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General Assembly Committee Bill No. 10
January Session, 2023
LCO No. 5227
Referred to Committee on HUMAN SERVICES
Introduced by:
(HS)
AN ACT PROMOTING ACCESS TO AFFORDABLE PRESCRIPTION
DRUGS, HEALTH CARE COVERAGE, TRANSPARENCY IN HEALTH
CARE COSTS, HOME AND COMMUNITY -BASED SUPPORT FOR
VULNERABLE PERSONS AND RIGHTS REGARDING GENDER
IDENTITY AND EXPRESSION.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. Subsection (d) of section 19a-754b of the general statutes is 1
repealed and the following is substituted in lieu thereof (Effective July 1, 2
2023): 3
(d) (1) On or before March 1, 2020, and annually thereafter, the 4
executive director of the Office of Health Strategy, in consultation with 5
the Comptroller, Commissioner of Social Services and Commissioner of 6
Public Health, shall prepare and make public a list of not more than ten 7
outpatient prescription drugs that the executive director, in the 8
executive director's discretion, determines are (A) provided at 9
substantial cost to the state, considering the net cost of such drugs, or 10
(B) critical to public health. The list shall include outpatient prescription 11
drugs from different therapeutic classes of outpatient prescription 12
drugs and at least one generic outpatient prescription drug. 13
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(2) [The executive director shall not list any outpatient prescription 14
drug under subdivision (1) of this subsection unless the wholesale 15
acquisition cost of the drug, less all rebates paid to the state for such 16
drug during the immediately preceding calendar year, (A) increased by 17
at least (i) twenty per cent during the immediately preceding calendar 18
year, or (ii) fifty per cent during the immediately preceding three 19
calendar years, and (B) was not less than sixty dollars for (i) a thirty-day 20
supply of such drug, or (ii) a course of treatment of such drug lasting 21
less than thirty days.] Prior to publishing the annual list of outpatient 22
prescription drugs pursuant to subdivision (1) of this subsection, the 23
executive director shall prepare a preliminary list of those outpatient 24
prescription drugs that the executive director plans to include on the 25
list. The executive director shall make the preliminary list available for 26
public comment for not less than thirty days, during which time any 27
manufacturer of an outpatient prescription drug named on the 28
preliminary list may produce documentation to establish that the 29
wholesale acquisition cost of the drug, less all rebates paid to the state 30
for such drug during the immediately preceding calendar year, does not 31
exceed the limits established in subdivision (3) of this subsection. If such 32
documentation establishes, to the satisfaction of the executive director, 33
that the wholesale acquisition cost, less all rebates paid to the state for 34
such drug during the immediately preceding calendar year, does not 35
exceed the limits established in subdivision (3) of this subsection, the 36
executive director shall remove such drug from the list before 37
publishing the final list. The executive director shall publish a final list 38
pursuant to subdivision (1) of this subsection not later than fifteen days 39
after the closing of the public comment period. 40
(3) The executive director shall not list any outpatient prescription 41
drug under subdivision (1) or (2) of this subsection unless the wholesale 42
acquisition cost of the drug (A) increased by at least sixteen per cent 43
cumulatively during the immediately preceding two calendar years, 44
and (B) was not less than forty dollars for a course of therapy. 45
[(3)] (4) (A) The pharmaceutical manufacturer of an outpatient 46
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prescription drug included on a list prepared by the executive director 47
pursuant to subdivision (1) of this subsection shall provide to the office, 48
in a form and manner specified by the executive director, (i) a written, 49
narrative description, suitable for public release, of all factors that 50
caused the increase in the wholesale acquisition cost of the listed 51
outpatient prescription drug, and (ii) aggregate, company-level research 52
and development costs and such other capital expenditures that the 53
executive director, in the executive director's discretion, deems relevant 54
for the most recent year for which final audited data are available. 55
(B) The quality and types of information and data that a 56
pharmaceutical manufacturer submits to the office under this 57
subdivision shall be consistent with the quality and types of information 58
and data that the pharmaceutical manufacturer includes in (i) such 59
pharmaceutical manufacturer's annual consolidated report on Securities 60
and Exchange Commission Form 10 -K, or (ii) any other public 61
disclosure. 62
[(4)] (5) The office shall establish a standardized form for reporting 63
information and data pursuant to this subsection after consulting with 64
pharmaceutical manufacturers. The form shall be designed to minimize 65
the administrative burden and cost of reporting on the office and 66
pharmaceutical manufacturers. 67
Sec. 2. (NEW) (Effective January 1, 2024, and applicable to contracts 68
entered into, amended or renewed on and after January 1, 2024) (a) For the 69
purposes of this section and sections 3 and 4 of this act: 70
(1) "Distributor" means any person or entity, including any 71
wholesaler, who supplies drugs, devices or cosmetics prepared, 72
produced or packaged by manufacturers, to other wholesalers, 73
manufacturers, distributors, hospitals, clinics, practitioners or 74
pharmacies or federal, state and municipal agencies; 75
(2) "Manufacturer" means the following: 76
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(A) Any entity described in 42 USC 1396r-8(k)(5) that is subject to the 77
pricing limitations set forth in 42 USC 256b; and 78
(B) Any wholesaler described in 42 USC 1396r-8(k)(11) engaged in the 79
distribution of covered drugs for any entity described in 42 USC1396r-80
8(k)(5) that is subject to the pricing limitations set forth in 42 USC 256b; 81
(3) "ERISA plan" means an employee welfare benefit plan subject to 82
the Employee Retirement Income Security Act of 1974, as amended from 83
time to time; 84
(4) (A) "Health benefit plan" means any insurance policy or contract 85
offered, delivered, issued for delivery, renewed, amended or continued 86
in the state by a health carrier to provide, deliver, pay for or reimburse 87
any of the costs of health care services; 88
(B) "Health benefit plan" does not include: 89
(i) Coverage of the type specified in subdivisions (5), (6), (7), (8), (9), 90
(14), (15) and (16) of section 38a-469 of the general statutes or any 91
combination thereof; 92
(ii) Coverage issued as a supplement to liability insurance; 93
(iii) Liability insurance, including general liability insurance and 94
automobile liability insurance; 95
(iv) Workers' compensation insurance; 96
(v) Automobile medical payment insurance; 97
(vi) Credit insurance; 98
(vii) Coverage for on-site medical clinics; or 99
(viii) Other similar insurance coverage specified in regulations issued 100
pursuant to the Health Insurance Portability and Accountability Act of 101
1996, P.L. 104-191, as amended from time to time, under which benefits 102
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for health care services are secondary or incidental to other insurance 103
benefits; and 104
(C) "Health benefit plan" does not include the following benefits if 105
such benefits are provided under a separate insurance policy, certificate 106
or contract or are otherwise not an integral part of the plan: 107
(i) Limited scope dental or vision benefits; 108
(ii) Benefits for long-term care, nursing home care, home health care, 109
community-based care or any combination thereof; 110
(iii) Other similar, limited benefits specified in regulations issued 111
pursuant to the Health Insurance Portability and Accountability Act of 112
1996, P.L. 104-191, as amended from time to time; 113
(iv) Other supplemental coverage, similar to coverage of the type 114
specified in subdivisions (9) and (14) of section 38a-469 of the general 115
statutes, provided under a group health plan; or 116
(v) Coverage of the type specified in subdivision (3) or (13) of section 117
38a-469 of the general statutes or other fixed indemnity insurance if (I) 118
such coverage is provided under a separate insurance policy, certificate 119
or contract, (II) there is no coordination between the provision of the 120
benefits and any exclusion of benefits under any group health plan 121
maintained by the same plan sponsor, and (III) the benefits are paid with 122
respect to an event without regard to whether benefits were also 123
provided under any group health plan maintained by the same plan 124
sponsor; 125
(5) "Maximum fair price" means the maximum rate for a prescription 126
drug published by the Secretary of the United States Department of 127
Health and Human Services under Section 1191 of the Inflation 128
Reduction Act of 2022, P.L. 117-169, as amended from time to time. 129
"Maximum fair price" does not include any dispensing fee paid to a 130
pharmacy for dispensing any referenced drug; 131
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(6) "Participating ERISA plan" means any employee welfare benefit 132
plan subject to the Employee Retirement Income Security Act of 1974, as 133
amended from time to time, that elects to participate in the requirements 134
pursuant to section 3 or 4 of this act; 135
(7) "Price applicability period" has the same meaning as provided in 136
Section 1191 of the Inflation Reduction Act of 2022, P.L. 117-169, as 137
amended from time to time; 138
(8) "Purchaser" means any state entity, health benefit plan or 139
participating ERISA plan; 140
(9) "Referenced drug" means any prescription drug subject to the 141
maximum fair price; and 142
(10) "State entity" means any agency of this state, including, any 143
agent, vendor, fiscal agent, contractor or other person acting on behalf 144
of this state, that purchases a prescription drug on behalf of this state for 145
a person who maintains a health insurance policy that is paid for by this 146
state, including health insurance coverage offered through local, state or 147
federal agencies or through organizations licensed in this state. "State 148
entity" does not include the medical assistance program administered 149
under Title XIX of the Social Security Act, 42 USC 1396 et seq., as 150
amended from time to time. 151
Sec. 3. (NEW) (Effective January 1, 2024, and applicable to contracts 152
entered into, amended or renewed on and after January 1, 2024) (a) No 153
purchaser shall purchase a referenced drug or seek reimbursement for 154
a referenced drug to be dispensed, delivered or administered to an 155
insured in this state, by hand delivery, mail or by other means, directly 156
or through a distributor, for a cost that exceeds the maximum fair price 157
during the price applicability period for such drug published pursuant 158
to Section 1191 of the Inflation Reduction Act of 2022, P.L. 117-169, as 159
amended from time to time. 160
(b) Each purchaser shall calculate such purchaser's savings generated 161
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pursuant to subsection (a) of this section and shall apply such savings 162
to reduce prescription drug costs for the purchaser's insureds. Not later 163
than January fifteenth of each calendar year, a purchaser shall submit a 164
report to the Insurance Department that (1) provides an assessment of 165
such purchaser's savings for each referenced drug for the previous 166
calendar year, and (2) identifies how each purchaser applied such 167
savings to (A) reduce prescription drug costs for such purchaser's 168
insureds, and (B) decrease cost disparities. 169
(c) An ERISA plan may elect to participate in the requirements of this 170
section by notifying the Insurance Department, in writing, not later than 171
January first of each calendar year. 172
(d) Any violation by a purchaser of subsection (a) of this section shall 173
be subject to a civil penalty of one thousand dollars for each such 174
violation. 175
