Connecticut Senate Bill SB00010 Comm Sub / Bill

                     
 
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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repealed and the following is substituted in lieu thereof (Effective July 2 
1, 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 6 
of Public Health, shall prepare and make public a list of not more than 7 
ten 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 11 
prescription drugs from different therapeutic classes of outpatient 12 
prescription drugs and at least one generic outpatient prescription 13  Committee Bill No. 10 
 
 
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drug. 14 
(2) [The executive director shall not list any outpatient prescription 15 
drug under subdivision (1) of this subsection unless the wholesale 16 
acquisition cost of the drug, less all rebates paid to the state for such 17 
drug during the immediately preceding calendar year, (A) increased 18 
by at least (i) twenty per cent during the immediately preceding 19 
calendar year, or (ii) fifty per cent during the immediately preceding 20 
three calendar years, and (B) was not less than sixty dollars for (i) a 21 
thirty-day supply of such drug, or (ii) a course of treatment of such 22 
drug lasting less than thirty days.] Prior to publishing the annual list of 23 
outpatient prescription drugs pursuant to subdivision (1) of this 24 
subsection, the executive director shall prepare a preliminary list of 25 
those outpatient prescription drugs that the executive director plans to 26 
include on the list. The executive director shall make the preliminary 27 
list available for public comment for not less than thirty days, during 28 
which time any manufacturer of an outpatient prescription drug 29 
named on the preliminary list may produce documentation to establish 30 
that the wholesale acquisition cost of the drug, less all rebates paid to 31 
the state for such drug during the immediately preceding calendar 32 
year, does not exceed the limits established in subdivision (3) of this 33 
subsection. If such documentation establishes, to the satisfaction of the 34 
executive director, that the wholesale acquisition cost, less all rebates 35 
paid to the state for such drug during the immediately preceding 36 
calendar year, does not exceed the limits established in subdivision (3) 37 
of this subsection, the executive director shall remove such drug from 38 
the list before publishing the final list. The executive director shall 39 
publish a final list pursuant to subdivision (1) of this subsection not 40 
later than fifteen days after the closing of the public comment period. 41 
(3) The executive director shall not list any outpatient prescription 42 
drug under subdivision (1) or (2) of this subsection unless the 43 
wholesale acquisition cost of the drug (A) increased by at least sixteen 44 
per cent cumulatively during the immediately preceding two calendar 45 
years, and (B) was not less than forty dollars for a course of therapy. 46  Committee Bill No. 10 
 
 
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[(3)] (4) (A) The pharmaceutical manufacturer of an outpatient 47 
prescription drug included on a list prepared by the executive director 48 
pursuant to subdivision (1) of this subsection shall provide to the 49 
office, in a form and manner specified by the executive director, (i) a 50 
written, narrative description, suitable for public release, of all factors 51 
that caused the increase in the wholesale acquisition cost of the listed 52 
outpatient prescription drug, and (ii) aggregate, company-level 53 
research and development costs and such other capital expenditures 54 
that the executive director, in the executive director's discretion, deems 55 
relevant for the most recent year for which final audited data are 56 
available. 57 
(B) The quality and types of information and data that a 58 
pharmaceutical manufacturer submits to the office under this 59 
subdivision shall be consistent with the quality and types of 60 
information and data that the pharmaceutical manufacturer includes 61 
in (i) such pharmaceutical manufacturer's annual consolidated report 62 
on Securities and Exchange Commission Form 10-K, or (ii) any other 63 
public disclosure. 64 
[(4)] (5) The office shall establish a standardized form for reporting 65 
information and data pursuant to this subsection after consulting with 66 
pharmaceutical manufacturers. The form shall be designed to 67 
minimize the administrative burden and cost of reporting on the office 68 
and pharmaceutical manufacturers. 69 
Sec. 2. (NEW) (Effective January 1, 2024, and applicable to contracts 70 
entered into, amended or renewed on and after January 1, 2024) (a) For the 71 
purposes of this section and sections 3 and 4 of this act: 72 
(1) "Distributor" means any person or entity, including any 73 
wholesaler, who supplies drugs, devices or cosmetics prepared, 74 
produced or packaged by manufacturers, to other wholesalers, 75 
manufacturers, distributors, hospitals, clinics, practitioners or 76 
pharmacies or federal, state and municipal agencies; 77  Committee Bill No. 10 
 
 
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(2) "Manufacturer" means the following: 78 
(A) Any entity described in 42 USC 1396r-8(k)(5) that is subject to 79 
the pricing limitations set forth in 42 USC 256b; and 80 
(B) Any wholesaler described in 42 USC 1396r-8(k)(11) engaged in 81 
the distribution of covered drugs for any entity described in 42 82 
USC1396r-8(k)(5) that is subject to the pricing limitations set forth in 42 83 
USC 256b; 84 
(3) "ERISA plan" means an employee welfare benefit plan subject to 85 
the Employee Retirement Income Security Act of 1974, as amended 86 
from time to time; 87 
(4) (A) "Health benefit plan" means any insurance policy or contract 88 
offered, delivered, issued for delivery, renewed, amended or 89 
continued in the state by a health carrier to provide, deliver, pay for or 90 
reimburse any of the costs of health care services; 91 
(B) "Health benefit plan" does not include: 92 
(i) Coverage of the type specified in subdivisions (5), (6), (7), (8), (9), 93 
(14), (15) and (16) of section 38a-469 of the general statutes or any 94 
combination thereof; 95 
(ii) Coverage issued as a supplement to liability insurance; 96 
(iii) Liability insurance, including general liability insurance and 97 
automobile liability insurance; 98 
(iv) Workers' compensation insurance; 99 
(v) Automobile medical payment insurance; 100 
(vi) Credit insurance; 101 
(vii) Coverage for on-site medical clinics; or 102 
(viii) Other similar insurance coverage specified in regulations 103  Committee Bill No. 10 
 
 
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issued pursuant to the Health Insurance Portability and Accountability 104 
Act of 1996, P.L. 104-191, as amended from time to time, under which 105 
benefits for health care services are secondary or incidental to other 106 
insurance benefits; and 107 
(C) "Health benefit plan" does not include the following benefits if 108 
such benefits are provided under a separate insurance policy, 109 
certificate or contract or are otherwise not an integral part of the plan: 110 
(i) Limited scope dental or vision benefits; 111 
(ii) Benefits for long-term care, nursing home care, home health 112 
care, community-based care or any combination thereof; 113 
(iii) Other similar, limited benefits specified in regulations issued 114 
pursuant to the Health Insurance Portability and Accountability Act of 115 
1996, P.L. 104-191, as amended from time to time; 116 
(iv) Other supplemental coverage, similar to coverage of the type 117 
specified in subdivisions (9) and (14) of section 38a-469 of the general 118 
statutes, provided under a group health plan; or 119 
(v) Coverage of the type specified in subdivision (3) or (13) of 120 
section 38a-469 of the general statutes or other fixed indemnity 121 
insurance if (I) such coverage is provided under a separate insurance 122 
policy, certificate or contract, (II) there is no coordination between the 123 
provision of the benefits and any exclusion of benefits under any 124 
group health plan maintained by the same plan sponsor, and (III) the 125 
benefits are paid with respect to an event without regard to whether 126 
benefits were also provided under any group health plan maintained 127 
by the same plan sponsor; 128 
(5) "Maximum fair price" means the maximum rate for a 129 
prescription drug published by the Secretary of the United States 130 
Department of Health and Human Services under Section 1191 of the 131 
Inflation Reduction Act of 2022, P.L. 117-169, as amended from time to 132 
time. "Maximum fair price" does not include any dispensing fee paid 133  Committee Bill No. 10 
 
 
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to a pharmacy for dispensing any referenced drug; 134 
(6) "Participating ERISA plan" means any employee welfare benefit 135 
plan subject to the Employee Retirement Income Security Act of 1974, 136 
as amended from time to time, that elects to participate in the 137 
requirements pursuant to section 3 or 4 of this act; 138 
(7) "Price applicability period" has the same meaning as provided in 139 
Section 1191 of the Inflation Reduction Act of 2022, P.L. 117-169, as 140 
amended from time to time; 141 
(8) "Purchaser" means any state entity, health benefit plan or 142 
participating ERISA plan; 143 
(9) "Referenced drug" means any prescription drug subject to the 144 
maximum fair price; and 145 
(10) "State entity" means any agency of this state, including, any 146 
agent, vendor, fiscal agent, contractor or other person acting on behalf 147 
of this state, that purchases a prescription drug on behalf of this state 148 
for a person who maintains a health insurance policy that is paid for 149 
by this state, including health insurance coverage offered through 150 
local, state or federal agencies or through organizations licensed in this 151 
state. "State entity" does not include the medical assistance program 152 
administered under Title XIX of the Social Security Act, 42 USC 1396 et 153 
seq., as amended from time to time. 154 
Sec. 3. (NEW) (Effective January 1, 2024, and applicable to contracts 155 
entered into, amended or renewed on and after January 1, 2024) (a) No 156 
purchaser shall purchase a referenced drug or seek reimbursement for 157 
a referenced drug to be dispensed, delivered or administered to an 158 
insured in this state, by hand delivery, mail or by other means, directly 159 
or through a distributor, for a cost that exceeds the maximum fair price 160 
during the price applicability period for such drug published pursuant 161 
to Section 1191 of the Inflation Reduction Act of 2022, P.L. 117-169, as 162 
amended from time to time. 163  Committee Bill No. 10 
 
