granted a certification under subdivision 1277
1548	1548		(15) of this section, including the name and taxpayer identification 1278
1549	1549		number of each individual; 1279
1550	1550		(B) The name and taxpayer identification number of each individual 1280
1551	1551		who was an employee of an employer but who was determined to be 1281
1552	1552		eligible for the premium tax credit under Section 36B of the Internal 1282
1553	1553		Revenue Code because: 1283
1554	1554		(i) The employer did not provide minimum essential health benefits 1284
1555	1555		coverage; or 1285 Substitute Bill No. 842
1556	1556
1557	1557
1558	1558		LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
1559		-	~~R02~~-SB.docx }
	1559	+	R01-SB.docx }
1560	1560		44 of 59
1561	1561
1562	1562		(ii) The employer provided the minimum essential coverage but it 1286
1563	1563		was determined under Section 36B(c)(2)(C) of the Internal Revenue 1287
1564	1564		Code to be unaffordable to the employee or not provide the required 1288
1565	1565		minimum actuarial value; and 1289
1566	1566		(C) The name and taxpayer identification number of: 1290
1567	1567		(i) Each individual who notifies the exchange under Section 1291
1568	1568		1411(b)(4) of the Affordable Care Act that such individual has changed 1292
1569	1569		employers; and 1293
1570	1570		(ii) Each individual who ceases coverage under a qualified health 1294
1571	1571		plan during a plan year and the effective date of that cessation; 1295
1572	1572		(17) Provide to each employer the name of each employee, as 1296
1573	1573		described in subparagraph (B) of subdivision (16) of this section, of the 1297
1574	1574		employer who ceases coverage under a qualified health plan during a 1298
1575	1575		plan year and the effective date of the cessation; 1299
1576	1576		(18) Perform duties required of, or delegated to, the exchange by the 1300
1577	1577		Secretary or the Secretary of the Treasury of the United States related to 1301
1578	1578		determining eligibility for premium tax credits, reduced cost-sharing or 1302
1579	1579		individual responsibility requirement exemptions; 1303
1580	1580		(19) Select entities qualified to serve as Navigators in accordance with 1304
1581	1581		Section 1311(i) of the Affordable Care Act and award grants to enable 1305
1582	1582		Navigators to: 1306
1583	1583		(A) Conduct public education activities to raise awareness of the 1307
1584	1584		availability of qualified health plans; 1308
1585	1585		(B) Distribute fair and impartial information concerning enrollment 1309
1586	1586		in qualified health plans and the availability of premium tax credits 1310
1587	1587		under Section 36B of the Internal Revenue Code and cost-sharing 1311
1588	1588		reductions under Section 1402 of the Affordable Care Act; 1312
1589	1589		(C) Facilitate enrollment in qualified health plans; 1313 Substitute Bill No. 842
1590	1590
1591	1591
1592	1592		LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
1593		-	~~R02~~-SB.docx }
	1593	+	R01-SB.docx }
1594	1594		45 of 59
1595	1595
1596	1596		(D) Provide referrals to the Office of the Healthcare Advocate or 1314
1597	1597		health insurance ombudsman established under Section 2793 of the 1315
1598	1598		Public Health Service Act, 42 USC 300gg-93, as amended from time to 1316
1599	1599		time, or any other appropriate state agency or agencies, for any enrollee 1317
1600	1600		with a grievance, complaint or question regarding the enrollee's health 1318
1601	1601		benefit plan, coverage or a determination under that plan or coverage; 1319
1602	1602		and 1320
1603	1603		(E) Provide information in a manner that is culturally and 1321
1604	1604		linguistically appropriate to the needs of the population being served by 1322
1605	1605		the exchange; 1323
1606	1606		(20) Review the rate of premium growth within and outside the 1324
1607	1607		exchange and consider such information in developing 1325
1608	1608		recommendations on whether to continue limiting qualified employer 1326
1609	1609		status to small employers; 1327
1610	1610		(21) Credit the amount, in accordance with Section 10108 of the 1328
1611	1611		Affordable Care Act, of any free choice voucher to the monthly 1329
1612	1612		premium of the plan in which a qualified employee is enrolled and 1330
1613	1613		collect the amount credited from the offering employer; 1331
1614	1614		(22) Consult with stakeholders relevant to carrying out the activities 1332
1615	1615		required under sections 38a-1080 to 38a-1090, inclusive, as amended by 1333
1616	1616		this act, including, but not limited to: 1334
1617	1617		(A) Individuals who are knowledgeable about the health care system, 1335
1618	1618		have background or experience in making informed decisions regarding 1336
1619	1619		health, medical and scientific matters and are enrollees in qualified 1337
1620	1620		health plans; 1338
1621	1621		(B) Individuals and entities with experience in facilitating enrollment 1339
1622	1622		in qualified health plans; 1340
1623	1623		(C) Representatives of small employers and s elf-employed 1341
1624	1624		individuals; 1342 Substitute Bill No. 842
1625	1625
1626	1626
1627	1627		LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