(e) The Insurance Commissioner shall adopt regulations, in 176
accordance with the provisions of chapter 54 of the general statutes, to 177
implement the provisions of this section and section 4 of this act. 178
Sec. 4. (NEW) (Effective January 1, 2024, and applicable to contracts 179
entered into, amended or renewed on and after January 1, 2024) (a) No 180
manufacturer or distributor of a referenced drug shall withdraw such 181
referenced drug from sale or distribution in this state to attempt to avoid 182
any loss of revenue resulting from the maximum fair price requirement 183
established in section 3 of this act. 184
(b) Each manufacturer or distributor shall provide not less than one 185
hundred eighty days' written notice to the Insurance Commissioner and 186
Attorney General prior to withdrawing a referenced drug from sale or 187
distribution in this state. 188
(c) If any manufacturer or distributor violates the provisions of 189
subsection (a) or (b) of this section, such manufacturer or distributor 190
shall be subject to a civil penalty of (1) five hundred thousand dollars, 191
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or (2) such purchaser's amount of annual savings generated pursuant to 192
subsection (a) of section 3 of this act, as determined by the Insurance 193
Commissioner, whichever is greater. 194
(d) It shall be a violation of this section for any manufacturer or 195
distributor of a referenced drug to negotiate with a purchaser or seller 196
of a referenced drug at a price that exceeds the maximum fair price. 197
(e) The Attorney General shall have exclusive authority to enforce 198
violations of this section and section 3 of this act. 199
Sec. 5. (NEW) (Effective July 1, 2023) (a) As used in this section and 200
section 6 of this act, (1) "federal 340B drug pricing program" means the 201
plan described in Section 340B of the Public Health Service Act, 42 USC 202
256b, as amended from time to time, (2) "340B covered entity" means a 203
provider participating in the federal 340B drug pricing program, (3) 204
"prescription drug" has the same meaning as provided in section 19a-205
754b of the general statutes, and (4) "rebate" has the same meaning as 206
provided in section 38a-479ooo of the general statutes. 207
(b) Not later than January fifteenth annually, a 340B covered entity 208
shall provide a report to the executive director of the Office of Health 209
Strategy, established pursuant to section 19a-754a of the general 210
statutes, as amended by this act, providing, for the previous calendar 211
year (1) a list of all prescription drugs, identified by the national drug 212
code number, purchased through the federal 340B drug pricing 213
program, (2) the actual purchase price of each such prescription drug 214
after any rebate or discount provided pursuant to the program, (3) the 215
actual payment each such 340B covered entity received from any private 216
or public health insurance plan, except for Medicaid and Medicare, or 217
patient for each such prescription drug, (4) the average percentage 218
savings realized by each 340B covered entity on the cost of prescription 219
drugs under the 340B program, and (5) how the 340B covered entity 220
used prescription drug cost savings under the program. The executive 221
director shall include a link to the report on the office's Internet web site. 222
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Sec. 6. (NEW) (Effective July 1, 2023) No 340B covered entity shall 223
attempt to collect as medical debt any payment for a prescription drug 224
obtained with a rebate or at a discounted price through the federal 340B 225
drug pricing program by such entity but charged to a patient by the 226
entity at a higher price. 227
Sec. 7. (NEW) (Effective July 1, 2023) (a) There is established a 228
Prescription Drug Payment Evaluation Committee to recommend 229
upper payment limits on not fewer than eight prescription drugs to the 230
executive director of the Office of Health Strategy based on evaluation 231
of upper payment limits on such drugs set by other states or foreign 232
jurisdictions. 233
(b) Members of the committee shall be as follows: 234
(1) Three appointed by the speaker of the House of Representatives, 235
who shall be (A) a representative of a state-wide health care advocacy 236
coalition, (B) a representative of a state-wide advocacy organization for 237
elderly persons, and (C) a representative of a state-wide organization 238
for diverse communities; 239
(2) Three appointed by the president pro tempore of the Senate, who 240
shall be (A) a representative of a labor union, (B) a health services 241
researcher, and (C) a consumer who has experienced barriers to 242
obtaining prescription drugs due to the cost of such drugs; 243
(3) Two appointed by the majority leader of the House of 244
Representatives, who shall be representatives of 340B covered entities, 245
as defined in section 5 of this act; 246
(4) Two appointed by the minority leader of the Hous e of 247
Representatives, who shall be representatives of private insurers; 248
(5) Two appointed by the majority leader of the Senate, who shall be 249
representatives of organizations representing health care providers; 250
(6) Two appointed by the minority leader of the Senate, who shall be 251
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(A) a representative of a pharmaceutical company doing business in the 252
state, and (B) a representative of an academic institution with expertise 253
in health care costs; 254
(7) Two appointed by the Governor, who shall be (A) a representative 255
of pharmacists, and (B) a representative of pharmacy benefit managers; 256
(8) The Secretary of the Office of Policy and Management, or the 257
secretary's designee; 258
(9) The Commissioner of Social Services, or the commissioner's 259
designee; 260
(10) The Commissioner of Public Health, or the commissioner's 261
designee; 262
(11) The Insurance Commissioner, or the commissioner's designee; 263
(12) The Commissioner of Consumer Protection, or the 264
commissioner's designee; 265
(13) The executive director of the Office of Health Strategy, or the 266
executive director's designee; and 267
(14) The Healthcare Advocate, or the Healthcare Advocate's 268
designee. 269
(c) All initial appointments to the committee shall be made not later 270
than thirty days after the effective date of this section. Any vacancy shall 271
be filled by the appointing authority. 272
(d) The speaker of the House of Representatives and the president 273
pro tempore of the Senate shall select the chairpersons of the committee 274
from among the members of the committee. Such chairpersons shall 275
schedule the first meeting of the committee, which shall be held not later 276
than sixty days after the effective date of this section. 277
(e) The administrative staff of the joint standing committee of the 278
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General Assembly having cognizance of matters relating to insurance 279
shall serve as administrative staff of the committee. 280
(f) Not later than December 1, 2023, and annually thereafter, the 281
committee shall submit a report, in accordance with the provisions of 282
section 11-4a of the general statutes, to the executive director of the 283
Office of Health Strategy and the joint standing committees of the 284
General Assembly having cognizance of matters relating to 285
appropriations and the budgets of state agencies, human services, 286
insurance and public health with its recommendations concerning 287
upper payment limits for not fewer than eight prescription drugs. 288
Sec. 8. Section 3-112 of the general statutes is repealed and the 289
following is substituted in lieu thereof (Effective July 1, 2023): 290
(a) The Comptroller shall: (1) Establish and maintain the accounts of 291
the state government and perform such other duties as are prescribed 292
by the Constitution of the state; (2) register all warrants or orders for the 293
disbursement of the public money; (3) adjust and settle all demands 294
against the state not first adjusted and settled by the General Assembly 295
and give orders on the Treasurer for the balance found and allowed; (4) 296
prescribe the mode of keeping and rendering all public accounts of 297
departments or agencies of the state and of institutions supported by the 298
state or receiving state aid by appropriation from the General Assembly; 299
(5) prepare and issue effective accounting and payroll manuals for use 300
by the various agencies of the state; (6) from time to time, examine and 301
state the amount of all debts and credits of the state; present all claims 302
in favor of the state against any bankrupt, insolvent debtor or deceased 303
person; and institute and maintain suits, in the name of the state, against 304
all persons who have received money or property belonging to the state 305
and have not accounted for it; and (7) administer the Connecticut 306
Retirement Security Program, established pursuant to section 31-418. 307
(b) All moneys recovered, procured or received for the state by the 308
authority of the Comptroller shall be paid to the Treasurer, who shall 309
file a duplicate receipt therefor with the Comptroller. The Comptroller 310
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may require reports from any department, agency or institution as 311
aforesaid upon any matter of property or finance at any time and under 312
such regulations as the Comptroller prescribes and shall require special 313
reports upon request of the Governor, and the information contained in 314
such special reports shall be transmitted by him to the Governor. All 315
records, books and papers in any public office shall at all reasonable 316
times be open to inspection by the Comptroller. The Comptroller may 317
draw his order on the Treasurer for a petty cash fund for any budgeted 318
agency. Expenditures from such petty cash funds shall be subject to such 319
procedures as the Comptroller establishes. In accordance with 320
established procedures, the Comptroller may enter into such contractual 321
agreements as may be necessary for the discharge of his duties. As used 322
in this section, "adjust" means to determine the amount equitably due in 323
respect to each item of each claim or demand. 324
(c) The Comptroller shall establish and administer a prescription 325
drug discount card program available to all residents of the state. The 326
Comptroller may coordinate participation in a multistate prescription 327
drug consortium for the purposes of pooling prescription drug 328
purchasing power to lower costs by negotiating discounts with 329
prescription drug manufacturers and coordinating volume discount 330
contracting. 331
Sec. 9. Section 38a-477g of the general statutes is repealed and the 332
following is substituted in lieu thereof (Effective January 1, 2024): 333
(a) As used in this section: [(1) "Covered person", "facility" and "health 334
carrier" have the same meanings as provided in section 38a-591a, (2) 335
"health care provider" has the same meaning as provided in subsection 336
(a) of section 38a-477aa, and (3) "intermediary", "network", "network 337
plan" and "participating provider" have the same meanings as provided 338
in subsection (a) of section 38a-472f.] 339
(1) "All-or-nothing clause" means a provision in a health care contract 340
that: 341
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(A) Requires the health insurance carrier or health plan administrator 342
to include all members of a health care provider in a network plan; or 343
(B) Requires the health insurance carrier or health plan administrator 344
to enter into any additional contract with an affiliate of the health care 345
provider as a condition to entering into a contract with such health care 346
provider. 347
(2) "Anti-steering clause" means a provision of a health care contract 348
that restricts the ability of the health insurance carrier or health plan 349
administrator from encouraging an enrollee to obtain a health care 350
service from a competitor of the hospital or health system, including 351
offering incentives to encourage enrollees to utilize specific health care 352
providers. 353
(3) "Anti-tiering clause" means a provision in a health care contract 354
that: 355
