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OLR Bill Analysis
sSB 10
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.
TABLE OF CONTENTS:
SUMMARY
§ 1 — OHS OUTPATIENT PRESCRIPTION DRUG LIST
Allows a wider range of drugs to be included on OHS’s annual list of 10 drugs that are
provided at a substantial state cost, and gives manufacturers the opportunity, following a
public comment period, to show that a drug does not meet the inclusion criteria
§§ 2-4 — PURCHASER PRICE LIMIT ON PRESCRIPTION DRUGS
Prohibits purchasers (e.g., insurance plans) from purchasing prescription drugs for prices
above the “maximum fair price” set by federal law for Medicare; requires purchasers to
apply related savings towards reducing insureds’ prescription drug costs; prohibits drug
manufacturers and distributors from withdrawing drugs from sale or distribution in the
state to avoid revenue loss; and sets penalties and reporting requirements
§§ 5 & 6 — DRUG PRICING AND REPORTING FOR 340B ENTITIES
Prohibits 340B covered entities from trying to collect as medical debt any payment for a
prescription drug obtained with a rebate or discounted price through the federal 340B
drug pricing program if they charged the patient a higher price and establishes a
prescription drug reporting requirement for these entities
§ 7 — PRESCRIPTION DRUG PAYMENT EVALUATI ON COMMITTEE
Establishes a Prescription Drug Payment Evaluation Committee to recommend to OHS
upper payment limits on at least eight prescription drugs based on an evaluation of upper
payment limits in other jurisdictions
§ 8 — PRESCRIPTION DRUG DISCOUNT CARD PROGRAM
Requires the comptroller to establish and administers a prescription drug discount card
program available to all state residents
§ 9 — PROHIBITED CONTRACT CLAUSES IN HEALTH CARE
Prohibits health insurance carriers, health care providers, and certain others from entering
into health care contracts that include all-or-nothing clauses, anti-steering clauses, anti-
tiering clauses, or any other clause that results or intends to result in anticompetitive
effects
§ 10 — SOCIAL WORKERS AND HOME CARE 2023SB-00010-R000735-BA.DOCX
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Requires DSS to include at least two licensed clinical social worker visits in the fee
schedule for people enrolled in CHCPE or any DSS-administered home- and community-
based waiver
§§ 11 & 12 — COMMUNITY HEALTH WORKERS
Requires DSS to provide Medicaid reimbursement to certified community health workers
and requires OHS to convene forums and meetings with stakeholders to align community
health worker programs funded through various sources
§§ 13 & 14 — COVERED CONNECTICUT EXPANSI ON
Requires DSS to (1) amend the Covered Connecticut waiver to expand eligibility to
households with incomes up to 200% of FPL and (2) submit a plan to certain legislative
committees on further expanding eligibility to households with incomes up to 300% of
FPL
§ 15 — TAX RETURN INFORMATION FOR ACCESS HEALTH
OUTREACH
Requires Access Health CT and DRS to share tax return information so that Access
Health CT may do targeted outreach to uninsured state residents
§ 16 — VITAL RECORDS BIRTH CERTIFICATES
Allows people who submit certain documentation to change birth certificates to reflect
changes to a parent’s legal name
§ 17 — INMATE NAME CHANGE
Requires DOC, within 30 days of receiving an inmate’s or prisoner’s written request, to
change the person’s name in department records
§ 18 — INMATES WITH GENDER INCONGRUENCE
Provides inmates with a diagnosis of gender incongruence with certain rights, such as (1)
having DOC staff address them based on their gender identity and (2) with exceptions,
being placed in a correctional institution consistent with their gender identity
§§ 19 & 20 — REPRODUCTIVE AND GENDER-AFFIRMING HEALTH
CARE SERVICES AND GENDER INCONGRUENCE
Expands reproductive and gender-affirming health care services to include gender
incongruence for the purposes of a cause of action for recovery for persons against whom a
judgment was entered in another state for their participation in providing or receiving
these services that are legal in Connecticut; specifies gender dysphoria treatment is set
based on the most recent American Psychiatric Association manual
§ 21 — NAME CHANGE FEE ELIMINATION
Eliminates the $250 probate court filing fee to change a person’s name
§ 22 — DSS GENDER AFFIRMING PROCEDURES W ORKGROUP
Requires DSS to establish a working group to seek input on department guidelines for
gender-affirming procedures at least 120 days before amending the guidelines
SUMMARY
This bill makes changes in laws affecting prescription drug pricing 2023SB-00010-R000735-BA.DOCX
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and reporting, clauses in health care contracts, provider rates for social
workers and community health workers, Covered Connecticut
eligibility, tax return information sharing, birth certificates and name
changes, and gender identity provisions, as described in the section-by-
section analysis below.