 
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(b) Each purchaser shall calculate such purchaser's savings 164 
generated pursuant to subsection (a) of this section and shall apply 165 
such savings to reduce prescription drug costs for the purchaser's 166 
insureds. Not later than January fifteenth of each calendar year, a 167 
purchaser shall submit a report to the Insurance Department that (1) 168 
provides an assessment of such purchaser's savings for each referenced 169 
drug for the previous calendar year, and (2) identifies how each 170 
purchaser applied such savings to (A) reduce prescription drug costs 171 
for such purchaser's insureds, and (B) decrease cost disparities. 172 
(c) An ERISA plan may elect to participate in the requirements of 173 
this section by notifying the Insurance Department, in writing, not 174 
later than January first of each calendar year. 175 
(d) Any violation by a purchaser of subsection (a) of this section 176 
shall be subject to a civil penalty of one thousand dollars for each such 177 
violation. 178 
(e) The Insurance Commissioner shall adopt regulations, in 179 
accordance with the provisions of chapter 54 of the general statutes, to 180 
implement the provisions of this section and section 4 of this act. 181 
Sec. 4. (NEW) (Effective January 1, 2024, and applicable to contracts 182 
entered into, amended or renewed on and after January 1, 2024) (a) No 183 
manufacturer or distributor of a referenced drug shall withdraw such 184 
referenced drug from sale or distribution in this state to attempt to 185 
avoid any loss of revenue resulting from the maximum fair price 186 
requirement established in section 3 of this act. 187 
(b) Each manufacturer or distributor shall provide not less than one 188 
hundred eighty days' written notice to the Insurance Commissioner 189 
and Attorney General prior to withdrawing a referenced drug from 190 
sale or distribution in this state. 191 
(c) If any manufacturer or distributor violates the provisions of 192 
subsection (a) or (b) of this section, such manufacturer or distributor 193 
shall be subject to a civil penalty of (1) five hundred thousand dollars, 194  Committee Bill No. 10 
 
 
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or (2) such purchaser's amount of annual savings generated pursuant 195 
to subsection (a) of section 3 of this act, as determined by the Insurance 196 
Commissioner, whichever is greater. 197 
(d) It shall be a violation of this section for any manufacturer or 198 
distributor of a referenced drug to negotiate with a purchaser or seller 199 
of a referenced drug at a price that exceeds the maximum fair price. 200 
(e) The Attorney General shall have exclusive authority to enforce 201 
violations of this section and section 3 of this act. 202 
Sec. 5. (NEW) (Effective July 1, 2023) (a) As used in this section and 203 
section 6 of this act, (1) "federal 340B drug pricing program" means the 204 
plan described in Section 340B of the Public Health Service Act, 42 USC 205 
256b, as amended from time to time, (2) "340B covered entity" means a 206 
provider participating in the federal 340B drug pricing program, (3) 207 
"prescription drug" has the same meaning as provided in section 19a-208 
754b of the general statutes, and (4) "rebate" has the same meaning as 209 
provided in section 38a-479ooo of the general statutes. 210 
(b) Not later than January fifteenth annually, a 340B covered entity 211 
shall provide a report to the executive director of the Office of Health 212 
Strategy, established pursuant to section 19a-754a of the general 213 
statutes, as amended by this act, providing, for the previous calendar 214 
year (1) a list of all prescription drugs, identified by the national drug 215 
code number, purchased through the federal 340B drug pricing 216 
program, (2) the actual purchase price of each such prescription drug 217 
after any rebate or discount provided pursuant to the program, (3) the 218 
actual payment each such 340B covered entity received from any 219 
private or public health insurance plan, except for Medicaid and 220 
Medicare, or patient for each such prescription drug, (4) the average 221 
percentage savings realized by each 340B covered entity on the cost of 222 
prescription drugs under the 340B program, and (5) how the 340B 223 
covered entity used prescription drug cost savings under the program. 224 
The executive director shall include a link to the report on the office's 225 
Internet web site. 226  Committee Bill No. 10 
 
 
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Sec. 6. (NEW) (Effective July 1, 2023) No 340B covered entity shall 227 
attempt to collect as medical debt any payment for a prescription drug 228 
obtained with a rebate or at a discounted price through the federal 229 
340B drug pricing program by such entity but charged to a patient by 230 
the entity at a higher price. 231 
Sec. 7. (NEW) (Effective July 1, 2023) (a) There is established a 232 
Prescription Drug Payment Evaluation Committee to recommend 233 
upper payment limits on not fewer than eight prescription drugs to the 234 
executive director of the Office of Health Strategy based on evaluation 235 
of upper payment limits on such drugs set by other states or foreign 236 
jurisdictions. 237 
(b) Members of the committee shall be as follows: 238 
(1) Three appointed by the speaker of the House of Representatives, 239 
who shall be (A) a representative of a state-wide health care advocacy 240 
coalition, (B) a representative of a state-wide advocacy organization for 241 
elderly persons, and (C) a representative of a state-wide organization 242 
for diverse communities; 243 
(2) Three appointed by the president pro tempore of the Senate, 244 
who shall be (A) a representative of a labor union, (B) a health services 245 
researcher, and (C) a consumer who has experienced barriers to 246 
obtaining prescription drugs due to the cost of such drugs; 247 
(3) Two appointed by the majority leader of the House of 248 
Representatives, who shall be representatives of 340B covered entities, 249 
as defined in section 5 of this act; 250 
(4) Two appointed by the minority leader of the House of 251 
Representatives, who shall be representatives of private insurers; 252 
(5) Two appointed by the majority leader of the Senate, who shall be 253 
representatives of organizations representing health care providers; 254 
(6) Two appointed by the minority leader of the Senate, who shall 255  Committee Bill No. 10 
 
 
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be (A) a representative of a pharmaceutical company doing business in 256 
the state, and (B) a representative of an academic institution with 257 
expertise in health care costs; 258 
(7) Two appointed by the Governor, who shall be (A) a 259 
representative of pharmacists, and (B) a representative of pharmacy 260 
benefit managers; 261 
(8) The Secretary of the Office of Policy and Management, or the 262 
secretary's designee; 263 
(9) The Commissioner of Social Services, or the commissioner's 264 
designee; 265 
(10) The Commissioner of Public Health, or the commissioner's 266 
designee; 267 
(11) The Insurance Commissioner, or the commissioner's designee; 268 
(12) The Commissioner of Consumer Protection, or the 269 
commissioner's designee; 270 
(13) The executive director of the Office of Health Strategy, or the 271 
executive director's designee; and 272 
(14) The Healthcare Advocate, or the Healthcare Advocate's 273 
designee. 274 
(c) All initial appointments to the committee shall be made not later 275 
than thirty days after the effective date of this section. Any vacancy 276 
shall be filled by the appointing authority. 277 
(d) The speaker of the House of Representatives and the president 278 
pro tempore of the Senate shall select the chairpersons of the 279 
committee from among the members of the committee. Such 280 
chairpersons shall schedule the first meeting of the committee, which 281 
shall be held not later than sixty days after the effective date of this 282 
section. 283  Committee Bill No. 10 
 
 
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(e) The administrative staff of the joint standing committee of the 284 
General Assembly having cognizance of matters relating to insurance 285 
shall serve as administrative staff of the committee. 286 
(f) Not later than December 1, 2023, and annually thereafter, the 287 
committee shall submit a report, in accordance with the provisions of 288 
section 11-4a of the general statutes, to the executive director of the 289 
Office of Health Strategy and the joint standing committees of the 290 
General Assembly having cognizance of matters relating to 291 
appropriations and the budgets of state agencies, human services, 292 
insurance and public health with its recommendations concerning 293 
upper payment limits for not fewer than eight prescription drugs. 294 
Sec. 8. Section 3-112 of the general statutes is repealed and the 295 
following is substituted in lieu thereof (Effective July 1, 2023): 296 
(a) The Comptroller shall: (1) Establish and maintain the accounts of 297 
the state government and perform such other duties as are prescribed 298 
by the Constitution of the state; (2) register all warrants or orders for 299 
the disbursement of the public money; (3) adjust and settle all 300 
demands against the state not first adjusted and settled by the General 301 
Assembly and give orders on the Treasurer for the balance found and 302 
allowed; (4) prescribe the mode of keeping and rendering all public 303 
accounts of departments or agencies of the state and of institutions 304 
supported by the state or receiving state aid by appropriation from the 305 
General Assembly; (5) prepare and issue effective accounting and 306 
payroll manuals for use by the various agencies of the state; (6) from 307 
time to time, examine and state the amount of all debts and credits of 308 
the state; present all claims in favor of the state against any bankrupt, 309 
insolvent debtor or deceased person; and institute and maintain suits, 310 
in the name of the state, against all persons who have received money 311 
or property belonging to the state and have not accounted for it; and 312 
(7) administer the Connecticut Retirement Security Program, 313 
established pursuant to section 31-418. 314 
(b) All moneys recovered, procured or received for the state by the 315  Committee Bill No. 10 
 
 
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authority of the Comptroller shall be paid to the Treasurer, who shall 316 
file a duplicate receipt therefor with the Comptroller. The Comptroller 317 
may require reports from any department, agency or institution as 318 
aforesaid upon any matter of property or finance at any time and 319 
under such regulations as the Comptroller prescribes and shall require 320 
special reports upon request of the Governor, and the information 321 
contained in such special reports shall be transmitted by him to the 322 
Governor. All records, books and papers in any public office shall at all 323 
reasonable times be open to inspection by the Comptroller. The 324 
Comptroller may draw his order on the Treasurer for a petty cash fund 325 
for any budgeted agency. Expenditures from such petty cash funds 326 
shall be subject to such procedures as the Comptroller establishes. In 327 
accordance with established procedures, the Comptroller may enter 328 
into such contractual agreements as may be necessary for the discharge 329 
of his duties. As used in this section, "adjust" means to determine the 330 
amount equitably due in respect to each item of each claim or demand. 331 
(c) The Comptroller shall establish and administer a prescription 332 
drug discount card program available to all residents of the state. The 333 
Comptroller may coordinate participation in a multistate prescription 334 
drug consortium for the purposes of pooling prescription drug 335 
purchasing power to lower costs by negotiating discounts with 336 
prescription drug manufacturers and coordinating volume discount 337 
contracting. 338 
Sec. 9. Section 38a-477g of the general statutes is repealed and the 339 
following is substituted in lieu thereof (Effective January 1, 2024): 340 
(a) As used in this section: [(1) "Covered person", "facility" and 341 
"health carrier" have the same meanings as provided in section 38a-342 
591a, (2) "health care provider" has the same meaning as provided in 343 
subsection (a) of section 38a-477aa, and (3) "intermediary", "network", 344 
"network plan" and "participating provider" have the same meanings 345 
as provided in subsection (a) of section 38a-472f.] 346 
(1) "All-or-nothing clause" means a provision in a health care 347  Committee Bill No. 10 
 