1628		-	~~R02~~-SB.docx }
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1629	1629		46 of 59
1630	1630
1631	1631		(D) The Department of Social Services; and 1343
1632	1632		(E) Advocates for enrolling hard-to-reach populations; 1344
1633	1633		(23) Meet the following financial integrity requirements: 1345
1634	1634		(A) Keep an accurate accounting of all activities, receipts and 1346
1635	1635		expenditures and annually submit to the Secretary, the Governor, the 1347
1636	1636		Insurance Commissioner and the General Assembly a report concerning 1348
1637	1637		such accountings; 1349
1638	1638		(B) Fully cooperate with any investigation conducted by the Secretary 1350
1639	1639		pursuant to the Secretary's authority under the Affordable Care Act and 1351
1640	1640		allow the Secretary, in coordination with the Inspector General of the 1352
1641	1641		United States Department of Health and Human Services, to: 1353
1642	1642		(i) Investigate the affairs of the exchange; 1354
1643	1643		(ii) Examine the properties and records of the exchange; and 1355
1644	1644		(iii) Require periodic reports in relation to the activities undertaken 1356
1645	1645		by the exchange; and 1357
1646	1646		(C) Not use any funds in carrying out its activities under sections 38a-1358
1647	1647		1080 to 38a-1089, inclusive, as amended by this act, that are intended for 1359
1648	1648		the administrative and operational expenses of the exchange, for staff 1360
1649	1649		retreats, promotional giveaways, excessive executive compensation or 1361
1650	1650		promotion of federal or state legislative and regulatory modifications; 1362
1651	1651		(24) (A) Seek to include the most comprehensive health benefit plans 1363
1652	1652		that offer high quality benefits at the most affordable price in the 1364
1653	1653		exchange, (B) encourage health carriers to offer tiered health care 1365
1654	1654		provider network plans that have different cost-sharing rates for 1366
1655	1655		different health care provider tiers and reward enrollees for choosing 1367
1656	1656		low-cost, high-quality health care providers by offering lower 1368
1657	1657		copayments, deductibles or other out-of-pocket expenses, and (C) offer 1369
1658	1658		any such tiered health care provider network plans through the 1370 Substitute Bill No. 842
1659	1659
1660	1660
1661	1661		LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
1662		-	~~R02~~-SB.docx }
	1662	+	R01-SB.docx }
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1664	1664
1665	1665		exchange; [and] 1371
1666	1666		(25) Report at least annually to the General Assembly on the effect of 1372
1667	1667		adverse selection on the operations of the exchange and make legislative 1373
1668	1668		recommendations, if necessary, to reduce the negative impact from any 1374
1669	1669		such adverse selection on the sustainability of the exchange, including 1375
1670	1670		recommendations to ensure that regulation of insurers and health 1376
1671	1671		benefit plans are similar for qualified health plans offered through the 1377
1672	1672		exchange and health benefit plans offered outside the exchange. The 1378
1673	1673		exchange shall evaluate whether adverse selection is occurring with 1379
1674	1674		respect to health benefit plans that are grandfathered under the 1380
1675	1675		Affordable Care Act, self-insured plans, plans sold through the 1381
1676	1676		exchange and plans sold outside the exchange; [.] 1382
1677	1677		(26) Administer the Connecticut Health Insurance Exchange account 1383
1678	1678		established under section 13 of this act; 1384
1679	1679		(27) Consult with the Office of Health Strategy established under 1385
1680	1680		section 19a-754a, as amended by this act, for the purposes set forth in 1386
1681	1681		subsection (b) of section 16 of this act; 1387
1682	1682		(28) Subject to the approval required under subsection (d) of section 1388
1683	1683		16 of this act: 1389
1684	1684		(A) Establish the subsidiary described in subdivision (1) of subsection 1390
1685	1685		(b) of section 16 of this act not later than November 1, 2021, which, if 1391
1686	1686		established, shall: 1392
1687	1687		(i) Require each health carrier offering coverage through such 1393
1688	1688		subsidiary to: 1394
1689	1689		(I) Collect demographic data, including, but not limited to, self-1395
1690	1690		reported ethnic and racial data, concerning the individuals receiving 1396
1691	1691		such coverage by, at a minimum, utilizing standardized categories 1397
1692	1692		developed by the Office of Health Strategy pursuant to subdivision (9) 1398
1693	1693		of subsection (b) of section 19a-754a of the general statutes, as amended 1399
1694	1694		by this act, including an "other" category and allowing any individual 1400 Substitute Bill No. 842
1695	1695
1696	1696
1697	1697		LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
1698		-	~~R02~~-SB.docx }
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1699	1699		48 of 59
1700	1700
1701	1701		who is self-reporting ethnic or racial data to write in such individual's 1401
1702	1702		ethnicity or race, and select multiple ethnicities and races, on any form 1402
1703	1703		provided by such health carrier to collect such ethnic or racial data; and 1403