EFFECTIVE DATE: Various, see below
§ 1 — OHS OUTPATIENT PRESCRIPTION DRUG L IST
Allows a wider range of drugs to be included on OHS’s annual list of 10 drugs that are
provided at a substantial state cost, and gives manufacturers the opportunity, following a
public comment period, to show that a drug does not meet the inclusion criteria
Existing law requires the Office of Health Strategy (OHS), in
consultation with the comptroller and the commissioners of public
health and social services, to annually identify up to 10 outpatient
prescription drugs that are (1) provided at a substantial state cost,
considering their net cost, or (2) critical to public health. Manufacturers
of these identified drugs must give OHS certain information on the (1)
factors that led to an increase in the drug’s wholesale acquisition cost
and (2) company’s research and development costs and other capital
costs.
Current law sets certain parameters for the drugs OHS may include
on this list, requiring both a minimum (1) percentage increase in the
drug’s cost over prior years and (2) total cost for a specified supply or
course of treatment. As shown in the table below, the bill lowers the
minimum required cost increase and total cost that qualifies a drug for
inclusion on the list.
Table: Minimum Requirements for List of Outpatient Prescription Drugs
Current Law Bill
Cost increase At least 20% during the prior
year or 50% during the prior
three years
At least 16% cumulatively
during the two prior years
Cost for course of
treatment
At least $60 for a 30-day
supply or shorter course of
treatment
At least $40 for a course of
treatment of unspecified
duration
The bill requires OHS to make the list public and to make a 2023SB-00010-R000735-BA.DOCX
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preliminary list available for public comment. Under the bill, the OHS
executive director must prepare a preliminary list of outpatient
prescription drugs she plans to include on the list. She must make the
preliminary list available for public comment for at least 30 days. During
the public comment period, any manufacturer of a drug included on the
preliminary list may document that the drug’s wholesale acquisition
cost, less all rebates paid to the state during the last calendar year, does
not exceed the criteria described above. The OHS executive director
must remove the drug from the preliminary list if the manufacturer’s
documentation establishes, to the executive director’s satisfaction, that
the drug does not meet the criteria for inclusion. The OHS executive
director must publish a final list within 15 days after the public comment
period closes.
By law, OHS may impose a penalty of up to $7,500 on pharmaceutical
manufacturers for violating these provisions.
EFFECTIVE DATE: July 1, 2023
Background — Related Bill
sHB 6669 (File 453), § 10, favorably reported by the Public Health
Committee, contains nearly identical provisions, but is effective October
1, 2023.
§§ 2-4 — PURCHASER PRICE LIMIT ON PRESCRIPTION DRUGS
Prohibits purchasers (e.g., insurance plans) from purchasing prescription drugs for prices
above the “maximum fair price” set by federal law for Medicare; requires purchasers to
apply related savings towards reducing insureds’ prescription drug costs; prohibits drug
manufacturers and distributors from withdrawing drugs from sale or distribution in the
state to avoid revenue loss; and sets penalties and reporting requirements
The bill prohibits certain purchasers (e.g., insurance plans, see below)
from purchasing or seeking reimbursement for a prescription drug for
a price above its maximum fair price (MFP) as established in federal law
for certain drugs (i.e., a “referenced drug”). The bill applies only to
drugs intended to be dispensed, delivered, or administered to an
insured in the state, directly or through a distributor.
Maximum Fair Price
The federal Inflation Reduction Act (IRA) requires the U.S. Health 2023SB-00010-R000735-BA.DOCX
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and Human Services (HHS) secretary to negotiate the MFP for certain
drugs covered under Medicare (generally based on those with the
highest Medicare spending) and sets upper limits on the negotiated
price. Under the IRA, the number of drugs subject to this negotiation
increases over time (beginning with 10 drugs for the 2026 plan year) and
certain drugs are exempted (e.g., those with generic versions).
Generally, the MFP for a drug is applicable until a generic version is
available (P.L. 117-169, § 1191). Under the bill, the MFP excludes any
dispensing fee paid to a pharmacy to dispense a referenced drug.
Purchasers Subject to the Price Limit
A purchaser is any state entity, health benefit plan, or voluntarily
participating Employee Retirement Income Security Act (ERISA) plan.
Under the bill, a:
1. “state entity” is any state agency or anyone acting on the state’s
behalf that purchases a prescription drug for someone with
health insurance paid for by the state, including health insurance
offered by local, state, or federal agencies or through
organizations licensed in the state, but excluding Medicaid;
2. “health benefit plan” is an insurance policy or contract offered,
delivered, issued for delivery, renewed, amended or continued
in the state by a health carrier to provide, deliver, pay for, or
reimburse any health care services costs (see below for exempted
coverage types and benefits); and
3. “participating ERISA plan” is any employee welfare benefit plan
subject to the federal ERISA that elects to participate in the bill’s
price limit requirements.