(A) Restricts the ability of the health insurance carrier or health plan 356
administrator to introduce and modify a tiered network plan or assign 357
health care providers into tiers; or 358
(B) Requires the health insurance carrier or health plan administrator 359
to place all members of a health care provider in the same tier of a tiered 360
network plan. 361
(4) "Covered person", "facility" and "health carrier" have the same 362
meanings as provided in section 38a-591a. 363
(5) "Health care provider" has the same meaning as provided in 364
subsection (a) of section 38a-477aa. 365
(6) "Health plan administrator" means a third-party administrator 366
who acts on behalf of a plan sponsor to administer a health benefit plan. 367
(7) "Intermediary", "network", "network plan" and "participating 368
provider" have the same meanings as provided in subsection (a) of 369
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section 38a-472f. 370
(8) "Tiered network" has the same meaning as provided in section 371
38a-472f. 372
(9) "Value-based care" means a health care coverage model in which 373
providers, including hospitals and physicians, are paid based on patient 374
health outcomes. 375
(b) (1) Each contract entered into, renewed or amended on or after 376
January 1, [2017] 2024, between a health carrier and a participating 377
provider shall include: 378
(A) A hold harmless provision that specifies protections for covered 379
persons. Such provision shall include the following statement or a 380
substantially similar statement: "Provider agrees that in no event, 381
including, but not limited to, nonpayment by the health carrier or 382
intermediary, the insolvency of the health carrier or intermediary, or a 383
breach of this agreement, shall the provider bill, charge, collect a deposit 384
from, seek compensation, remuneration or reimbursement from, or 385
have any recourse against a covered person or a person (other than the 386
health carrier or intermediary) acting on behalf of the covered person 387
for services provided pursuant to this agreement. This agreement does 388
not prohibit the provider from collecting coinsurance, deductibles or 389
copayments, as specifically provided in the evidence of coverage, or fees 390
for uncovered services delivered on a fee-for-service basis to covered 391
persons. Nor does this agreement prohibit a provider (except for a 392
health care provider who is employed full-time on the staff of a health 393
carrier and has agreed to provide services exclusively to that health 394
carrier's covered persons and no others) and a covered person from 395
agreeing to continue services solely at the expense of the covered 396
person, as long as the provider has clearly informed the covered person 397
that the health carrier does not cover or continue to cover a specific 398
service or services. Except as provided herein, this agreement does not 399
prohibit the provider from pursuing any available legal remedy."; 400
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(B) A provision that in the event of a health carrier or intermediary 401
insolvency or other cessation of operations, the participating provider's 402
obligation to deliver covered health care services to covered persons 403
without requesting payment from a covered person other than a 404
coinsurance, copayment, deductible or other out-of-pocket expense for 405
such services will continue until the earlier of (i) the termination of the 406
covered person's coverage under the network plan, including any 407
extension of coverage provided under the contract terms or applicable 408
state or federal law for covered persons who are in an active course of 409
treatment, as set forth in subdivision (2) of subsection (g) of section 38a-410
472f, or are totally disabled, or (ii) the date the contract between the 411
health carrier and the participating provider would have terminated if 412
the health carrier or intermediary had remained in operation, including 413
any extension of coverage required under applicable state or federal law 414
for covered persons who are in an active course of treatment or are 415
totally disabled; 416
(C) (i) A provision that requires the participating provider to make 417
health records available to appropriate state and federal authorities 418
involved in assessing the quality of care provided to, or investigating 419
grievances or complaints of, covered persons, and (ii) a statement that 420
such participating provider shall comply with applicable state and 421
federal laws related to the confidentiality of medical and health records 422
and a covered person's right to view, obtain copies of or amend such 423
covered person's medical and health records; and 424
(D) (i) If such contract is entered into, renewed or amended before 425
July 1, 2022, definitions of what is considered timely notice and a 426
material change for the purposes of subparagraph (A) of subdivision (2) 427
of subsection (c) of this section, or (ii) if such contract is entered into, 428
renewed or amended on or after July 1, 2022, (I) a statement disclosing 429
the ninety-day advance written notice requirement established under 430
subparagraph (B) of subdivision (2) of subsection (c) of this section and 431
what is considered a material change for the purposes of subdivision (2) 432
of subsection (c) of this section, and (II) provisions affording the 433
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participating provider a right to appeal any proposed change to the 434
provisions, other documents, provider manuals or policies disclosed 435
pursuant to subdivision (1) of subsection (c) of this section. 436
(2) The contract terms set forth in subparagraphs (A) and (B) of 437
subdivision (1) of this subsection shall (A) be construed in favor of the 438
covered person, (B) survive the termination of the contract regardless of 439
the reason for the termination, including the insolvency of the health 440
carrier, and (C) supersede any oral or written agreement between a 441
health care provider and a covered person or a covered person's 442
authorized representative that is contrary to or inconsistent with the 443
requirements set forth in subdivision (1) of this subsection. 444
(3) No contract subject to this subsection shall include any provision 445
that conflicts with the provisions contained in the network plan or 446
required under this section, section 38a-472f or section 38a-477h. 447
(4) No health carrier or participating provider that is a party to a 448
contract under this subsection shall assign or delegate any right or 449
responsibility required under such contract without the prior written 450
consent of the other party. 451
(c) (1) At the time a contract subject to subsection (b) of this section is 452
signed, the health carrier or such health carrier's intermediary shall 453
disclose to a participating provider: 454
(A) All provisions and other documents incorporated by reference in 455
such contract; and 456
(B) If such contract is entered into, renewed or amended on or after 457
July 1, 2022, all provider manuals and policies incorporated by reference 458
in such contract, if any. 459
(2) While such contract is in force, the health carrier shall: 460
(A) If such contract is entered into, renewed or amended before July 461
1, 2022, timely notify a participating provider of any change to the 462
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provisions or other documents specified under subparagraph (A) of 463
subdivision (1) of this subsection that will result in a material change to 464
such contract; or 465
(B) If such contract is entered into, renewed or amended on or after 466
July 1, 2022, provide to a participating provider at least ninety days' 467
advance written notice of any change to the provisions or other 468
documents specified under subparagraph (A) of subdivision (1) of this 469
subsection, and any change to the provider manuals and policies 470
specified under subparagraph (B) of subdivision (1) of this subsection, 471
that will result in a material change to such contract or the procedures 472
that a participating provider must follow pursuant to such contract. 473
(d) (1) (A) Each contract between a health carrier and an intermediary 474
entered into, renewed or amended on or after January 1, 2017, shall 475
satisfy the requirements of this subsection. 476
(B) Each intermediary and participating providers with whom such 477
intermediary contracts shall comply with the applicable requirements 478
of this subsection. 479
(2) No health carrier shall assign or delegate to an intermediary such 480
health carrier's responsibilities to monitor the offering of covered 481
benefits to covered persons. To the extent a health carrier assigns or 482
delegates to an intermediary other responsibilities, such health carrier 483
shall retain full responsibility for such intermediary's compliance with 484
the requirements of this section. 485
(3) A health carrier shall have the right to approve or disapprove the 486
participation status of a health care provider or facility in such health 487
carrier's own or a contracted network that is subcontracted for the 488
purpose of providing covered benefits to the health carrier's covered 489
persons. 490
(4) A health carrier shall maintain at its principal place of business in 491
this state copies of all intermediary subcontracts or ensure that such 492
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health carrier has access to all such subcontracts. Such health carrier 493
shall have the right, upon twenty days' prior written notice, to make 494
copies of any intermediary subcontracts to facilitate regulatory review. 495
(5) (A) Each intermediary shall, if applicable, (i) transmit to the health 496
carrier documentation of health care services utilization and claims 497
paid, and (ii) maintain at its principal place of business in this state, for 498
a period of time prescribed by the commissioner, the books, records, 499
financial information and documentation of health care services 500
received by covered persons, in a manner that facilitates regulatory 501
review, and shall allow the commissioner access to such books, records, 502
financial information and documentation as necessary for the 503
commissioner to determine compliance with this section and section 504
38a-472f. 505
(B) Each health carrier shall monitor the timeliness and 506
appropriateness of payments made by its intermediary to participating 507
providers and of health care services received by covered persons. 508
(6) In the event of the intermediary's insolvency, a health carrier shall 509
have the right to require the assignment to the health carrier of the 510
provisions of a participating provider's contract that address such 511
participating provider's obligation to provide covered benefits. If a 512
health carrier requires such assignment, such health carrier shall remain 513
obligated to pay the participating provider for providing covered 514
benefits under the same terms and conditions as the intermediary prior 515
to the insolvency. 516
(e) The commissioner shall not act to arbitrate, mediate or settle (1) 517
disputes regarding a health carrier's decision not to include a health care 518
provider or facility in such health carrier's network or network plan, or 519
(2) any other dispute between a health carrier, such health carrier's 520
intermediary or one or more participating providers, that arises under 521
or by reason of a participating provider contract or the termination of 522
such contract. 523
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(f) No health insurance carrier, health care provider, health plan 524
administrator or any agent or other entity that contracts on behalf of a 525
health care provider, health insurance carrier or health plan 526
administrator may offer, solicit, request, amend, renew or enter into a 527
health care contract that would directly or indirectly include any of the 528
following provisions: 529
(1) An all-or-nothing clause; 530
(2) An anti-steering clause; 531
(3) An anti-tiering clause; or 532
(4) Any other clause that results or intends to result in 533
anticompetitive effects. 534
(g) Any contract, written policy, written procedure or agreement that 535