 
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contract that: 348 
(A) Requires the health insurance carrier or health plan 349 
administrator to include all members of a health care provider in a 350 
network plan; or 351 
(B) Requires the health insurance carrier or health plan 352 
administrator to enter into any additional contract with an affiliate of 353 
the health care provider as a condition to entering into a contract with 354 
such health care provider. 355 
(2) "Anti-steering clause" means a provision of a health care contract 356 
that restricts the ability of the health insurance carrier or health plan 357 
administrator from encouraging an enrollee to obtain a health care 358 
service from a competitor of the hospital or health system, including 359 
offering incentives to encourage enrollees to utilize specific health care 360 
providers. 361 
(3) "Anti-tiering clause" means a provision in a health care contract 362 
that: 363 
(A) Restricts the ability of the health insurance carrier or health plan 364 
administrator to introduce and modify a tiered network plan or assign 365 
health care providers into tiers; or 366 
(B) Requires the health insurance carrier or health plan 367 
administrator to place all members of a health care provider in the 368 
same tier of a tiered network plan. 369 
(4) "Covered person", "facility" and "health carrier" have the same 370 
meanings as provided in section 38a-591a. 371 
(5) "Health care provider" has the same meaning as provided in 372 
subsection (a) of section 38a-477aa. 373 
(6) "Health plan administrator" means a third-party administrator 374 
who acts on behalf of a plan sponsor to administer a health benefit 375  Committee Bill No. 10 
 
 
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plan. 376 
(7) "Intermediary", "network", "network plan" and "participating 377 
provider" have the same meanings as provided in subsection (a) of 378 
section 38a-472f. 379 
(8) "Tiered network" has the same meaning as provided in section 380 
38a-472f. 381 
(9) "Value-based care" means a health care coverage model in which 382 
providers, including hospitals and physicians, are paid based on 383 
patient health outcomes. 384 
(b) (1) Each contract entered into, renewed or amended on or after 385 
January 1, [2017] 2024, between a health carrier and a participating 386 
provider shall include: 387 
(A) A hold harmless provision that specifies protections for covered 388 
persons. Such provision shall include the following statement or a 389 
substantially similar statement: "Provider agrees that in no event, 390 
including, but not limited to, nonpayment by the health carrier or 391 
intermediary, the insolvency of the health carrier or intermediary, or a 392 
breach of this agreement, shall the provider bill, charge, collect a 393 
deposit from, seek compensation, remuneration or reimbursement 394 
from, or have any recourse against a covered person or a person (other 395 
than the health carrier or intermediary) acting on behalf of the covered 396 
person for services provided pursuant to this agreement. This 397 
agreement does not prohibit the provider from collecting coinsurance, 398 
deductibles or copayments, as specifically provided in the evidence of 399 
coverage, or fees for uncovered services delivered on a fee-for-service 400 
basis to covered persons. Nor does this agreement prohibit a provider 401 
(except for a health care provider who is employed full-time on the 402 
staff of a health carrier and has agreed to provide services exclusively 403 
to that health carrier's covered persons and no others) and a covered 404 
person from agreeing to continue services solely at the expense of the 405 
covered person, as long as the provider has clearly informed the 406  Committee Bill No. 10 
 
 
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covered person that the health carrier does not cover or continue to 407 
cover a specific service or services. Except as provided herein, this 408 
agreement does not prohibit the provider from pursuing any available 409 
legal remedy."; 410 
(B) A provision that in the event of a health carrier or intermediary 411 
insolvency or other cessation of operations, the participating provider's 412 
obligation to deliver covered health care services to covered persons 413 
without requesting payment from a covered person other than a 414 
coinsurance, copayment, deductible or other out-of-pocket expense for 415 
such services will continue until the earlier of (i) the termination of the 416 
covered person's coverage under the network plan, including any 417 
extension of coverage provided under the contract terms or applicable 418 
state or federal law for covered persons who are in an active course of 419 
treatment, as set forth in subdivision (2) of subsection (g) of section 420 
38a-472f, or are totally disabled, or (ii) the date the contract between 421 
the health carrier and the participating provider would have 422 
terminated if the health carrier or intermediary had remained in 423 
operation, including any extension of coverage required under 424 
applicable state or federal law for covered persons who are in an active 425 
course of treatment or are totally disabled; 426 
(C) (i) A provision that requires the participating provider to make 427 
health records available to appropriate state and federal authorities 428 
involved in assessing the quality of care provided to, or investigating 429 
grievances or complaints of, covered persons, and (ii) a statement that 430 
such participating provider shall comply with applicable state and 431 
federal laws related to the confidentiality of medical and health 432 
records and a covered person's right to view, obtain copies of or 433 
amend such covered person's medical and health records; and 434 
(D) (i) If such contract is entered into, renewed or amended before 435 
July 1, 2022, definitions of what is considered timely notice and a 436 
material change for the purposes of subparagraph (A) of subdivision 437 
(2) of subsection (c) of this section, or (ii) if such contract is entered 438 
into, renewed or amended on or after July 1, 2022, (I) a statement 439  Committee Bill No. 10 
 
 
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disclosing the ninety-day advance written notice requirement 440 
established under subparagraph (B) of subdivision (2) of subsection (c) 441 
of this section and what is considered a material change for the 442 
purposes of subdivision (2) of subsection (c) of this section, and (II) 443 
provisions affording the participating provider a right to appeal any 444 
proposed change to the provisions, other documents, provider 445 
manuals or policies disclosed pursuant to subdivision (1) of subsection 446 
(c) of this section. 447 
(2) The contract terms set forth in subparagraphs (A) and (B) of 448 
subdivision (1) of this subsection shall (A) be construed in favor of the 449 
covered person, (B) survive the termination of the contract regardless 450 
of the reason for the termination, including the insolvency of the health 451 
carrier, and (C) supersede any oral or written agreement between a 452 
health care provider and a covered person or a covered person's 453 
authorized representative that is contrary to or inconsistent with the 454 
requirements set forth in subdivision (1) of this subsection. 455 
(3) No contract subject to this subsection shall include any provision 456 
that conflicts with the provisions contained in the network plan or 457 
required under this section, section 38a-472f or section 38a-477h. 458 
(4) No health carrier or participating provider that is a party to a 459 
contract under this subsection shall assign or delegate any right or 460 
responsibility required under such contract without the prior written 461 
consent of the other party. 462 
(c) (1) At the time a contract subject to subsection (b) of this section 463 
is signed, the health carrier or such health carrier's intermediary shall 464 
disclose to a participating provider: 465 
(A) All provisions and other documents incorporated by reference 466 
in such contract; and 467 
(B) If such contract is entered into, renewed or amended on or after 468 
July 1, 2022, all provider manuals and policies incorporated by 469 
reference in such contract, if any. 470  Committee Bill No. 10 
 
 
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(2) While such contract is in force, the health carrier shall: 471 
(A) If such contract is entered into, renewed or amended before July 472 
1, 2022, timely notify a participating provider of any change to the 473 
provisions or other documents specified under subparagraph (A) of 474 
subdivision (1) of this subsection that will result in a material change 475 
to such contract; or 476 
(B) If such contract is entered into, renewed or amended on or after 477 
July 1, 2022, provide to a participating provider at least ninety days' 478 
advance written notice of any change to the provisions or other 479 
documents specified under subparagraph (A) of subdivision (1) of this 480 
subsection, and any change to the provider manuals and policies 481 
specified under subparagraph (B) of subdivision (1) of this subsection, 482 
that will result in a material change to such contract or the procedures 483 
that a participating provider must follow pursuant to such contract. 484 
(d) (1) (A) Each contract between a health carrier and an 485 
intermediary entered into, renewed or amended on or after January 1, 486 
2017, shall satisfy the requirements of this subsection. 487 
(B) Each intermediary and participating providers with whom such 488 
intermediary contracts shall comply with the applicable requirements 489 
of this subsection. 490 
(2) No health carrier shall assign or delegate to an intermediary such 491 
health carrier's responsibilities to monitor the offering of covered 492 
benefits to covered persons. To the extent a health carrier assigns or 493 
delegates to an intermediary other responsibilities, such health carrier 494 
shall retain full responsibility for such intermediary's compliance with 495 
the requirements of this section. 496 
(3) A health carrier shall have the right to approve or disapprove the 497 
participation status of a health care provider or facility in such health 498 
carrier's own or a contracted network that is subcontracted for the 499 
purpose of providing covered benefits to the health carrier's covered 500 
persons. 501  Committee Bill No. 10 
 
 
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(4) A health carrier shall maintain at its principal place of business 502 
in this state copies of all intermediary subcontracts or ensure that such 503 
health carrier has access to all such subcontracts. Such health carrier 504 
shall have the right, upon twenty days' prior written notice, to make 505 
copies of any intermediary subcontracts to facilitate regulatory review. 506 
(5) (A) Each intermediary shall, if applicable, (i) transmit to the 507 
health carrier documentation of health care services utilization and 508 
claims paid, and (ii) maintain at its principal place of business in this 509 
state, for a period of time prescribed by the commissioner, the books, 510 
records, financial information and documentation of health care 511 
services received by covered persons, in a manner that facilitates 512 
regulatory review, and shall allow the commissioner access to such 513 
books, records, financial information and documentation as necessary 514 
for the commissioner to determine compliance with this section and 515 
section 38a-472f. 516 
(B) Each health carrier shall monitor the timeliness and 517 
appropriateness of payments made by its intermediary to participating 518 
providers and of health care services received by covered persons. 519 
(6) In the event of the intermediary's insolvency, a health carrier 520 
shall have the right to require the assignment to the health carrier of 521 
the provisions of a participating provider's contract that address such 522 
participating provider's obligation to provide covered benefits. If a 523 
health carrier requires such assignment, such health carrier shall 524 
remain obligated to pay the participating provider for providing 525 
covered benefits under the same terms and conditions as the 526 
intermediary prior to the insolvency. 527 
(e) The commissioner shall not act to arbitrate, mediate or settle (1) 528 
disputes regarding a health carrier's decision not to include a health 529 
care provider or facility in such health carrier's network or network 530 
plan, or (2) any other dispute between a health carrier, such health 531 
carrier's intermediary or one or more participating providers, that 532 
arises under or by reason of a participating provider contract or the 533  Committee Bill No. 10 
 