1704	1704		(II) Not later than February 1, 2022, and annually thereafter, submit a 1404
1705	1705		report to such subsidiary disclosing, in the aggregate, the demographic 1405
1706	1706		data collected by such health carrier pursuant to subparagraph (A)(i)(I) 1406
1707	1707		of this subdivision; and 1407
1708	1708		(ii) Not later than March 1, 2022, and annually thereafter, submit a 1408
1709	1709		report to the exchange disclosing, in the aggregate, the demographic 1409
1710	1710		data that health carriers submitted to such subsidiary pursuant to 1410
1711	1711		subparagraph (A)(i)(II) of this subdivision for the preceding calendar 1411
1712	1712		year; 1412
1713	1713		(B) Seek the state innovation waiver described in subdivision (2) of 1413
1714	1714		subsection (b) of section 16 of this act not later than November 1, 2021; 1414
1715	1715		and 1415
1716	1716		(C) Use the moneys deposited in the Connecticut Health Insurance 1416
1717	1717		Exchange account established under section 13 of this act for the 1417
1718	1718		purposes set forth in subdivision (3) of subsection (b) of section 16 of 1418
1719	1719		this act and, if the exchange uses any funds deposited in said account to 1419
1720	1720		provide premium and cost -sharing subsidies described in 1420
1721	1721		subparagraph (B) of subdivision (3) of subsection (b) of section 16 of this 1421
1722	1722		act, collect, at least annually, demographic data, including, but not 1422
1723	1723		limited to, self-reported ethnic and racial data, concerning the 1423
1724	1724		individuals receiving such subsidies by, at a minimum: 1424
1725	1725		(i) Utilizing standardized categories developed by the Office of 1425
1726	1726		Health Strategy pursuant to subdivision (9) of subsection (b) of section 1426
1727	1727		19a-754a of the general statutes, as amended by this act; and 1427
1728	1728		(ii) Including an "other" category and allowing any individual who is 1428
1729	1729		self-reporting ethnic or racial data to write in such individual's ethnicity 1429
1730	1730		or race and select multiple ethnicities and races on any form provided 1430
1731	1731		by the exchange to collect such ethnic or racial data; and 1431 Substitute Bill No. 842
1732	1732
1733	1733
1734	1734		LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
1735		-	~~R02~~-SB.docx }
	1735	+	R01-SB.docx }
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1737	1737
1738	1738		(29) Determine whether individuals referred to the exchange by the 1432
1739	1739		Labor Commissioner pursuant to section 18 of this act are eligible for 1433
1740	1740		free or subsidized health coverage or other assistance or benefits, 1434
1741	1741		including, but not limited to, assistance under the supplemental 1435
1742	1742		nutrition assistance program, and, if such individuals are eligible for 1436
1743	1743		such coverage, assistance or benefits, enroll such individuals in such 1437
1744	1744		coverage, assistance or benefits. 1438
1745	1745		Sec. 12. Section 38a-1089 of the general statutes is repealed and the 1439
1746	1746		following is substituted in lieu thereof (Effective July 1, 2021): 1440
1747	1747		(a) Not later than January 1, 2012, and annually thereafter until 1441
1748	1748		January 1, 2014, the chief executive officer of the exchange shall report, 1442
1749	1749		in accordance with section 11-4a, to the Governor and the General 1443
1750	1750		Assembly on a plan, and any revisions or amendments to such plan, to 1444
1751	1751		establish a health insurance exchange in the state. Such report shall 1445
1752	1752		address: 1446
1753	1753		(1) Whether to establish two separate exchanges, one for the 1447
1754	1754		individual health insurance market and one for the small employer 1448
1755	1755		health insurance market, or to establish a single exchange; 1449
1756	1756		(2) Whether to merge the individual and small employer health 1450
1757	1757		insurance markets; 1451
1758	1758		(3) Whether to revise the definition of "small employer" from not 1452
1759	1759		more than fifty employees to not more than one hundred employees; 1453
1760	1760		(4) Whether to allow large employers to participate in the exchange 1454
1761	1761		beginning in 2017; 1455
1762	1762		(5) Whether to require qualified health plans to provide the essential 1456
1763	1763		health benefits package, as described in Section 1302(a) of the 1457
1764	1764		Affordable Care Act, or include additional state mandated benefits; 1458
1765	1765		(6) Whether to list dental benefits separately on the exchange's 1459
1766	1766		Internet web site where a qualified health plan includes dental benefits; 1460 Substitute Bill No. 842
1767	1767
1768	1768
1769	1769		LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
1770		-	~~R02~~-SB.docx }
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1772	1772
1773	1773		(7) The relationship of the exchange to insurance producers; 1461
1774	1774		(8) The capacity of the exchange to award Navigator grants pursuant 1462
1775	1775		to section 38a-1087; 1463
1776	1776		(9) Ways to ensure that the exchange is financially sustainable by 1464
1777	1777		2015, as required by the Affordable Care Act including, but not limited 1465