contains a clause contrary to the provisions set forth in subsection (f) of 536
this section shall be null and void. All remaining clauses of the contract 537
shall remain in effect for the duration of the contract term. 538
(h) Nothing in this section shall be construed to prohibit value-based 539
care. 540
(i) The Insurance Commissioner may adopt regulations, in 541
accordance with chapter 54, to implement the provisions of subsection 542
(f) of this section. 543
Sec. 10. Subsection (a) of section 17b-242 of the general statutes is 544
repealed and the following is substituted in lieu thereof (Effective July 1, 545
2023): 546
(a) The Department of Social Services shall determine the rates to be 547
paid to home health care agencies and home health aide agencies by the 548
state or any town in the state for persons aided or cared for by the state 549
or any such town. The Commissioner of Social Services shall establish a 550
fee schedule for home health services to be effective on and after July 1, 551
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1994. The commissioner may annually modify such fee schedule if such 552
modification is needed to ensure that the conversion to an 553
administrative services organization is cost neutral to home health care 554
agencies and home health aide agencies in the aggregate and ensures 555
patient access. Utilization may be a factor in determining cost neutrality. 556
The commissioner shall increase the fee schedule for home health 557
services provided under the Connecticut home-care program for the 558
elderly established under section 17b-342, effective July 1, 2000, by two 559
per cent over the fee schedule for home health services for the previous 560
year. The commissioner shall include in the fee schedule not less than 561
two licensed clinical social worker visits to each individual enrolled in 562
the Connecticut home-care program for the elderly or any home and 563
community-based Medicaid waiver program administered by the 564
Department of Social Services. The commissioner may increase any fee 565
payable to a home health care agency or home health aide agency upon 566
the application of such an agency evidencing extraordinary costs related 567
to (1) serving persons with AIDS; (2) high-risk maternal and child health 568
care; (3) escort services; or (4) extended hour services. In no case shall 569
any rate or fee exceed the charge to the general public for similar 570
services. A home health care agency or home health aide agency which, 571
due to any material change in circumstances, is aggrieved by a rate 572
determined pursuant to this subsection may, within ten days of receipt 573
of written notice of such rate from the Commissioner of Social Services, 574
request in writing a hearing on all items of aggrievement. The 575
commissioner shall, upon the receipt of all documentation necessary to 576
evaluate the request, determine whether there has been such a change 577
in circumstances and shall conduct a hearing if appropriate. The 578
Commissioner of Social Services shall adopt regulations, in accordance 579
with chapter 54, to implement the provisions of this subsection. The 580
commissioner may implement policies and procedures to carry out the 581
provisions of this subsection while in the process of adopting 582
regulations, provided notice of intent to adopt the regulations is 583
published in the Connecticut Law Journal not later than twenty days 584
after the date of implementing the policies and procedures. Such 585
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policies and procedures shall be valid for not longer than nine months. 586
Sec. 11. (NEW) (Effective from passage) (a) For purposes of this section, 587
"certified community health worker" has the same meaning as provided 588
in section 20-195ttt of the general statutes. The Commissioner of Social 589
Services shall design and implement a program to provide Medicaid 590
reimbursement to certified community health workers for services 591
provided to HUSKY Health program members, including, but not 592
limited to: (1) Coordination of medical, oral and behavioral health care 593
services and social supports; (2) connection to and navigation of health 594
systems and services; (3) prenatal, birth, lactation and postpartum 595
supports; and (4) health promotion, coaching and self-management 596
education. 597
(b) The commissioner shall provide reimbursement for the services 598
of certified community health workers in a manner and at a rate 599
conducive to workforce growth. 600
(c) The commissioner and the commissioner's designees shall consult 601
with certified community health workers and others throughout the 602
design and implementation of the certified community health worker 603
reimbursement program in a manner that (1) is inclusive of community-604
based and clinic-based certified community health workers; (2) is 605
representative of medical assistance program member demographics; 606
and (3) helps shape the reimbursement program's design and 607
implementation. 608
(d) The Department of Social Services shall coordinate with the Office 609
of Health Strategy to identify opportunities for the integration of 610
certified community health workers into the medical assistance 611
program. Not later than January 1, 2024, and annually thereafter until 612
the reimbursement program is fully implemented, the Department of 613
Social Services shall submit a report, in accordance with the provisions 614
of section 11-4a of the general statutes, to the joint standing committee 615
of the General Assembly having cognizance of matters relating to 616
human services and the Council on Medical Assistance Program 617
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Oversight. Such report shall contain an update on the certified 618
community health worker reimbursement program and an evaluation 619
of its impact on health outcomes and health equity. 620
Sec. 12. Subsection (b) of section 19a-754a of the general statutes is 621
repealed and the following is substituted in lieu thereof (Effective from 622
passage): 623
(b) The Office of Health Strategy shall be responsible for the 624
following: 625
(1) Developing and implementing a comprehensive and cohesive 626
health care vision for the state, including, but not limited to, a 627
coordinated state health care cost containment strategy; 628
(2) Promoting effective health planning and the provision of quality 629
health care in the state in a manner that ensures access for all state 630
residents to cost-effective health care services, avoids the duplication of 631
such services and improves the availability and financial stability of 632
such services throughout the state; 633
(3) Directing and overseeing the State Innovation Model Initiative 634
and related successor initiatives; 635
(4) (A) Coordinating the state's health information technology 636
initiatives, (B) seeking funding for and overseeing the planning, 637
implementation and development of policies and procedures for the 638
administration of the all-payer claims database program established 639
under section 19a-775a, (C) establishing and maintaining a consumer 640
health information Internet web site under section 19a-755b, and (D) 641
designating an unclassified individual from the office to perform the 642
duties of a health information technology officer as set forth in sections 643
17b-59f and 17b-59g; 644
(5) Directing and overseeing the Health Systems Planning Unit 645
established under section 19a-612 and all of its duties and 646
responsibilities as set forth in chapter 368z; 647
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(6) Convening forums and meetings with state government and 648
external stakeholders, including, but not limited to, the Connecticut 649
Health Insurance Exchange, to discuss health care issues designed to 650
develop effective health care cost and quality strategies; 651
(7) Consulting with the Commissioner of Social Services, Insurance 652
Commissioner and Connecticut Health Insurance Exchange on the 653
Covered Connecticut program described in section 19a-754c; [and] 654
(8) (A) Setting an annual health care cost growth benchmark and 655
primary care spending target pursuant to section 19a-754g, (B) 656
developing and adopting health care quality benchmarks pursuant to 657
section 19a-754g, (C) developing strategies, in consultation with 658
stakeholders, to meet such benchmarks and targets developed pursuant 659
to section 19a-754g, (D) enhancing the transparency of provider entities, 660
as defined in subdivision (13) of section 19a-754f, (E) monitoring the 661
development of accountable care organizations and patient-centered 662
medical homes in the state, and (F) monitoring the adoption of 663
alternative payment methodologies in the state; and 664
(9) Convening forums and meetings with Access Health Connecticut, 665
the Department of Public Health, the birth-to-three program, as defined 666
in section 17a-248, state home visiting programs, community action 667
agencies, hospitals, community health centers and other state 668
government and external stakeholders to align community health 669
worker programs funded by the state medical assistance programs, 670
block grants, health care providers, private insurance carriers and other 671
external stakeholders. 672
Sec. 13. Section 17b-312 of the general statutes is repealed and the 673
following is substituted in lieu thereof (Effective from passage): 674
(a) The Commissioner of Social Services shall seek, in accordance 675
with the provisions of section 17b-8 and in consultation with the 676
Insurance Commissioner and the Office of Health Strategy established 677
under section 19a-754a, as amended by this act, a waiver under Section 678
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1115 of the Social Security Act, as amended from time to time, to [seek] 679
obtain federal funds to support the Covered Connecticut program 680
established under section 19a-754c. Upon approval by the Centers for 681
Medicare and Medicaid Services, the Commissioner of Social Services 682
shall implement the waiver. 683
(b) Not later than thirty days after the effective date of this section, 684
the commissioner shall amend the waiver submitted in accordance with 685
subsection (a) of this section, to the extent permissible under federal law 686
and in accordance with section 17b-8, to provide coverage through the 687
Covered Connecticut program to persons otherwise qualified for the 688
program whose income does not exceed two hundred per cent of the 689
federal poverty level. The commissioner shall consult with the 690
Insurance Commissioner and the executive director of the Office of 691
Health Strategy in submitting the waiver amendment. 692
Sec. 14. (NEW) (Effective from passage) (a) Not later than sixty days 693
after the effective date of this section, the Commissioner of Social 694
Services, in consultation with the Insurance Commissioner and the 695
executive director of the Office of Health Strategy established under 696
section 19a-754a of the general statutes, as amended by this act, shall 697
develop a plan for a second tier of the Covered Connecticut program 698
established pursuant to section 19a-754c of the general statutes. The plan 699
shall provide state-assisted health care coverage for persons otherwise 700
qualified for the program whose income exceeds two hundred per cent 701
of the federal poverty level but does not exceed three hundred per cent 702
of the federal poverty level. 703
(b) The plan developed pursuant to subsection (a) of this section may 704
include (1) reduced benefits from the Covered Connecticut program, 705
provided such benefits are in accordance with the requirements of the 706
Patient Protection and Affordable Care Act, P.L. 111-148, as amended 707
by the Health Care and Education Reconciliation Act, P.L. 111-152, as 708
both may be amended from time to time, and regulations adopted 709
thereunder, and (2) income-based copayments by enrollees. 710
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(c) The Commissioner of Social Services shall submit the plan 711
developed in accordance with this section to the joint standing 712
committees of the General Assembly having cognizance of matters 713
relating to appropriations and the budgets of state agencies, human 714