The bill allows ERISA plans to elect to participate by notifying the
Insurance Department in writing by January 1 each calendar year.
Purchasers Exempt From the Price Limit
The bill generally excludes single service ancillary health coverages
(e.g., dental, vision, prescription drug), long-term care, workers’
compensation, and any other coverages under which health care 2023SB-00010-R000735-BA.DOCX
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services are secondary or incidental to other insurance benefits,
including those specified in certain federal HIPPA regulations.
Exempted coverage types include:
1. disability income protection, accident only, long term care,
specified accident, Medicare supplement, TriCare supplement,
travel health, or single service ancillary health;
2. liability insurance (e.g., general or automotive) or coverage
issued as a supplement to liability insurance; and
3. workers compensation, automobile medical payment insurance,
credit insurance, and coverage for on-site medical clinics.
The bill also exempts benefits if they are provided under a separate
insurance policy, certificate, or contract or are otherwise not an integral
part of the plan (e.g., home health care benefits). It exempts hospital
confinement indemnity coverage, or specified disease coverage if (1)
provided under a separate insurance policy, certificate, or contract, (2)
there is no coordination between the provision of these benefits and the
exclusion of benefits under a group health plan maintained by the same
plan sponsor, and (3) the benefits are paid without regard to whether
benefits were also provided under any group health plan maintained by
the same plan sponsor.
Purchaser Savings and Reporting Requirement
The bill requires purchasers to calculate their savings that result from
the price limit described above and apply these savings to reduce their
insureds’ prescription drugs costs. (The bill does not describe what
higher price purchasers must use to calculate savings.)
The bill requires purchasers to report annually by January 15 to the
Insurance Department to:
1. assess the purchaser’s savings for each referenced drug for the
previous year, and
2. identify how the purchaser applied savings to re duce 2023SB-00010-R000735-BA.DOCX
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prescription drug costs and decrease cost disparities.
Prohibiting Manufacturers and Distributors From Withdrawing
Drugs From the Market
The bill prohibits certain manufacturers or distributors from
withdrawing a referenced drug from sale or distribution in the state to
attempt to avoid revenue loss resulting from the maximum fair price
requirement described above. The bill requires manufacturers and
distributors to provide at least 180 days’ notice to the insurance
commissioner and the attorney general before withdrawing a
referenced drug from sale or distribution in the state.
Under the bill, manufacturers include (1) any entity (a) engaged in
the production, preparation, propagation, compounding, conversion,
processing, packaging, repackaging, labelling, relabeling or distributing
prescription drug products and (b) subject to federal 340B price limits
(see Background) and (2) wholesalers distributing 340B covered drugs to
these entities. A distributor is any entity, including a wholesaler, that
supplies drugs, devices, or cosmetics prepared, produced, or packaged
by manufacturers, to other wholesalers, manufacturers, distributors,
hospitals, clinics, practitioners, or pharmacies or federal, state, and
municipal agencies.
The bill prohibits referenced drug manufacturers and distributors
from negotiating with a purchaser or seller of a referenced drug at a
price that exceeds the MFP. (The bill does not define “seller.”) The bill
deems doing so a violation, but does not prescribe a penalty.
Regulations, Violations, and Penalties
The bill subjects purchasers that violate the bill’s maximum fair price
provisions to a $1,000 civil penalty for each violation.
For manufacturers and distributors that violate the bill’s provisions
on removing referenced drugs from the market, the bill sets a civil
penalty of $500,000 or the purchaser’s annual savings generated under
the maximum fair price provisions, whichever is greater. (The amount
of the second penalty is unclear as a distributor or wholesaler may work
with multiple purchasers.) 2023SB-00010-R000735-BA.DOCX
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The bill requires the insurance commissioner to adopt regulations to
implement these provisions. It gives the attorney general exclusive
authority to enforce its penalties.
EFFECTIVE DATE: January 1, 2024, and applicable to contracts
entered into, amended, or renewed on and after that date.
Background — Federal 340 Price Limits
Under the 340B program, federal law requires the HHS secretary to
enter into purchase agreement with drug manufacturers that participate
in Medicaid. These agreements generally limit the price at which
manufacturers may sell certain covered outpatient drugs to “covered
entities” (e.g., federally qualified health centers, children’s hospitals,
and other providers that care for underserved populations) (42 U.S.C. §
256b).
