CT
Connecticut Senate Bill SB00010

Connecticut 2023 Regular Session

Connecticut Senate Bill SB00010 Compare Versions

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7-General Assembly Substitute Bill No. 10
7+General Assembly Committee Bill No. 10
88 January Session, 2023
9+LCO No. 5227
10+
11+
12+Referred to Committee on HUMAN SERVICES
13+
14+
15+Introduced by:
16+(HS)
917
1018
1119
1220 AN ACT PROMOTING ACCESS TO AFFORDABLE PRESCRIPTION
1321 DRUGS, HEALTH CARE COVERAGE, TRANSPARENCY IN HEALTH
1422 CARE COSTS, HOME AND COMMUNITY -BASED SUPPORT FOR
1523 VULNERABLE PERSONS AND RIGHTS REGARDING GENDER
1624 IDENTITY AND EXPRESSION.
1725 Be it enacted by the Senate and House of Representatives in General
1826 Assembly convened:
1927
2028 Section 1. Subsection (d) of section 19a-754b of the general statutes is 1
21-repealed and the following is substituted in lieu thereof (Effective July 1, 2
22-2023): 3
29+repealed and the following is substituted in lieu thereof (Effective July 2
30+1, 2023): 3
2331 (d) (1) On or before March 1, 2020, and annually thereafter, the 4
2432 executive director of the Office of Health Strategy, in consultation with 5
25-the Comptroller, Commissioner of Social Services and Commissioner of 6
26-Public Health, shall prepare and make public a list of not more than ten 7
27-outpatient prescription drugs that the executive director, in the 8
33+the Comptroller, Commissioner of Social Services and Commissioner 6
34+of Public Health, shall prepare and make public a list of not more than 7
35+ten outpatient prescription drugs that the executive director, in the 8
2836 executive director's discretion, determines are (A) provided at 9
2937 substantial cost to the state, considering the net cost of such drugs, or 10
30-(B) critical to public health. The list shall include outpatient prescription 11
31-drugs from different therapeutic classes of outpatient prescription 12
32-drugs and at least one generic outpatient prescription drug. 13
33-(2) [The executive director shall not list any outpatient prescription 14
34-drug under subdivision (1) of this subsection unless the wholesale 15
35-acquisition cost of the drug, less all rebates paid to the state for such 16 Substitute Bill No. 10
38+(B) critical to public health. The list shall include outpatient 11
39+prescription drugs from different therapeutic classes of outpatient 12
40+prescription drugs and at least one generic outpatient prescription 13 Committee Bill No. 10
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42-drug during the immediately preceding calendar year, (A) increased by 17
43-at least (i) twenty per cent during the immediately preceding calendar 18
44-year, or (ii) fifty per cent during the immediately preceding three 19
45-calendar years, and (B) was not less than sixty dollars for (i) a thirty-day 20
46-supply of such drug, or (ii) a course of treatment of such drug lasting 21
47-less than thirty days.] Prior to publishing the annual list of outpatient 22
48-prescription drugs pursuant to subdivision (1) of this subsection, the 23
49-executive director shall prepare a preliminary list of those outpatient 24
50-prescription drugs that the executive director plans to include on the 25
51-list. The executive director shall make the preliminary list available for 26
52-public comment for not less than thirty days, during which time any 27
53-manufacturer of an outpatient prescription drug named on the 28
54-preliminary list may produce documentation to establish that the 29
55-wholesale acquisition cost of the drug, less all rebates paid to the state 30
56-for such drug during the immediately preceding calendar year, does not 31
57-exceed the limits established in subdivision (3) of this subsection. If such 32
58-documentation establishes, to the satisfaction of the executive director, 33
59-that the wholesale acquisition cost, less all rebates paid to the state for 34
60-such drug during the immediately preceding calendar year, does not 35
61-exceed the limits established in subdivision (3) of this subsection, the 36
62-executive director shall remove such drug from the list before 37
63-publishing the final list. The executive director shall publish a final list 38
64-pursuant to subdivision (1) of this subsection not later than fifteen days 39
65-after the closing of the public comment period. 40
66-(3) The executive director shall not list any outpatient prescription 41
67-drug under subdivision (1) or (2) of this subsection unless the wholesale 42
68-acquisition cost of the drug, less all rebates paid to the state for such 43
69-drug during the immediately preceding calendar year, (A) increased by 44
70-at least sixteen per cent cumulatively during the immediately preceding 45
71-two calendar years, and (B) was not less than forty dollars for a course 46
72-of therapy. 47
73-[(3)] (4) (A) The pharmaceutical manufacturer of an outpatient 48
74-prescription drug included on a list prepared by the executive director 49 Substitute Bill No. 10
47+drug. 14
48+(2) [The executive director shall not list any outpatient prescription 15
49+drug under subdivision (1) of this subsection unless the wholesale 16
50+acquisition cost of the drug, less all rebates paid to the state for such 17
51+drug during the immediately preceding calendar year, (A) increased 18
52+by at least (i) twenty per cent during the immediately preceding 19
53+calendar year, or (ii) fifty per cent during the immediately preceding 20
54+three calendar years, and (B) was not less than sixty dollars for (i) a 21
55+thirty-day supply of such drug, or (ii) a course of treatment of such 22
56+drug lasting less than thirty days.] Prior to publishing the annual list of 23
57+outpatient prescription drugs pursuant to subdivision (1) of this 24
58+subsection, the executive director shall prepare a preliminary list of 25
59+those outpatient prescription drugs that the executive director plans to 26
60+include on the list. The executive director shall make the preliminary 27
61+list available for public comment for not less than thirty days, during 28
62+which time any manufacturer of an outpatient prescription drug 29
63+named on the preliminary list may produce documentation to establish 30
64+that the wholesale acquisition cost of the drug, less all rebates paid to 31
65+the state for such drug during the immediately preceding calendar 32
66+year, does not exceed the limits established in subdivision (3) of this 33
67+subsection. If such documentation establishes, to the satisfaction of the 34
68+executive director, that the wholesale acquisition cost, less all rebates 35
69+paid to the state for such drug during the immediately preceding 36
70+calendar year, does not exceed the limits established in subdivision (3) 37
71+of this subsection, the executive director shall remove such drug from 38
72+the list before publishing the final list. The executive director shall 39
73+publish a final list pursuant to subdivision (1) of this subsection not 40
74+later than fifteen days after the closing of the public comment period. 41
75+(3) The executive director shall not list any outpatient prescription 42
76+drug under subdivision (1) or (2) of this subsection unless the 43
77+wholesale acquisition cost of the drug (A) increased by at least sixteen 44
78+per cent cumulatively during the immediately preceding two calendar 45
79+years, and (B) was not less than forty dollars for a course of therapy. 46 Committee Bill No. 10
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81-pursuant to subdivision (1) of this subsection shall provide to the office, 50
82-in a form and manner specified by the executive director, (i) a written, 51
83-narrative description, suitable for public release, of all factors that 52
84-caused the increase in the wholesale acquisition cost of the listed 53
85-outpatient prescription drug, and (ii) aggregate, company-level research 54
86-and development costs and such other capital expenditures that the 55
87-executive director, in the executive director's discretion, deems relevant 56
88-for the most recent year for which final audited data are available. 57
86+[(3)] (4) (A) The pharmaceutical manufacturer of an outpatient 47
87+prescription drug included on a list prepared by the executive director 48
88+pursuant to subdivision (1) of this subsection shall provide to the 49
89+office, in a form and manner specified by the executive director, (i) a 50
90+written, narrative description, suitable for public release, of all factors 51
91+that caused the increase in the wholesale acquisition cost of the listed 52
92+outpatient prescription drug, and (ii) aggregate, company-level 53
93+research and development costs and such other capital expenditures 54
94+that the executive director, in the executive director's discretion, deems 55
95+relevant for the most recent year for which final audited data are 56
96+available. 57
8997 (B) The quality and types of information and data that a 58
9098 pharmaceutical manufacturer submits to the office under this 59
91-subdivision shall be consistent with the quality and types of information 60
92-and data that the pharmaceutical manufacturer includes in (i) such 61
93-pharmaceutical manufacturer's annual consolidated report on Securities 62
94-and Exchange Commission Form 10 -K, or (ii) any other public 63
95-disclosure. 64
99+subdivision shall be consistent with the quality and types of 60
100+information and data that the pharmaceutical manufacturer includes 61
101+in (i) such pharmaceutical manufacturer's annual consolidated report 62
102+on Securities and Exchange Commission Form 10-K, or (ii) any other 63
103+public disclosure. 64
96104 [(4)] (5) The office shall establish a standardized form for reporting 65
97105 information and data pursuant to this subsection after consulting with 66
98-pharmaceutical manufacturers. The form shall be designed to minimize 67
99-the administrative burden and cost of reporting on the office and 68
100-pharmaceutical manufacturers. 69
106+pharmaceutical manufacturers. The form shall be designed to 67
107+minimize the administrative burden and cost of reporting on the office 68
108+and pharmaceutical manufacturers. 69
101109 Sec. 2. (NEW) (Effective January 1, 2024, and applicable to contracts 70
102110 entered into, amended or renewed on and after January 1, 2024) (a) For the 71
103111 purposes of this section and sections 3 and 4 of this act: 72
104112 (1) "Distributor" means any person or entity, including any 73
105113 wholesaler, who supplies drugs, devices or cosmetics prepared, 74
106114 produced or packaged by manufacturers, to other wholesalers, 75
107115 manufacturers, distributors, hospitals, clinics, practitioners or 76
108-pharmacies or federal, state and municipal agencies; 77
109-(2) "Manufacturer" means the following: 78
110-(A) Any entity described in 42 USC 1396r-8(k)(5) that is subject to the 79
111-pricing limitations set forth in 42 USC 256b; and 80 Substitute Bill No. 10
116+pharmacies or federal, state and municipal agencies; 77 Committee Bill No. 10
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118-(B) Any wholesaler described in 42 USC 1396r-8(k)(11) engaged in the 81
119-distribution of covered drugs for any entity described in 42 USC1396r-82
120-8(k)(5) that is subject to the pricing limitations set forth in 42 USC 256b; 83
121-(3) "ERISA plan" means an employee welfare benefit plan subject to 84
122-the Employee Retirement Income Security Act of 1974, as amended from 85
123-time to time; 86
124-(4) (A) "Health benefit plan" means any insurance policy or contract 87
125-offered, delivered, issued for delivery, renewed, amended or continued 88
126-in the state by a health carrier to provide, deliver, pay for or reimburse 89
127-any of the costs of health care services; 90
128-(B) "Health benefit plan" does not include: 91
129-(i) Coverage of the type specified in subdivisions (5), (6), (7), (8), (9), 92
130-(14), (15) and (16) of section 38a-469 of the general statutes or any 93
131-combination thereof; 94
132-(ii) Coverage issued as a supplement to liability insurance; 95
133-(iii) Liability insurance, including general liability insurance and 96
134-automobile liability insurance; 97
135-(iv) Workers' compensation insurance; 98
136-(v) Automobile medical payment insurance; 99
137-(vi) Credit insurance; 100
138-(vii) Coverage for on-site medical clinics; or 101
139-(viii) Other similar insurance coverage specified in regulations issued 102
140-pursuant to the Health Insurance Portability and Accountability Act of 103
141-1996, P.L. 104-191, as amended from time to time, under which benefits 104
142-for health care services are secondary or incidental to other insurance 105
143-benefits; and 106 Substitute Bill No. 10
123+(2) "Manufacturer" means the following: 78
124+(A) Any entity described in 42 USC 1396r-8(k)(5) that is subject to 79
125+the pricing limitations set forth in 42 USC 256b; and 80
126+(B) Any wholesaler described in 42 USC 1396r-8(k)(11) engaged in 81
127+the distribution of covered drugs for any entity described in 42 82
128+USC1396r-8(k)(5) that is subject to the pricing limitations set forth in 42 83
129+USC 256b; 84
130+(3) "ERISA plan" means an employee welfare benefit plan subject to 85
131+the Employee Retirement Income Security Act of 1974, as amended 86
132+from time to time; 87
133+(4) (A) "Health benefit plan" means any insurance policy or contract 88
134+offered, delivered, issued for delivery, renewed, amended or 89
135+continued in the state by a health carrier to provide, deliver, pay for or 90
136+reimburse any of the costs of health care services; 91
137+(B) "Health benefit plan" does not include: 92
138+(i) Coverage of the type specified in subdivisions (5), (6), (7), (8), (9), 93
139+(14), (15) and (16) of section 38a-469 of the general statutes or any 94
140+combination thereof; 95
141+(ii) Coverage issued as a supplement to liability insurance; 96
142+(iii) Liability insurance, including general liability insurance and 97
143+automobile liability insurance; 98
144+(iv) Workers' compensation insurance; 99
145+(v) Automobile medical payment insurance; 100
146+(vi) Credit insurance; 101
147+(vii) Coverage for on-site medical clinics; or 102
148+(viii) Other similar insurance coverage specified in regulations 103 Committee Bill No. 10
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150-(C) "Health benefit plan" does not include the following benefits if 107
151-such benefits are provided under a separate insurance policy, certificate 108
152-or contract or are otherwise not an integral part of the plan: 109
153-(i) Limited scope dental or vision benefits; 110
154-(ii) Benefits for long-term care, nursing home care, home health care, 111
155-community-based care or any combination thereof; 112
156-(iii) Other similar, limited benefits specified in regulations issued 113
157-pursuant to the Health Insurance Portability and Accountability Act of 114
158-1996, P.L. 104-191, as amended from time to time; 115
159-(iv) Other supplemental coverage, similar to coverage of the type 116
160-specified in subdivisions (9) and (14) of section 38a-469 of the general 117
161-statutes, provided under a group health plan; or 118
162-(v) Coverage of the type specified in subdivision (3) or (13) of section 119
163-38a-469 of the general statutes or other fixed indemnity insurance if (I) 120
164-such coverage is provided under a separate insurance policy, certificate 121
165-or contract, (II) there is no coordination between the provision of the 122
166-benefits and any exclusion of benefits under any group health plan 123
167-maintained by the same plan sponsor, and (III) the benefits are paid with 124
168-respect to an event without regard to whether benefits were also 125
169-provided under any group health plan maintained by the same plan 126
170-sponsor; 127
171-(5) "Maximum fair price" means the maximum rate for a prescription 128
172-drug published by the Secretary of the United States Department of 129
173-Health and Human Services under Section 1191 of the Inflation 130
174-Reduction Act of 2022, P.L. 117-169, as amended from time to time. 131
175-"Maximum fair price" does not include any dispensing fee paid to a 132
176-pharmacy for dispensing any referenced drug; 133
177-(6) "Participating ERISA plan" means any employee welfare benefit 134
178-plan subject to the Employee Retirement Income Security Act of 1974, as 135
179-amended from time to time, that elects to participate in the requirements 136 Substitute Bill No. 10
155+issued pursuant to the Health Insurance Portability and Accountability 104
156+Act of 1996, P.L. 104-191, as amended from time to time, under which 105
157+benefits for health care services are secondary or incidental to other 106
158+insurance benefits; and 107
159+(C) "Health benefit plan" does not include the following benefits if 108