services and insurance. Not later than thirty days after the date of their 715
receipt of such plan, the joint standing committees shall hold a public 716
hearing on the plan. At the conclusion of a public hearing held in 717
accordance with the provisions of this section, the joint standing 718
committees shall advise the commissioner of their approval, denial or 719
modifications, if any, of the commissioner's plan. If the joint standing 720
committees advise the commissioner of their denial of approval, the 721
commissioner shall not implement the plan. If such committees do not 722
concur, the committee chairpersons shall appoint a committee of 723
conference which shall be composed of three members from each joint 724
standing committee. At least one member appointed from each joint 725
standing committee shall be a member of the minority party. The report 726
of the committee of conference shall be made to each joint standing 727
committee, which shall vote to accept or reject the report. The report of 728
the committee of conference may not be amended. If a joint standing 729
committee rejects the report of the committee of conference, that joint 730
standing committee shall notify the commissioner of the rejection and 731
the commissioner's plan shall be deemed approved. If the joint standing 732
committees accept the report, the committee having cognizance of 733
matters relating to appropriations and the budgets of state agencies 734
shall advise the commissioner of their approval, denial or modifications, 735
if any, of the commissioner's plan. If the joint standing committees do 736
not so advise the commissioner during the thirty-day period, the plan 737
shall be deemed denied. Any implementation of the plan developed 738
pursuant to this section shall be in accordance with the approval or 739
modifications, if any, of the joint standing committees of the General 740
Assembly having cognizance of matters relating to appropriations and 741
the budgets of state agencies, human services and insurance. 742
(d) To the extent permissible under federal law, the commissioner 743
may seek approval of a Medicaid waiver in accordance with section 17b-744
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8 of the general statutes to obtain federal financial participation for the 745
plan developed pursuant to this section. 746
Sec. 15. Section 38a-1084 of the general statutes is repealed and the 747
following is substituted in lieu thereof (Effective from passage): 748
The exchange shall: 749
(1) Administer the exchange for both qualified individuals and 750
qualified employers; 751
(2) Commission surveys of individuals, small employers and health 752
care providers on issues related to health care and health care coverage; 753
(3) Implement procedures for the certification, recertification and 754
decertification, consistent with guidelines developed by the Secretary 755
under Section 1311(c) of the Affordable Care Act, and section 38a-1086, 756
of health benefit plans as qualified health plans; 757
(4) Provide for the operation of a toll-free telephone hotline to 758
respond to requests for assistance; 759
(5) Provide for enrollment periods, as provided under Section 760
1311(c)(6) of the Affordable Care Act; 761
(6) Maintain an Internet web site through which enrollees and 762
prospective enrollees of qualified health plans may obtain standardized 763
comparative information on such plans including, but not limited to, the 764
enrollee satisfaction survey information under Section 1311(c)(4) of the 765
Affordable Care Act and any other information or tools to assist 766
enrollees and prospective enrollees evaluate qualified health plans 767
offered through the exchange; 768
(7) Publish the average costs of licensing, regulatory fees and any 769
other payments required by the exchange and the administrative costs 770
of the exchange, including information on moneys lost to waste, fraud 771
and abuse, on an Internet web site to educate individuals on such costs; 772
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(8) On or before the open enrollment period for plan year 2017, assign 773
a rating to each qualified health plan offered through the exchange in 774
accordance with the criteria developed by the Secretary under Section 775
1311(c)(3) of the Affordable Care Act, and determine each qualified 776
health plan's level of coverage in accordance with regulations issued by 777
the Secretary under Section 1302(d)(2)(A) of the Affordable Care Act; 778
(9) Use a standardized format for presenting health benefit options in 779
the exchange, including the use of the uniform outline of coverage 780
established under Section 2715 of the Public Health Service Act, 42 USC 781
300gg-15, as amended from time to time; 782
(10) Inform individuals, in accordance with Section 1413 of the 783
Affordable Care Act, of eligibility requirements for the Medicaid 784
program under Title XIX of the Social Security Act, as amended from 785
time to time, the Children's Health Insurance Program (CHIP) under 786
Title XXI of the Social Security Act, as amended from time to time, or 787
any applicable state or local public program, and enroll an individual in 788
such program if the exchange determines, through screening of the 789
application by the exchange, that such individual is eligible for any such 790
program; 791
(11) Collaborate with the Department of Social Services, to the extent 792
possible, to allow an enrollee who loses premium tax credit eligibility 793
under Section 36B of the Internal Revenue Code and is eligible for 794
HUSKY A or any other state or local public program, to remain enrolled 795
in a qualified health plan; 796
(12) Establish and make available by electronic means a calculator to 797
determine the actual cost of coverage after application of any premium 798
tax credit under Section 36B of the Internal Revenue Code and any cost-799
sharing reduction under Section 1402 of the Affordable Care Act; 800
(13) Establish a program for small employers through which 801
qualified employers may access coverage for their employees and that 802
shall enable any qualified employer to specify a level of coverage so that 803
Committee Bill No. 10
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any of its employees may enroll in any qualified health plan offered 804
through the exchange at the specified level of coverage; 805
(14) Offer enrollees and small employers the option of having the 806
exchange collect and administer premiums, including through 807
allocation of premiums among the various insurers and qualified health 808
plans chosen by individual employers; 809
(15) Grant a certification, subject to Section 1411 of the Affordable 810
Care Act, attesting that, for purposes of the individual responsibility 811
penalty under Section 5000A of the Internal Revenue Code, an 812
individual is exempt from the individual responsibility requirement or 813
from the penalty imposed by said Section 5000A because: 814
(A) There is no affordable qualified health plan available through the 815
exchange, or the individual's employer, covering the individual; or 816
(B) The individual meets the requirements for any other such 817
exemption from the individual responsibility requirement or penalty; 818
(16) Provide to the Secretary of the Treasury of the United States the 819
following: 820
(A) A list of the individuals granted a certification under subdivision 821
(15) of this section, including the name and taxpayer identification 822
number of each individual; 823
(B) The name and taxpayer identification number of each individual 824
who was an employee of an employer but who was determined to be 825
eligible for the premium tax credit under Section 36B of the Internal 826
Revenue Code because: 827
(i) The employer did not provide minimum essential health benefits 828
coverage; or 829
(ii) The employer provided the minimum essential coverage but it 830
was determined under Section 36B(c)(2)(C) of the Internal Revenue 831
Committee Bill No. 10
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Code to be unaffordable to the employee or not provide the required 832
minimum actuarial value; and 833
(C) The name and taxpayer identification number of: 834
(i) Each individual who notifies the exchange under Section 835
1411(b)(4) of the Affordable Care Act that such individual has changed 836
employers; and 837
(ii) Each individual who ceases coverage under a qualified health 838
plan during a plan year and the effective date of that cessation; 839
(17) Provide to each employer the name of each employee, as 840
described in subparagraph (B) of subdivision (16) of this section, of the 841
employer who ceases coverage under a qualified health plan during a 842
plan year and the effective date of the cessation; 843
(18) Perform duties required of, or delegated to, the exchange by the 844
Secretary or the Secretary of the Treasury of the United States related to 845
determining eligibility for premium tax credits, reduced cost-sharing or 846
individual responsibility requirement exemptions; 847
(19) Select entities qualified to serve as Navigators in accordance with 848
Section 1311(i) of the Affordable Care Act and award grants to enable 849
Navigators to: 850
(A) Conduct public education activities to raise awareness of the 851
availability of qualified health plans; 852
(B) Distribute fair and impartial information concerning enrollment 853
in qualified health plans and the availability of premium tax credits 854
under Section 36B of the Internal Revenue Code and cost-sharing 855
reductions under Section 1402 of the Affordable Care Act; 856
(C) Facilitate enrollment in qualified health plans; 857
(D) Provide referrals to the Office of the Healthcare Advocate or 858
health insurance ombudsman established under Section 2793 of the 859
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Public Health Service Act, 42 USC 300gg-93, as amended from time to 860
time, or any other appropriate state agency or agencies, for any enrollee 861
with a grievance, complaint or question regarding the enrollee's health 862
benefit plan, coverage or a determination under that plan or coverage; 863
and 864
(E) Provide information in a manner that is culturally and 865
linguistically appropriate to the needs of the population being served by 866
the exchange; 867
(20) Review the rate of premium growth within and outside the 868
exchange and consider such i nformation in developing 869
recommendations on whether to continue limiting qualified employer 870
status to small employers; 871
(21) Credit the amount, in accordance with Section 10108 of the 872
Affordable Care Act, of any free choice voucher to the monthly 873
premium of the plan in which a qualified employee is enrolled and 874
collect the amount credited from the offering employer; 875
(22) Consult with stakeholders relevant to carrying out the activities 876
required under sections 38a-1080 to 38a-1090, inclusive, including, but 877
not limited to: 878
(A) Individuals who are knowledgeable about the health care system, 879
have background or experience in making informed decisions regarding 880
health, medical and scientific matters and are enrollees in qualified 881
health plans; 882
(B) Individuals and entities with experience in facilitating enrollment 883
in qualified health plans; 884
(C) Representatives of small employers and self-employed 885
individuals; 886
(D) The Department of Social Services; and 887
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(E) Advocates for enrolling hard-to-reach populations; 888
(23) Meet the following financial integrity requirements: 889
(A) Keep an accurate accounting of all activities, receipts and 890
expenditures and annually submit to the Secretary, the Governor, the 891
Insurance Commissioner and the General Assembly a report concerning 892
such accountings; 893
(B) Fully cooperate with any investigation conducted by the Secretary 894
pursuant to the Secretary's authority under the Affordable Care Act and 895
allow the Secretary, in coordination with the Inspector General of the 896
United States Department of Health and Human Services, to: 897
(i) Investigate the affairs of the exchange; 898
(ii) Examine the properties and records of the exchange; and 899