§§ 5 & 6 — DRUG PRICING AND REPORTING FO R 340B ENTITIES
Prohibits 340B covered entities from trying to collect as medical debt any payment for a
prescription drug obtained with a rebate or discounted price through the federal 340B
drug pricing program if they charged the patient a higher price and establishes a
prescription drug reporting requirement for these entities
Section 340B of the federal Public Health Service Act (i.e., the 340B
Drug Pricing Program) requires drug manufacturers participating in
Medicaid to sell certain outpatient prescription drugs (“covered drugs”)
at discounted prices to health care organizations that care for uninsured
and low-income patients. These organizations include federally
qualified health centers, children’s hospitals, hospitals that serve a
disproportionate number of low-income patients, and other safety net
providers (“340B covered entities”).
The bill prohibits these covered entities from trying to collect as
medical debt a payment for a prescription drug prescribed by a health
care provider to a person in the state that the entity gets with a rebate or
discounted price through the 340B program that exceeds the entity’s
cost for the drug. Under the bill, a rebate is a discount or concession
affecting an outpatient prescription drug price, that a pharmaceutical
manufacturer directly provides to a (1) health carrier or (2) pharmacy
benefits manager after the manager processes a claim from a pharmacist 2023SB-00010-R000735-BA.DOCX
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or pharmacy.
The bill also requires 340B covered entities to annually report by
January 15 to the OHS executive director the following information on
drugs prescribed by a health care provider to people in the state for the
previous calendar year:
1. a list of all prescription drugs, identified by the national drug
code number, purchased through the federal 340B drug pricing
program;
2. the actual price of each prescription drug after any rebate or
discount provided through the program;
3. the actual payment each 340B covered entity received from any
private or public health insurance plan, excluding Medicaid and
Medicare, or patient for each of these prescription drugs; and
4. the average percentage savings realized by each 340B covered
entity on prescription drug costs under the program and how the
entity used the savings.
The bill requires the executive director to link to the report on the
OHS website.
EFFECTIVE DATE: July 1, 2023
Background — Related Bill
sHB 6669 (File 453), §§ 16-19, favorably reported by the Public Health
Committee, makes various changes affecting 340B program
participants, including (1) prohibiting pharmacy benefit managers
(PBMs) from discriminating against 340B covered entities in connection
with dispensing covered drugs, (2) requiring drug manufacturers to
comply with specified federal pricing requirements when selling
covered drugs to these entities, (3) allowing covered entities or the
attorney general to seek relief if a PBM tries to enforce contract
provisions that violate the bill, and (4) requiring hospitals that
participate in the 340B program to annually report certain information 2023SB-00010-R000735-BA.DOCX
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to OHS.
§ 7 — PRESCRIPTION DRUG PAYMENT EVALUATI ON COMMITTEE
Establishes a Prescription Drug Payment Evaluation Committee to recommend to OHS
upper payment limits on at least eight prescription drugs based on an evaluation of upper
payment limits in other jurisdictions
The bill establishes a 23-member Prescription Drug Payment
Evaluation Committee to recommend upper payment limits to the OHS
executive director for at least eight prescription drugs based on an
evaluation of upper payment limits set by other states or foreign
jurisdictions.
Under the bill, the committee consists of the (1) Office of Policy and
Management (OPM) secretary; OHS executive director; Healthcare
Advocate; Consumer Protection, Insurance, Public Health, and Social
Services department commissioners; or their designees, and (2)
appointed members shown in the table below.
Table: Appointed Members
Appointing Authority Members
House speaker • Statewide health care advocacy
coalition representative
• Statewide advocacy organization for
elderly persons representative
• Statewide organization for diverse
communities representative
Senate president pro tempore • Labor union representative
• Health services researcher
• Consumer who experienced cost
barriers to obtaining prescription drugs
House majority leader • 340 covered entity representatives (2)
House minority leader • Private insurer representatives (2)
Senate majority leader • Health care provider organization
representatives (2)
Senate minority leader • Representative of a pharmaceutical
company doing business in the state
• Representative of an academic
institution with health care cost
expertise 2023SB-00010-R000735-BA.DOCX
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Appointing Authority Members
Governor • Pharmacist representative
• Pharmacy benefit manager
representative
The bill requires appointing authorities to make initial appointments
to the committee by August 1, 2023, and fill any vacancies. Under the
bill, the House speaker and the Senate president pro tempore select the
committee’s chairpersons from among its members. The chairpersons
must schedule the committee’s first meeting, which must be held by
September 1, 2023. The Insurance Committee administrative staff serves
as the committee’s administrative staff.
The bill requires the committee to report annually, beginning by
December 1, 2023, to the OHS executive director and the
Appropriations, Human Services, Insurance, and Public Health
committees on its recommendations for upper payment limits on at least
eight prescription drugs.
EFFECTIVE DATE: July 1, 2023
§ 8 — PRESCRIPTION DRUG DISCOUNT CARD PR OGRAM
Requires the comptroller to establish and administers a prescription drug discount card
program available to all state residents
The bill requires the comptroller to establish and administer a
prescription drug discount card program available to all state residents.