 
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termination of such contract. 534 
(f) No health insurance carrier, health care provider, health plan 535 
administrator or any agent or other entity that contracts on behalf of a 536 
health care provider, health insurance carrier or health plan 537 
administrator may offer, solicit, request, amend, renew or enter into a 538 
health care contract that would directly or indirectly include any of the 539 
following provisions: 540 
(1) An all-or-nothing clause; 541 
(2) An anti-steering clause; 542 
(3) An anti-tiering clause; or 543 
(4) Any other clause that results or intends to result in 544 
anticompetitive effects. 545 
(g) Any contract, written policy, written procedure or agreement 546 
that contains a clause contrary to the provisions set forth in subsection 547 
(f) of this section shall be null and void. All remaining clauses of the 548 
contract shall remain in effect for the duration of the contract term. 549 
(h) Nothing in this section shall be construed to prohibit value-550 
based care. 551 
(i) The Insurance Commissioner may adopt regulations, in 552 
accordance with chapter 54, to implement the provisions of subsection 553 
(f) of this section. 554 
Sec. 10. Subsection (a) of section 17b-242 of the general statutes is 555 
repealed and the following is substituted in lieu thereof (Effective July 556 
1, 2023): 557 
(a) The Department of Social Services shall determine the rates to be 558 
paid to home health care agencies and home health aide agencies by 559 
the state or any town in the state for persons aided or cared for by the 560 
state or any such town. The Commissioner of Social Services shall 561  Committee Bill No. 10 
 
 
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establish a fee schedule for home health services to be effective on and 562 
after July 1, 1994. The commissioner may annually modify such fee 563 
schedule if such modification is needed to ensure that the conversion 564 
to an administrative services organization is cost neutral to home 565 
health care agencies and home health aide agencies in the aggregate 566 
and ensures patient access. Utilization may be a factor in determining 567 
cost neutrality. The commissioner shall increase the fee schedule for 568 
home health services provided under the Connecticut home-care 569 
program for the elderly established under section 17b-342, effective 570 
July 1, 2000, by two per cent over the fee schedule for home health 571 
services for the previous year. The commissioner shall include in the 572 
fee schedule not less than two licensed clinical social worker visits to 573 
each individual enrolled in the Connecticut home-care program for the 574 
elderly or any home and community-based Medicaid waiver program 575 
administered by the Department of Social Services. The commissioner 576 
may increase any fee payable to a home health care agency or home 577 
health aide agency upon the application of such an agency evidencing 578 
extraordinary costs related to (1) serving persons with AIDS; (2) high-579 
risk maternal and child health care; (3) escort services; or (4) extended 580 
hour services. In no case shall any rate or fee exceed the charge to the 581 
general public for similar services. A home health care agency or home 582 
health aide agency which, due to any material change in 583 
circumstances, is aggrieved by a rate determined pursuant to this 584 
subsection may, within ten days of receipt of written notice of such 585 
rate from the Commissioner of Social Services, request in writing a 586 
hearing on all items of aggrievement. The commissioner shall, upon 587 
the receipt of all documentation necessary to evaluate the request, 588 
determine whether there has been such a change in circumstances and 589 
shall conduct a hearing if appropriate. The Commissioner of Social 590 
Services shall adopt regulations, in accordance with chapter 54, to 591 
implement the provisions of this subsection. The commissioner may 592 
implement policies and procedures to carry out the provisions of this 593 
subsection while in the process of adopting regulations, provided 594 
notice of intent to adopt the regulations is published in the Connecticut 595 
Law Journal not later than twenty days after the date of implementing 596  Committee Bill No. 10 
 
 
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the policies and procedures. Such policies and procedures shall be 597 
valid for not longer than nine months. 598 
Sec. 11. (NEW) (Effective from passage) (a) For purposes of this 599 
section, "certified community health worker" has the same meaning as 600 
provided in section 20-195ttt of the general statutes. The Commissioner 601 
of Social Services shall design and implement a program to provide 602 
Medicaid reimbursement to certified community health workers for 603 
services provided to HUSKY Health program members, including, but 604 
not limited to: (1) Coordination of medical, oral and behavioral health 605 
care services and social supports; (2) connection to and navigation of 606 
health systems and services; (3) prenatal, birth, lactation and 607 
postpartum supports; and (4) health promotion, coaching and self-608 
management education. 609 
(b) The commissioner shall provide reimbursement for the services 610 
of certified community health workers in a manner and at a rate 611 
conducive to workforce growth. 612 
(c) The commissioner and the commissioner's designees shall 613 
consult with certified community health workers and others 614 
throughout the design and implementation of the certified community 615 
health worker reimbursement program in a manner that (1) is inclusive 616 
of community-based and clinic-based certified community health 617 
workers; (2) is representative of medical assistance program member 618 
demographics; and (3) helps shape the reimbursement program's 619 
design and implementation. 620 
(d) The Department of Social Services shall coordinate with the 621 
Office of Health Strategy to identify opportunities for the integration of 622 
certified community health workers into the medical assistance 623 
program. Not later than January 1, 2024, and annually thereafter until 624 
the reimbursement program is fully implemented, the Department of 625 
Social Services shall submit a report, in accordance with the provisions 626 
of section 11-4a of the general statutes, to the joint standing committee 627 
of the General Assembly having cognizance of matters relating to 628  Committee Bill No. 10 
 
 
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human services and the Council on Medical Assistance Program 629 
Oversight. Such report shall contain an update on the certified 630 
community health worker reimbursement program and an evaluation 631 
of its impact on health outcomes and health equity. 632 
Sec. 12. Subsection (b) of section 19a-754a of the general statutes is 633 
repealed and the following is substituted in lieu thereof (Effective from 634 
passage): 635 
(b) The Office of Health Strategy shall be responsible for the 636 
following: 637 
(1) Developing and implementing a comprehensive and cohesive 638 
health care vision for the state, including, but not limited to, a 639 
coordinated state health care cost containment strategy; 640 
(2) Promoting effective health planning and the provision of quality 641 
health care in the state in a manner that ensures access for all state 642 
residents to cost-effective health care services, avoids the duplication 643 
of such services and improves the availability and financial stability of 644 
such services throughout the state; 645 
(3) Directing and overseeing the State Innovation Model Initiative 646 
and related successor initiatives; 647 
(4) (A) Coordinating the state's health information technology 648 
initiatives, (B) seeking funding for and overseeing the planning, 649 
implementation and development of policies and procedures for the 650 
administration of the all-payer claims database program established 651 
under section 19a-775a, (C) establishing and maintaining a consumer 652 
health information Internet web site under section 19a-755b, and (D) 653 
designating an unclassified individual from the office to perform the 654 
duties of a health information technology officer as set forth in sections 655 
17b-59f and 17b-59g; 656 
(5) Directing and overseeing the Health Systems Planning Unit 657 
established under section 19a-612 and all of its duties and 658  Committee Bill No. 10 
 
 
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responsibilities as set forth in chapter 368z; 659 
(6) Convening forums and meetings with state government and 660 
external stakeholders, including, but not limited to, the Connecticut 661 
Health Insurance Exchange, to discuss health care issues designed to 662 
develop effective health care cost and quality strategies; 663 
(7) Consulting with the Commissioner of Social Services, Insurance 664 
Commissioner and Connecticut Health Insurance Exchange on the 665 
Covered Connecticut program described in section 19a-754c; [and] 666 
(8) (A) Setting an annual health care cost growth benchmark and 667 
primary care spending target pursuant to section 19a-754g, (B) 668 
developing and adopting health care quality benchmarks pursuant to 669 
section 19a-754g, (C) developing strategies, in consultation with 670 
stakeholders, to meet such benchmarks and targets developed 671 
pursuant to section 19a-754g, (D) enhancing the transparency of 672 
provider entities, as defined in subdivision (13) of section 19a-754f, (E) 673 
monitoring the development of accountable care organizations and 674 
patient-centered medical homes in the state, and (F) monitoring the 675 
adoption of alternative payment methodologies in the state; and 676 
(9) Convening forums and meetings with Access Health 677 
Connecticut, the Department of Public Health, the birth-to-three 678 
program, as defined in section 17a-248, state home visiting programs, 679 
community action agencies, hospitals, community health centers and 680 
other state government and external stakeholders to align community 681 
health worker programs funded by the state medical assistance 682 
programs, block grants, health care providers, private insurance 683 
carriers and other external stakeholders. 684 
Sec. 13. Section 17b-312 of the general statutes is repealed and the 685 
following is substituted in lieu thereof (Effective from passage): 686 
(a) The Commissioner of Social Services shall seek, in accordance 687 
with the provisions of section 17b-8 and in consultation with the 688 
Insurance Commissioner and the Office of Health Strategy established 689  Committee Bill No. 10 
 
 
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under section 19a-754a, as amended by this act, a waiver under Section 690 
1115 of the Social Security Act, as amended from time to time, to [seek] 691 
obtain federal funds to support the Covered Connecticut program 692 
established under section 19a-754c. Upon approval by the Centers for 693 
Medicare and Medicaid Services, the Commissioner of Social Services 694 
shall implement the waiver. 695 
(b) Not later than thirty days after the effective date of this section, 696 
the commissioner shall amend the waiver submitted in accordance 697 
with subsection (a) of this section, to the extent permissible under 698 
federal law and in accordance with section 17b-8, to provide coverage 699 
through the Covered Connecticut program to persons otherwise 700 
qualified for the program whose income does not exceed two hundred 701 
per cent of the federal poverty level. The commissioner shall consult 702 
with the Insurance Commissioner and the executive director of the 703 
Office of Health Strategy in submitting the waiver amendment. 704 
Sec. 14. (NEW) (Effective from passage) (a) Not later than sixty days 705 
after the effective date of this section, the Commissioner of Social 706 
Services, in consultation with the Insurance Commissioner and the 707 
executive director of the Office of Health Strategy established under 708 
section 19a-754a of the general statutes, as amended by this act, shall 709 
develop a plan for a second tier of the Covered Connecticut program 710 
established pursuant to section 19a-754c of the general statutes. The 711 
plan shall provide state-assisted health care coverage for persons 712 
otherwise qualified for the program whose income exceeds two 713 
hundred per cent of the federal poverty level but does not exceed three 714 
hundred per cent of the federal poverty level. 715 
(b) The plan developed pursuant to subsection (a) of this section 716 
may include (1) reduced benefits from the Covered Connecticut 717 
program, provided such benefits are in accordance with the 718 
requirements of the Patient Protection and Affordable Care Act, P.L. 719 
111-148, as amended by the Health Care and Education Reconciliation 720 
Act, P.L. 111-152, as both may be amended from time to time, and 721 
regulations adopted thereunder, and (2) income-based copayments by 722  Committee Bill No. 10 
 