160+such benefits are provided under a separate insurance policy, 109
161+certificate or contract or are otherwise not an integral part of the plan: 110
162+(i) Limited scope dental or vision benefits; 111
163+(ii) Benefits for long-term care, nursing home care, home health 112
164+care, community-based care or any combination thereof; 113
165+(iii) Other similar, limited benefits specified in regulations issued 114
166+pursuant to the Health Insurance Portability and Accountability Act of 115
167+1996, P.L. 104-191, as amended from time to time; 116
168+(iv) Other supplemental coverage, similar to coverage of the type 117
169+specified in subdivisions (9) and (14) of section 38a-469 of the general 118
170+statutes, provided under a group health plan; or 119
171+(v) Coverage of the type specified in subdivision (3) or (13) of 120
172+section 38a-469 of the general statutes or other fixed indemnity 121
173+insurance if (I) such coverage is provided under a separate insurance 122
174+policy, certificate or contract, (II) there is no coordination between the 123
175+provision of the benefits and any exclusion of benefits under any 124
176+group health plan maintained by the same plan sponsor, and (III) the 125
177+benefits are paid with respect to an event without regard to whether 126
178+benefits were also provided under any group health plan maintained 127
179+by the same plan sponsor; 128
180+(5) "Maximum fair price" means the maximum rate for a 129
181+prescription drug published by the Secretary of the United States 130
182+Department of Health and Human Services under Section 1191 of the 131
183+Inflation Reduction Act of 2022, P.L. 117-169, as amended from time to 132
184+time. "Maximum fair price" does not include any dispensing fee paid 133 Committee Bill No. 10
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186-pursuant to section 3 or 4 of this act; 137
187-(7) "Price applicability period" has the same meaning as provided in 138
188-Section 1191 of the Inflation Reduction Act of 2022, P.L. 117-169, as 139
189-amended from time to time; 140
190-(8) "Purchaser" means any state entity, health benefit plan or 141
191-participating ERISA plan; 142
192-(9) "Referenced drug" means any prescription drug subject to the 143
193-maximum fair price; and 144
194-(10) "State entity" means any agency of this state, including, any 145
195-agent, vendor, fiscal agent, contractor or other person acting on behalf 146
196-of this state, that purchases a prescription drug on behalf of this state for 147
197-a person who maintains a health insurance policy that is paid for by this 148
198-state, including health insurance coverage offered through local, state or 149
199-federal agencies or through organizations licensed in this state. "State 150
200-entity" does not include the medical assistance program administered 151
201-under Title XIX of the Social Security Act, 42 USC 1396 et seq., as 152
202-amended from time to time. 153
203-Sec. 3. (NEW) (Effective January 1, 2024, and applicable to contracts 154
204-entered into, amended or renewed on and after January 1, 2024) (a) No 155
205-purchaser shall purchase a referenced drug or seek reimbursement for 156
206-a referenced drug to be dispensed, delivered or administered to an 157
207-insured in this state, by hand delivery, mail or by other means, directly 158
208-or through a distributor, for a cost that exceeds the maximum fair price 159
209-during the price applicability period for such drug published pursuant 160
210-to Section 1191 of the Inflation Reduction Act of 2022, P.L. 117-169, as 161
211-amended from time to time. 162
212-(b) Each purchaser shall calculate such purchaser's savings generated 163
213-pursuant to subsection (a) of this section and shall apply such savings 164
214-to reduce prescription drug costs for the purchaser's insureds. Not later 165
215-than January fifteenth of each calendar year, a purchaser shall submit a 166
216-report to the Insurance Department that (1) provides an assessment of 167 Substitute Bill No. 10
191+to a pharmacy for dispensing any referenced drug; 134
192+(6) "Participating ERISA plan" means any employee welfare benefit 135
193+plan subject to the Employee Retirement Income Security Act of 1974, 136
194+as amended from time to time, that elects to participate in the 137
195+requirements pursuant to section 3 or 4 of this act; 138
196+(7) "Price applicability period" has the same meaning as provided in 139
197+Section 1191 of the Inflation Reduction Act of 2022, P.L. 117-169, as 140
198+amended from time to time; 141
199+(8) "Purchaser" means any state entity, health benefit plan or 142
200+participating ERISA plan; 143
201+(9) "Referenced drug" means any prescription drug subject to the 144
202+maximum fair price; and 145
203+(10) "State entity" means any agency of this state, including, any 146
204+agent, vendor, fiscal agent, contractor or other person acting on behalf 147
205+of this state, that purchases a prescription drug on behalf of this state 148
206+for a person who maintains a health insurance policy that is paid for 149
207+by this state, including health insurance coverage offered through 150
208+local, state or federal agencies or through organizations licensed in this 151
209+state. "State entity" does not include the medical assistance program 152
210+administered under Title XIX of the Social Security Act, 42 USC 1396 et 153
211+seq., as amended from time to time. 154
212+Sec. 3. (NEW) (Effective January 1, 2024, and applicable to contracts 155
213+entered into, amended or renewed on and after January 1, 2024) (a) No 156
214+purchaser shall purchase a referenced drug or seek reimbursement for 157
215+a referenced drug to be dispensed, delivered or administered to an 158
216+insured in this state, by hand delivery, mail or by other means, directly 159
217+or through a distributor, for a cost that exceeds the maximum fair price 160
218+during the price applicability period for such drug published pursuant 161
219+to Section 1191 of the Inflation Reduction Act of 2022, P.L. 117-169, as 162
220+amended from time to time. 163 Committee Bill No. 10
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223-such purchaser's savings for each referenced drug for the previous 168
224-calendar year, and (2) identifies how each purchaser applied such 169
225-savings to (A) reduce prescription drug costs for such purchaser's 170
226-insureds, and (B) decrease cost disparities. 171
227-(c) An ERISA plan may elect to participate in the requirements of this 172
228-section by notifying the Insurance Department, in writing, not later than 173
229-January first of each calendar year. 174
230-(d) Any violation by a purchaser of subsection (a) of this section shall 175
231-be subject to a civil penalty of one thousand dollars for each such 176
232-violation. 177
233-(e) The Insurance Commissioner shall adopt regulations, in 178
234-accordance with the provisions of chapter 54 of the general statutes, to 179
235-implement the provisions of this section and section 4 of this act. 180
236-Sec. 4. (NEW) (Effective January 1, 2024, and applicable to contracts 181
237-entered into, amended or renewed on and after January 1, 2024) (a) No 182
238-manufacturer or distributor of a referenced drug shall withdraw such 183
239-referenced drug from sale or distribution in this state to attempt to avoid 184
240-any loss of revenue resulting from the maximum fair price requirement 185
241-established in section 3 of this act. 186
242-(b) Each manufacturer or distributor shall provide not less than one 187
243-hundred eighty days' written notice to the Insurance Commissioner and 188
244-Attorney General prior to withdrawing a referenced drug from sale or 189
245-distribution in this state. 190
246-(c) If any manufacturer or distributor violates the provisions of 191
247-subsection (a) or (b) of this section, such manufacturer or distributor 192
248-shall be subject to a civil penalty of (1) five hundred thousand dollars, 193
249-or (2) such purchaser's amount of annual savings generated pursuant to 194
250-subsection (a) of section 3 of this act, as determined by the Insurance 195
251-Commissioner, whichever is greater. 196
252-(d) It shall be a violation of this section for any manufacturer or 197 Substitute Bill No. 10
227+(b) Each purchaser shall calculate such purchaser's savings 164
228+generated pursuant to subsection (a) of this section and shall apply 165
229+such savings to reduce prescription drug costs for the purchaser's 166
230+insureds. Not later than January fifteenth of each calendar year, a 167
231+purchaser shall submit a report to the Insurance Department that (1) 168
232+provides an assessment of such purchaser's savings for each referenced 169
233+drug for the previous calendar year, and (2) identifies how each 170
234+purchaser applied such savings to (A) reduce prescription drug costs 171
235+for such purchaser's insureds, and (B) decrease cost disparities. 172
236+(c) An ERISA plan may elect to participate in the requirements of 173
237+this section by notifying the Insurance Department, in writing, not 174
238+later than January first of each calendar year. 175
239+(d) Any violation by a purchaser of subsection (a) of this section 176
240+shall be subject to a civil penalty of one thousand dollars for each such 177
241+violation. 178
242+(e) The Insurance Commissioner shall adopt regulations, in 179
243+accordance with the provisions of chapter 54 of the general statutes, to 180
244+implement the provisions of this section and section 4 of this act. 181
245+Sec. 4. (NEW) (Effective January 1, 2024, and applicable to contracts 182
246+entered into, amended or renewed on and after January 1, 2024) (a) No 183
247+manufacturer or distributor of a referenced drug shall withdraw such 184
248+referenced drug from sale or distribution in this state to attempt to 185
249+avoid any loss of revenue resulting from the maximum fair price 186
250+requirement established in section 3 of this act. 187
251+(b) Each manufacturer or distributor shall provide not less than one 188
252+hundred eighty days' written notice to the Insurance Commissioner 189
253+and Attorney General prior to withdrawing a referenced drug from 190
254+sale or distribution in this state. 191
255+(c) If any manufacturer or distributor violates the provisions of 192
256+subsection (a) or (b) of this section, such manufacturer or distributor 193
257+shall be subject to a civil penalty of (1) five hundred thousand dollars, 194 Committee Bill No. 10
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259-distributor of a referenced drug to negotiate with a purchaser or seller 198
260-of a referenced drug at a price that exceeds the maximum fair price. 199
261-(e) The Attorney General shall have exclusive authority to enforce 200
262-violations of this section and section 3 of this act. 201
263-Sec. 5. (NEW) (Effective July 1, 2023) (a) As used in this section and 202
264-section 6 of this act, (1) "federal 340B drug pricing program" means the 203
265-plan described in Section 340B of the Public Health Service Act, 42 USC 204
266-256b, as amended from time to time, (2) "340B covered entity" means a 205
267-provider participating in the federal 340B drug pricing program, (3) 206
268-"prescription drug" has the same meaning as provided in section 19a-207
269-754b of the general statutes, and (4) "rebate" has the same meaning as 208
270-provided in section 38a-479ooo of the general statutes. 209
271-(b) Not later than January fifteenth annually, a 340B covered entity 210
272-shall provide a report to the executive director of the Office of Health 211
273-Strategy, established pursuant to section 19a-754a of the general 212
274-statutes, as amended by this act, providing, for the previous calendar 213
275-year (1) a list of all prescription drugs, identified by the national drug 214
276-code number, purchased through the federal 340B drug pricing 215
277-program, (2) the actual purchase price of each such prescription drug 216
278-after any rebate or discount provided pursuant to the program, (3) the 217
279-actual payment each such 340B covered entity received from any private 218
280-or public health insurance plan, except for Medicaid and Medicare, or 219
281-patient for each such prescription drug, (4) the average percentage 220
282-savings realized by each 340B covered entity on the cost of prescription 221
283-drugs under the 340B program, and (5) how the 340B covered entity 222
284-used prescription drug cost savings under the program. The executive 223
285-director shall include a link to the report on the office's Internet web site. 224
286-Sec. 6. (NEW) (Effective July 1, 2023) No 340B covered entity shall 225
287-attempt to collect as medical debt any payment for a prescription drug 226
288-obtained with a rebate or at a discounted price through the federal 340B 227
289-drug pricing program that exceeds the cost of such drug paid by such 228
290-entity. 229 Substitute Bill No. 10
264+or (2) such purchaser's amount of annual savings generated pursuant 195
265+to subsection (a) of section 3 of this act, as determined by the Insurance 196
266+Commissioner, whichever is greater. 197
267+(d) It shall be a violation of this section for any manufacturer or 198
268+distributor of a referenced drug to negotiate with a purchaser or seller 199
269+of a referenced drug at a price that exceeds the maximum fair price. 200
270+(e) The Attorney General shall have exclusive authority to enforce 201
271+violations of this section and section 3 of this act. 202
272+Sec. 5. (NEW) (Effective July 1, 2023) (a) As used in this section and 203
273+section 6 of this act, (1) "federal 340B drug pricing program" means the 204
274+plan described in Section 340B of the Public Health Service Act, 42 USC 205
275+256b, as amended from time to time, (2) "340B covered entity" means a 206
276+provider participating in the federal 340B drug pricing program, (3) 207
277+"prescription drug" has the same meaning as provided in section 19a-208
278+754b of the general statutes, and (4) "rebate" has the same meaning as 209
279+provided in section 38a-479ooo of the general statutes. 210
280+(b) Not later than January fifteenth annually, a 340B covered entity 211
281+shall provide a report to the executive director of the Office of Health 212
282+Strategy, established pursuant to section 19a-754a of the general 213
283+statutes, as amended by this act, providing, for the previous calendar 214
284+year (1) a list of all prescription drugs, identified by the national drug 215
285+code number, purchased through the federal 340B drug pricing 216
286+program, (2) the actual purchase price of each such prescription drug 217
287+after any rebate or discount provided pursuant to the program, (3) the 218
288+actual payment each such 340B covered entity received from any 219
289+private or public health insurance plan, except for Medicaid and 220
290+Medicare, or patient for each such prescription drug, (4) the average 221
291+percentage savings realized by each 340B covered entity on the cost of 222
292+prescription drugs under the 340B program, and (5) how the 340B 223
293+covered entity used prescription drug cost savings under the program. 224
294+The executive director shall include a link to the report on the office's 225
295+Internet web site. 226 Committee Bill No. 10
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297-Sec. 7. (NEW) (Effective July 1, 2023) (a) There is established a 230
298-Prescription Drug Payment Evaluation Committee to recommend 231
299-upper payment limits on not fewer than eight prescription drugs to the 232
300-executive director of the Office of Health Strategy based on evaluation 233
301-of upper payment limits on such drugs set by other states or foreign 234
302-jurisdictions. 235
303-(b) Members of the committee shall be as follows: 236
304-(1) Three appointed by the speaker of the House of Representatives, 237
305-who shall be (A) a representative of a state-wide health care advocacy 238
306-coalition, (B) a representative of a state-wide advocacy organization for 239
307-elderly persons, and (C) a representative of a state-wide organization 240
308-for diverse communities; 241
309-(2) Three appointed by the president pro tempore of the Senate, who 242
310-shall be (A) a representative of a labor union, (B) a health services 243
311-researcher, and (C) a consumer who has experienced barriers to 244
312-obtaining prescription drugs due to the cost of such drugs; 245
313-(3) Two appointed by the majority leader of the House of 246
314-Representatives, who shall be representatives of 340B covered entities, 247
315-as defined in section 5 of this act; 248
316-(4) Two appointed by the minority leader of the House of 249
317-Representatives, who shall be representatives of private insurers; 250
318-(5) Two appointed by the majority leader of the Senate, who shall be 251