It also authorizes the comptroller to coordinate participation in a
multistate prescription drug consortium to pool purchasing power to
lower costs by negotiating discounts with drug manufacturers and
coordinating volume discount contracting.
EFFECTIVE DATE: July 1, 2023
Background — Related Bill
sHB 6669 (File 453), § 1, favorably reported by the Public Health
Committee includes similar provisions.
§ 9 — PROHIBITED CONTRACT CLAUSES IN HEA LTH CARE 2023SB-00010-R000735-BA.DOCX
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Prohibits health insurance carriers, health care providers, and certain others from entering
into health care contracts that include all-or-nothing clauses, anti-steering clauses, anti-
tiering clauses, or any other clause that results or intends to result in anticompetitive
effects
The bill prohibits health insurance carriers (generally, insurers and
HMOs), health care providers, health plan administrators, or any agent
or entity contracting on their behalf, beginning January 1, 2024, from
offering, soliciting, requesting, amending, renewing, or entering a
health care contract that directly or indirectly includes all-or-nothing
clauses, anti-steering clauses, anti-tiering clauses, or any other clause
that results or intends to result in anticompetitive effects. The bill
explicitly does not prohibit “value-based care,” which is a health care
coverage model in which providers, including hospitals and physicians,
are paid based on patient health outcomes.
Under the bill, any prohibited clause in a contract, written policy,
written procedure, or agreement is null and void, but the contract’s
other clauses remain in effect for the contract term.
The bill allows the insurance commissioner to adopt regulations
implementing these provisions.
Prohibited Clauses
Under the bill, an “all-or-nothing clause” requires health insurance
carriers or health plan administrators to (a) include all members of a
health care provider in a network plan or (b) contract with a provider’s
affiliate as a condition of contracting with the provider. Under the bill,
a health plan administrator is a third-party administrator acting on a
plan sponsor’s behalf to administer a health benefit plan.
An “anti-steering clause” restricts a carrier or administrator from
encouraging an enrollee to get health care services from a competing
hospital or health system, including by offering incentives for enrollees
to use specific health care providers.
An “anti-tiering clause” (1) restricts a health carrier’s or plan
administrator’s ability to introduce or change a tiered network plan or
assign health care providers into tiers or (2) requires a health carrier or 2023SB-00010-R000735-BA.DOCX
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plan administrator to place all members of a health care provider in the
same tier. A “tiered network” identifies and groups some or all types of
health care providers and facilities into specific groups to which
different participating provider reimbursement, covered person cost-
sharing, or participating provider access requirements apply for the
same health care services.
EFFECTIVE DATE: January 1, 2024
Background — Related Bills
sSB 983 (File 341), favorably reported by the Insurance and Real
Estate Committee, contains similar contract provisions.
sHB 6620 (File 326), favorably reported by the Insurance and Real
Estate and Judiciary committees, also contains similar provisions.
§ 10 — SOCIAL WORKER S AND HOME CARE
Requires DSS to include at least two licensed clinical social worker visits in the fee
schedule for people enrolled in CHCPE or any DSS-administered home- and community-
based waiver
The bill requires the Department of Social Services (DSS)
commissioner to include in the fee schedule for home health services at
least two licensed clinical social worker visits to each person enrolled in
the Connecticut Home Care Program for Elders (CHCPE) or any home-
and community-based Medicaid waiver program DSS administers.
CHCPE is a Medicaid waiver- and state-funded program that
provides a range of home- and community-based services for eligible
people ages 65 or older who are at risk of inappropriate
institutionalization. DSS administers other home- and community-
based waivers serving various populations (e.g., the Acquired Brain
Injury waiver).
EFFECTIVE DATE: July 1, 2023
Background — Related Bills
sSB 412, favorably reported by the Appropriations and Human
Services committees, requires DSS to increase rates for certain complex
care nursing services in the fee schedule for home health services. 2023SB-00010-R000735-BA.DOCX
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sSB 946, favorably reported by the Appropriations and Human
Services committees, (1) requires DSS to compensate family caregivers
who provide personal care services under CHCPE, (2) reduces cost
sharing for the state-funded portion of the program, and (3) makes
technical changes.
§§ 11 & 12 — COMMUNITY HEALTH WORKERS
Requires DSS to provide Medicaid reimbursement to certified community health workers
and requires OHS to convene forums and meetings with stakeholders to align community
health worker programs funded through various sources
The bill requires DSS to design and implement a program to give
Medicaid reimbursement to certified community health workers (CHW)
for certain services provided to HUSKY Health (i.e., Medicaid and the
state children’s health insurance) members. Under existing law and the
bill, a certified CHW is a public health outreach professional who:
1. has an in-depth understanding of a community’s experience,
language, culture, and socioeconomic needs;
2. provides services that include outreach, engagement, education,
coaching, informal counseling, social support, advocacy, care
coordination, and research, basic screenings, and risk
assessments associated with social determinants of health (i.e.,
societal factors that contribute to a person’s state of health); and
3. is certified by the Department of Public Health (DPH) as a CHW.