1778	1778		to, assessments or user fees charged to carriers; 1466
1779	1779		(10) Methods to independently evaluate consumers' experience, 1467
1780	1780		including, but not limited to, hiring consultants to act as secret shoppers; 1468
1781	1781		and 1469
1782	1782		(11) The status of the implementation and administration of the all-1470
1783	1783		payer claims database program established under section 19a-755a. 1471
1784	1784		(b) Not later than January 1, 2012, and annually thereafter, the chief 1472
1785	1785		executive officer of the exchange shall report, in accordance with section 1473
1786	1786		11-4a, to the Governor and the General Assembly on: 1474
1787	1787		(1) Any private or federal funds received during the preceding 1475
1788	1788		calendar year and, if applicable, how such funds were expended; 1476
1789	1789		(2) The adequacy of federal funds for the exchange prior to January 1477
1790	1790		1, 2015; 1478
1791	1791		(3) The amount and recipients of any grants awarded; and 1479
1792	1792		(4) The current financial status of the exchange. 1480
1793	1793		(c) Not later than April 1, 2022, and annually thereafter, the chief 1481
1794	1794		executive officer of the exchange shall submit a report, in accordance 1482
1795	1795		with section 11-4a, to the joint standing committee of the General 1483
1796	1796		Assembly having cognizance of matters relating to insurance disclosing, 1484
1797	1797		in the aggregate, the demographic data, if any, that: 1485
1798	1798		(1) The subsidiary established pursuant to subparagraph (A) of 1486
1799	1799		subdivision (28) of section 38a-1084, as amended by this act, reported to 1487 Substitute Bill No. 842
1800	1800
1801	1801
1802	1802		LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
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1805	1805
1806	1806		the exchange pursuant to subparagraph (A)(ii) of subdivision (28) of 1488
1807	1807		section 38a-1084, as amended by this act, for the preceding calendar 1489
1808	1808		year; and 1490
1809	1809		(2) The exchange collected pursuant to subparagraph (C) of 1491
1810	1810		subdivision (28) of section 38a-1084, as amended by this act, for the 1492
1811	1811		preceding calendar year. 1493
1812	1812		(d) Not later than January 1, 2023, and annually thereafter, the chief 1494
1813	1813		executive officer of the exchange shall submit a report, in accordance 1495
1814	1814		with section 11-4a, to the joint standing committees of the General 1496
1815	1815		Assembly having cognizance of matters relating to appropriations, 1497
1816	1816		human services and insurance regarding expenditures from the 1498
1817	1817		Connecticut Health Insurance Exchange account established under 1499
1818	1818		section 13 of this act for the preceding calendar year and disclosing 1500
1819	1819		whether such funds were sufficient to carry out the purposes set forth 1501
1820	1820		in subdivision (3) of subsection (b) of section 16 of this act for such 1502
1821	1821		preceding calendar year. 1503
1822	1822		Sec. 13. (NEW) (Effective July 1, 2021) There is established an account 1504
1823	1823		to be known as the "Connecticut Health Insurance Exchange account" 1505
1824	1824		which shall be a separate, nonlapsing account within the General Fund. 1506
1825	1825		The account shall contain any moneys required by law to be deposited 1507
1826	1826		in the account. Moneys in the account shall be expended by the 1508
1827	1827		exchange for the purposes set forth in subparagraph (C) of subdivision 1509
1828	1828		(28) of section 38a-1084 of the general statutes, as amended by this act. 1510
1829	1829		Sec. 14. (NEW) (Effective July 1, 2021) (a) For the purposes of this 1511
1830	1830		section, "individual market" has the same meaning as provided in 1512
1831	1831		Section 1304 of the Affordable Care Act. 1513
1832	1832		(b) Notwithstanding any provision of the general statutes and to the 1514
1833	1833		extent permitted by federal law, each qualified health plan that is 1515
1834	1834		offered through the exchange, in the individual market and at a silver 1516
1835	1835		level of coverage for plan year 2022 or any subsequent plan year shall 1517
1836	1836		provide coverage for the following benefits: 1518 Substitute Bill No. 842
1837	1837
1838	1838
1839	1839		LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
1840		-	~~R02~~-SB.docx }
	1840	+	R01-SB.docx }
1841	1841		52 of 59
1842	1842
1843	1843		(1) Angiotensin converting enzyme inhibitors for an enrollee who is 1519
1844	1844		diagnosed with congestive heart failure, diabetes or coronary artery 1520
1845	1845		disease by a licensed health care provider who is acting within such 1521
1846	1846		health care provider's scope of practice; 1522
1847	1847		(2) Anti-resorptive therapy for an enrollee who is diagnosed with 1523
1848	1848		osteoporosis or osteopenia by a licensed health care provider who is 1524
1849	1849		acting within such health care provider's scope of practice; 1525
1850	1850		(3) Beta-adrenergic blocking agents for an enrollee who is diagnosed 1526
1851	1851		with congestive heart failure or coronary artery disease by a licensed 1527
1852	1852		health care provider who is acting within such health care provider's 1528