 
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enrollees. 723 
(c) The Commissioner of Social Services shall submit the plan 724 
developed in accordance with this section to the joint standing 725 
committees of the General Assembly having cognizance of matters 726 
relating to appropriations and the budgets of state agencies, human 727 
services and insurance. Not later than thirty days after the date of their 728 
receipt of such plan, the joint standing committees shall hold a public 729 
hearing on the plan. At the conclusion of a public hearing held in 730 
accordance with the provisions of this section, the joint standing 731 
committees shall advise the commissioner of their approval, denial or 732 
modifications, if any, of the commissioner's plan. If the joint standing 733 
committees advise the commissioner of their denial of approval, the 734 
commissioner shall not implement the plan. If such committees do not 735 
concur, the committee chairpersons shall appoint a committee of 736 
conference which shall be composed of three members from each joint 737 
standing committee. At least one member appointed from each joint 738 
standing committee shall be a member of the minority party. The 739 
report of the committee of conference shall be made to each joint 740 
standing committee, which shall vote to accept or reject the report. The 741 
report of the committee of conference may not be amended. If a joint 742 
standing committee rejects the report of the committee of conference, 743 
that joint standing committee shall notify the commissioner of the 744 
rejection and the commissioner's plan shall be deemed approved. If the 745 
joint standing committees accept the report, the committee having 746 
cognizance of matters relating to appropriations and the budgets of 747 
state agencies shall advise the commissioner of their approval, denial 748 
or modifications, if any, of the commissioner's plan. If the joint 749 
standing committees do not so advise the commissioner during the 750 
thirty-day period, the plan shall be deemed denied. Any 751 
implementation of the plan developed pursuant to this section shall be 752 
in accordance with the approval or modifications, if any, of the joint 753 
standing committees of the General Assembly having cognizance of 754 
matters relating to appropriations and the budgets of state agencies, 755 
human services and insurance. 756  Committee Bill No. 10 
 
 
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(d) To the extent permissible under federal law, the commissioner 757 
may seek approval of a Medicaid waiver in accordance with section 758 
17b-8 of the general statutes to obtain federal financial participation for 759 
the plan developed pursuant to this section. 760 
Sec. 15. Section 38a-1084 of the general statutes is repealed and the 761 
following is substituted in lieu thereof (Effective from passage): 762 
The exchange shall: 763 
(1) Administer the exchange for both qualified individuals and 764 
qualified employers; 765 
(2) Commission surveys of individuals, small employers and health 766 
care providers on issues related to health care and health care 767 
coverage; 768 
(3) Implement procedures for the certification, recertification and 769 
decertification, consistent with guidelines developed by the Secretary 770 
under Section 1311(c) of the Affordable Care Act, and section 38a-1086, 771 
of health benefit plans as qualified health plans; 772 
(4) Provide for the operation of a toll-free telephone hotline to 773 
respond to requests for assistance; 774 
(5) Provide for enrollment periods, as provided under Section 775 
1311(c)(6) of the Affordable Care Act; 776 
(6) Maintain an Internet web site through which enrollees and 777 
prospective enrollees of qualified health plans may obtain 778 
standardized comparative information on such plans including, but 779 
not limited to, the enrollee satisfaction survey information under 780 
Section 1311(c)(4) of the Affordable Care Act and any other 781 
information or tools to assist enrollees and prospective enrollees 782 
evaluate qualified health plans offered through the exchange; 783 
(7) Publish the average costs of licensing, regulatory fees and any 784  Committee Bill No. 10 
 
 
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other payments required by the exchange and the administrative costs 785 
of the exchange, including information on moneys lost to waste, fraud 786 
and abuse, on an Internet web site to educate individuals on such 787 
costs; 788 
(8) On or before the open enrollment period for plan year 2017, 789 
assign a rating to each qualified health plan offered through the 790 
exchange in accordance with the criteria developed by the Secretary 791 
under Section 1311(c)(3) of the Affordable Care Act, and determine 792 
each qualified health plan's level of coverage in accordance with 793 
regulations issued by the Secretary under Section 1302(d)(2)(A) of the 794 
Affordable Care Act; 795 
(9) Use a standardized format for presenting health benefit options 796 
in the exchange, including the use of the uniform outline of coverage 797 
established under Section 2715 of the Public Health Service Act, 42 798 
USC 300gg-15, as amended from time to time; 799 
(10) Inform individuals, in accordance with Section 1413 of the 800 
Affordable Care Act, of eligibility requirements for the Medicaid 801 
program under Title XIX of the Social Security Act, as amended from 802 
time to time, the Children's Health Insurance Program (CHIP) under 803 
Title XXI of the Social Security Act, as amended from time to time, or 804 
any applicable state or local public program, and enroll an individual 805 
in such program if the exchange determines, through screening of the 806 
application by the exchange, that such individual is eligible for any 807 
such program; 808 
(11) Collaborate with the Department of Social Services, to the 809 
extent possible, to allow an enrollee who loses premium tax credit 810 
eligibility under Section 36B of the Internal Revenue Code and is 811 
eligible for HUSKY A or any other state or local public program, to 812 
remain enrolled in a qualified health plan; 813 
(12) Establish and make available by electronic means a calculator to 814 
determine the actual cost of coverage after application of any premium 815  Committee Bill No. 10 
 
 
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tax credit under Section 36B of the Internal Revenue Code and any 816 
cost-sharing reduction under Section 1402 of the Affordable Care Act; 817 
(13) Establish a program for small employers through which 818 
qualified employers may access coverage for their employees and that 819 
shall enable any qualified employer to specify a level of coverage so 820 
that any of its employees may enroll in any qualified health plan 821 
offered through the exchange at the specified level of coverage; 822 
(14) Offer enrollees and small employers the option of having the 823 
exchange collect and administer premiums, including through 824 
allocation of premiums among the various insurers and qualified 825 
health plans chosen by individual employers; 826 
(15) Grant a certification, subject to Section 1411 of the Affordable 827 
Care Act, attesting that, for purposes of the individual responsibility 828 
penalty under Section 5000A of the Internal Revenue Code, an 829 
individual is exempt from the individual responsibility requirement or 830 
from the penalty imposed by said Section 5000A because: 831 
(A) There is no affordable qualified health plan available through 832 
the exchange, or the individual's employer, covering the individual; or 833 
(B) The individual meets the requirements for any other such 834 
exemption from the individual responsibility requirement or penalty; 835 
(16) Provide to the Secretary of the Treasury of the United States the 836 
following: 837 
(A) A list of the individuals granted a certification under 838 
subdivision (15) of this section, including the name and taxpayer 839 
identification number of each individual; 840 
(B) The name and taxpayer identification number of each individual 841 
who was an employee of an employer but who was determined to be 842 
eligible for the premium tax credit under Section 36B of the Internal 843 
Revenue Code because: 844  Committee Bill No. 10 
 
 
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(i) The employer did not provide minimum essential health benefits 845 
coverage; or 846 
(ii) The employer provided the minimum essential coverage but it 847 
was determined under Section 36B(c)(2)(C) of the Internal Revenue 848 
Code to be unaffordable to the employee or not provide the required 849 
minimum actuarial value; and 850 
(C) The name and taxpayer identification number of: 851 
(i) Each individual who notifies the exchange under Section 852 
1411(b)(4) of the Affordable Care Act that such individual has changed 853 
employers; and 854 
(ii) Each individual who ceases coverage under a qualified health 855 
plan during a plan year and the effective date of that cessation; 856 
(17) Provide to each employer the name of each employee, as 857 
described in subparagraph (B) of subdivision (16) of this section, of the 858 
employer who ceases coverage under a qualified health plan during a 859 
plan year and the effective date of the cessation; 860 
(18) Perform duties required of, or delegated to, the exchange by the 861 
Secretary or the Secretary of the Treasury of the United States related 862 
to determining eligibility for premium tax credits, reduced cost-863 
sharing or individual responsibility requirement exemptions; 864 
(19) Select entities qualified to serve as Navigators in accordance 865 
with Section 1311(i) of the Affordable Care Act and award grants to 866 
enable Navigators to: 867 
(A) Conduct public education activities to raise awareness of the 868 
availability of qualified health plans; 869 
(B) Distribute fair and impartial information concerning enrollment 870 
in qualified health plans and the availability of premium tax credits 871 
under Section 36B of the Internal Revenue Code and cost-sharing 872  Committee Bill No. 10 
 
 
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reductions under Section 1402 of the Affordable Care Act; 873 
(C) Facilitate enrollment in qualified health plans; 874 
(D) Provide referrals to the Office of the Healthcare Advocate or 875 
health insurance ombudsman established under Section 2793 of the 876 
Public Health Service Act, 42 USC 300gg-93, as amended from time to 877 
time, or any other appropriate state agency or agencies, for any 878 
enrollee with a grievance, complaint or question regarding the 879 
enrollee's health benefit plan, coverage or a determination under that 880 
plan or coverage; and 881 
(E) Provide information in a manner that is culturally and 882 
linguistically appropriate to the needs of the population being served 883 
by the exchange; 884 
(20) Review the rate of premium growth within and outside the 885 
exchange and cons ider such information in developing 886 
recommendations on whether to continue limiting qualified employer 887 
status to small employers; 888 
(21) Credit the amount, in accordance with Section 10108 of the 889 
Affordable Care Act, of any free choice voucher to the monthly 890 
premium of the plan in which a qualified employee is enrolled and 891 
collect the amount credited from the offering employer; 892 
(22) Consult with stakeholders relevant to carrying out the activities 893 
required under sections 38a-1080 to 38a-1090, inclusive, including, but 894 
not limited to: 895 
(A) Individuals who are knowledgeable about the health care 896 
system, have background or experience in making informed decisions 897 
regarding health, medical and scientific matters and are enrollees in 898 
qualified health plans; 899 
(B) Individuals and entities with experience in facilitating 900 
enrollment in qualified health plans; 901  Committee Bill No. 10 
 