(iii) Require periodic reports in relation to the activities undertaken 900
by the exchange; and 901
(C) Not use any funds in carrying out its activities under sections 38a-902
1080 to 38a-1089, inclusive, that are intended for the administrative and 903
operational expenses of the exchange, for staff retreats, promotional 904
giveaways, excessive executive compensation or promotion of federal 905
or state legislative and regulatory modifications; 906
(24) (A) Seek to include the most comprehensive health benefit plans 907
that offer high quality benefits at the most affordable price in the 908
exchange, (B) encourage health carriers to offer tiered health care 909
provider network plans that have different cost-sharing rates for 910
different health care provider tiers and reward enrollees for choosing 911
low-cost, high-quality health care providers by offering lower 912
copayments, deductibles or other out-of-pocket expenses, and (C) offer 913
any such tiered health care provider network plans through the 914
exchange; 915
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(25) Report at least annually to the General Assembly on the effect of 916
adverse selection on the operations of the exchange and make legislative 917
recommendations, if necessary, to reduce the negative impact from any 918
such adverse selection on the sustainability of the exchange, including 919
recommendations to ensure that regulation of insurers and health 920
benefit plans are similar for qualified health plans offered through the 921
exchange and health benefit plans offered outside the exchange. The 922
exchange shall evaluate whether adverse selection is occurring with 923
respect to health benefit plans that are grandfathered under the 924
Affordable Care Act, self-insured plans, plans sold through the 925
exchange and plans sold outside the exchange; [and] 926
(26) Consult with the Commissioner of Social Services, Insurance 927
Commissioner and Office of Health Strategy, established under section 928
19a-754a, as amended by this act, for the purposes set forth in section 929
19a-754c; and 930
(27) (A) Notwithstanding the provisions of section 12-15, the 931
exchange shall make a written request to the Commissioner of Revenue 932
Services, for return or return information, as such terms are defined in 933
section 12-15, for use in conducting targeted outreach to uninsured 934
residents of this state. If the Commissioner of Revenue Services deems 935
such return or return information to be relevant to the targeted outreach 936
to uninsured residents, said commissioner may disclose such 937
information to the exchange. To effectuate the disclosure of such 938
information, the Commissioner of Revenue Services and the exchange 939
shall enter into a memorandum of understanding that sets forth the 940
specific information to be disclosed and contains the terms and 941
conditions under which said commissioner will disclose such 942
information to the exchange. Any return or return information disclosed 943
by the Commissioner of Revenue Services shall not be redisclosed by 944
the recipient to a third party without permission from the commissioner 945
and shall only be used by the exchange in the manner prescribed in the 946
memorandum of understanding. Any person who violates the 947
provisions of this subparagraph shall be fined not more than five 948
Committee Bill No. 10
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thousand dollars. 949
(B) To assist the exchange in conducting targeted outreach to 950
uninsured residents of this state, the Commissioner of Revenue Services 951
shall revise the tax return form prescribed under chapter 229 to include 952
space on the tax return for residents to authorize the exchange to contact 953
such residents regarding enrollment through the exchange. The 954
Commissioner of Revenue Services and the exchange shall develop 955
language to be included on the tax return form and shall include in the 956
instructions accompanying the tax return a description of how the 957
authorization provided will be relayed to the exchange. 958
Sec. 16. Section 19a-42 of the general statutes is repealed and the 959
following is substituted in lieu thereof (Effective July 1, 2023): 960
(a) To protect the integrity and accuracy of vital records, a certificate 961
registered under chapter 93 may be amended only in accordance with 962
sections 19a-41 to 19a-45, inclusive, chapter 93, regulations adopted by 963
the Commissioner of Public Health pursuant to chapter 54 and uniform 964
procedures prescribed by the commissioner. Only the commissioner 965
may amend birth certificates to reflect changes concerning parentage or 966
the legal name of a parent or birth or marriage certificates to reflect 967
changes concerning gender. [change.] Amendments related to 968
parentage, [or] gender change or the legally changed name of a parent 969
shall result in the creation of a replacement certificate that supersedes 970
the original, and shall in no way reveal the original language changed 971
by the amendment. Any amendment to a vital record made by the 972
registrar of vital statistics of the town in which the vital event occurred 973
or by the commissioner shall be in accordance with such regulations and 974
uniform procedures. 975
(b) The commissioner and the registrar of vital statistics shall 976
maintain sufficient documentation, as prescribed by the commissioner, 977
to support amendments and shall ensure the confidentiality of such 978
documentation as required by law. The date of amendment and a 979
summary description of the evidence submitted in support of the 980
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amendment shall be endorsed on or made part of the record and the 981
original certificate shall be marked "Amended", except for amendments 982
[due to] concerning parentage, [or] gender change or the legally 983
changed name of a parent. When the registrar of the town in which the 984
vital event occurred amends a certificate, such registrar shall, within ten 985
days of making such amendment, forward an amended certificate to the 986
commissioner and to any registrar having a copy of the certificate. When 987
the commissioner amends a birth certificate, including changes [due to] 988
concerning parentage, [or] gender change or the legally changed name 989
of a parent, the commissioner shall forward an amended certificate to 990
the registrars of vital statistics affected and their records shall be 991
amended accordingly. 992
(c) An amended certificate shall supersede the original certificate that 993
has been changed and shall be marked "Amended", except for 994
amendments [due to] concerning parentage, [or] gender change or the 995
legally changed name of a parent. The original certificate in the case of 996
parentage, [or] gender change or the legally changed name of a parent 997
shall be physically or electronically sealed and kept in a confidential file 998
by the department and the registrar of any town in which the birth was 999
recorded, and may be unsealed for issuance only as provided in section 1000
7-53 with regard to an original birth certificate or upon a written order 1001
of a court of competent jurisdiction. The amended certificate shall 1002
become the official record. 1003
(d) (1) Upon receipt of (A) an acknowledgment of parentage executed 1004
in accordance with the provisions of sections 46b-476 to 46b-487, 1005
inclusive, by both parents of a child, or (B) a certified copy of an order 1006
of a court of competent jurisdiction establishing the parentage of a child, 1007
the commissioner shall include on or amend, as appropriate, such 1008
child's birth certificate to show such parentage if parentage is not 1009
already shown on such birth certificate and to change the name of the 1010
child under eighteen years of age if so indicated on the acknowledgment 1011
of parentage form or within the certified court order as part of the 1012
parentage action. If a person who is the subject of a voluntary 1013
Committee Bill No. 10
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acknowledgment of parentage, as described in this subdivision, is 1014
eighteen years of age or older, the commissioner shall obtain a notarized 1015
affidavit from such person affirming that such person agrees to the 1016
commissioner's amendment of such person's birth certificate as such 1017
amendment relates to the acknowledgment of parentage. The 1018
commissioner shall amend the birth certificate for an adult child to 1019
change the child's name only pursuant to a court order. 1020
(2) If the birth certificate lists the information of a parent other than 1021
the parent who gave birth, the commissioner shall not remove or replace 1022
the parent's information unless presented with a certified court order 1023
that meets the requirements specified in section 7-50, or upon the proper 1024
filing of a rescission, in accordance with the provisions of section 46b-1025
570. The commissioner shall thereafter amend such child's birth 1026
certificate to remove or change the name of the parent other than the 1027
person who gave birth and, if relevant, to change the name of the child, 1028
as requested at the time of the filing of a rescission, in accordance with 1029
the provisions of section 46b-570. Birth certificates amended under this 1030
subsection shall not be marked "Amended". 1031
(e) When the parent or parents of a child request the amendment of 1032
the child's birth certificate to reflect a new name of the parent who gave 1033
birth because the name on the original certificate is fictitious, such 1034
parent or parents shall obtain an order of a court of competent 1035
jurisdiction declaring the person who gave birth to be the child's parent. 1036
Upon receipt of a certified copy of such order, the department shall 1037
amend the child's birth certificate to reflect the parent's true name. 1038
(f) Upon receipt of a certified copy of an order of a court of competent 1039
jurisdiction changing the name of a person born in this state and upon 1040
request of such person or such person's parents, guardian, or legal 1041
representative, the commissioner or the registrar of vital statistics of the 1042
town in which the vital event occurred shall amend the birth certificate 1043
to show the new name by a method prescribed by the department. 1044
(g) When an applicant submits the documentation required by the 1045
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LCO No. 5227 36 of 48
regulations to amend a vital record, the commissioner shall hold a 1046
hearing, in accordance with chapter 54, if the commissioner has 1047
reasonable cause to doubt the validity or adequacy of such 1048
documentation. 1049
(h) When an amendment under this section involves the changing of 1050
existing language on a death certificate due to an error pertaining to the 1051
cause of death, the death certificate shall be amended in such a manner 1052
that the original language is still visible. A copy of the death certificate 1053
shall be made. The original death certificate shall be sealed and kept in 1054
a confidential file at the department and only the commissioner may 1055
order it unsealed. The copy shall be amended in such a manner that the 1056
language to be changed is no longer visible. The copy shall be a public 1057
document. 1058
(i) The commissioner shall issue a new birth certificate to reflect a 1059
gender change upon receipt of the following documents submitted in 1060
the form and manner prescribed by the commissioner: (1) A written 1061
request from the applicant, signed under penalty of law, for a 1062
replacement birth certificate to reflect that the applicant's gender differs 1063
from the sex designated on the original birth certificate; (2) a notarized 1064
affidavit by a physician licensed pursuant to chapter 370 or holding a 1065
current license in good standing in another state, a physician assistant 1066
licensed pursuant to chapter 370 or holding a current license in good 1067
standing in another state, an advanced practice registered nurse 1068
licensed pursuant to chapter 378 or holding a current license in good 1069
standing in another state, or a psychologist licensed pursuant to chapter 1070
383 or holding a current license in good standing in another state, stating 1071