1853	1853		scope of practice; 1529
1854	1854		(4) Blood pressure monitors for an enrollee who is diagnosed with 1530
1855	1855		hypertension by a licensed health care provider who is acting within 1531
1856	1856		such health care provider's scope of practice; 1532
1857	1857		(5) Inhaled corticosteroids and peak flow meters for an enrollee who 1533
1858	1858		is diagnosed with asthma by a licensed health care provider who is 1534
1859	1859		acting within such health care provider's scope of practice; 1535
1860	1860		(6) Insulin and other glucose lowering agents, retinopathy screening, 1536
1861	1861		glucometers and hemoglobin A1C testing for an enrollee who is 1537
1862	1862		diagnosed with diabetes by a licensed health care provider who is acting 1538
1863	1863		within such health care provider's scope of practice; 1539
1864	1864		(7) International normalized ratio testing for an enrollee who is 1540
1865	1865		diagnosed with liver disease or a bleeding disorder by a licensed health 1541
1866	1866		care provider who is acting within such health care provider's scope of 1542
1867	1867		practice; 1543
1868	1868		(8) Low density lipoprotein testing for an enrollee who is diagnosed 1544
1869	1869		with heart disease by a licensed health care provider who is acting 1545
1870	1870		within such health care provider's scope of practice; 1546
1871	1871		(9) Selective serotonin reuptake inhibitors for an enrollee who is 1547 Substitute Bill No. 842
1872	1872
1873	1873
1874	1874		LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
1875		-	~~R02~~-SB.docx }
	1875	+	R01-SB.docx }
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1877	1877
1878	1878		diagnosed with depression by a licensed health care provider who is 1548
1879	1879		acting within such health care provider's scope of practice; and 1549
1880	1880		(10) Statins for an enrollee who is diagnosed with heart disease or 1550
1881	1881		diabetes by a licensed health care provider who is acting within such 1551
1882	1882		health care provider's scope of practice. 1552
1883	1883		(c) Notwithstanding any provision of the general statutes and to the 1553
1884	1884		extent permitted by federal law, each qualified health plan described in 1554
1885	1885		subsection (b) of this section shall: 1555
1886	1886		(1) Have a minimum actuarial value of at least seventy per cent; and 1556
1887	1887		(2) Provide enrollees with access to the broadest provider network 1557
1888	1888		available under the qualified health plans offered by the health carrier 1558
1889	1889		through the exchange. 1559
1890	1890		Sec. 15. Subsections (a) and (b) of section 19a-754a of the general 1560
1891	1891		statutes are repealed and the following is substituted in lieu thereof 1561
1892	1892		(Effective July 1, 2021): 1562
1893	1893		(a) There is established an Office of Health Strategy, which shall be 1563
1894	1894		within the Department of Public Health for administrative purposes 1564
1895	1895		only. The department head of said office shall be the executive director 1565
1896	1896		of the Office of Health Strategy, who shall be appointed by the Governor 1566
1897	1897		in accordance with the provisions of sections 4-5 to 4-8, inclusive, with 1567
1898	1898		the powers and duties therein prescribed. 1568
1899	1899		(b) The Office of Health Strategy shall be responsible for the 1569
1900	1900		following: 1570
1901	1901		(1) Developing and implementing a comprehensive and cohesive 1571
1902	1902		health care vision for the state, including, but not limited to, a 1572
1903	1903		coordinated state health care cost containment strategy; 1573
1904	1904		(2) Promoting effective health planning and the provision of quality 1574
1905	1905		health care in the state in a manner that ensures access for all state 1575 Substitute Bill No. 842
1906	1906
1907	1907
1908	1908		LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
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1910	1910		54 of 59
1911	1911
1912	1912		residents to cost-effective health care services, avoids the duplication of 1576
1913	1913		such services and improves the availability and financial stability of 1577
1914	1914		such services throughout the state; 1578
1915	1915		(3) Directing and overseeing the State Innovation Model Initiative 1579
1916	1916		and related successor initiatives; 1580
1917	1917		(4) (A) Coordinating the state's health information technology 1581
1918	1918		initiatives, (B) seeking funding for and overseeing the planning, 1582
1919	1919		implementation and development of policies and procedures for the 1583
1920	1920		administration of the all-payer claims database program established 1584
1921	1921		under section 19a-775a, (C) establishing and maintaining a consumer 1585
1922	1922		health information Internet web site under section 19a-755b, and (D) 1586
1923	1923		designating an unclassified individual from the office to perform the 1587
1924	1924		duties of a health information technology officer as set forth in sections 1588
1925	1925		17b-59f and 17b-59g; 1589
1926	1926		(5) Directing and overseeing the Health Systems Planning Unit 1590
1927	1927		established under section 19a-612 and all of its duties and 1591