 
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(C) Representatives of small employers and self-employed 902 
individuals; 903 
(D) The Department of Social Services; and 904 
(E) Advocates for enrolling hard-to-reach populations; 905 
(23) Meet the following financial integrity requirements: 906 
(A) Keep an accurate accounting of all activities, receipts and 907 
expenditures and annually submit to the Secretary, the Governor, the 908 
Insurance Commissioner and the General Assembly a report 909 
concerning such accountings; 910 
(B) Fully cooperate with any investigation conducted by the 911 
Secretary pursuant to the Secretary's authority under the Affordable 912 
Care Act and allow the Secretary, in coordination with the Inspector 913 
General of the United States Department of Health and Human 914 
Services, to: 915 
(i) Investigate the affairs of the exchange; 916 
(ii) Examine the properties and records of the exchange; and 917 
(iii) Require periodic reports in relation to the activities undertaken 918 
by the exchange; and 919 
(C) Not use any funds in carrying out its activities under sections 920 
38a-1080 to 38a-1089, inclusive, that are intended for the administrative 921 
and operational expenses of the exchange, for staff retreats, 922 
promotional giveaways, excessive executive compensation or 923 
promotion of federal or state legislative and regulatory modifications; 924 
(24) (A) Seek to include the most comprehensive health benefit 925 
plans that offer high quality benefits at the most affordable price in the 926 
exchange, (B) encourage health carriers to offer tiered health care 927 
provider network plans that have different cost-sharing rates for 928 
different health care provider tiers and reward enrollees for choosing 929  Committee Bill No. 10 
 
 
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low-cost, high-quality health care providers by offering lower 930 
copayments, deductibles or other out-of-pocket expenses, and (C) offer 931 
any such tiered health care provider network plans through the 932 
exchange; 933 
(25) Report at least annually to the General Assembly on the effect 934 
of adverse selection on the operations of the exchange and make 935 
legislative recommendations, if necessary, to reduce the negative 936 
impact from any such adverse selection on the sustainability of the 937 
exchange, including recommendations to ensure that regulation of 938 
insurers and health benefit plans are similar for qualified health plans 939 
offered through the exchange and health benefit plans offered outside 940 
the exchange. The exchange shall evaluate whether adverse selection is 941 
occurring with respect to health benefit plans that are grandfathered 942 
under the Affordable Care Act, self-insured plans, plans sold through 943 
the exchange and plans sold outside the exchange; [and] 944 
(26) Consult with the Commissioner of Social Services, Insurance 945 
Commissioner and Office of Health Strategy, established under section 946 
19a-754a, as amended by this act, for the purposes set forth in section 947 
19a-754c; and 948 
(27) (A) Notwithstanding the provisions of section 12-15, the 949 
exchange shall make a written request to the Commissioner of 950 
Revenue Services, for return or return information, as such terms are 951 
defined in section 12-15, for use in conducting targeted outreach to 952 
uninsured residents of this state. If the Commissioner of Revenue 953 
Services deems such return or return information to be relevant to the 954 
targeted outreach to uninsured residents, said commissioner may 955 
disclose such information to the exchange. To effectuate the disclosure 956 
of such information, the Commissioner of Revenue Services and the 957 
exchange shall enter into a memorandum of understanding that sets 958 
forth the specific information to be disclosed and contains the terms 959 
and conditions under which said commissioner will disclose such 960 
information to the exchange. Any return or return information 961 
disclosed by the Commissioner of Revenue Services shall not be 962  Committee Bill No. 10 
 
 
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redisclosed by the recipient to a third party without permission from 963 
the commissioner and shall only be used by the exchange in the 964 
manner prescribed in the memorandum of understanding. Any person 965 
who violates the provisions of this subparagraph shall be fined not 966 
more than five thousand dollars. 967 
(B) To assist the exchange in conducting targeted outreach to 968 
uninsured residents of this state, the Commissioner of Revenue 969 
Services shall revise the tax return form prescribed under chapter 229 970 
to include space on the tax return for residents to authorize the 971 
exchange to contact such residents regarding enrollment through the 972 
exchange. The Commissioner of Revenue Services and the exchange 973 
shall develop language to be included on the tax return form and shall 974 
include in the instructions accompanying the tax return a description 975 
of how the authorization provided will be relayed to the exchange. 976 
Sec. 16. Section 19a-42 of the general statutes is repealed and the 977 
following is substituted in lieu thereof (Effective July 1, 2023): 978 
(a) To protect the integrity and accuracy of vital records, a certificate 979 
registered under chapter 93 may be amended only in accordance with 980 
sections 19a-41 to 19a-45, inclusive, chapter 93, regulations adopted by 981 
the Commissioner of Public Health pursuant to chapter 54 and 982 
uniform procedures prescribed by the commissioner. Only the 983 
commissioner may amend birth certificates to reflect changes 984 
concerning parentage or the legal name of a parent or birth or marriage 985 
certificates to reflect changes concerning gender. [change.] 986 
Amendments related to parentage, [or] gender change or the legally 987 
changed name of a parent shall result in the creation of a replacement 988 
certificate that supersedes the original, and shall in no way reveal the 989 
original language changed by the amendment. Any amendment to a 990 
vital record made by the registrar of vital statistics of the town in 991 
which the vital event occurred or by the commissioner shall be in 992 
accordance with such regulations and uniform procedures. 993 
(b) The commissioner and the registrar of vital statistics shall 994  Committee Bill No. 10 
 
 
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maintain sufficient documentation, as prescribed by the commissioner, 995 
to support amendments and shall ensure the confidentiality of such 996 
documentation as required by law. The date of amendment and a 997 
summary description of the evidence submitted in support of the 998 
amendment shall be endorsed on or made part of the record and the 999 
original certificate shall be marked "Amended", except for 1000 
amendments [due to] concerning parentage, [or] gender change or the 1001 
legally changed name of a parent. When the registrar of the town in 1002 
which the vital event occurred amends a certificate, such registrar 1003 
shall, within ten days of making such amendment, forward an 1004 
amended certificate to the commissioner and to any registrar having a 1005 
copy of the certificate. When the commissioner amends a birth 1006 
certificate, including changes [due to] concerning parentage, [or] 1007 
gender change or the legally changed name of a parent , the 1008 
commissioner shall forward an amended certificate to the registrars of 1009 
vital statistics affected and their records shall be amended accordingly. 1010 
(c) An amended certificate shall supersede the original certificate 1011 
that has been changed and shall be marked "Amended", except for 1012 
amendments [due to] concerning parentage, [or] gender change or the 1013 
legally changed name of a parent. The original certificate in the case of 1014 
parentage, [or] gender change or the legally changed name of a parent 1015 
shall be physically or electronically sealed and kept in a confidential 1016 
file by the department and the registrar of any town in which the birth 1017 
was recorded, and may be unsealed for issuance only as provided in 1018 
section 7-53 with regard to an original birth certificate or upon a 1019 
written order of a court of competent jurisdiction. The amended 1020 
certificate shall become the official record. 1021 
(d) (1) Upon receipt of (A) an acknowledgment of parentage 1022 
executed in accordance with the provisions of sections 46b-476 to 46b-1023 
487, inclusive, by both parents of a child, or (B) a certified copy of an 1024 
order of a court of competent jurisdiction establishing the parentage of 1025 
a child, the commissioner shall include on or amend, as appropriate, 1026 
such child's birth certificate to show such parentage if parentage is not 1027  Committee Bill No. 10 
 
 
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already shown on such birth certificate and to change the name of the 1028 
child under eighteen years of age if so indicated on the 1029 
acknowledgment of parentage form or within the certified court order 1030 
as part of the parentage action. If a person who is the subject of a 1031 
voluntary acknowledgment of parentage, as described in this 1032 
subdivision, is eighteen years of age or older, the commissioner shall 1033 
obtain a notarized affidavit from such person affirming that such 1034 
person agrees to the commissioner's amendment of such person's birth 1035 
certificate as such amendment relates to the acknowledgment of 1036 
parentage. The commissioner shall amend the birth certificate for an 1037 
adult child to change the child's name only pursuant to a court order. 1038 
(2) If the birth certificate lists the information of a parent other than 1039 
the parent who gave birth, the commissioner shall not remove or 1040 
replace the parent's information unless presented with a certified court 1041 
order that meets the requirements specified in section 7-50, or upon the 1042 
proper filing of a rescission, in accordance with the provisions of 1043 
section 46b-570. The commissioner shall thereafter amend such child's 1044 
birth certificate to remove or change the name of the parent other than 1045 
the person who gave birth and, if relevant, to change the name of the 1046 
child, as requested at the time of the filing of a rescission, in 1047 
accordance with the provisions of section 46b-570. Birth certificates 1048 
amended under this subsection shall not be marked "Amended". 1049 
(e) When the parent or parents of a child request the amendment of 1050 
the child's birth certificate to reflect a new name of the parent who 1051 
gave birth because the name on the original certificate is fictitious, such 1052 
parent or parents shall obtain an order of a court of competent 1053 
jurisdiction declaring the person who gave birth to be the child's 1054 
parent. Upon receipt of a certified copy of such order, the department 1055 
shall amend the child's birth certificate to reflect the parent's true 1056 
name. 1057 
(f) Upon receipt of a certified copy of an order of a court of 1058 
competent jurisdiction changing the name of a person born in this state 1059 
and upon request of such person or such person's parents, guardian, or 1060  Committee Bill No. 10 
 
 
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legal representative, the commissioner or the registrar of vital statistics 1061 
of the town in which the vital event occurred shall amend the birth 1062 
certificate to show the new name by a method prescribed by the 1063 
department. 1064 
(g) When an applicant submits the documentation required by the 1065 
regulations to amend a vital record, the commissioner shall hold a 1066 
hearing, in accordance with chapter 54, if the commissioner has 1067 
reasonable cause to doubt the validity or adequacy of such 1068 
documentation. 1069 
(h) When an amendment under this section involves the changing of 1070 
existing language on a death certificate due to an error pertaining to 1071 
the cause of death, the death certificate shall be amended in such a 1072 
manner that the original language is still visible. A copy of the death 1073 
certificate shall be made. The original death certificate shall be sealed 1074 
and kept in a confidential file at the department and only the 1075 
commissioner may order it unsealed. The copy shall be amended in 1076 
such a manner that the language to be changed is no longer visible. 1077 
The copy shall be a public document. 1078 
(i) The commissioner shall issue a new birth certificate to reflect a 1079 
gender change upon receipt of the following documents submitted in 1080 
the form and manner prescribed by the commissioner: (1) A written 1081 
request from the applicant, signed under penalty of law, for a 1082 
replacement birth certificate to reflect that the applicant's gender 1083 
differs from the sex designated on the original birth certificate; (2) a 1084 
notarized affidavit by a physician licensed pursuant to chapter 370 or 1085 
holding a current license in good standing in another state, a physician 1086 
assistant licensed pursuant to chapter 370 or holding a current license 1087 
in good standing in another state, an advanced practice registered 1088 
nurse licensed pursuant to chapter 378 or holding a current license in 1089 
good standing in another state, or a psychologist licensed pursuant to 1090 
chapter 383 or holding a current license in good standing in another 1091 
state, stating that the applicant has undergone surgical, hormonal or 1092 
other treatment clinically appropriate for the applicant for the purpose 1093  Committee Bill No. 10 
 