319-representatives of organizations representing health care providers; 252
320-(6) Two appointed by the minority leader of the Senate, who shall be 253
321-(A) a representative of a pharmaceutical company doing business in the 254
322-state, and (B) a representative of an academic institution with expertise 255
323-in health care costs; 256
324-(7) Two appointed by the Governor, who shall be (A) a representative 257
325-of pharmacists, and (B) a representative of pharmacy benefit managers; 258 Substitute Bill No. 10
302+Sec. 6. (NEW) (Effective July 1, 2023) No 340B covered entity shall 227
303+attempt to collect as medical debt any payment for a prescription drug 228
304+obtained with a rebate or at a discounted price through the federal 229
305+340B drug pricing program by such entity but charged to a patient by 230
306+the entity at a higher price. 231
307+Sec. 7. (NEW) (Effective July 1, 2023) (a) There is established a 232
308+Prescription Drug Payment Evaluation Committee to recommend 233
309+upper payment limits on not fewer than eight prescription drugs to the 234
310+executive director of the Office of Health Strategy based on evaluation 235
311+of upper payment limits on such drugs set by other states or foreign 236
312+jurisdictions. 237
313+(b) Members of the committee shall be as follows: 238
314+(1) Three appointed by the speaker of the House of Representatives, 239
315+who shall be (A) a representative of a state-wide health care advocacy 240
316+coalition, (B) a representative of a state-wide advocacy organization for 241
317+elderly persons, and (C) a representative of a state-wide organization 242
318+for diverse communities; 243
319+(2) Three appointed by the president pro tempore of the Senate, 244
320+who shall be (A) a representative of a labor union, (B) a health services 245
321+researcher, and (C) a consumer who has experienced barriers to 246
322+obtaining prescription drugs due to the cost of such drugs; 247
323+(3) Two appointed by the majority leader of the House of 248
324+Representatives, who shall be representatives of 340B covered entities, 249
325+as defined in section 5 of this act; 250
326+(4) Two appointed by the minority leader of the House of 251
327+Representatives, who shall be representatives of private insurers; 252
328+(5) Two appointed by the majority leader of the Senate, who shall be 253
329+representatives of organizations representing health care providers; 254
330+(6) Two appointed by the minority leader of the Senate, who shall 255 Committee Bill No. 10
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332-(8) The Secretary of the Office of Policy and Management, or the 259
333-secretary's designee; 260
334-(9) The Commissioner of Social Services, or the commissioner's 261
335-designee; 262
336-(10) The Commissioner of Public Health, or the commissioner's 263
337-designee; 264
338-(11) The Insurance Commissioner, or the commissioner's designee; 265
339-(12) The Commissioner of Consumer Protection, or the 266
340-commissioner's designee; 267
341-(13) The executive director of the Office of Health Strategy, or the 268
342-executive director's designee; and 269
343-(14) The Healthcare Advocate, or the Healthcare Advocate's 270
344-designee. 271
345-(c) All initial appointments to the committee shall be made not later 272
346-than August 1, 2023. Any vacancy shall be filled by the appointing 273
347-authority. 274
348-(d) The speaker of the House of Representatives and the president 275
349-pro tempore of the Senate shall select the chairpersons of the committee 276
350-from among the members of the committee. Such chairpersons shall 277
351-schedule the first meeting of the committee, which shall be held not later 278
352-than September 1, 2023. 279
353-(e) The administrative staff of the joint standing committee of the 280
354-General Assembly having cognizance of matters relating to insurance 281
355-shall serve as administrative staff of the committee. 282
356-(f) Not later than December 1, 2023, and annually thereafter, the 283
357-committee shall submit a report, in accordance with the provisions of 284
358-section 11-4a of the general statutes, to the executive director of the 285
359-Office of Health Strategy and the joint standing committees of the 286 Substitute Bill No. 10
337+be (A) a representative of a pharmaceutical company doing business in 256
338+the state, and (B) a representative of an academic institution with 257
339+expertise in health care costs; 258
340+(7) Two appointed by the Governor, who shall be (A) a 259
341+representative of pharmacists, and (B) a representative of pharmacy 260
342+benefit managers; 261
343+(8) The Secretary of the Office of Policy and Management, or the 262
344+secretary's designee; 263
345+(9) The Commissioner of Social Services, or the commissioner's 264
346+designee; 265
347+(10) The Commissioner of Public Health, or the commissioner's 266
348+designee; 267
349+(11) The Insurance Commissioner, or the commissioner's designee; 268
350+(12) The Commissioner of Consumer Protection, or the 269
351+commissioner's designee; 270
352+(13) The executive director of the Office of Health Strategy, or the 271
353+executive director's designee; and 272
354+(14) The Healthcare Advocate, or the Healthcare Advocate's 273
355+designee. 274
356+(c) All initial appointments to the committee shall be made not later 275
357+than thirty days after the effective date of this section. Any vacancy 276
358+shall be filled by the appointing authority. 277
359+(d) The speaker of the House of Representatives and the president 278
360+pro tempore of the Senate shall select the chairpersons of the 279
361+committee from among the members of the committee. Such 280
362+chairpersons shall schedule the first meeting of the committee, which 281
363+shall be held not later than sixty days after the effective date of this 282
364+section. 283 Committee Bill No. 10
360365
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366-General Assembly having cognizance of matters relating to 287
367-appropriations and the budgets of state agencies, human services, 288
368-insurance and public health with its recommendations concerning 289
369-upper payment limits for not fewer than eight prescription drugs. 290
370-Sec. 8. Section 3-112 of the general statutes is repealed and the 291
371-following is substituted in lieu thereof (Effective July 1, 2023): 292
372-(a) The Comptroller shall: (1) Establish and maintain the accounts of 293
373-the state government and perform such other duties as are prescribed 294
374-by the Constitution of the state; (2) register all warrants or orders for the 295
375-disbursement of the public money; (3) adjust and settle all demands 296
376-against the state not first adjusted and settled by the General Assembly 297
377-and give orders on the Treasurer for the balance found and allowed; (4) 298
378-prescribe the mode of keeping and rendering all public accounts of 299
379-departments or agencies of the state and of institutions supported by the 300
380-state or receiving state aid by appropriation from the General Assembly; 301
381-(5) prepare and issue effective accounting and payroll manuals for use 302
382-by the various agencies of the state; (6) from time to time, examine and 303
383-state the amount of all debts and credits of the state; present all claims 304
384-in favor of the state against any bankrupt, insolvent debtor or deceased 305
385-person; and institute and maintain suits, in the name of the state, against 306
386-all persons who have received money or property belonging to the state 307
387-and have not accounted for it; and (7) administer the Connecticut 308
388-Retirement Security Program, established pursuant to section 31-418. 309
389-(b) All moneys recovered, procured or received for the state by the 310
390-authority of the Comptroller shall be paid to the Treasurer, who shall 311
391-file a duplicate receipt therefor with the Comptroller. The Comptroller 312
392-may require reports from any department, agency or institution as 313
393-aforesaid upon any matter of property or finance at any time and under 314
394-such regulations as the Comptroller prescribes and shall require special 315
395-reports upon request of the Governor, and the information contained in 316
396-such special reports shall be transmitted by him to the Governor. All 317
397-records, books and papers in any public office shall at all reasonable 318
398-times be open to inspection by the Comptroller. The Comptroller may 319 Substitute Bill No. 10
371+(e) The administrative staff of the joint standing committee of the 284
372+General Assembly having cognizance of matters relating to insurance 285
373+shall serve as administrative staff of the committee. 286
374+(f) Not later than December 1, 2023, and annually thereafter, the 287
375+committee shall submit a report, in accordance with the provisions of 288
376+section 11-4a of the general statutes, to the executive director of the 289
377+Office of Health Strategy and the joint standing committees of the 290
378+General Assembly having cognizance of matters relating to 291
379+appropriations and the budgets of state agencies, human services, 292
380+insurance and public health with its recommendations concerning 293
381+upper payment limits for not fewer than eight prescription drugs. 294
382+Sec. 8. Section 3-112 of the general statutes is repealed and the 295
383+following is substituted in lieu thereof (Effective July 1, 2023): 296
384+(a) The Comptroller shall: (1) Establish and maintain the accounts of 297
385+the state government and perform such other duties as are prescribed 298
386+by the Constitution of the state; (2) register all warrants or orders for 299
387+the disbursement of the public money; (3) adjust and settle all 300
388+demands against the state not first adjusted and settled by the General 301
389+Assembly and give orders on the Treasurer for the balance found and 302
390+allowed; (4) prescribe the mode of keeping and rendering all public 303
391+accounts of departments or agencies of the state and of institutions 304
392+supported by the state or receiving state aid by appropriation from the 305
393+General Assembly; (5) prepare and issue effective accounting and 306
394+payroll manuals for use by the various agencies of the state; (6) from 307
395+time to time, examine and state the amount of all debts and credits of 308
396+the state; present all claims in favor of the state against any bankrupt, 309
397+insolvent debtor or deceased person; and institute and maintain suits, 310
398+in the name of the state, against all persons who have received money 311
399+or property belonging to the state and have not accounted for it; and 312
400+(7) administer the Connecticut Retirement Security Program, 313
401+established pursuant to section 31-418. 314
402+(b) All moneys recovered, procured or received for the state by the 315 Committee Bill No. 10
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405-draw his order on the Treasurer for a petty cash fund for any budgeted 320
406-agency. Expenditures from such petty cash funds shall be subject to such 321
407-procedures as the Comptroller establishes. In accordance with 322
408-established procedures, the Comptroller may enter into such contractual 323
409-agreements as may be necessary for the discharge of his duties. As used 324
410-in this section, "adjust" means to determine the amount equitably due in 325
411-respect to each item of each claim or demand. 326
412-(c) The Comptroller shall establish and administer a prescription 327
413-drug discount card program available to all residents of the state. The 328
414-Comptroller may coordinate participation in a multistate prescription 329
415-drug consortium for the purposes of pooling prescription drug 330
416-purchasing power to lower costs by negotiating discounts with 331
417-prescription drug manufacturers and coordinating volume discount 332
418-contracting. 333
419-Sec. 9. Section 38a-477g of the general statutes is repealed and the 334
420-following is substituted in lieu thereof (Effective January 1, 2024): 335
421-(a) As used in this section: [(1) "Covered person", "facility" and "health 336
422-carrier" have the same meanings as provided in section 38a-591a, (2) 337
423-"health care provider" has the same meaning as provided in subsection 338
424-(a) of section 38a-477aa, and (3) "intermediary", "network", "network 339
425-plan" and "participating provider" have the same meanings as provided 340
426-in subsection (a) of section 38a-472f.] 341
427-(1) "All-or-nothing clause" means a provision in a health care contract 342
428-that: 343
429-(A) Requires the health insurance carrier or health plan administrator 344
430-to include all members of a health care provider in a network plan; or 345
431-(B) Requires the health insurance carrier or health plan administrator 346
432-to enter into any additional contract with an affiliate of the health care 347
433-provider as a condition to entering into a contract with such health care 348
434-provider. 349 Substitute Bill No. 10
409+authority of the Comptroller shall be paid to the Treasurer, who shall 316
410+file a duplicate receipt therefor with the Comptroller. The Comptroller 317
411+may require reports from any department, agency or institution as 318
412+aforesaid upon any matter of property or finance at any time and 319
413+under such regulations as the Comptroller prescribes and shall require 320
414+special reports upon request of the Governor, and the information 321
415+contained in such special reports shall be transmitted by him to the 322
416+Governor. All records, books and papers in any public office shall at all 323
417+reasonable times be open to inspection by the Comptroller. The 324
418+Comptroller may draw his order on the Treasurer for a petty cash fund 325
419+for any budgeted agency. Expenditures from such petty cash funds 326
420+shall be subject to such procedures as the Comptroller establishes. In 327
421+accordance with established procedures, the Comptroller may enter 328
422+into such contractual agreements as may be necessary for the discharge 329
423+of his duties. As used in this section, "adjust" means to determine the 330
424+amount equitably due in respect to each item of each claim or demand. 331
425+(c) The Comptroller shall establish and administer a prescription 332
426+drug discount card program available to all residents of the state. The 333
427+Comptroller may coordinate participation in a multistate prescription 334
428+drug consortium for the purposes of pooling prescription drug 335
429+purchasing power to lower costs by negotiating discounts with 336
430+prescription drug manufacturers and coordinating volume discount 337
431+contracting. 338
432+Sec. 9. Section 38a-477g of the general statutes is repealed and the 339
433+following is substituted in lieu thereof (Effective January 1, 2024): 340
434+(a) As used in this section: [(1) "Covered person", "facility" and 341
435+"health carrier" have the same meanings as provided in section 38a-342
436+591a, (2) "health care provider" has the same meaning as provided in 343
437+subsection (a) of section 38a-477aa, and (3) "intermediary", "network", 344
438+"network plan" and "participating provider" have the same meanings 345
439+as provided in subsection (a) of section 38a-472f.] 346
440+(1) "All-or-nothing clause" means a provision in a health care 347 Committee Bill No. 10
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441-(2) "Anti-steering clause" means a provision of a health care contract 350
442-that restricts the ability of the health insurance carrier or health plan 351
443-administrator from encouraging an enrollee to obtain a health care 352
444-service from a competitor of the hospital or health system, including 353
445-offering incentives to encourage enrollees to utilize specific health care 354
446-providers. 355
447-(3) "Anti-tiering clause" means a provision in a health care contract 356
448-that: 357
449-(A) Restricts the ability of the health insurance carrier or health plan 358
450-administrator to introduce and modify a tiered network plan or assign 359
451-health care providers into tiers; or 360
452-(B) Requires the health insurance carrier or health plan administrator 361
453-to place all members of a health care provider in the same tier of a tiered 362
454-network plan. 363
455-(4) "Covered person", "facility" and "health carrier" have the same 364
456-meanings as provided in section 38a-591a. 365
457-(5) "Health care provider" has the same meaning as provided in 366
458-subsection (a) of section 38a-477aa. 367
459-(6) "Health plan administrator" means a third-party administrator 368
460-who acts on behalf of a plan sponsor to administer a health benefit plan. 369
461-(7) "Intermediary", "network", "network plan" and "participating 370