1928	1928		responsibilities as set forth in chapter 368z; [and] 1592
1929	1929		(6) Convening forums and meetings with state government and 1593
1930	1930		external stakeholders, including, but not limited to, the Connecticut 1594
1931	1931		Health Insurance Exchange, to discuss health care issues designed to 1595
1932	1932		develop effective health care cost and quality strategies; [.] 1596
1933	1933		(7) Annually (A) determining the amount described in subparagraph 1597
1934	1934		(A)(i) of subdivision (1) of subsection (b) of section 9 of this act, and (B) 1598
1935	1935		reporting such amount to the Insurance Commissioner pursuant to 1599
1936	1936		subparagraph (A)(ii) or (B) of subdivision (1) of subsection (b) of section 1600
1937	1937		9 of this act; 1601
1938	1938		(8) Developing a plan pursuant to subsection (b) of section 16 of this 1602
1939	1939		act and submitting a report containing such plan pursuant to subsection 1603
1940	1940		(c) of section 16 of this act; and 1604
1941	1941		(9) Developing standardized categories that enable (A) the 1605 Substitute Bill No. 842
1942	1942
1943	1943
1944	1944		LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
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1946	1946		55 of 59
1947	1947
1948	1948		Comptroller to collect demographic data pursuant to subparagraph (D) 1606
1949	1949		of subdivision (1) of subsection (c) of section 2 of this act, (B) health 1607
1950	1950		carriers to collect and submit demographic data pursuant to 1608
1951	1951		subparagraph (A) of subdivision (28) of section 38a-1084, as amended 1609
1952	1952		by this act, and (C) the exchange to collect demographic data pursuant 1610
1953	1953		to subparagraph (C) of subdivision (28) of section 38a-1084, as amended 1611
1954	1954		by this act. 1612
1955	1955		Sec. 16. (NEW) (Effective July 1, 2021) (a) For the purposes of this 1613
1956	1956		section: 1614
1957	1957		(1) "Account" means the Connecticut Health Insurance Exchange 1615
1958	1958		account established under section 13 of this act; 1616
1959	1959		(2) "Affordable Care Act" has the same meaning as provided in 1617
1960	1960		section 38a-1080 of the general statutes, as amended by this act; 1618
1961	1961		(3) "Exchange" has the same meaning as provided in section 38a-1080 1619
1962	1962		of the general statutes, as amended by this act; 1620
1963	1963		(4) "Office of Health Strategy" means the Office of Health Strategy 1621
1964	1964		established under section 19a-754a of the general statutes, as amended 1622
1965	1965		by this act; and 1623
1966	1966		(5) "Qualified health plan" has the same meaning as provided in 1624
1967	1967		section 38a-1080 of the general statutes, as amended by this act. 1625
1968	1968		(b) The Office of Health Strategy shall, in consultation with the 1626
1969	1969		exchange, develop a plan for the exchange to: 1627
1970	1970		(1) Establish a subsidiary, in the manner set forth in section 38a-1093 1628
1971	1971		of the general statutes, to create a marketplace for health carriers to offer 1629
1972	1972		affordable health insurance coverage to persons who are ineligible for 1630
1973	1973		coverage under the qualified health plans offered through the exchange; 1631
1974	1974		(2) Seek a state innovation waiver pursuant to Section 1332 of the 1632
1975	1975		Affordable Care Act for the purpose of: 1633 Substitute Bill No. 842
1976	1976
1977	1977
1978	1978		LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
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1980	1980		56 of 59
1981	1981
1982	1982		(A) Reducing the cost of health insurance coverage in this state, 1634
1983	1983		including, but not limited to, premiums and cost-sharing for such 1635
1984	1984		coverage; and 1636
1985	1985		(B) Making health insurance coverage available to persons in this 1637
1986	1986		state who are ineligible for coverage under a qualified health plan 1638
1987	1987		offered through the exchange; and 1639
1988	1988		(3) For plan year 2022 and subsequent plan years, use the moneys 1640
1989	1989		deposited in the account to: 1641
1990	1990		(A) Reduce the cost of qualified health plans offered through the 1642
1991	1991		exchange by, among other things: 1643
1992	1992		(i) Eliminating premiums for such qualified health plans for persons 1644
1993	1993		with a household income not exceeding two hundred one per cent of the 1645
1994	1994		federal poverty level; 1646
1995	1995		(ii) Reducing premiums and cost-sharing for such qualified health 1647
1996	1996		plans for persons with a household income exceeding two hundred one 1648
1997	1997		per cent of the federal poverty level; and 1649
1998	1998		(iii) Establishing a reinsurance program, provided the exchange shall 1650
1999	1999		not use more than twenty million dollars in the account to fund the 1651
2000	2000		reinsurance program for any fiscal year; 1652
2001	2001		(B) Make coverage affordable for persons who are ineligible for 1653
2002	2002		coverage under a qualified health plan offered through the exchange by, 1654
2003	2003		among other things, providing premium and cost-sharing subsidies to 1655
2004	2004		such persons which, in the aggregate for all such persons, shall not 1656