 
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of gender transition; and (3) if an applicant is also requesting a change 1094 
of name listed on the original birth certificate, proof of a legal name 1095 
change. The new birth certificate shall reflect the new gender identity 1096 
by way of a change in the sex designation on the original birth 1097 
certificate and, if applicable, the legal name change. 1098 
(j) The commissioner shall issue a new birth certificate to reflect the 1099 
legally changed name of a parent of the child who is the subject of such 1100 
birth certificate upon receipt of the following documents, submitted in 1101 
a form and manner prescribed by the commissioner: (1) A written 1102 
request from the parent, signed under penalty of law, for a 1103 
replacement birth certificate to reflect that the parent's legal name 1104 
differs from the name designated on the original birth certificate, and 1105 
(2) proof of such parent's legal name change. 1106 
[(j)] (k) The commissioner shall issue a new marriage certificate to 1107 
reflect a gender change upon receipt of the following documents, 1108 
submitted in a form and manner prescribed by the commissioner: (1) A 1109 
written request from the applicant, signed under penalty of law, for a 1110 
replacement marriage certificate to reflect that the applicant's gender 1111 
differs from the sex designated on the original marriage certificate, 1112 
along with an affirmation that the marriage is still legally intact; (2) a 1113 
notarized statement from the spouse named on the marriage certificate 1114 
to be amended, consenting to the amendment; (3) (A) a United States 1115 
passport or amended birth certificate or court order reflecting the 1116 
applicant's gender as of the date of the request or (B) a notarized 1117 
affidavit by a physician licensed pursuant to chapter 370 or holding a 1118 
current license in good standing in another state, physician assistant 1119 
licensed pursuant to chapter 370 or holding a current license in good 1120 
standing in another state, an advanced practice registered nurse 1121 
licensed pursuant to chapter 378 or holding a current license in good 1122 
standing in another state or a psychologist licensed pursuant to 1123 
chapter 383 or holding a current license in good standing in another 1124 
state stating that the applicant has undergone surgical, hormonal or 1125 
other treatment clinically appropriate for the applicant for the purpose 1126  Committee Bill No. 10 
 
 
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of gender transition; and (4) if an applicant is also requesting a change 1127 
of name listed on the original marriage certificate, proof of a legal 1128 
name change. The new marriage certificate shall reflect the new gender 1129 
identity by way of a change in the sex designation on the original 1130 
marriage certificate and, if applicable, the legal name change. 1131 
Sec. 17. (NEW) (Effective from passage) (a) For purposes of this 1132 
section, "inmate" and "prisoner" have the same meanings as provided 1133 
in section 18-84 of the general statutes. 1134 
(b) Not later than thirty days after the written request of any inmate 1135 
or prisoner whose name has been ordered changed pursuant to section 1136 
45a-99 or section 52-11 of the general statutes, the Commissioner of 1137 
Correction shall change such inmate or prisoner's name in the records 1138 
of the Department of Correction in accordance with such order. Any 1139 
such written request shall be accompanied by a certified copy of such 1140 
order. 1141 
Sec. 18. Section 18-81ii of the general statutes is repealed and the 1142 
following is substituted in lieu thereof (Effective July 1, 2023): 1143 
Any inmate of a correctional institution, as described in section 18-1144 
78, who has a gender identity that differs from the inmate's assigned 1145 
sex at birth and has a diagnosis of gender dysphoria, as set forth in the 1146 
most recent edition of the American Psychiatric Association's 1147 
"Diagnostic and Statistical Manual of Mental Disorders" or gender 1148 
incongruence, as defined in the 11
th
 edition of the "International 1149 
Statistical Classification of Diseases and Related Health Problems", 1150 
shall: (1) Be addressed by correctional staff in a manner that is 1151 
consistent with the inmate's gender identity, (2) have access to 1152 
commissary items, clothing, personal property, programming and 1153 
educational materials that are consistent with the inmate's gender 1154 
identity, and (3) have the right to be searched by a correctional staff 1155 
member of the same gender identity, unless the inmate requests 1156 
otherwise or under exigent circumstances. An inmate who has a birth 1157 
certificate, passport or driver's license that reflects his or her gender 1158  Committee Bill No. 10 
 
 
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identity or who can meet established standards for obtaining such a 1159 
document to confirm the inmate's gender identity shall presumptively 1160 
be placed in a correctional institution with inmates of the gender 1161 
consistent with the inmate's gender identity. Such presumptive 1162 
placement may be overcome by a demonstration by the Commissioner 1163 
of Correction, or the commissioner's designee, that the placement 1164 
would present significant safety, management or security problems. In 1165 
making determinations pursuant to this section, the inmate's views 1166 
with respect to his or her safety shall be given serious consideration by 1167 
the Commissioner of Correction, or the commissioner's designee. 1168 
Sec. 19. Section 52-571m of the general statutes is repealed and the 1169 
following is substituted in lieu thereof (Effective July 1, 2023): 1170 
(a) As used in this section: 1171 
(1) "Reproductive health care services" includes all medical, 1172 
surgical, counseling or referral services relating to the human 1173 
reproductive system, including, but not limited to, services relating to 1174 
pregnancy, contraception or the termination of a pregnancy and all 1175 
medical care relating to treatment of gender dysphoria as set forth in 1176 
the most recent edition of the American Psychiatric Association's 1177 
"Diagnostic and Statistical Manual of Mental Disorders" and gender 1178 
incongruence, as defined in the 11
th
 edition of the "International 1179 
Statistical Classification of Diseases and Related Health Problems"; and 1180 
(2) "Person" includes an individual, a partnership, an association, a 1181 
limited liability company or a corporation. 1182 
(b) When any person has had a judgment entered against such 1183 
person, in any state, where liability, in whole or in part, is based on the 1184 
alleged provision, receipt, assistance in receipt or provision, material 1185 
support for, or any theory of vicarious, joint, several or conspiracy 1186 
liability derived therefrom, for reproductive health care services that 1187 
are permitted under the laws of this state, such person may recover 1188 
damages from any party that brought the action leading to that 1189  Committee Bill No. 10 
 
 
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judgment or has sought to enforce that judgment. Recoverable 1190 
damages shall include: (1) Just damages created by the action that led 1191 
to that judgment, including, but not limited to, money damages in the 1192 
amount of the judgment in that other state and costs, expenses and 1193 
reasonable attorney's fees spent in defending the action that resulted in 1194 
the entry of a judgment in another state; and (2) costs, expenses and 1195 
reasonable attorney's fees incurred in bringing an action under this 1196 
section as may be allowed by the court. 1197 
(c) The provisions of this section shall not apply to a judgment 1198 
entered in another state that is based on: (1) An action founded in tort, 1199 
contract or statute, and for which a similar claim would exist under the 1200 
laws of this state, brought by the patient who received the 1201 
reproductive health care services upon which the original lawsuit was 1202 
based or the patient's authorized legal representative, for damages 1203 
suffered by the patient or damages derived from an individual's loss of 1204 
consortium of the patient; (2) an action founded in contract, and for 1205 
which a similar claim would exist under the laws of this state, brought 1206 
or sought to be enforced by a party with a contractual relationship 1207 
with the person that is the subject of the judgment entered in another 1208 
state; or (3) an action where no part of the acts that formed the basis for 1209 
liability occurred in this state. 1210 
Sec. 20. Section 52-571n of the general statutes is repealed and the 1211 
following is substituted in lieu thereof (Effective July 1, 2023): 1212 
(a) As used in this section: 1213 
(1) "Gender-affirming health care services" means all medical care 1214 
relating to the treatment of gender dysphoria as set forth in the most 1215 
recent edition of the American Psychiatric Association's "Diagnostic 1216 
and Statistical Manual of Mental Disorders" and gender incongruence, 1217 
as defined in the 11
th
 edition of the "International Statistical 1218 
Classification of Diseases and Related Health Problems"; 1219 
(2) "Reproductive health care services" includes all medical, 1220  Committee Bill No. 10 
 
 
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surgical, counseling or referral services relating to the human 1221 
reproductive system, including, but not limited to, services relating to 1222 
pregnancy, contraception or the termination of a pregnancy; and 1223 
(3) "Person" includes an individual, a partnership, an association, a 1224 
limited liability company or a corporation. 1225 
(b) When any person has had a judgment entered against such 1226 
person, in any state, where liability, in whole or in part, is based on the 1227 
alleged provision, receipt, assistance in receipt or provision, material 1228 
support for, or any theory of vicarious, joint, several or conspiracy 1229 
liability derived therefrom, for reproductive health care services and 1230 
gender-affirming health care services that are permitted under the 1231 
laws of this state, such person may recover damages from any party 1232 
that brought the action leading to that judgment or has sought to 1233 
enforce that judgment. Recoverable damages shall include: (1) Just 1234 
damages created by the action that led to that judgment, including, but 1235 
not limited to, money damages in the amount of the judgment in that 1236 
other state and costs, expenses and reasonable attorney's fees spent in 1237 
defending the action that resulted in the entry of a judgment in another 1238 
state; and (2) costs, expenses and reasonable attorney's fees incurred in 1239 
bringing an action under this section as may be allowed by the court. 1240 
(c) The provisions of this section shall not apply to a judgment 1241 
entered in another state that is based on: (1) An action founded in tort, 1242 
contract or statute, and for which a similar claim would exist under the 1243 
laws of this state, brought by the patient who received the 1244 
reproductive health care services or gender-affirming health care 1245 
services upon which the original lawsuit was based or the patient's 1246 
authorized legal representative, for damages suffered by the patient or 1247 
damages derived from an individual's loss of consortium of the 1248 
patient; (2) an action founded in contract, and for which a similar claim 1249 
would exist under the laws of this state, brought or sought to be 1250 
enforced by a party with a contractual relationship with the person 1251 
that is the subject of the judgment entered in another state; or (3) an 1252 
action where no part of the acts that formed the basis for liability 1253  Committee Bill No. 10 
 