462-provider" have the same meanings as provided in subsection (a) of 371
463-section 38a-472f. 372
464-(8) "Tiered network" has the same meaning as provided in section 373
465-38a-472f. 374
466-(9) "Value-based care" means a health care coverage model in which 375
467-providers, including hospitals and physicians, are paid based on patient 376
468-health outcomes. 377 Substitute Bill No. 10
447+contract that: 348
448+(A) Requires the health insurance carrier or health plan 349
449+administrator to include all members of a health care provider in a 350
450+network plan; or 351
451+(B) Requires the health insurance carrier or health plan 352
452+administrator to enter into any additional contract with an affiliate of 353
453+the health care provider as a condition to entering into a contract with 354
454+such health care provider. 355
455+(2) "Anti-steering clause" means a provision of a health care contract 356
456+that restricts the ability of the health insurance carrier or health plan 357
457+administrator from encouraging an enrollee to obtain a health care 358
458+service from a competitor of the hospital or health system, including 359
459+offering incentives to encourage enrollees to utilize specific health care 360
460+providers. 361
461+(3) "Anti-tiering clause" means a provision in a health care contract 362
462+that: 363
463+(A) Restricts the ability of the health insurance carrier or health plan 364
464+administrator to introduce and modify a tiered network plan or assign 365
465+health care providers into tiers; or 366
466+(B) Requires the health insurance carrier or health plan 367
467+administrator to place all members of a health care provider in the 368
468+same tier of a tiered network plan. 369
469+(4) "Covered person", "facility" and "health carrier" have the same 370
470+meanings as provided in section 38a-591a. 371
471+(5) "Health care provider" has the same meaning as provided in 372
472+subsection (a) of section 38a-477aa. 373
473+(6) "Health plan administrator" means a third-party administrator 374
474+who acts on behalf of a plan sponsor to administer a health benefit 375 Committee Bill No. 10
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475-(b) (1) Each contract entered into, renewed or amended on or after 378
476-January 1, 2017, between a health carrier and a participating provider 379
477-shall include: 380
478-(A) A hold harmless provision that specifies protections for covered 381
479-persons. Such provision shall include the following statement or a 382
480-substantially similar statement: "Provider agrees that in no event, 383
481-including, but not limited to, nonpayment by the health carrier or 384
482-intermediary, the insolvency of the health carrier or intermediary, or a 385
483-breach of this agreement, shall the provider bill, charge, collect a deposit 386
484-from, seek compensation, remuneration or reimbursement from, or 387
485-have any recourse against a covered person or a person (other than the 388
486-health carrier or intermediary) acting on behalf of the covered person 389
487-for services provided pursuant to this agreement. This agreement does 390
488-not prohibit the provider from collecting coinsurance, deductibles or 391
489-copayments, as specifically provided in the evidence of coverage, or fees 392
490-for uncovered services delivered on a fee-for-service basis to covered 393
491-persons. Nor does this agreement prohibit a provider (except for a 394
492-health care provider who is employed full-time on the staff of a health 395
493-carrier and has agreed to provide services exclusively to that health 396
494-carrier's covered persons and no others) and a covered person from 397
495-agreeing to continue services solely at the expense of the covered 398
496-person, as long as the provider has clearly informed the covered person 399
497-that the health carrier does not cover or continue to cover a specific 400
498-service or services. Except as provided herein, this agreement does not 401
499-prohibit the provider from pursuing any available legal remedy."; 402
500-(B) A provision that in the event of a health carrier or intermediary 403
501-insolvency or other cessation of operations, the participating provider's 404
502-obligation to deliver covered health care services to covered persons 405
503-without requesting payment from a covered person other than a 406
504-coinsurance, copayment, deductible or other out-of-pocket expense for 407
505-such services will continue until the earlier of (i) the termination of the 408
506-covered person's coverage under the network plan, including any 409
507-extension of coverage provided under the contract terms or applicable 410 Substitute Bill No. 10
481+plan. 376
482+(7) "Intermediary", "network", "network plan" and "participating 377
483+provider" have the same meanings as provided in subsection (a) of 378
484+section 38a-472f. 379
485+(8) "Tiered network" has the same meaning as provided in section 380
486+38a-472f. 381
487+(9) "Value-based care" means a health care coverage model in which 382
488+providers, including hospitals and physicians, are paid based on 383
489+patient health outcomes. 384
490+(b) (1) Each contract entered into, renewed or amended on or after 385
491+January 1, [2017] 2024, between a health carrier and a participating 386
492+provider shall include: 387
493+(A) A hold harmless provision that specifies protections for covered 388
494+persons. Such provision shall include the following statement or a 389
495+substantially similar statement: "Provider agrees that in no event, 390
496+including, but not limited to, nonpayment by the health carrier or 391
497+intermediary, the insolvency of the health carrier or intermediary, or a 392
498+breach of this agreement, shall the provider bill, charge, collect a 393
499+deposit from, seek compensation, remuneration or reimbursement 394
500+from, or have any recourse against a covered person or a person (other 395
501+than the health carrier or intermediary) acting on behalf of the covered 396
502+person for services provided pursuant to this agreement. This 397
503+agreement does not prohibit the provider from collecting coinsurance, 398
504+deductibles or copayments, as specifically provided in the evidence of 399
505+coverage, or fees for uncovered services delivered on a fee-for-service 400
506+basis to covered persons. Nor does this agreement prohibit a provider 401
507+(except for a health care provider who is employed full-time on the 402
508+staff of a health carrier and has agreed to provide services exclusively 403
509+to that health carrier's covered persons and no others) and a covered 404
510+person from agreeing to continue services solely at the expense of the 405
511+covered person, as long as the provider has clearly informed the 406 Committee Bill No. 10
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514-state or federal law for covered persons who are in an active course of 411
515-treatment, as set forth in subdivision (2) of subsection (g) of section 38a-412
516-472f, or are totally disabled, or (ii) the date the contract between the 413
517-health carrier and the participating provider would have terminated if 414
518-the health carrier or intermediary had remained in operation, including 415
519-any extension of coverage required under applicable state or federal law 416
520-for covered persons who are in an active course of treatment or are 417
521-totally disabled; 418
522-(C) (i) A provision that requires the participating provider to make 419
523-health records available to appropriate state and federal authorities 420
524-involved in assessing the quality of care provided to, or investigating 421
525-grievances or complaints of, covered persons, and (ii) a statement that 422
526-such participating provider shall comply with applicable state and 423
527-federal laws related to the confidentiality of medical and health records 424
528-and a covered person's right to view, obtain copies of or amend such 425
529-covered person's medical and health records; and 426
530-(D) (i) If such contract is entered into, renewed or amended before 427
531-July 1, 2022, definitions of what is considered timely notice and a 428
532-material change for the purposes of subparagraph (A) of subdivision (2) 429
533-of subsection (c) of this section, or (ii) if such contract is entered into, 430
534-renewed or amended on or after July 1, 2022, (I) a statement disclosing 431
535-the ninety-day advance written notice requirement established under 432
536-subparagraph (B) of subdivision (2) of subsection (c) of this section and 433
537-what is considered a material change for the purposes of subdivision (2) 434
538-of subsection (c) of this section, and (II) provisions affording the 435
539-participating provider a right to appeal any proposed change to the 436
540-provisions, other documents, provider manuals or policies disclosed 437
541-pursuant to subdivision (1) of subsection (c) of this section. 438
542-(2) The contract terms set forth in subparagraphs (A) and (B) of 439
543-subdivision (1) of this subsection shall (A) be construed in favor of the 440
544-covered person, (B) survive the termination of the contract regardless of 441
545-the reason for the termination, including the insolvency of the health 442
546-carrier, and (C) supersede any oral or written agreement between a 443 Substitute Bill No. 10
518+covered person that the health carrier does not cover or continue to 407
519+cover a specific service or services. Except as provided herein, this 408
520+agreement does not prohibit the provider from pursuing any available 409
521+legal remedy."; 410
522+(B) A provision that in the event of a health carrier or intermediary 411
523+insolvency or other cessation of operations, the participating provider's 412
524+obligation to deliver covered health care services to covered persons 413
525+without requesting payment from a covered person other than a 414
526+coinsurance, copayment, deductible or other out-of-pocket expense for 415
527+such services will continue until the earlier of (i) the termination of the 416
528+covered person's coverage under the network plan, including any 417
529+extension of coverage provided under the contract terms or applicable 418
530+state or federal law for covered persons who are in an active course of 419
531+treatment, as set forth in subdivision (2) of subsection (g) of section 420
532+38a-472f, or are totally disabled, or (ii) the date the contract between 421
533+the health carrier and the participating provider would have 422
534+terminated if the health carrier or intermediary had remained in 423
535+operation, including any extension of coverage required under 424
536+applicable state or federal law for covered persons who are in an active 425
537+course of treatment or are totally disabled; 426
538+(C) (i) A provision that requires the participating provider to make 427
539+health records available to appropriate state and federal authorities 428
540+involved in assessing the quality of care provided to, or investigating 429
541+grievances or complaints of, covered persons, and (ii) a statement that 430
542+such participating provider shall comply with applicable state and 431
543+federal laws related to the confidentiality of medical and health 432
544+records and a covered person's right to view, obtain copies of or 433
545+amend such covered person's medical and health records; and 434
546+(D) (i) If such contract is entered into, renewed or amended before 435
547+July 1, 2022, definitions of what is considered timely notice and a 436
548+material change for the purposes of subparagraph (A) of subdivision 437
549+(2) of subsection (c) of this section, or (ii) if such contract is entered 438
550+into, renewed or amended on or after July 1, 2022, (I) a statement 439 Committee Bill No. 10
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553-health care provider and a covered person or a covered person's 444
554-authorized representative that is contrary to or inconsistent with the 445
555-requirements set forth in subdivision (1) of this subsection. 446
556-(3) No contract subject to this subsection shall include any provision 447
557-that conflicts with the provisions contained in the network plan or 448
558-required under this section, section 38a-472f or section 38a-477h. 449
559-(4) No health carrier or participating provider that is a party to a 450
560-contract under this subsection shall assign or delegate any right or 451
561-responsibility required under such contract without the prior written 452
562-consent of the other party. 453
563-(c) (1) At the time a contract subject to subsection (b) of this section is 454
564-signed, the health carrier or such health carrier's intermediary shall 455
565-disclose to a participating provider: 456
566-(A) All provisions and other documents incorporated by reference in 457
567-such contract; and 458
568-(B) If such contract is entered into, renewed or amended on or after 459
569-July 1, 2022, all provider manuals and policies incorporated by reference 460
570-in such contract, if any. 461
571-(2) While such contract is in force, the health carrier shall: 462
572-(A) If such contract is entered into, renewed or amended before July 463
573-1, 2022, timely notify a participating provider of any change to the 464
574-provisions or other documents specified under subparagraph (A) of 465
575-subdivision (1) of this subsection that will result in a material change to 466
576-such contract; or 467
557+disclosing the ninety-day advance written notice requirement 440
558+established under subparagraph (B) of subdivision (2) of subsection (c) 441
559+of this section and what is considered a material change for the 442
560+purposes of subdivision (2) of subsection (c) of this section, and (II) 443
561+provisions affording the participating provider a right to appeal any 444
562+proposed change to the provisions, other documents, provider 445
563+manuals or policies disclosed pursuant to subdivision (1) of subsection 446
564+(c) of this section. 447
565+(2) The contract terms set forth in subparagraphs (A) and (B) of 448
566+subdivision (1) of this subsection shall (A) be construed in favor of the 449
567+covered person, (B) survive the termination of the contract regardless 450
568+of the reason for the termination, including the insolvency of the health 451
569+carrier, and (C) supersede any oral or written agreement between a 452
570+health care provider and a covered person or a covered person's 453
571+authorized representative that is contrary to or inconsistent with the 454
572+requirements set forth in subdivision (1) of this subsection. 455
573+(3) No contract subject to this subsection shall include any provision 456
574+that conflicts with the provisions contained in the network plan or 457
575+required under this section, section 38a-472f or section 38a-477h. 458
576+(4) No health carrier or participating provider that is a party to a 459
577+contract under this subsection shall assign or delegate any right or 460
578+responsibility required under such contract without the prior written 461
579+consent of the other party. 462
580+(c) (1) At the time a contract subject to subsection (b) of this section 463
581+is signed, the health carrier or such health carrier's intermediary shall 464
582+disclose to a participating provider: 465
583+(A) All provisions and other documents incorporated by reference 466
584+in such contract; and 467
577585 (B) If such contract is entered into, renewed or amended on or after 468
578-July 1, 2022, provide to a participating provider at least ninety days' 469
579-advance written notice of any change to the provisions or other 470
580-documents specified under subparagraph (A) of subdivision (1) of this 471
581-subsection, and any change to the provider manuals and policies 472 Substitute Bill No. 10
586+July 1, 2022, all provider manuals and policies incorporated by 469
587+reference in such contract, if any. 470 Committee Bill No. 10
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588-specified under subparagraph (B) of subdivision (1) of this subsection, 473
589-that will result in a material change to such contract or the procedures 474
590-that a participating provider must follow pursuant to such contract. 475
591-(d) (1) (A) Each contract between a health carrier and an intermediary 476
592-entered into, renewed or amended on or after January 1, 2017, shall 477
593-satisfy the requirements of this subsection. 478
594-(B) Each intermediary and participating providers with whom such 479
595-intermediary contracts shall comply with the applicable requirements 480
596-of this subsection. 481
597-(2) No health carrier shall assign or delegate to an intermediary such 482
598-health carrier's responsibilities to monitor the offering of covered 483
599-benefits to covered persons. To the extent a health carrier assigns or 484