Under the bill, services CHWs may provide under DSS’s program
include:
1. coordination of medical, oral, and behavioral health care services
and social supports;
2. connection to, and navigation of, health systems and services;
3. prenatal, birth, lactation, and postpartum supports; and
4. health promotion, coaching, and self-management education.
The bill requires the commissioner to reimburse certified CHW 2023SB-00010-R000735-BA.DOCX
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services in a way and at a rate conducive to workforce growth.
Throughout the program’s design and implementation, the
commissioner and her designees must consult with certified CHWs and
others in a way that (1) includes community-based and clinic-based
certified CHWs, (2) represents medical assistance program beneficiary
demographics, and (3) helps shape the program’s design and
implementation. The bill also requires DSS to coordinate with OHS to
identify opportunities to integrate CHWs into the medical assistance
program.
The bill requires DSS, by January 1, 2024, and annually thereafter,
until the program is fully implemented, to report to the Human Services
Committee and the Council on Medical Assistance Program Oversight
(MAPOC). The report must provide a program update and evaluate the
program’s impact on health outcomes and health equity.
The bill also requires OHS to convene forums and meetings with
stakeholders to align CHW programs funded by state medical
assistance program, block grants, private insurance carriers, and others.
Stakeholders include Access Health Connecticut, DPH, the Birth-to-
Three program, state home visiting programs, community action
agencies, hospitals, community health centers, and other state
government and external stakeholders. The bill sets this requirement as
part of OHS’s ongoing duties.
EFFECTIVE DATE: Upon passage
Background — Related Bill
sSB 991 (File 438), favorably reported by the Human Services
Committee, similarly requires DSS to establish a program to reimburse
certified CHWs and report to the Human Services Committee and
MAPOC.
§§ 13 & 14 — COVERED CONNECTICUT EXPANSI ON
Requires DSS to (1) amend the Covered Connecticut waiver to expand eligibility to
households with incomes up to 200% of FPL and (2) submit a plan to certain legislative
committees on further expanding eligibility to households with incomes up to 300% of
FPL 2023SB-00010-R000735-BA.DOCX
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The bill expands eligibility for the Covered Connecticut health
coverage program (see Background). It requires the DSS commissioner,
within 30 days of its passage, to amend the state’s Medicaid waiver
supporting the program to expand eligibility to people otherwise
qualified for the program with income up to 200% of the federal poverty
level (FPL), rather than up to 175% of FPL, as under current law. She
must do this to the extent federal law allows and according to existing
law’s legislative approval process for Medicaid waivers and waiver
amendments (see Background). The bill also requires her to consult with
the insurance commissioner and the executive director of OHS in
submitting this waiver amendment.
The bill further requires the DSS commissioner, within 60 days of its
passage and in consultation with the insurance commissioner and OHS
executive director, to develop a plan for a second tier of the Covered
Connecticut program for people otherwise qualified for the program
with income over 200% and up to 300% of FPL. Under the bill, the
developed plan may offer (1) reduced benefits consistent with certain
federal requirements and (2) income-based copayments by enrollees.
The DSS commissioner must submit this plan to the Appropriations,
Human Services, and Insurance committees, which must then hold a
public hearing within 30 days after receiving it. At the hearing’s
conclusion, the committees must advise the commissioner of their
approval, denial, or modification of the plan.
If the committees disagree on the plan, the committee chairpersons
must appoint a nine-member conference committee composed of three
members from each committee. At least one member from each
committee must be from the minority party. The conference committee
must report to the standing committees, which must in turn vote to
accept or reject, but not amend, the report. If a committee rejects the
conference report, it must notify the commissioner, and the plan is
deemed approved. If all the committees accept the report, the
Appropriations Committee must advise the commissioner of the
approval, denial, or modification of the plan. 2023SB-00010-R000735-BA.DOCX
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If the committees advise the commissioner of their denial, she must
not implement the plan. If they do not advise the commissioner within
30 days after receiving the plan, the plan is deemed denied. Any
implementation of the plan must follow the committees’ approval or
modifications. The DSS commissioner may, to the extent permissible
under federal law, seek approval of a Medicaid waiver to get federal
funds for the developed plan.