that the applicant has undergone surgical, hormonal or other treatment 1072
clinically appropriate for the applicant for the purpose of gender 1073
transition; and (3) if an applicant is also requesting a change of name 1074
listed on the original birth certificate, proof of a legal name change. The 1075
new birth certificate shall reflect the new gender identity by way of a 1076
change in the sex designation on the original birth certificate and, if 1077
applicable, the legal name change. 1078
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(j) The commissioner shall issue a new birth certificate to reflect the 1079
legally changed name of a parent of the child who is the subject of such 1080
birth certificate upon receipt of the following documents, submitted in 1081
a form and manner prescribed by the commissioner: (1) A written 1082
request from the parent, signed under penalty of law, for a replacement 1083
birth certificate to reflect that the parent's legal name differs from the 1084
name designated on the original birth certificate, and (2) proof of such 1085
parent's legal name change. 1086
[(j)] (k) The commissioner shall issue a new marriage certificate to 1087
reflect a gender change upon receipt of the following documents, 1088
submitted in a form and manner prescribed by the commissioner: (1) A 1089
written request from the applicant, signed under penalty of law, for a 1090
replacement marriage certificate to reflect that the applicant's gender 1091
differs from the sex designated on the original marriage certificate, 1092
along with an affirmation that the marriage is still legally intact; (2) a 1093
notarized statement from the spouse named on the marriage certificate 1094
to be amended, consenting to the amendment; (3) (A) a United States 1095
passport or amended birth certificate or court order reflecting the 1096
applicant's gender as of the date of the request or (B) a notarized 1097
affidavit by a physician licensed pursuant to chapter 370 or holding a 1098
current license in good standing in another state, physician assistant 1099
licensed pursuant to chapter 370 or holding a current license in good 1100
standing in another state, an advanced practice registered nurse 1101
licensed pursuant to chapter 378 or holding a current license in good 1102
standing in another state or a psychologist licensed pursuant to chapter 1103
383 or holding a current license in good standing in another state stating 1104
that the applicant has undergone surgical, hormonal or other treatment 1105
clinically appropriate for the applicant for the purpose of gender 1106
transition; and (4) if an applicant is also requesting a change of name 1107
listed on the original marriage certificate, proof of a legal name change. 1108
The new marriage certificate shall reflect the new gender identity by 1109
way of a change in the sex designation on the original marriage 1110
certificate and, if applicable, the legal name change. 1111
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Sec. 17. (NEW) (Effective from passage) (a) For purposes of this section, 1112
"inmate" and "prisoner" have the same meanings as provided in section 1113
18-84 of the general statutes. 1114
(b) Not later than thirty days after the written request of any inmate 1115
or prisoner whose name has been ordered changed pursuant to section 1116
45a-99 or section 52-11 of the general statutes, the Commissioner of 1117
Correction shall change such inmate or prisoner's name in the records 1118
of the Department of Correction in accordance with such order. Any 1119
such written request shall be accompanied by a certified copy of such 1120
order. 1121
Sec. 18. Section 18-81ii of the general statutes is repealed and the 1122
following is substituted in lieu thereof (Effective July 1, 2023): 1123
Any inmate of a correctional institution, as described in section 18-78, 1124
who has a gender identity that differs from the inmate's assigned sex at 1125
birth and has a diagnosis of gender dysphoria, as set forth in the most 1126
recent edition of the American Psychiatric Association's "Diagnostic and 1127
Statistical Manual of Mental Disorders" or gender incongruence, as 1128
defined in the 11
th
edition of the "International Statistical Classification 1129
of Diseases and Related Health Problems", shall: (1) Be addressed by 1130
correctional staff in a manner that is consistent with the inmate's gender 1131
identity, (2) have access to commissary items, clothing, personal 1132
property, programming and educational materials that are consistent 1133
with the inmate's gender identity, and (3) have the right to be searched 1134
by a correctional staff member of the same gender identity, unless the 1135
inmate requests otherwise or under exigent circumstances. An inmate 1136
who has a birth certificate, passport or driver's license that reflects his 1137
or her gender identity or who can meet established standards for 1138
obtaining such a document to confirm the inmate's gender identity shall 1139
presumptively be placed in a correctional institution with inmates of the 1140
gender consistent with the inmate's gender identity. Such presumptive 1141
placement may be overcome by a demonstration by the Commissioner 1142
of Correction, or the commissioner's designee, that the placement would 1143
Committee Bill No. 10
LCO No. 5227 39 of 48
present significant safety, management or security problems. In making 1144
determinations pursuant to this section, the inmate's views with respect 1145
to his or her safety shall be given serious consideration by the 1146
Commissioner of Correction, or the commissioner's designee. 1147
Sec. 19. Section 52-571m of the general statutes is repealed and the 1148
following is substituted in lieu thereof (Effective July 1, 2023): 1149
(a) As used in this section: 1150
(1) "Reproductive health care services" includes all medical, surgical, 1151
counseling or referral services relating to the human reproductive 1152
system, including, but not limited to, services relating to pregnancy, 1153
contraception or the termination of a pregnancy and all medical care 1154
relating to treatment of gender dysphoria as set forth in the most recent 1155
edition of the American Psychiatric Association's "Diagnostic and 1156
Statistical Manual of Mental Disorders" and gender incongruence, as 1157
defined in the 11
th
edition of the "International Statistical Classification 1158
of Diseases and Related Health Problems"; and 1159
(2) "Person" includes an individual, a partnership, an association, a 1160
limited liability company or a corporation. 1161
(b) When any person has had a judgment entered against such 1162
person, in any state, where liability, in whole or in part, is based on the 1163
alleged provision, receipt, assistance in receipt or provision, material 1164
support for, or any theory of vicarious, joint, several or conspiracy 1165
liability derived therefrom, for reproductive health care services that are 1166
permitted under the laws of this state, such person may recover 1167
damages from any party that brought the action leading to that 1168
judgment or has sought to enforce that judgment. Recoverable damages 1169
shall include: (1) Just damages created by the action that led to that 1170
judgment, including, but not limited to, money damages in the amount 1171
of the judgment in that other state and costs, expenses and reasonable 1172
attorney's fees spent in defending the action that resulted in the entry of 1173
a judgment in another state; and (2) costs, expenses and reasonable 1174
Committee Bill No. 10
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attorney's fees incurred in bringing an action under this section as may 1175
be allowed by the court. 1176
(c) The provisions of this section shall not apply to a judgment 1177
entered in another state that is based on: (1) An action founded in tort, 1178
contract or statute, and for which a similar claim would exist under the 1179
laws of this state, brought by the patient who received the reproductive 1180
health care services upon which the original lawsuit was based or the 1181
patient's authorized legal representative, for damages suffered by the 1182
patient or damages derived from an individual's loss of consortium of 1183
the patient; (2) an action founded in contract, and for which a similar 1184
claim would exist under the laws of this state, brought or sought to be 1185
enforced by a party with a contractual relationship with the person that 1186
is the subject of the judgment entered in another state; or (3) an action 1187
where no part of the acts that formed the basis for liability occurred in 1188
this state. 1189
Sec. 20. Section 52-571n of the general statutes is repealed and the 1190
following is substituted in lieu thereof (Effective July 1, 2023): 1191
(a) As used in this section: 1192
(1) "Gender-affirming health care services" means all medical care 1193
relating to the treatment of gender dysphoria as set forth in the most 1194
recent edition of the American Psychiatric Association's "Diagnostic and 1195
Statistical Manual of Mental Disorders" and gender incongruence, as 1196
defined in the 11
th
edition of the "International Statistical Classification 1197
of Diseases and Related Health Problems"; 1198
(2) "Reproductive health care services" includes all medical, surgical, 1199
counseling or referral services relating to the human reproductive 1200
system, including, but not limited to, services relating to pregnancy, 1201
contraception or the termination of a pregnancy; and 1202
(3) "Person" includes an individual, a partnership, an association, a 1203
limited liability company or a corporation. 1204
Committee Bill No. 10
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(b) When any person has had a judgment entered against such 1205
person, in any state, where liability, in whole or in part, is based on the 1206
alleged provision, receipt, assistance in receipt or provision, material 1207
support for, or any theory of vicarious, joint, several or conspiracy 1208
liability derived therefrom, for reproductive health care services and 1209
gender-affirming health care services that are permitted under the laws 1210
of this state, such person may recover damages from any party that 1211
brought the action leading to that judgment or has sought to enforce that 1212
judgment. Recoverable damages shall include: (1) Just damages created 1213
by the action that led to that judgment, including, but not limited to, 1214
money damages in the amount of the judgment in that other state and 1215
costs, expenses and reasonable attorney's fees spent in defending the 1216
action that resulted in the entry of a judgment in another state; and (2) 1217
costs, expenses and reasonable attorney's fees incurred in bringing an 1218
action under this section as may be allowed by the court. 1219
(c) The provisions of this section shall not apply to a judgment 1220
entered in another state that is based on: (1) An action founded in tort, 1221
contract or statute, and for which a similar claim would exist under the 1222
laws of this state, brought by the patient who received the reproductive 1223
health care services or gender-affirming health care services upon which 1224
the original lawsuit was based or the patient's authorized legal 1225
representative, for damages suffered by the patient or damages derived 1226
from an individual's loss of consortium of the patient; (2) an action 1227
founded in contract, and for which a similar claim would exist under 1228
the laws of this state, brought or sought to be enforced by a party with 1229
a contractual relationship with the person that is the subject of the 1230
judgment entered in another state; or (3) an action where no part of the 1231
acts that formed the basis for liability occurred in this state. 1232
Sec. 21. Subsection (b) of section 45a-106a of the general statutes is 1233
repealed and the following is substituted in lieu thereof (Effective July 1, 1234
2023): 1235
(b) The fee to file each of the following motions, petitions or 1236
Committee Bill No. 10
LCO No. 5227 42 of 48
applications in a Probate Court is two hundred fifty dollars: 1237
(1) With respect to a minor child: (A) Appoint a temporary guardian, 1238
temporary custodian, guardian, coguardian, permanent guardian or 1239