 
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occurred in this state. 1254 
Sec. 21. Subsection (b) of section 45a-106a of the general statutes is 1255 
repealed and the following is substituted in lieu thereof (Effective July 1256 
1, 2023): 1257 
(b) The fee to file each of the following motions, petitions or 1258 
applications in a Probate Court is two hundred fifty dollars: 1259 
(1) With respect to a minor child: (A) Appoint a temporary 1260 
guardian, temporary custodian, guardian, coguardian, permanent 1261 
guardian or statutory parent, (B) remove a guardian, including the 1262 
appointment of another guardian, (C) reinstate a parent as guardian, 1263 
(D) terminate parental rights, including the appointment of a guardian 1264 
or statutory parent, (E) grant visitation, (F) make findings regarding 1265 
special immigrant juvenile status, (G) approve placement of a child for 1266 
adoption outside this state, (H) approve an adoption, (I) validate a 1267 
foreign adoption, (J) review, modify or enforce a cooperative 1268 
postadoption agreement, (K) review an order concerning contact 1269 
between an adopted child and his or her siblings, (L) resolve a dispute 1270 
concerning a standby guardian, (M) approve a plan for voluntary 1271 
services provided by the Department of Children and Families, (N) 1272 
determine whether the termination of voluntary services provided by 1273 
the Department of Children and Families is in accordance with 1274 
applicable regulations, (O) conduct an in-court review to modify an 1275 
order, (P) grant emancipation, (Q) grant approval to marry, (R) 1276 
transfer funds to a custodian under sections 45a-557 to 45a-560b, 1277 
inclusive, (S) appoint a successor custodian under section 45a-559c, (T) 1278 
resolve a dispute concerning custodianship under sections 45a-557 to 1279 
45a-560b, inclusive, and (U) grant authority to purchase real estate; 1280 
(2) Determine parentage; 1281 
(3) Validate a genetic surrogacy agreement; 1282 
(4) Determine the age and date of birth of an adopted person born 1283 
outside the United States; 1284  Committee Bill No. 10 
 
 
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(5) With respect to adoption records: (A) Appoint a guardian ad 1285 
litem for a biological relative who cannot be located or appears to be 1286 
incompetent, (B) appeal the refusal of an agency to release information, 1287 
(C) release medical information when required for treatment, and (D) 1288 
grant access to an original birth certificate; 1289 
(6) Approve an adult adoption; 1290 
(7) With respect to a conservatorship: (A) Appoint a temporary 1291 
conservator, conservator or special limited conservator, (B) change 1292 
residence, terminate a tenancy or lease, sell or dispose household 1293 
furnishings, or place in a long-term care facility, (C) determine 1294 
competency to vote, (D) approve a support allowance for a spouse, (E) 1295 
grant authority to elect the spousal share, (F) grant authority to 1296 
purchase real estate, (G) give instructions regarding administration of 1297 
a joint asset or liability, (H) distribute gifts, (I) grant authority to 1298 
consent to involuntary medication, (J) determine whether informed 1299 
consent has been given for voluntary admission to a hospital for 1300 
psychiatric disabilities, (K) determine life-sustaining medical 1301 
treatment, (L) transfer to or from another state, (M) modify the 1302 
conservatorship in connection with a periodic review, (N) excuse 1303 
accounts under rules of procedure approved by the Supreme Court 1304 
under section 45a-78, (O) terminate the conservatorship, and (P) grant 1305 
a writ of habeas corpus; 1306 
(8) With respect to a power of attorney: (A) Compel an account by 1307 
an agent, (B) review the conduct of an agent, (C) construe the power of 1308 
attorney, and (D) mandate acceptance of the power of attorney; 1309 
(9) Resolve a dispute concerning advance directives or life-1310 
sustaining medical treatment when the individual does not have a 1311 
conservator or guardian; 1312 
(10) With respect to an elderly person, as defined in section 17b-450: 1313 
(A) Enjoin an individual from interfering with the provision of 1314 
protective services to such elderly person, and (B) authorize the 1315  Committee Bill No. 10 
 
 
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Commissioner of Social Services to enter the premises of such elderly 1316 
person to determine whether such elderly person needs protective 1317 
services; 1318 
(11) With respect to an adult with intellectual disability: (A) Appoint 1319 
a temporary limited guardian, guardian or standby guardian, (B) grant 1320 
visitation, (C) determine competency to vote, (D) modify the 1321 
guardianship in connection with a periodic review, (E) determine life-1322 
sustaining medical treatment, (F) approve an involuntary placement, 1323 
(G) review an involuntary placement, (H) authorize a guardian to 1324 
manage the finances of such adult, and (I) grant a writ of habeas 1325 
corpus; 1326 
(12) With respect to psychiatric disability: (A) Commit an individual 1327 
for treatment, (B) issue a warrant for examination of an individual at a 1328 
general hospital, (C) determine whether there is probable cause to 1329 
continue an involuntary confinement, (D) review an involuntary 1330 
confinement for possible release, (E) authorize shock therapy, (F) 1331 
authorize medication for treatment of psychiatric disability, (G) review 1332 
the status of an individual under the age of sixteen as a voluntary 1333 
patient, and (H) recommit an individual under the age of sixteen for 1334 
further treatment; 1335 
(13) With respect to drug or alcohol dependency: (A) Commit an 1336 
individual for treatment, (B) recommit an individual for further 1337 
treatment, and (C) terminate an involuntary confinement; 1338 
(14) With respect to tuberculosis: (A) Commit an individual for 1339 
treatment, (B) issue a warrant to enforce an examination order, and (C) 1340 
terminate an involuntary confinement; 1341 
(15) Compel an account by the trustee of an inter vivos trust, 1342 
custodian under sections 45a-557 to 45a-560b, inclusive, or treasurer of 1343 
an ecclesiastical society or cemetery association; 1344 
(16) With respect to a testamentary or inter vivos trust: (A) 1345 
Construe, validate, divide, combine, reform, modify or terminate the 1346  Committee Bill No. 10 
 
 
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trust, (B) enforce the provisions of a pet trust, (C) excuse a final 1347 
account under rules of procedure approved by the Supreme Court 1348 
under section 45a-78, and (D) assume jurisdiction of an out-of-state 1349 
trust; 1350 
(17) Authorize a fiduciary to establish a trust; 1351 
(18) Appoint a trustee for a missing person; 1352 
[(19) Change a person's name;] 1353 
[(20)] (19) Issue an order to amend the birth certificate of an 1354 
individual born in another state to reflect a gender change; 1355 
[(21)] (20) Require the Department of Public Health to issue a 1356 
delayed birth certificate; 1357 
[(22)] (21) Compel the board of a cemetery association to disclose 1358 
the minutes of the annual meeting; 1359 
[(23)] (22) Issue an order to protect a grave marker; 1360 
[(24)] (23) Restore rights to purchase, possess and transport 1361 
firearms; 1362 
[(25)] (24) Issue an order permitting sterilization of an individual; 1363 
[(26)] (25) Approve the transfer of structured settlement payment 1364 
rights; and 1365 
[(27)] (26) With respect to any case in a Probate Court other than a 1366 
decedent's estate: (A) Compel or approve an action by the fiduciary, 1367 
(B) give instruction to the fiduciary, (C) authorize a fiduciary to 1368 
compromise a claim, (D) list, sell or mortgage real property, (E) 1369 
determine title to property, (F) resolve a dispute between cofiduciaries 1370 
or among fiduciaries, (G) remove a fiduciary, (H) appoint a successor 1371 
fiduciary or fill a vacancy in the office of fiduciary, (I) approve 1372 
fiduciary or attorney's fees, (J) apply the doctrine of cy pres or 1373  Committee Bill No. 10 
 
 
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approximation, (K) reconsider, modify or revoke an order, and (L) 1374 
decide an action on a probate bond. 1375 
Sec. 22. (NEW) (Effective from passage) (a) As used in this section, 1376 
"gender-affirming procedure" means a medical procedure or treatment 1377 
to alter the physical characteristics of a person diagnosed with (1) 1378 
gender dysphoria, as described in the most recent edition of the 1379 
American Psychiatric Association's "Diagnostic and Statistical Manual 1380 
of Mental Disorders", or (2) gender incongruence, as defined in the 11
th
 1381 
edition of the "International Statistical Classification of Diseases and 1382 
Related Health Problems", in a manner consistent with such person's 1383 
gender identity. 1384 
(b) The Commissioner of Social Services shall establish a working 1385 
group to seek input on department guidelines for gender-affirming 1386 
procedures not later than one hundred twenty days before amending 1387 
such guidelines. The working group shall consist of (1) six health care 1388 
providers who treat persons seeking gender-affirming procedures or 1389 
persons who have had such procedures, (2) two HUSKY Health 1390 
program members who have had such procedures, and (3) the 1391 
commissioner or the commissioner's designee. All appointments to the 1392 
working group shall be made by the commissioner. The commissioner, 1393 
or the commissioner's designee, shall serve as cochairperson of the 1394 
working group with a member chosen by the majority of working 1395 
group members to serve as cochairperson. 1396 
(c) The commissioner, or the commissioner's designee, shall convene 1397 
the working group not later than ninety days before any amendments 1398 
planned for the gender-affirming procedure guidelines. The group 1399 
shall meet not less than two times monthly. 1400 
(d) The commissioner shall file a report, in accordance with the 1401 
provisions of section 11-4a of the general statutes, to the joint standing 1402 
committees of the General Assembly having cognizance of matters 1403 
relating to human services and public health not later than thirty days 1404 
before any amendments the commissioner has proposed for the 1405  Committee Bill No. 10 
 
 
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gender-affirming procedure guidelines. The report shall include, but 1406 
not be limited to, (1) the proposed amendments, and (2) the working 1407 
group's recommendations concerning such amendments. The working 1408 
group shall terminate on the date such report is issued. 1409 
(e) The provisions of this section shall not apply to any changes 1410 
required to be made to the gender-affirming procedure guidelines to 1411 
comply with federal law or regulations concerning reimbursement for 1412 
such procedures under Title XIX or Title XXI of the Social Security Act. 1413 
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  Committee Bill No. 10 
 
 
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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 
 
HS Joint Favorable C/R 	APP