600-delegates to an intermediary other responsibilities, such health carrier 485
601-shall retain full responsibility for such intermediary's compliance with 486
602-the requirements of this section. 487
603-(3) A health carrier shall have the right to approve or disapprove the 488
604-participation status of a health care provider or facility in such health 489
605-carrier's own or a contracted network that is subcontracted for the 490
606-purpose of providing covered benefits to the health carrier's covered 491
607-persons. 492
608-(4) A health carrier shall maintain at its principal place of business in 493
609-this state copies of all intermediary subcontracts or ensure that such 494
610-health carrier has access to all such subcontracts. Such health carrier 495
611-shall have the right, upon twenty days' prior written notice, to make 496
612-copies of any intermediary subcontracts to facilitate regulatory review. 497
613-(5) (A) Each intermediary shall, if applicable, (i) transmit to the health 498
614-carrier documentation of health care services utilization and claims 499
615-paid, and (ii) maintain at its principal place of business in this state, for 500
616-a period of time prescribed by the commissioner, the books, records, 501
617-financial information and documentation of health care services 502
618-received by covered persons, in a manner that facilitates regulatory 503 Substitute Bill No. 10
594+(2) While such contract is in force, the health carrier shall: 471
595+(A) If such contract is entered into, renewed or amended before July 472
596+1, 2022, timely notify a participating provider of any change to the 473
597+provisions or other documents specified under subparagraph (A) of 474
598+subdivision (1) of this subsection that will result in a material change 475
599+to such contract; or 476
600+(B) If such contract is entered into, renewed or amended on or after 477
601+July 1, 2022, provide to a participating provider at least ninety days' 478
602+advance written notice of any change to the provisions or other 479
603+documents specified under subparagraph (A) of subdivision (1) of this 480
604+subsection, and any change to the provider manuals and policies 481
605+specified under subparagraph (B) of subdivision (1) of this subsection, 482
606+that will result in a material change to such contract or the procedures 483
607+that a participating provider must follow pursuant to such contract. 484
608+(d) (1) (A) Each contract between a health carrier and an 485
609+intermediary entered into, renewed or amended on or after January 1, 486
610+2017, shall satisfy the requirements of this subsection. 487
611+(B) Each intermediary and participating providers with whom such 488
612+intermediary contracts shall comply with the applicable requirements 489
613+of this subsection. 490
614+(2) No health carrier shall assign or delegate to an intermediary such 491
615+health carrier's responsibilities to monitor the offering of covered 492
616+benefits to covered persons. To the extent a health carrier assigns or 493
617+delegates to an intermediary other responsibilities, such health carrier 494
618+shall retain full responsibility for such intermediary's compliance with 495
619+the requirements of this section. 496
620+(3) A health carrier shall have the right to approve or disapprove the 497
621+participation status of a health care provider or facility in such health 498
622+carrier's own or a contracted network that is subcontracted for the 499
623+purpose of providing covered benefits to the health carrier's covered 500
624+persons. 501 Committee Bill No. 10
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625-review, and shall allow the commissioner access to such books, records, 504
626-financial information and documentation as necessary for the 505
627-commissioner to determine compliance with this section and section 506
628-38a-472f. 507
629-(B) Each health carrier shall monitor the timeliness and 508
630-appropriateness of payments made by its intermediary to participating 509
631-providers and of health care services received by covered persons. 510
632-(6) In the event of the intermediary's insolvency, a health carrier shall 511
633-have the right to require the assignment to the health carrier of the 512
634-provisions of a participating provider's contract that address such 513
635-participating provider's obligation to provide covered benefits. If a 514
636-health carrier requires such assignment, such health carrier shall remain 515
637-obligated to pay the participating provider for providing covered 516
638-benefits under the same terms and conditions as the intermediary prior 517
639-to the insolvency. 518
640-(e) The commissioner shall not act to arbitrate, mediate or settle (1) 519
641-disputes regarding a health carrier's decision not to include a health care 520
642-provider or facility in such health carrier's network or network plan, or 521
643-(2) any other dispute between a health carrier, such health carrier's 522
644-intermediary or one or more participating providers, that arises under 523
645-or by reason of a participating provider contract or the termination of 524
646-such contract. 525
647-(f) On and after January 1, 2024, no health insurance carrier, health 526
648-care provider, health plan administrator or any agent or other entity that 527
649-contracts on behalf of a health care provider, health insurance carrier or 528
650-health plan administrator may offer, solicit, request, amend, renew or 529
651-enter into a health care contract that would directly or indirectly include 530
652-any of the following provisions: 531
653-(1) An all-or-nothing clause; 532
654-(2) An anti-steering clause; 533 Substitute Bill No. 10
631+(4) A health carrier shall maintain at its principal place of business 502
632+in this state copies of all intermediary subcontracts or ensure that such 503
633+health carrier has access to all such subcontracts. Such health carrier 504
634+shall have the right, upon twenty days' prior written notice, to make 505
635+copies of any intermediary subcontracts to facilitate regulatory review. 506
636+(5) (A) Each intermediary shall, if applicable, (i) transmit to the 507
637+health carrier documentation of health care services utilization and 508
638+claims paid, and (ii) maintain at its principal place of business in this 509
639+state, for a period of time prescribed by the commissioner, the books, 510
640+records, financial information and documentation of health care 511
641+services received by covered persons, in a manner that facilitates 512
642+regulatory review, and shall allow the commissioner access to such 513
643+books, records, financial information and documentation as necessary 514
644+for the commissioner to determine compliance with this section and 515
645+section 38a-472f. 516
646+(B) Each health carrier shall monitor the timeliness and 517
647+appropriateness of payments made by its intermediary to participating 518
648+providers and of health care services received by covered persons. 519
649+(6) In the event of the intermediary's insolvency, a health carrier 520
650+shall have the right to require the assignment to the health carrier of 521
651+the provisions of a participating provider's contract that address such 522
652+participating provider's obligation to provide covered benefits. If a 523
653+health carrier requires such assignment, such health carrier shall 524
654+remain obligated to pay the participating provider for providing 525
655+covered benefits under the same terms and conditions as the 526
656+intermediary prior to the insolvency. 527
657+(e) The commissioner shall not act to arbitrate, mediate or settle (1) 528
658+disputes regarding a health carrier's decision not to include a health 529
659+care provider or facility in such health carrier's network or network 530
660+plan, or (2) any other dispute between a health carrier, such health 531
661+carrier's intermediary or one or more participating providers, that 532
662+arises under or by reason of a participating provider contract or the 533 Committee Bill No. 10
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661-(3) An anti-tiering clause; or 534
662-(4) Any other clause that results or intends to result in 535
663-anticompetitive effects. 536
664-(g) On and after January 1, 2024, any contract, written policy, written 537
665-procedure or agreement that contains a clause contrary to the provisions 538
666-set forth in subsection (f) of this section shall be null and void. All 539
667-remaining clauses of the contract shall remain in effect for the duration 540
668-of the contract term. 541
669-(h) Nothing in this section shall be construed to prohibit value-based 542
670-care. 543
671-(i) The Insurance Commissioner may adopt regulat ions, in 544
672-accordance with chapter 54, to implement the provisions of subsection 545
673-(f) of this section. 546
674-Sec. 10. Subsection (a) of section 17b-242 of the general statutes is 547
675-repealed and the following is substituted in lieu thereof (Effective July 1, 548
676-2023): 549
677-(a) The Department of Social Services shall determine the rates to be 550
678-paid to home health care agencies and home health aide agencies by the 551
679-state or any town in the state for persons aided or cared for by the state 552
680-or any such town. The Commissioner of Social Services shall establish a 553
681-fee schedule for home health services to be effective on and after July 1, 554
682-1994. The commissioner may annually modify such fee schedule if such 555
683-modification is needed to ensure that the conversion to an 556
684-administrative services organization is cost neutral to home health care 557
685-agencies and home health aide agencies in the aggregate and ensures 558
686-patient access. Utilization may be a factor in determining cost neutrality. 559
687-The commissioner shall increase the fee schedule for home health 560
688-services provided under the Connecticut home-care program for the 561
689-elderly established under section 17b-342, effective July 1, 2000, by two 562
690-per cent over the fee schedule for home health services for the previous 563
691-year. The commissioner shall include in the fee schedule not less than 564 Substitute Bill No. 10
669+termination of such contract. 534
670+(f) No health insurance carrier, health care provider, health plan 535
671+administrator or any agent or other entity that contracts on behalf of a 536
672+health care provider, health insurance carrier or health plan 537
673+administrator may offer, solicit, request, amend, renew or enter into a 538
674+health care contract that would directly or indirectly include any of the 539
675+following provisions: 540
676+(1) An all-or-nothing clause; 541
677+(2) An anti-steering clause; 542
678+(3) An anti-tiering clause; or 543
679+(4) Any other clause that results or intends to result in 544
680+anticompetitive effects. 545
681+(g) Any contract, written policy, written procedure or agreement 546
682+that contains a clause contrary to the provisions set forth in subsection 547
683+(f) of this section shall be null and void. All remaining clauses of the 548
684+contract shall remain in effect for the duration of the contract term. 549
685+(h) Nothing in this section shall be construed to prohibit value-550
686+based care. 551
687+(i) The Insurance Commissioner may adopt regulations, in 552
688+accordance with chapter 54, to implement the provisions of subsection 553
689+(f) of this section. 554
690+Sec. 10. Subsection (a) of section 17b-242 of the general statutes is 555
691+repealed and the following is substituted in lieu thereof (Effective July 556
692+1, 2023): 557
693+(a) The Department of Social Services shall determine the rates to be 558
694+paid to home health care agencies and home health aide agencies by 559
695+the state or any town in the state for persons aided or cared for by the 560
696+state or any such town. The Commissioner of Social Services shall 561 Committee Bill No. 10
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698-two licensed clinical social worker visits to each individual enrolled in 565
699-the Connecticut home-care program for the elderly or any home and 566
700-community-based Medicaid waiver program administered by the 567
701-Department of Social Services. The commissioner may increase any fee 568
702-payable to a home health care agency or home health aide agency upon 569
703-the application of such an agency evidencing extraordinary costs related 570
704-to (1) serving persons with AIDS; (2) high-risk maternal and child health 571
705-care; (3) escort services; or (4) extended hour services. In no case shall 572
706-any rate or fee exceed the charge to the general public for similar 573
707-services. A home health care agency or home health aide agency which, 574
708-due to any material change in circumstances, is aggrieved by a rate 575
709-determined pursuant to this subsection may, within ten days of receipt 576
710-of written notice of such rate from the Commissioner of Social Services, 577
711-request in writing a hearing on all items of aggrievement. The 578
712-commissioner shall, upon the receipt of all documentation necessary to 579
713-evaluate the request, determine whether there has been such a change 580
714-in circumstances and shall conduct a hearing if appropriate. The 581
715-Commissioner of Social Services shall adopt regulations, in accordance 582
716-with chapter 54, to implement the provisions of this subsection. The 583
717-commissioner may implement policies and procedures to carry out the 584
718-provisions of this subsection while in the process of adopting 585
719-regulations, provided notice of intent to adopt the regulations is 586
720-published in the Connecticut Law Journal not later than twenty days 587
721-after the date of implementing the policies and procedures. Such 588
722-policies and procedures shall be valid for not longer than nine months. 589
723-Sec. 11. (NEW) (Effective from passage) (a) For purposes of this section, 590
724-"certified community health worker" has the same meaning as provided 591
725-in section 20-195ttt of the general statutes. The Commissioner of Social 592
726-Services shall design and implement a program to provide Medicaid 593
727-reimbursement to certified community health workers for services 594
728-provided to HUSKY Health program members, including, but not 595
729-limited to: (1) Coordination of medical, oral and behavioral health care 596
730-services and social supports; (2) connection to and navigation of health 597
731-systems and services; (3) prenatal, birth, lactation and postpartum 598 Substitute Bill No. 10
703+establish a fee schedule for home health services to be effective on and 562
704+after July 1, 1994. The commissioner may annually modify such fee 563
705+schedule if such modification is needed to ensure that the conversion 564
706+to an administrative services organization is cost neutral to home 565
707+health care agencies and home health aide agencies in the aggregate 566
708+and ensures patient access. Utilization may be a factor in determining 567
709+cost neutrality. The commissioner shall increase the fee schedule for 568
710+home health services provided under the Connecticut home-care 569
711+program for the elderly established under section 17b-342, effective 570
712+July 1, 2000, by two per cent over the fee schedule for home health 571
713+services for the previous year. The commissioner shall include in the 572
714+fee schedule not less than two licensed clinical social worker visits to 573
715+each individual enrolled in the Connecticut home-care program for the 574
716+elderly or any home and community-based Medicaid waiver program 575
717+administered by the Department of Social Services. The commissioner 576
718+may increase any fee payable to a home health care agency or home 577
719+health aide agency upon the application of such an agency evidencing 578
720+extraordinary costs related to (1) serving persons with AIDS; (2) high-579
721+risk maternal and child health care; (3) escort services; or (4) extended 580
722+hour services. In no case shall any rate or fee exceed the charge to the 581
723+general public for similar services. A home health care agency or home 582
724+health aide agency which, due to any material change in 583
725+circumstances, is aggrieved by a rate determined pursuant to this 584
726+subsection may, within ten days of receipt of written notice of such 585
727+rate from the Commissioner of Social Services, request in writing a 586
728+hearing on all items of aggrievement. The commissioner shall, upon 587
729+the receipt of all documentation necessary to evaluate the request, 588
730+determine whether there has been such a change in circumstances and 589
731+shall conduct a hearing if appropriate. The Commissioner of Social 590