2005	2005		exceed twenty-five million dollars per year; and 1657
2006	2006		(C) Implement the provisions of the state innovation waiver 1658
2007	2007		described in subdivision (2) of this subsection if the federal government 1659
2008	2008		issues such waiver for this state. 1660
2009	2009		(c) Not later than August 1, 2021, the Office of Health Strategy shall 1661 Substitute Bill No. 842
2010	2010
2011	2011
2012	2012		LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
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2014	2014		57 of 59
2015	2015
2016	2016		submit a report, in accordance with section 11-4a of the general statutes, 1662
2017	2017		to the joint standing committee of the General Assembly having 1663
2018	2018		cognizance of matters relating to insurance. Such report shall contain 1664
2019	2019		the plan developed pursuant to subsection (b) of this section. 1665
2020	2020		(d) Not later than October 1, 2021, the joint standing committee of the 1666
2021	2021		General Assembly having cognizance of matters relating to insurance 1667
2022	2022		shall advise the Office of Health Strategy and the exchange of its 1668
2023	2023		approval or rejection of the plan contained in the report submitted by 1669
2024	2024		the Office of Health Strategy pursuant to subsection (c) of this section. If 1670
2025	2025		the committee does not act on or before said date, said plan shall be 1671
2026	2026		deemed rejected. 1672
2027	2027		(e) The Office of Health Strategy shall consult with the Department 1673
2028	2028		of Social Services and the exchange to determine whether this state 1674
2029	2029		should seek a waiver from the federal government under Section 1115 1675
2030	2030		of the Social Security Act, 42 USC 1315, as amended from time to time, 1676
2031	2031		to reduce costs to moderate and low income families. If, following such 1677
2032	2032		consultation, the Office of Health Strategy determines that this state 1678
2033	2033		should seek such waiver, the Office of Health Strategy may submit a 1679
2034	2034		report, in accordance with section 11-4a of the general statutes, to the 1680
2035	2035		joint standing committees of the General Assembly having cognizance 1681
2036	2036		of matters relating to appropriations, human services and insurance 1682
2037	2037		disclosing such determination and the reasons therefor. 1683
2038	2038		Sec. 17. Subsection (a) of section 17b-261 of the general statutes is 1684
2039	2039		repealed and the following is substituted in lieu thereof (Effective July 1, 1685
2040	2040		2021): 1686
2041	2041		(a) Medical assistance shall be provided for any otherwise eligible 1687
2042	2042		person whose income, including any available support from legally 1688
2043	2043		liable relatives and the income of the person's spouse or dependent 1689
2044	2044		child, is not more than one hundred forty-three per cent, pending 1690
2045	2045		approval of a federal waiver applied for pursuant to subsection (e) of 1691
2046	2046		this section, of the benefit amount paid to a person with no income 1692
2047	2047		under the temporary family assistance program in the appropriate 1693 Substitute Bill No. 842
2048	2048
2049	2049
2050	2050		LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
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2052	2052		58 of 59
2053	2053
2054	2054		region of residence and if such person is an institutionalized individual 1694
2055	2055		as defined in Section 1917 of the Social Security Act, 42 USC 1396p(h)(3), 1695
2056	2056		and has not made an assignment or transfer or other disposition of 1696
2057	2057		property for less than fair market value for the purpose of establishing 1697
2058	2058		eligibility for benefits or assistance under this section. Any such 1698
2059	2059		disposition shall be treated in accordance with Section 1917(c) of the 1699
2060	2060		Social Security Act, 42 USC 1396p(c). Any disposition of property made 1700
2061	2061		on behalf of an applicant or recipient or the spouse of an applicant or 1701
2062	2062		recipient by a guardian, conservator, person authorized to make such 1702
2063	2063		disposition pursuant to a power of attorney or other person so 1703
2064	2064		authorized by law shall be attributed to such applicant, recipient or 1704
2065	2065		spouse. A disposition of property ordered by a court shall be evaluated 1705
2066	2066		in accordance with the standards applied to any other such disposition 1706
2067	2067		for the purpose of determining eligibility. The commissioner shall 1707
2068	2068		establish the standards for eligibility for medical assistance at one 1708
2069	2069		hundred forty-three per cent of the benefit amount paid to a household 1709
2070	2070		of equal size with no income under the temporary family assistance 1710
2071	2071		program in the appropriate region of residence. In determining 1711
2072	2072		eligibility, the commissioner shall not consider as income Aid and 1712
2073	2073		Attendance pension benefits granted to a veteran, as defined in section 1713
2074	2074		27-103, or the surviving spouse of such veteran. Except as provided in 1714
2075	2075		section 17b-277 and section 17b-292, the medical assistance program 1715