EFFECTIVE DATE: Upon passage
Background — Covered Connecticut Program
This program provides no-cost health insurance, dental insurance,
and non-emergency medical transportation to eligible adults and their
tax dependents. Generally, program participants must (1) have
household incomes too high to qualify for Medicaid but under program
limits, (2) be covered by a silver-level health plan offered on the state’s
health insurance exchange (Access Health CT), and (3) qualify for
federal qualified health plan premium and cost-sharing subsidies (CGS
§ 19a-754c).
Background — Legislative Approval Process
State law requires the DSS commissioner to submit federal waiver
applications, renewals, and amendments to the Appropriations and
Human Services committees before submitting them to the federal
Centers for Medicare and Medicaid Services for approval. The
committees must:
1. hold a public hearing within 30 days after receiving the
application;
2. approve, deny, or modify a waiver application; and
3. appoint a conference committee if the committees do not agree
on the decision (CGS § 17b-8).
For waivers on Covered Connecticut, the Insurance and Real Estate
Committee also participates in this process (CGS § 19a-754c). (These
requirements do not apply to applications for routine operational 2023SB-00010-R000735-BA.DOCX
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issues.)
Background — Related Bill
sSB 978, favorably reported by the Appropriations and Human
Services committees, similarly requires the DSS commissioner to amend
the Medicaid waiver to expand eligibility to 200% of FPL, but by January
1, 2024, rather than within 30 days after the bill’s passage.
§ 15 — TAX RETURN INFORMATION FOR ACCESS HEALTH
OUTREACH
Requires Access Health CT and DRS to share tax return information so that Access
Health CT may do targeted outreach to uninsured state residents
The bill requires Access Health CT (i.e., the Connecticut Health
Insurance Exchange) to make a written request to the Department of
Revenue Services (DRS) commissioner for returns or return information
to use for targeted outreach to uninsured state residents. By law, a
“return” is any tax or information return, estimated tax declaration, or
refund claims, among other things. “Return information” includes a
taxpayer’s identity; the nature, source, or amount of a taxpayer’s
income, payments, receipts, deductions, exceptions, credits, assets,
liabilities, net worth; and any other data the DRS commissioner receives
on a return (CGS § 12-15(h)).
Under the bill, if the DRS commissioner deems a return or return
information relevant to the targeted outreach to uninsured residents, he
may disclose it to the exchange. To make this disclosure, the bill requires
the DRS commissioner and the exchange to enter into a memorandum
of understanding (MOU) stating the specific information to be disclosed
and the terms and conditions for disclosure. Under the bill, disclosed
information may only be used by the exchange as described in the MOU.
The bill prohibits anyone who receives disclosed information from DRS
from redisclosing it to a third party without the commissioner’s
permission and sets a $5,000 fine for violating these provisions.
The bill further requires the DRS commissioner to revise the state’s
income tax return form to include a space for residents to authorize the
exchange to contact them about health insurance enrollment through
the exchange. It also requires the DRS commissioner and the exchange 2023SB-00010-R000735-BA.DOCX
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to write language for the tax return form (presumably related to the
authorization space) and include, in the form’s instructions, a
description of how the authorization will be relayed to the exchange.
EFFECTIVE DATE: Upon passage
§ 16 — VITAL RECORDS BIRTH CERTIFICATES
Allows people who submit certain documentation to change birth certificates to reflect
changes to a parent’s legal name
The bill allows people who submit certain documentation to change
birth certificates to reflect changes to a parent’s legal name. The DPH
commissioner must issue a new birth certificate in these instances when
she receives (1) a written request from the parent, signed under penalty
of law, for a replacement birth certificate with the parent’s new legal
name, and (2) proof of the parent’s legal name change.
The bill generally extends to these amended birth certificates existing
procedures for amended birth certificates reflecting gender change (e.g.,
allowing only the DPH commissioner, and not local registrars, to amend
the certificate, and providing that the replacement certificate is not
marked “amended”).
EFFECTIVE DATE: July 1, 2023
§ 17 — INMATE NAME CHANGE
Requires DOC, within 30 days of receiving an inmate’s or prisoner’s written request, to
change the person’s name in department records
The bill requires the Department of Correction (DOC) commissioner
to change an inmate or prisoner’s name in department records within
30 days after he or she makes a written request. The inmate or prisoner
must have had his or her name legally changed and provide the name
change order.
By law, an “inmate” or “prisoner” includes anyone in DOC custody
or confined in any DOC institution or facility until released from
custody or control, including anyone on parole.
EFFECTIVE DATE: Upon passage 2023SB-00010-R000735-BA.DOCX
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§ 18 — INMATES WITH GENDER INCONGRUENCE
Provides inmates with a diagnosis of gender incongruence with certain rights, such as (1)
having DOC staff address them based on their gender identity and (2) with exceptions,
being placed in a correctional institution consistent with their gender identity
By law, DOC must adhere to certain requirements on the treatment
and placement of inmates with a diagnosis of gender dysphoria and a
gender identity that differs from their assigned sex at birth. For example,
(1) correctional staff must address the inmate according to their gender
identity and (2) except in limited circumstances, DOC must place an
inmate with a documented gender identity change in an institution
consistent with their gender identity.