732+Services shall adopt regulations, in accordance with chapter 54, to 591
733+implement the provisions of this subsection. The commissioner may 592
734+implement policies and procedures to carry out the provisions of this 593
735+subsection while in the process of adopting regulations, provided 594
736+notice of intent to adopt the regulations is published in the Connecticut 595
737+Law Journal not later than twenty days after the date of implementing 596 Committee Bill No. 10
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738-supports; and (4) health promotion, coaching and self-management 599
739-education. 600
740-(b) The commissioner shall provide reimbursement for the services 601
741-of certified community health workers in a manner and at a rate 602
742-conducive to workforce growth. 603
743-(c) The commissioner and the commissioner's designees shall consult 604
744-with certified community health workers and others throughout the 605
745-design and implementation of the certified community health worker 606
746-reimbursement program in a manner that (1) is inclusive of community-607
747-based and clinic-based certified community health workers; (2) is 608
748-representative of medical assistance program member demographics; 609
749-and (3) helps shape the reimbursement program's design and 610
750-implementation. 611
751-(d) The Department of Social Services shall coordinate with the Office 612
752-of Health Strategy to identify opportunities for the integration of 613
753-certified community health workers into the medical assistance 614
754-program. Not later than January 1, 2024, and annually thereafter until 615
755-the reimbursement program is fully implemented, the Department of 616
756-Social Services shall submit a report, in accordance with the provisions 617
757-of section 11-4a of the general statutes, to the joint standing committee 618
758-of the General Assembly having cognizance of matters relating to 619
759-human services and the Council on Medical Assistance Program 620
760-Oversight. Such report shall contain an update on the certified 621
761-community health worker reimbursement program and an evaluation 622
762-of its impact on health outcomes and health equity. 623
763-Sec. 12. Subsection (b) of section 19a-754a of the general statutes is 624
764-repealed and the following is substituted in lieu thereof (Effective from 625
765-passage): 626
766-(b) The Office of Health Strategy shall be responsible for the 627
767-following: 628
768-(1) Developing and implementing a comprehensive and cohesive 629 Substitute Bill No. 10
744+the policies and procedures. Such policies and procedures shall be 597
745+valid for not longer than nine months. 598
746+Sec. 11. (NEW) (Effective from passage) (a) For purposes of this 599
747+section, "certified community health worker" has the same meaning as 600
748+provided in section 20-195ttt of the general statutes. The Commissioner 601
749+of Social Services shall design and implement a program to provide 602
750+Medicaid reimbursement to certified community health workers for 603
751+services provided to HUSKY Health program members, including, but 604
752+not limited to: (1) Coordination of medical, oral and behavioral health 605
753+care services and social supports; (2) connection to and navigation of 606
754+health systems and services; (3) prenatal, birth, lactation and 607
755+postpartum supports; and (4) health promotion, coaching and self-608
756+management education. 609
757+(b) The commissioner shall provide reimbursement for the services 610
758+of certified community health workers in a manner and at a rate 611
759+conducive to workforce growth. 612
760+(c) The commissioner and the commissioner's designees shall 613
761+consult with certified community health workers and others 614
762+throughout the design and implementation of the certified community 615
763+health worker reimbursement program in a manner that (1) is inclusive 616
764+of community-based and clinic-based certified community health 617
765+workers; (2) is representative of medical assistance program member 618
766+demographics; and (3) helps shape the reimbursement program's 619
767+design and implementation. 620
768+(d) The Department of Social Services shall coordinate with the 621
769+Office of Health Strategy to identify opportunities for the integration of 622
770+certified community health workers into the medical assistance 623
771+program. Not later than January 1, 2024, and annually thereafter until 624
772+the reimbursement program is fully implemented, the Department of 625
773+Social Services shall submit a report, in accordance with the provisions 626
774+of section 11-4a of the general statutes, to the joint standing committee 627
775+of the General Assembly having cognizance of matters relating to 628 Committee Bill No. 10
769776
770777
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775-health care vision for the state, including, but not limited to, a 630
776-coordinated state health care cost containment strategy; 631
777-(2) Promoting effective health planning and the provision of quality 632
778-health care in the state in a manner that ensures access for all state 633
779-residents to cost-effective health care services, avoids the duplication of 634
780-such services and improves the availability and financial stability of 635
781-such services throughout the state; 636
782-(3) Directing and overseeing the State Innovation Model Initiative 637
783-and related successor initiatives; 638
784-(4) (A) Coordinating the state's health information technology 639
785-initiatives, (B) seeking funding for and overseeing the planning, 640
786-implementation and development of policies and procedures for the 641
787-administration of the all-payer claims database program established 642
788-under section 19a-775a, (C) establishing and maintaining a consumer 643
789-health information Internet web site under section 19a-755b, and (D) 644
790-designating an unclassified individual from the office to perform the 645
791-duties of a health information technology officer as set forth in sections 646
792-17b-59f and 17b-59g; 647
793-(5) Directing and overseeing the Health Systems Planning Unit 648
794-established under section 19a-612 and all of its duties and 649
795-responsibilities as set forth in chapter 368z; 650
796-(6) Convening forums and meetings with state government and 651
797-external stakeholders, including, but not limited to, the Connecticut 652
798-Health Insurance Exchange, to discuss health care issues designed to 653
799-develop effective health care cost and quality strategies; 654
800-(7) Consulting with the Commissioner of Social Services, Insurance 655
801-Commissioner and Connecticut Health Insurance Exchange on the 656
802-Covered Connecticut program described in section 19a-754c; [and] 657
803-(8) (A) Setting an annual health care cost growth benchmark and 658
804-primary care spending target pursuant to section 19a-754g, (B) 659 Substitute Bill No. 10
782+human services and the Council on Medical Assistance Program 629
783+Oversight. Such report shall contain an update on the certified 630
784+community health worker reimbursement program and an evaluation 631
785+of its impact on health outcomes and health equity. 632
786+Sec. 12. Subsection (b) of section 19a-754a of the general statutes is 633
787+repealed and the following is substituted in lieu thereof (Effective from 634
788+passage): 635
789+(b) The Office of Health Strategy shall be responsible for the 636
790+following: 637
791+(1) Developing and implementing a comprehensive and cohesive 638
792+health care vision for the state, including, but not limited to, a 639
793+coordinated state health care cost containment strategy; 640
794+(2) Promoting effective health planning and the provision of quality 641
795+health care in the state in a manner that ensures access for all state 642
796+residents to cost-effective health care services, avoids the duplication 643
797+of such services and improves the availability and financial stability of 644
798+such services throughout the state; 645
799+(3) Directing and overseeing the State Innovation Model Initiative 646
800+and related successor initiatives; 647
801+(4) (A) Coordinating the state's health information technology 648
802+initiatives, (B) seeking funding for and overseeing the planning, 649
803+implementation and development of policies and procedures for the 650
804+administration of the all-payer claims database program established 651
805+under section 19a-775a, (C) establishing and maintaining a consumer 652
806+health information Internet web site under section 19a-755b, and (D) 653
807+designating an unclassified individual from the office to perform the 654
808+duties of a health information technology officer as set forth in sections 655
809+17b-59f and 17b-59g; 656
810+(5) Directing and overseeing the Health Systems Planning Unit 657
811+established under section 19a-612 and all of its duties and 658 Committee Bill No. 10
805812
806813
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810817
811-developing and adopting health care quality benchmarks pursuant to 660
812-section 19a-754g, (C) developing strategies, in consultation with 661
813-stakeholders, to meet such benchmarks and targets developed pursuant 662
814-to section 19a-754g, (D) enhancing the transparency of provider entities, 663
815-as defined in subdivision (13) of section 19a-754f, (E) monitoring the 664
816-development of accountable care organizations and patient-centered 665
817-medical homes in the state, and (F) monitoring the adoption of 666
818-alternative payment methodologies in the state; and 667
819-(9) Convening forums and meetings with Access Health Connecticut, 668
820-the Department of Public Health, the birth-to-three program, as defined 669
821-in section 17a-248, state home visiting programs, community action 670
822-agencies, hospitals, community health centers and other state 671
823-government and external stakeholders to align community health 672
824-worker programs funded by the state medical assistance program, block 673
825-grants, health care providers, private insurance carriers and other 674
826-external stakeholders. 675
827-Sec. 13. Section 17b-312 of the general statutes is repealed and the 676
828-following is substituted in lieu thereof (Effective from passage): 677
829-(a) The Commissioner of Social Services shall seek, in accordance 678
830-with the provisions of section 17b-8 and in consultation with the 679
831-Insurance Commissioner and the Office of Health Strategy established 680
832-under section 19a-754a, as amended by this act, a waiver under Section 681
833-1115 of the Social Security Act, as amended from time to time, to [seek] 682
834-obtain federal funds to support the Covered Connecticut program 683
835-established under section 19a-754c. Upon approval by the Centers for 684
836-Medicare and Medicaid Services, the Commissioner of Social Services 685
837-shall implement the waiver. 686
838-(b) Not later than thirty days after the effective date of this section, 687
839-the commissioner shall amend the waiver submitted in accordance with 688
840-subsection (a) of this section, to the extent permissible under federal law 689
841-and in accordance with section 17b-8, to provide coverage through the 690
842-Covered Connecticut program to persons otherwise qualified for the 691 Substitute Bill No. 10
818+responsibilities as set forth in chapter 368z; 659
819+(6) Convening forums and meetings with state government and 660
820+external stakeholders, including, but not limited to, the Connecticut 661
821+Health Insurance Exchange, to discuss health care issues designed to 662
822+develop effective health care cost and quality strategies; 663
823+(7) Consulting with the Commissioner of Social Services, Insurance 664
824+Commissioner and Connecticut Health Insurance Exchange on the 665
825+Covered Connecticut program described in section 19a-754c; [and] 666
826+(8) (A) Setting an annual health care cost growth benchmark and 667
827+primary care spending target pursuant to section 19a-754g, (B) 668
828+developing and adopting health care quality benchmarks pursuant to 669
829+section 19a-754g, (C) developing strategies, in consultation with 670
830+stakeholders, to meet such benchmarks and targets developed 671
831+pursuant to section 19a-754g, (D) enhancing the transparency of 672
832+provider entities, as defined in subdivision (13) of section 19a-754f, (E) 673
833+monitoring the development of accountable care organizations and 674
834+patient-centered medical homes in the state, and (F) monitoring the 675
835+adoption of alternative payment methodologies in the state; and 676
836+(9) Convening forums and meetings with Access Health 677
837+Connecticut, the Department of Public Health, the birth-to-three 678
838+program, as defined in section 17a-248, state home visiting programs, 679
839+community action agencies, hospitals, community health centers and 680
840+other state government and external stakeholders to align community 681
841+health worker programs funded by the state medical assistance 682
842+programs, block grants, health care providers, private insurance 683
843+carriers and other external stakeholders. 684
844+Sec. 13. Section 17b-312 of the general statutes is repealed and the 685
845+following is substituted in lieu thereof (Effective from passage): 686
846+(a) The Commissioner of Social Services shall seek, in accordance 687
847+with the provisions of section 17b-8 and in consultation with the 688
848+Insurance Commissioner and the Office of Health Strategy established 689 Committee Bill No. 10
843849
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849-program whose income does not exceed two hundred per cent of the 692
850-federal poverty level. The commissioner shall consult with the 693
851-Insurance Commissioner and the executive director of the Office of 694
852-Health Strategy in submitting the waiver amendment. 695
853-Sec. 14. (NEW) (Effective from passage) (a) Not later than sixty days 696
854-after the effective date of this section, the Commissioner of Social 697
855-Services, in consultation with the Insurance Commissioner and the 698
856-executive director of the Office of Health Strategy established under 699
857-section 19a-754a of the general statutes, as amended by this act, shall 700
858-develop a plan for a second tier of the Covered Connecticut program 701
859-established pursuant to section 19a-754c of the general statutes. The plan 702
860-shall provide state-assisted health care coverage for persons otherwise 703
861-qualified for the program whose income exceeds two hundred per cent 704
862-of the federal poverty level but does not exceed three hundred per cent 705
863-of the federal poverty level. 706
864-(b) The plan developed pursuant to subsection (a) of this section may 707
865-include (1) reduced benefits from the Covered Connecticut program, 708
866-provided such benefits are in accordance with the requirements of the 709
867-Patient Protection and Affordable Care Act, P.L. 111-148, as amended 710
868-by the Health Care and Education Reconciliation Act, P.L. 111-152, as 711
869-both may be amended from time to time, and regulations adopted 712
870-thereunder, and (2) income-based copayments by enrollees. 713
871-(c) The Commissioner of Social Services shall submit the plan 714
872-developed in accordance with this section to the joint standing 715
873-committees of the General Assembly having cognizance of matters 716
874-relating to appropriations and the budgets of state agencies, human 717
875-services and insurance. Not later than thirty days after the date of their 718
876-receipt of such plan, the joint standing committees shall hold a public 719
877-hearing on the plan. At the conclusion of a public hearing held in 720
878-accordance with the provisions of this section, the joint standing 721
879-committees shall advise the commissioner of their approval, denial or 722
880-modifications, if any, of the commissioner's plan. If the joint standing 723
881-committees advise the commissioner of their denial of approval, the 724 Substitute Bill No. 10
855+under section 19a-754a, as amended by this act, a waiver under Section 690
856+1115 of the Social Security Act, as amended from time to time, to [seek] 691
857+obtain federal funds to support the Covered Connecticut program 692
858+established under section 19a-754c. Upon approval by the Centers for 693
859+Medicare and Medicaid Services, the Commissioner of Social Services 694
860+shall implement the waiver. 695
861+(b) Not later than thirty days after the effective date of this section, 696
862+the commissioner shall amend the waiver submitted in accordance 697
863+with subsection (a) of this section, to the extent permissible under 698