2076	2076		shall provide coverage to persons under the age of nineteen with 1716
2077	2077		household income up to one hundred ninety-six per cent of the federal 1717
2078	2078		poverty level without an asset limit and to persons under the age of 1718
2079	2079		nineteen, who qualify for coverage under Section 1931 of the Social 1719
2080	2080		Security Act, with household income not exceeding one hundred 1720
2081	2081		ninety-six per cent of the federal poverty level without an asset limit, 1721
2082	2082		and their parents and needy caretaker relatives, who qualify for 1722
2083	2083		coverage under Section 1931 of the Social Security Act, with household 1723
2084	2084		income not exceeding [one hundred fifty-five] two hundred one per cent 1724
2085	2085		of the federal poverty level without an asset limit. Such levels shall be 1725
2086	2086		based on the regional differences in such benefit amount, if applicable, 1726
2087	2087		unless such levels based on regional differences are not in conformance 1727
2088	2088		with federal law. Any income in excess of the applicable amounts shall 1728 Substitute Bill No. 842
2089	2089
2090	2090
2091	2091		LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
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2093	2093		59 of 60
2094	2094
2095	2095		be applied as may be required by said federal law, and assistance shall 1729
2096	2096		be granted for the balance of the cost of authorized medical assistance. 1730
2097	2097		The Commissioner of Social Services shall provide applicants for 1731
2098	2098		assistance under this section, at the time of application, with a written 1732
2099	2099		statement advising them of (1) the effect of an assignment or transfer or 1733
2100	2100		other disposition of property on eligibility for benefits or assistance, (2) 1734
2101	2101		the effect that having income that exceeds the limits prescribed in this 1735
2102	2102		subsection will have with respect to program eligibility, and (3) the 1736
2103	2103		availability of, and eligibility for, services provided by the Nurturing 1737
2104	2104		Families Network established pursuant to section 17b-751b. For 1738
2105	2105		coverage dates on or after January 1, 2014, the department shall use the 1739
2106	2106		modified adjusted gross income financial eligibility rules set forth in 1740
2107	2107		Section 1902(e)(14) of the Social Security Act and the implementing 1741
2108	2108		regulations to determine eligibility for HUSKY A, HUSKY B and 1742
2109	2109		HUSKY D applicants, as defined in section 17b-290. Persons who are 1743
2110	2110		determined ineligible for assistance pursuant to this section shall be 1744
2111	2111		provided a written statement notifying such persons of their ineligibility 1745
2112	2112		and advising such persons of their potential eligibility for one of the 1746
2113	2113		other insurance affordability programs as defined in 42 CFR 435.4. 1747
2114	2114		Sec. 18. (NEW) (Effective July 1, 2021) The Labor Commissioner shall, 1748
2115	2115		within available appropriations, notify individuals applying for 1749
2116	2116		unemployment compensation benefits under chapter 567 of the general 1750
2117	2117		statutes that such individuals may be eligible for free or subsidized 1751
2118	2118		health coverage or other assistance or benefits, including, but not 1752
2119	2119		limited to, assistance under the supplemental nutrition assistance 1753
2120	2120		program. The commissioner shall refer such individuals to the exchange 1754
2121	2121		for the purpose of determining their eligibility for such coverage, 1755
2122	2122		assistance or benefits and, if such individuals are eligible for such 1756
2123	2123		coverage, assistance or benefits, enrolling such individuals in such 1757
2124	2124		coverage, assistance or benefits. For the purposes of this section, 1758
2125	2125		"exchange" and "qualified health plan" have the same meanings as 1759
2126	2126		provided in section 38a-1080 of the general statutes, as amended by this 1760
2127	2127		act. 1761 Substitute Bill No. 842
2128	2128
2129	2129
2130	2130		LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00842-
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2132	2132		60 of 60
2133	2133
2134	2134		This act shall take effect as follows and shall amend the following
2135	2135		sections:
2136	2136
2137	2137		Section 1 July 1, 2021 3-123rrr
2138	2138		Sec. 2 July 1, 2021 New section
2139	2139		Sec. 3 July 1, 2021 New section
2140	2140		Sec. 4 July 1, 2021 New section
2141	2141		Sec. 5 July 1, 2021 19a-7j
2142	2142		Sec. 6 July 1, 2021 19a-7p
2143	2143		Sec. 7 July 1, 2021 38a-52
2144	2144		Sec. 8 July 1, 2021 38a-1041
2145	2145		Sec. 9 July 1, 2021 New section
2146	2146		Sec. 10 July 1, 2021 38a-1080
2147	2147		Sec. 11 July 1, 2021 38a-1084
2148	2148		Sec. 12 July 1, 2021 38a-1089
2149	2149		Sec. 13 July 1, 2021 New section
2150	2150		Sec. 14 July 1, 2021 New section
2151	2151		Sec. 15 July 1, 2021 19a-754a(a) and (b)
2152	2152		Sec. 16 July 1, 2021 New section
2153	2153		Sec. 17 July 1, 2021 17b-261(a)
2154	2154		Sec. 18 July 1, 2021 New section
2155	2155
2156	2156		INS Joint Favorable Subst. C/R FIN
2157		-	FIN Joint Favorable
2158	2157