statutory parent, (B) remove a guardian, including the appointment of 1240
another guardian, (C) reinstate a parent as guardian, (D) terminate 1241
parental rights, including the appointment of a guardian or statutory 1242
parent, (E) grant visitation, (F) make findings regarding special 1243
immigrant juvenile status, (G) approve placement of a child for 1244
adoption outside this state, (H) approve an adoption, (I) validate a 1245
foreign adoption, (J) review, modify or enforce a cooperative 1246
postadoption agreement, (K) review an order concerning contact 1247
between an adopted child and his or her siblings, (L) resolve a dispute 1248
concerning a standby guardian, (M) approve a plan for voluntary 1249
services provided by the Department of Children and Families, (N) 1250
determine whether the termination of voluntary services provided by 1251
the Department of Children and Families is in accordance with 1252
applicable regulations, (O) conduct an in-court review to modify an 1253
order, (P) grant emancipation, (Q) grant approval to marry, (R) transfer 1254
funds to a custodian under sections 45a-557 to 45a-560b, inclusive, (S) 1255
appoint a successor custodian under section 45a-559c, (T) resolve a 1256
dispute concerning custodianship under sections 45a-557 to 45a-560b, 1257
inclusive, and (U) grant authority to purchase real estate; 1258
(2) Determine parentage; 1259
(3) Validate a genetic surrogacy agreement; 1260
(4) Determine the age and date of birth of an adopted person born 1261
outside the United States; 1262
(5) With respect to adoption records: (A) Appoint a guardian ad litem 1263
for a biological relative who cannot be located or appears to be 1264
incompetent, (B) appeal the refusal of an agency to release information, 1265
(C) release medical information when required for treatment, and (D) 1266
grant access to an original birth certificate; 1267
Committee Bill No. 10
LCO No. 5227 43 of 48
(6) Approve an adult adoption; 1268
(7) With respect to a conservatorship: (A) Appoint a temporary 1269
conservator, conservator or special limited conservator, (B) change 1270
residence, terminate a tenancy or lease, sell or dispose household 1271
furnishings, or place in a long-term care facility, (C) determine 1272
competency to vote, (D) approve a support allowance for a spouse, (E) 1273
grant authority to elect the spousal share, (F) grant authority to purchase 1274
real estate, (G) give instructions regarding administration of a joint asset 1275
or liability, (H) distribute gifts, (I) grant authority to consent to 1276
involuntary medication, (J) determine whether informed consent has 1277
been given for voluntary admission to a hospital for psychiatric 1278
disabilities, (K) determine life-sustaining medical treatment, (L) transfer 1279
to or from another state, (M) modify the conservatorship in connection 1280
with a periodic review, (N) excuse accounts under rules of procedure 1281
approved by the Supreme Court under section 45a-78, (O) terminate the 1282
conservatorship, and (P) grant a writ of habeas corpus; 1283
(8) With respect to a power of attorney: (A) Compel an account by an 1284
agent, (B) review the conduct of an agent, (C) construe the power of 1285
attorney, and (D) mandate acceptance of the power of attorney; 1286
(9) Resolve a dispute concerning advance directives or life-sustaining 1287
medical treatment when the individual does not have a conservator or 1288
guardian; 1289
(10) With respect to an elderly person, as defined in section 17b-450: 1290
(A) Enjoin an individual from interfering with the provision of 1291
protective services to such elderly person, and (B) authorize the 1292
Commissioner of Social Services to enter the premises of such elderly 1293
person to determine whether such elderly person needs protective 1294
services; 1295
(11) With respect to an adult with intellectual disability: (A) Appoint 1296
a temporary limited guardian, guardian or standby guardian, (B) grant 1297
visitation, (C) determine competency to vote, (D) modify the 1298
Committee Bill No. 10
LCO No. 5227 44 of 48
guardianship in connection with a periodic review, (E) determine life-1299
sustaining medical treatment, (F) approve an involuntary placement, 1300
(G) review an involuntary placement, (H) authorize a guardian to 1301
manage the finances of such adult, and (I) grant a writ of habeas corpus; 1302
(12) With respect to psychiatric disability: (A) Commit an individual 1303
for treatment, (B) issue a warrant for examination of an individual at a 1304
general hospital, (C) determine whether there is probable cause to 1305
continue an involuntary confinement, (D) review an involuntary 1306
confinement for possible release, (E) authorize shock therapy, (F) 1307
authorize medication for treatment of psychiatric disability, (G) review 1308
the status of an individual under the age of sixteen as a voluntary 1309
patient, and (H) recommit an individual under the age of sixteen for 1310
further treatment; 1311
(13) With respect to drug or alcohol dependency: (A) Commit an 1312
individual for treatment, (B) recommit an individual for further 1313
treatment, and (C) terminate an involuntary confinement; 1314
(14) With respect to tuberculosis: (A) Commit an individual for 1315
treatment, (B) issue a warrant to enforce an examination order, and (C) 1316
terminate an involuntary confinement; 1317
(15) Compel an account by the trustee of an inter vivos trust, 1318
custodian under sections 45a-557 to 45a-560b, inclusive, or treasurer of 1319
an ecclesiastical society or cemetery association; 1320
(16) With respect to a testamentary or inter vivos trust: (A) Construe, 1321
validate, divide, combine, reform, modify or terminate the trust, (B) 1322
enforce the provisions of a pet trust, (C) excuse a final account under 1323
rules of procedure approved by the Supreme Court under section 45a-1324
78, and (D) assume jurisdiction of an out-of-state trust; 1325
(17) Authorize a fiduciary to establish a trust; 1326
(18) Appoint a trustee for a missing person; 1327
Committee Bill No. 10
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[(19) Change a person's name;] 1328
[(20)] (19) Issue an order to amend the birth certificate of an 1329
individual born in another state to reflect a gender change; 1330
[(21)] (20) Require the Department of Public Health to issue a delayed 1331
birth certificate; 1332
[(22)] (21) Compel the board of a cemetery association to disclose the 1333
minutes of the annual meeting; 1334
[(23)] (22) Issue an order to protect a grave marker; 1335
[(24)] (23) Restore rights to purchase, possess and transport firearms; 1336
[(25)] (24) Issue an order permitting sterilization of an individual; 1337
[(26)] (25) Approve the transfer of structured settlement payment 1338
rights; and 1339
[(27)] (26) With respect to any case in a Probate Court other than a 1340
decedent's estate: (A) Compel or approve an action by the fiduciary, (B) 1341
give instruction to the fiduciary, (C) authorize a fiduciary to 1342
compromise a claim, (D) list, sell or mortgage real property, (E) 1343
determine title to property, (F) resolve a dispute between cofiduciaries 1344
or among fiduciaries, (G) remove a fiduciary, (H) appoint a successor 1345
fiduciary or fill a vacancy in the office of fiduciary, (I) approve fiduciary 1346
or attorney's fees, (J) apply the doctrine of cy pres or approximation, (K) 1347
reconsider, modify or revoke an order, and (L) decide an action on a 1348
probate bond. 1349
Sec. 22. (NEW) (Effective from passage) (a) As used in this section, 1350
"gender-affirming procedure" means a medical procedure or treatment 1351
to alter the physical characteristics of a person diagnosed with (1) 1352
gender dysphoria, as described in the most recent edition of the 1353
American Psychiatric Association's "Diagnostic and Statistical Manual 1354
of Mental Disorders", or (2) gender incongruence, as defined in the 11
th
1355
Committee Bill No. 10
LCO No. 5227 46 of 48
edition of the "International Statistical Classification of Diseases and 1356
Related Health Problems", in a manner consistent with such person's 1357
gender identity. 1358
(b) The Commissioner of Social Services shall establish a working 1359
group to seek input on department guidelines for gender-affirming 1360
procedures not later than one hundred twenty days before amending 1361
such guidelines. The working group shall consist of (1) six health care 1362
providers who treat persons seeking gender-affirming procedures or 1363
persons who have had such procedures, (2) two HUSKY Health 1364
program members who have had such procedures, and (3) the 1365
commissioner or the commissioner's designee. All appointments to the 1366
working group shall be made by the commissioner. The commissioner, 1367
or the commissioner's designee, shall serve as cochairperson of the 1368
working group with a member chosen by the majority of working group 1369
members to serve as cochairperson. 1370
(c) The commissioner, or the commissioner's designee, shall convene 1371
the working group not later than ninety days before any amendments 1372
planned for the gender-affirming procedure guidelines. The group shall 1373
meet not less than two times monthly. 1374
(d) The commissioner shall file a report, in accordance with the 1375
provisions of section 11-4a of the general statutes, to the joint standing 1376
committees of the General Assembly having cognizance of matters 1377
relating to human services and public health not later than thirty days 1378
before any amendments the commissioner has proposed for the gender-1379
affirming procedure guidelines. The report shall include, but not be 1380
limited to, (1) the proposed amendments, and (2) the working group's 1381
recommendations concerning such amendments. The working group 1382
shall terminate on the date such report is issued. 1383
(e) The provisions of this section shall not apply to any changes 1384
required to be made to the gender-affirming procedure guidelines to 1385
comply with federal law or regulations concerning reimbursement for 1386
such procedures under Title XIX or Title XXI of the Social Security Act. 1387
Committee Bill No. 10
LCO No. 5227 47 of 48
This act shall take effect as follows and shall amend the following
sections:
Section 1 July 1, 2023 19a-754b(d)
Sec. 2 January 1, 2024, and
applicable to contracts
entered into, amended or
renewed on and after
January 1, 2024
New section
Sec. 3 January 1, 2024, and
applicable to contracts
entered into, amended or
renewed on and after
January 1, 2024
New section
Sec. 4 January 1, 2024, and
applicable to contracts
entered into, amended or
renewed on and after
January 1, 2024
New section
Sec. 5 July 1, 2023 New section
Sec. 6 July 1, 2023 New section
Sec. 7 July 1, 2023 New section
Sec. 8 July 1, 2023 3-112
Sec. 9 January 1, 2024 38a-477g
Sec. 10 July 1, 2023 17b-242(a)
Sec. 11 from passage New section
Sec. 12 from passage 19a-754a(b)
Sec. 13 from passage 17b-312
Sec. 14 from passage New section
Sec. 15 from passage 38a-1084
Sec. 16 July 1, 2023 19a-42
Sec. 17 from passage New section
Sec. 18 July 1, 2023 18-81ii
Sec. 19 July 1, 2023 52-571m
Sec. 20 July 1, 2023 52-571n
Sec. 21 July 1, 2023 45a-106a(b)
Sec. 22 from passage New section
Statement of Purpose:
To promote transparency in health care and prescription drug costs,
expand access to affordable prescription drugs, integrate community
Committee Bill No. 10
LCO No. 5227 48 of 48
health workers and social workers into delivery of health care and home
and community-based services, expand the Covered Connecticut health
care program, connect uninsured persons with coverage and protect
rights regarding gender identity and expression.
[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except
that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not
underlined.]
Co-Sponsors: SEN. LOONEY, 11th Dist.; SEN. DUFF, 25th Dist.
SEN. ANWAR, 3rd Dist.; SEN. CABRERA, 17th Dist.
SEN. COHEN, 12th Dist.; SEN. FLEXER, 29th Dist.
SEN. FONFARA, 1st Dist.; SEN. GASTON, 23rd Dist.
SEN. HOCHADEL, 13th Dist.; SEN. KUSHNER, 24th Dist.
SEN. LESSER, 9th Dist.; SEN. LOPES, 6th Dist.
SEN. MAHER, 26th Dist.; SEN. MARONEY, 14th Dist.
SEN. MARX, 20th Dist.; SEN. MCCRORY, 2nd Dist.
SEN. MILLER P., 27th Dist.; SEN. MOORE, 22nd Dist.
SEN. RAHMAN, 4th Dist.; SEN. SLAP, 5th Dist.
SEN. WINFIELD, 10th Dist.; REP. NOLAN, 39th Dist.
S.B. 10