864+federal law and in accordance with section 17b-8, to provide coverage 699
865+through the Covered Connecticut program to persons otherwise 700
866+qualified for the program whose income does not exceed two hundred 701
867+per cent of the federal poverty level. The commissioner shall consult 702
868+with the Insurance Commissioner and the executive director of the 703
869+Office of Health Strategy in submitting the waiver amendment. 704
870+Sec. 14. (NEW) (Effective from passage) (a) Not later than sixty days 705
871+after the effective date of this section, the Commissioner of Social 706
872+Services, in consultation with the Insurance Commissioner and the 707
873+executive director of the Office of Health Strategy established under 708
874+section 19a-754a of the general statutes, as amended by this act, shall 709
875+develop a plan for a second tier of the Covered Connecticut program 710
876+established pursuant to section 19a-754c of the general statutes. The 711
877+plan shall provide state-assisted health care coverage for persons 712
878+otherwise qualified for the program whose income exceeds two 713
879+hundred per cent of the federal poverty level but does not exceed three 714
880+hundred per cent of the federal poverty level. 715
881+(b) The plan developed pursuant to subsection (a) of this section 716
882+may include (1) reduced benefits from the Covered Connecticut 717
883+program, provided such benefits are in accordance with the 718
884+requirements of the Patient Protection and Affordable Care Act, P.L. 719
885+111-148, as amended by the Health Care and Education Reconciliation 720
886+Act, P.L. 111-152, as both may be amended from time to time, and 721
887+regulations adopted thereunder, and (2) income-based copayments by 722 Committee Bill No. 10
882888
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887893
888-commissioner shall not implement the plan. If such committees do not 725
889-concur, the committee chairpersons shall appoint a committee of 726
890-conference which shall be composed of three members from each joint 727
891-standing committee. At least one member appointed from each joint 728
892-standing committee shall be a member of the minority party. The report 729
893-of the committee of conference shall be made to each joint standing 730
894-committee, which shall vote to accept or reject the report. The report of 731
895-the committee of conference may not be amended. If a joint standing 732
896-committee rejects the report of the committee of conference, that joint 733
897-standing committee shall notify the commissioner of the rejection and 734
898-the commissioner's plan shall be deemed approved. If the joint standing 735
899-committees accept the report, the committee having cognizance of 736
900-matters relating to appropriations and the budgets of state agencies 737
901-shall advise the commissioner of their approval, denial or modifications, 738
902-if any, of the commissioner's plan. If the joint standing committees do 739
903-not so advise the commissioner during the thirty-day period, the plan 740
904-shall be deemed denied. Any implementation of the plan developed 741
905-pursuant to this section shall be in accordance with the approval or 742
906-modifications, if any, of the joint standing committees of the General 743
907-Assembly having cognizance of matters relating to appropriations and 744
908-the budgets of state agencies, human services and insurance. 745
909-(d) To the extent permissible under federal law, the commissioner 746
910-may seek approval of a Medicaid waiver in accordance with section 17b-747
911-8 of the general statutes to obtain federal financial participation for the 748
912-plan developed pursuant to this section. 749
913-Sec. 15. Section 38a-1084 of the general statutes is repealed and the 750
914-following is substituted in lieu thereof (Effective from passage): 751
915-The exchange shall: 752
916-(1) Administer the exchange for both qualified individuals and 753
917-qualified employers; 754
918-(2) Commission surveys of individuals, small employers and health 755 Substitute Bill No. 10
894+enrollees. 723
895+(c) The Commissioner of Social Services shall submit the plan 724
896+developed in accordance with this section to the joint standing 725
897+committees of the General Assembly having cognizance of matters 726
898+relating to appropriations and the budgets of state agencies, human 727
899+services and insurance. Not later than thirty days after the date of their 728
900+receipt of such plan, the joint standing committees shall hold a public 729
901+hearing on the plan. At the conclusion of a public hearing held in 730
902+accordance with the provisions of this section, the joint standing 731
903+committees shall advise the commissioner of their approval, denial or 732
904+modifications, if any, of the commissioner's plan. If the joint standing 733
905+committees advise the commissioner of their denial of approval, the 734
906+commissioner shall not implement the plan. If such committees do not 735
907+concur, the committee chairpersons shall appoint a committee of 736
908+conference which shall be composed of three members from each joint 737
909+standing committee. At least one member appointed from each joint 738
910+standing committee shall be a member of the minority party. The 739
911+report of the committee of conference shall be made to each joint 740
912+standing committee, which shall vote to accept or reject the report. The 741
913+report of the committee of conference may not be amended. If a joint 742
914+standing committee rejects the report of the committee of conference, 743
915+that joint standing committee shall notify the commissioner of the 744
916+rejection and the commissioner's plan shall be deemed approved. If the 745
917+joint standing committees accept the report, the committee having 746
918+cognizance of matters relating to appropriations and the budgets of 747
919+state agencies shall advise the commissioner of their approval, denial 748
920+or modifications, if any, of the commissioner's plan. If the joint 749
921+standing committees do not so advise the commissioner during the 750
922+thirty-day period, the plan shall be deemed denied. Any 751
923+implementation of the plan developed pursuant to this section shall be 752
924+in accordance with the approval or modifications, if any, of the joint 753
925+standing committees of the General Assembly having cognizance of 754
926+matters relating to appropriations and the budgets of state agencies, 755
927+human services and insurance. 756 Committee Bill No. 10
919928
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925-care providers on issues related to health care and health care coverage; 756
926-(3) Implement procedures for the certification, recertification and 757
927-decertification, consistent with guidelines developed by the Secretary 758
928-under Section 1311(c) of the Affordable Care Act, and section 38a-1086, 759
929-of health benefit plans as qualified health plans; 760
930-(4) Provide for the operation of a toll-free telephone hotline to 761
931-respond to requests for assistance; 762
932-(5) Provide for enrollment periods, as provided under Section 763
933-1311(c)(6) of the Affordable Care Act; 764
934-(6) Maintain an Internet web site through which enrollees and 765
935-prospective enrollees of qualified health plans may obtain standardized 766
936-comparative information on such plans including, but not limited to, the 767
937-enrollee satisfaction survey information under Section 1311(c)(4) of the 768
938-Affordable Care Act and any other information or tools to assist 769
939-enrollees and prospective enrollees evaluate qualified health plans 770
940-offered through the exchange; 771
941-(7) Publish the average costs of licensing, regulatory fees and any 772
942-other payments required by the exchange and the administrative costs 773
943-of the exchange, including information on moneys lost to waste, fraud 774
944-and abuse, on an Internet web site to educate individuals on such costs; 775
945-(8) On or before the open enrollment period for plan year 2017, assign 776
946-a rating to each qualified health plan offered through the exchange in 777
947-accordance with the criteria developed by the Secretary under Section 778
948-1311(c)(3) of the Affordable Care Act, and determine each qualified 779
949-health plan's level of coverage in accordance with regulations issued by 780
950-the Secretary under Section 1302(d)(2)(A) of the Affordable Care Act; 781
951-(9) Use a standardized format for presenting health benefit options in 782
952-the exchange, including the use of the uniform outline of coverage 783
953-established under Section 2715 of the Public Health Service Act, 42 USC 784
954-300gg-15, as amended from time to time; 785 Substitute Bill No. 10
934+(d) To the extent permissible under federal law, the commissioner 757
935+may seek approval of a Medicaid waiver in accordance with section 758
936+17b-8 of the general statutes to obtain federal financial participation for 759
937+the plan developed pursuant to this section. 760
938+Sec. 15. Section 38a-1084 of the general statutes is repealed and the 761
939+following is substituted in lieu thereof (Effective from passage): 762
940+The exchange shall: 763
941+(1) Administer the exchange for both qualified individuals and 764
942+qualified employers; 765
943+(2) Commission surveys of individuals, small employers and health 766
944+care providers on issues related to health care and health care 767
945+coverage; 768
946+(3) Implement procedures for the certification, recertification and 769
947+decertification, consistent with guidelines developed by the Secretary 770
948+under Section 1311(c) of the Affordable Care Act, and section 38a-1086, 771
949+of health benefit plans as qualified health plans; 772
950+(4) Provide for the operation of a toll-free telephone hotline to 773
951+respond to requests for assistance; 774
952+(5) Provide for enrollment periods, as provided under Section 775
953+1311(c)(6) of the Affordable Care Act; 776
954+(6) Maintain an Internet web site through which enrollees and 777
955+prospective enrollees of qualified health plans may obtain 778
956+standardized comparative information on such plans including, but 779
957+not limited to, the enrollee satisfaction survey information under 780
958+Section 1311(c)(4) of the Affordable Care Act and any other 781
959+information or tools to assist enrollees and prospective enrollees 782
960+evaluate qualified health plans offered through the exchange; 783
961+(7) Publish the average costs of licensing, regulatory fees and any 784 Committee Bill No. 10
955962
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960967
961-(10) Inform individuals, in accordance with Section 1413 of the 786
962-Affordable Care Act, of eligibility requirements for the Medicaid 787
963-program under Title XIX of the Social Security Act, as amended from 788
964-time to time, the Children's Health Insurance Program (CHIP) under 789
965-Title XXI of the Social Security Act, as amended from time to time, or 790
966-any applicable state or local public program, and enroll an individual in 791
967-such program if the exchange determines, through screening of the 792
968-application by the exchange, that such individual is eligible for any such 793
969-program; 794
970-(11) Collaborate with the Department of Social Services, to the extent 795
971-possible, to allow an enrollee who loses premium tax credit eligibility 796
972-under Section 36B of the Internal Revenue Code and is eligible for 797
973-HUSKY A or any other state or local public program, to remain enrolled 798
974-in a qualified health plan; 799
975-(12) Establish and make available by electronic means a calculator to 800
976-determine the actual cost of coverage after application of any premium 801
977-tax credit under Section 36B of the Internal Revenue Code and any cost-802
978-sharing reduction under Section 1402 of the Affordable Care Act; 803
979-(13) Establish a program for small employers through which 804
980-qualified employers may access coverage for their employees and that 805
981-shall enable any qualified employer to specify a level of coverage so that 806
982-any of its employees may enroll in any qualified health plan offered 807
983-through the exchange at the specified level of coverage; 808
984-(14) Offer enrollees and small employers the option of having the 809
985-exchange collect and administer premiums, including through 810
986-allocation of premiums among the various insurers and qualified health 811
987-plans chosen by individual employers; 812
988-(15) Grant a certification, subject to Section 1411 of the Affordable 813
989-Care Act, attesting that, for purposes of the individual responsibility 814
990-penalty under Section 5000A of the Internal Revenue Code, an 815
991-individual is exempt from the individual responsibility requirement or 816 Substitute Bill No. 10
968+other payments required by the exchange and the administrative costs 785
969+of the exchange, including information on moneys lost to waste, fraud 786
970+and abuse, on an Internet web site to educate individuals on such 787
971+costs; 788
972+(8) On or before the open enrollment period for plan year 2017, 789
973+assign a rating to each qualified health plan offered through the 790
974+exchange in accordance with the criteria developed by the Secretary 791
975+under Section 1311(c)(3) of the Affordable Care Act, and determine 792
976+each qualified health plan's level of coverage in accordance with 793
977+regulations issued by the Secretary under Section 1302(d)(2)(A) of the 794
978+Affordable Care Act; 795
979+(9) Use a standardized format for presenting health benefit options 796
980+in the exchange, including the use of the uniform outline of coverage 797
981+established under Section 2715 of the Public Health Service Act, 42 798
982+USC 300gg-15, as amended from time to time; 799
983+(10) Inform individuals, in accordance with Section 1413 of the 800
984+Affordable Care Act, of eligibility requirements for the Medicaid 801
985+program under Title XIX of the Social Security Act, as amended from 802
986+time to time, the Children's Health Insurance Program (CHIP) under 803
987+Title XXI of the Social Security Act, as amended from time to time, or 804
988+any applicable state or local public program, and enroll an individual 805
989+in such program if the exchange determines, through screening of the 806
990+application by the exchange, that such individual is eligible for any 807
991+such program; 808
992+(11) Collaborate with the Department of Social Services, to the 809
993+extent possible, to allow an enrollee who loses premium tax credit 810
994+eligibility under Section 36B of the Internal Revenue Code and is 811
995+eligible for HUSKY A or any other state or local public program, to 812
996+remain enrolled in a qualified health plan; 813
997+(12) Establish and make available by electronic means a calculator to 814
998+determine the actual cost of coverage after application of any premium 815 Committee Bill No. 10
992999
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9971004
998-from the penalty imposed by said Section 5000A because: 817
999-(A) There is no affordable qualified health plan available through the 818
1000-exchange, or the individual's employer, covering the individual; or 819
1001-(B) The individual meets the requirements for any other such 820
1002-exemption from the individual responsibility requirement or penalty; 821
1003-(16) Provide to the Secretary of the Treasury of the United States the 822
1004-following: 823
1005-(A) A list of the individuals granted a certification under subdivision 824
1006-(15) of this section, including the name and taxpayer identification 825
1007-number of each individual; 826
1008-(B) The name and taxpayer identification number of each individual 827
1009-who was an employee of an employer but who was determined to be 828
1010-eligible for the premium tax credit under Section 36B of the Internal 829
1011-Revenue Code because: 830
1012-(i) The employer did not provide minimum essential health benefits 831
1013-coverage; or 832
1014-(ii) The employer provided the minimum essential coverage but it 833
1015-was determined under Section 36B(c)(2)(C) of the Internal Revenue 834
1016-Code to be unaffordable to the employee or not provide the required 835
1017-minimum actuarial value; and 836
1018-(C) The name and taxpayer identification number of: 837
1019-(i) Each individual who notifies the exchange under Section 838
1020-1411(b)(4) of the Affordable Care Act that such individual has changed 839
1021-employers; and 840
1022-(ii) Each individual who ceases coverage under a qualified health 841
1023-plan during a plan year and the effective date of that cessation; 842