The bill extends these requirements to include inmates with a gender
incongruence diagnosis, which is characterized by a marked and
persistent incongruence between someone’s experienced gender and
the assigned sex, provided that gender variant behavior and preferences
alone are not a basis for diagnosis (11th revision of the “International
Statistical Classification of Diseases and Related Health Problems”).
EFFECTIVE DATE: July 1, 2023
§§ 19 & 20 — REPRODUCTIVE AND GENDER-AFFIRMING HEALTH
CARE SERVICES AND GE NDER INCONGRUENCE
Expands reproductive and gender-affirming health care services to include gender
incongruence for the purposes of a cause of action for recovery for persons against whom a
judgment was entered in another state for their participation in providing or receiving
these services that are legal in Connecticut; specifies gender dysphoria treatment is set
based on the most recent American Psychiatric Association manual
Existing law generally provides a cause of action for persons (i.e., an
individual or certain legal entities) against whom a judgment was
entered in another state based on their allegedly providing or receiving
help from another person for reproductive or gender-affirming health
care services that are legal in Connecticut. It allows the person to recover
damages from any party that (1) brought the original action that
resulted in the judgment or (2) tried to enforce it. The court must award
a person who successfully brings an action the judgment amount
entered in the other states and certain costs, expenses, and reasonable
attorney’s fees. 2023SB-00010-R000735-BA.DOCX
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The bill expands the definition of “reproductive health care services”
and “gender-affirming health care services,” to include gender
incongruence.
Under current law, these services also include all medical care
relating to gender dysphoria treatment. The bill specifies that these
treatments are set in the most recent edition of the American Psychiatric
Association’s “Diagnostic and Statistical Manual of Mental Disorders.”
EFFECTIVE DATE: July 1, 2023
§ 21 — NAME CHANGE FEE ELIMINATION
Eliminates the $250 probate court filing fee to change a person’s name
The bill eliminates the $250 probate court filing fee for changing a
person’s name. By law, the superior and probate courts generally have
concurrent jurisdiction to grant name changes (CGS § 45a-99). With
exceptions, the Superior Court fee for a name change is $360, which
remains unchanged by the bill (CGS § 52-259).
EFFECTIVE DATE: July 1, 2023
§ 22 — DSS GENDER AFFIRMING PROCEDURES W ORKGROUP
Requires DSS to establish a working group to seek input on department guidelines for
gender-affirming procedures at least 120 days before amending the guidelines
The bill requires the DSS commissioner to establish a working group
to seek input on amendments to department guidelines for gender-
affirming procedures. Under the bill, these procedures are (1) medical
procedures or treatments to alter a person’s physical characteristics to
be consistent with the person’s gender identity and (2) for people
diagnosed with gender dysphoria (as described in the most recent
edition of the American Psychiatric Association’s “Diagnostic and
Statistical Manual of Mental Disorders”) or gender incongruence (as
defined in the “International Statistical Classification of Diseases and
Related Health Problems,” 11th revision).
The bill requires the DSS commissioner to make all appointments to
the working group. The working group includes the following
members: 2023SB-00010-R000735-BA.DOCX
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1. six health care providers who treat people who seek or have had
gender-affirming procedures;
2. two HUSKY Health program members who have had gender -
affirming procedures; and
3. the DSS commissioner or her designee, who serves as co-
chairperson with another member the majority of the workgroup
chooses as the other co-chairperson.
The bill requires the DSS commissioner to establish the working
group at least 120 days before amending the guidelines and convene it
at least 90 days before any amendments planned for the guidelines. The
working group must meet at least twice per month.
The bill requires the DSS commissioner to report to the Human
Services and Public Health committees at least 30 days before any
amendments the commissioner has proposed for the gender-affirming
procedure guidelines. The report must include the proposed
amendments and the working group’s recommendations on them. The
working group terminates when DSS issues the report. (Presumably, the
bill’s 120-, 90-, and 30-day deadlines are based on when changes to the
guidelines take effect.)
The bill exempts from its requirements any changes DSS must make
to comply with federal laws or regulations on Medicaid or the state
Children’s Health Insurance Program.
EFFECTIVE DATE: Upon passage
COMMITTEE ACTION
Human Services Committee
Joint Favorable Change of Reference - APP
Yea 14 Nay 7 (03/21/2023)
Appropriations Committee
Joint Favorable
Yea 36 Nay 14 (04/21/2023)