1024-(17) Provide to each employer the name of each employee, as 843 Substitute Bill No. 10
1005+tax credit under Section 36B of the Internal Revenue Code and any 816
1006+cost-sharing reduction under Section 1402 of the Affordable Care Act; 817
1007+(13) Establish a program for small employers through which 818
1008+qualified employers may access coverage for their employees and that 819
1009+shall enable any qualified employer to specify a level of coverage so 820
1010+that any of its employees may enroll in any qualified health plan 821
1011+offered through the exchange at the specified level of coverage; 822
1012+(14) Offer enrollees and small employers the option of having the 823
1013+exchange collect and administer premiums, including through 824
1014+allocation of premiums among the various insurers and qualified 825
1015+health plans chosen by individual employers; 826
1016+(15) Grant a certification, subject to Section 1411 of the Affordable 827
1017+Care Act, attesting that, for purposes of the individual responsibility 828
1018+penalty under Section 5000A of the Internal Revenue Code, an 829
1019+individual is exempt from the individual responsibility requirement or 830
1020+from the penalty imposed by said Section 5000A because: 831
1021+(A) There is no affordable qualified health plan available through 832
1022+the exchange, or the individual's employer, covering the individual; or 833
1023+(B) The individual meets the requirements for any other such 834
1024+exemption from the individual responsibility requirement or penalty; 835
1025+(16) Provide to the Secretary of the Treasury of the United States the 836
1026+following: 837
1027+(A) A list of the individuals granted a certification under 838
1028+subdivision (15) of this section, including the name and taxpayer 839
1029+identification number of each individual; 840
1030+(B) The name and taxpayer identification number of each individual 841
1031+who was an employee of an employer but who was determined to be 842
1032+eligible for the premium tax credit under Section 36B of the Internal 843
1033+Revenue Code because: 844 Committee Bill No. 10
10251034
10261035
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10291038 29 of 48
10301039
1031-described in subparagraph (B) of subdivision (16) of this section, of the 844
1032-employer who ceases coverage under a qualified health plan during a 845
1033-plan year and the effective date of the cessation; 846
1034-(18) Perform duties required of, or delegated to, the exchange by the 847
1035-Secretary or the Secretary of the Treasury of the United States related to 848
1036-determining eligibility for premium tax credits, reduced cost-sharing or 849
1037-individual responsibility requirement exemptions; 850
1038-(19) Select entities qualified to serve as Navigators in accordance with 851
1039-Section 1311(i) of the Affordable Care Act and award grants to enable 852
1040-Navigators to: 853
1041-(A) Conduct public education activities to raise awareness of the 854
1042-availability of qualified health plans; 855
1043-(B) Distribute fair and impartial information concerning enrollment 856
1044-in qualified health plans and the availability of premium tax credits 857
1045-under Section 36B of the Internal Revenue Code and cost-sharing 858
1046-reductions under Section 1402 of the Affordable Care Act; 859
1047-(C) Facilitate enrollment in qualified health plans; 860
1048-(D) Provide referrals to the Office of the Healthcare Advocate or 861
1049-health insurance ombudsman established under Section 2793 of the 862
1050-Public Health Service Act, 42 USC 300gg-93, as amended from time to 863
1051-time, or any other appropriate state agency or agencies, for any enrollee 864
1052-with a grievance, complaint or question regarding the enrollee's health 865
1053-benefit plan, coverage or a determination under that plan or coverage; 866
1054-and 867
1055-(E) Provide information in a manner that is culturally and 868
1056-linguistically appropriate to the needs of the population being served by 869
1057-the exchange; 870
1058-(20) Review the rate of premium growth within and outside the 871
1059-exchange and consider such information in developing 872 Substitute Bill No. 10
1040+(i) The employer did not provide minimum essential health benefits 845
1041+coverage; or 846
1042+(ii) The employer provided the minimum essential coverage but it 847
1043+was determined under Section 36B(c)(2)(C) of the Internal Revenue 848
1044+Code to be unaffordable to the employee or not provide the required 849
1045+minimum actuarial value; and 850
1046+(C) The name and taxpayer identification number of: 851
1047+(i) Each individual who notifies the exchange under Section 852
1048+1411(b)(4) of the Affordable Care Act that such individual has changed 853
1049+employers; and 854
1050+(ii) Each individual who ceases coverage under a qualified health 855
1051+plan during a plan year and the effective date of that cessation; 856
1052+(17) Provide to each employer the name of each employee, as 857
1053+described in subparagraph (B) of subdivision (16) of this section, of the 858
1054+employer who ceases coverage under a qualified health plan during a 859
1055+plan year and the effective date of the cessation; 860
1056+(18) Perform duties required of, or delegated to, the exchange by the 861
1057+Secretary or the Secretary of the Treasury of the United States related 862
1058+to determining eligibility for premium tax credits, reduced cost-863
1059+sharing or individual responsibility requirement exemptions; 864
1060+(19) Select entities qualified to serve as Navigators in accordance 865
1061+with Section 1311(i) of the Affordable Care Act and award grants to 866
1062+enable Navigators to: 867
1063+(A) Conduct public education activities to raise awareness of the 868
1064+availability of qualified health plans; 869
1065+(B) Distribute fair and impartial information concerning enrollment 870
1066+in qualified health plans and the availability of premium tax credits 871
1067+under Section 36B of the Internal Revenue Code and cost-sharing 872 Committee Bill No. 10
10601068
10611069
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10641072 30 of 48
10651073
1066-recommendations on whether to continue limiting qualified employer 873
1067-status to small employers; 874
1068-(21) Credit the amount, in accordance with Section 10108 of the 875
1069-Affordable Care Act, of any free choice voucher to the monthly 876
1070-premium of the plan in which a qualified employee is enrolled and 877
1071-collect the amount credited from the offering employer; 878
1072-(22) Consult with stakeholders relevant to carrying out the activities 879
1073-required under sections 38a-1080 to 38a-1090, inclusive, including, but 880
1074-not limited to: 881
1075-(A) Individuals who are knowledgeable about the health care system, 882
1076-have background or experience in making informed decisions regarding 883
1077-health, medical and scientific matters and are enrollees in qualified 884
1078-health plans; 885
1079-(B) Individuals and entities with experience in facilitating enrollment 886
1080-in qualified health plans; 887
1081-(C) Representatives of small employers and self-employed 888
1082-individuals; 889
1083-(D) The Department of Social Services; and 890
1084-(E) Advocates for enrolling hard-to-reach populations; 891
1085-(23) Meet the following financial integrity requirements: 892
1086-(A) Keep an accurate accounting of all activities, receipts and 893
1087-expenditures and annually submit to the Secretary, the Governor, the 894
1088-Insurance Commissioner and the General Assembly a report concerning 895
1089-such accountings; 896
1090-(B) Fully cooperate with any investigation conducted by the Secretary 897
1091-pursuant to the Secretary's authority under the Affordable Care Act and 898
1092-allow the Secretary, in coordination with the Inspector General of the 899
1093-United States Department of Health and Human Services, to: 900 Substitute Bill No. 10
1074+reductions under Section 1402 of the Affordable Care Act; 873
1075+(C) Facilitate enrollment in qualified health plans; 874
1076+(D) Provide referrals to the Office of the Healthcare Advocate or 875
1077+health insurance ombudsman established under Section 2793 of the 876
1078+Public Health Service Act, 42 USC 300gg-93, as amended from time to 877
1079+time, or any other appropriate state agency or agencies, for any 878
1080+enrollee with a grievance, complaint or question regarding the 879
1081+enrollee's health benefit plan, coverage or a determination under that 880
1082+plan or coverage; and 881
1083+(E) Provide information in a manner that is culturally and 882
1084+linguistically appropriate to the needs of the population being served 883
1085+by the exchange; 884
1086+(20) Review the rate of premium growth within and outside the 885
1087+exchange and cons ider such information in developing 886
1088+recommendations on whether to continue limiting qualified employer 887
1089+status to small employers; 888
1090+(21) Credit the amount, in accordance with Section 10108 of the 889
1091+Affordable Care Act, of any free choice voucher to the monthly 890
1092+premium of the plan in which a qualified employee is enrolled and 891
1093+collect the amount credited from the offering employer; 892
1094+(22) Consult with stakeholders relevant to carrying out the activities 893
1095+required under sections 38a-1080 to 38a-1090, inclusive, including, but 894
1096+not limited to: 895
1097+(A) Individuals who are knowledgeable about the health care 896
1098+system, have background or experience in making informed decisions 897
1099+regarding health, medical and scientific matters and are enrollees in 898
1100+qualified health plans; 899
1101+(B) Individuals and entities with experience in facilitating 900
1102+enrollment in qualified health plans; 901 Committee Bill No. 10
10941103
10951104
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10991108
1100-(i) Investigate the affairs of the exchange; 901
1101-(ii) Examine the properties and records of the exchange; and 902
1102-(iii) Require periodic reports in relation to the activities undertaken 903
1103-by the exchange; and 904
1104-(C) Not use any funds in carrying out its activities under sections 38a-905
1105-1080 to 38a-1089, inclusive, that are intended for the administrative and 906
1106-operational expenses of the exchange, for staff retreats, promotional 907
1107-giveaways, excessive executive compensation or promotion of federal 908
1108-or state legislative and regulatory modifications; 909
1109-(24) (A) Seek to include the most comprehensive health benefit plans 910
1110-that offer high quality benefits at the most affordable price in the 911
1111-exchange, (B) encourage health carriers to offer tiered health care 912
1112-provider network plans that have different cost-sharing rates for 913
1113-different health care provider tiers and reward enrollees for choosing 914
1114-low-cost, high-quality health care providers by offering lower 915
1115-copayments, deductibles or other out-of-pocket expenses, and (C) offer 916
1116-any such tiered health care provider network plans through the 917
1117-exchange; 918
1118-(25) Report at least annually to the General Assembly on the effect of 919
1119-adverse selection on the operations of the exchange and make legislative 920
1120-recommendations, if necessary, to reduce the negative impact from any 921
1121-such adverse selection on the sustainability of the exchange, including 922
1122-recommendations to ensure that regulation of insurers and health 923
1123-benefit plans are similar for qualified health plans offered through the 924
1124-exchange and health benefit plans offered outside the exchange. The 925
1125-exchange shall evaluate whether adverse selection is occurring with 926
1126-respect to health benefit plans that are grandfathered under the 927
1127-Affordable Care Act, self-insured plans, plans sold through the 928
1128-exchange and plans sold outside the exchange; [and] 929
1129-(26) Consult with the Commissioner of Social Services, Insurance 930
1130-Commissioner and Office of Health Strategy, established under section 931 Substitute Bill No. 10
1109+(C) Representatives of small employers and self-employed 902
1110+individuals; 903
1111+(D) The Department of Social Services; and 904
1112+(E) Advocates for enrolling hard-to-reach populations; 905
1113+(23) Meet the following financial integrity requirements: 906
1114+(A) Keep an accurate accounting of all activities, receipts and 907
1115+expenditures and annually submit to the Secretary, the Governor, the 908
1116+Insurance Commissioner and the General Assembly a report 909
1117+concerning such accountings; 910
1118+(B) Fully cooperate with any investigation conducted by the 911
1119+Secretary pursuant to the Secretary's authority under the Affordable 912
1120+Care Act and allow the Secretary, in coordination with the Inspector 913
1121+General of the United States Department of Health and Human 914
1122+Services, to: 915
1123+(i) Investigate the affairs of the exchange; 916
1124+(ii) Examine the properties and records of the exchange; and 917
1125+(iii) Require periodic reports in relation to the activities undertaken 918
1126+by the exchange; and 919
1127+(C) Not use any funds in carrying out its activities under sections 920
1128+38a-1080 to 38a-1089, inclusive, that are intended for the administrative 921
1129+and operational expenses of the exchange, for staff retreats, 922
1130+promotional giveaways, excessive executive compensation or 923
1131+promotion of federal or state legislative and regulatory modifications; 924
1132+(24) (A) Seek to include the most comprehensive health benefit 925
1133+plans that offer high quality benefits at the most affordable price in the 926
1134+exchange, (B) encourage health carriers to offer tiered health care 927
1135+provider network plans that have different cost-sharing rates for 928
1136+different health care provider tiers and reward enrollees for choosing 929 Committee Bill No. 10
11311137
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11361142
1137-19a-754a, as amended by this act, for the purposes set forth in section 932
1138-19a-754c; and 933
1139-(27) (A) Notwithstanding the provisions of section 12-15, the 934
1140-exchange shall make a written request to the Commissioner of Revenue 935
1141-Services, for return or return information, as such terms are defined in 936
1142-section 12-15, for use in conducting targeted outreach to uninsured 937
1143-residents of this state. If the Commissioner of Revenue Services deems 938
1144-such return or return information to be relevant to the targeted outreach 939
1145-to uninsured residents, said commissioner may disclose such 940
1146-information to the exchange. To effectuate the disclosure of such 941
1147-information, the Commissioner of Revenue Services and the exchange 942
1148-shall enter into a memorandum of understanding that sets forth the 943
1149-specific information to be disclosed and contains the terms and 944
1150-conditions under which said commissioner will disclose such 945
1151-information to the exchange. Any return or return information disclosed 946
1152-by the Commissioner of Revenue Services shall not be redisclosed by 947
1153-the recipient to a third party without permission from the commissioner 948
1154-and shall only be used by the exchange in the manner prescribed in the 949
1155-memorandum of understanding. Any person who violates the 950
1156-provisions of this subparagraph shall be fined not more than five 951
1157-thousand dollars. 952
1158-(B) To assist the exchange in conducting targeted outreach to 953
1159-uninsured residents of this state, the Commissioner of Revenue Services 954
1160-shall revise the tax return form prescribed under chapter 229 to include 955
1161-space on the tax return for residents to authorize the exchange to contact 956
1162-such residents regarding enrollment through the exchange. The 957
1163-Commissioner of Revenue Services and the exchange shall develop 958
1164-language to be included on the tax return form and shall include in the 959
1165-instructions accompanying the tax return a description of how the 960
1166-authorization provided will be relayed to the exchange. 961
1167-Sec. 16. Section 19a-42 of the general statutes is repealed and the 962
1168-following is substituted in lieu thereof (Effective July 1, 2023): 963 Substitute Bill No. 10
1143+low-cost, high-quality health care providers by offering lower 930
1144+copayments, deductibles or other out-of-pocket expenses, and (C) offer 931
1145+any such tiered health care provider network plans through the 932
1146+exchange; 933
1147+(25) Report at least annually to the General Assembly on the effect 934
1148+of adverse selection on the operations of the exchange and make 935
1149+legislative recommendations, if necessary, to reduce the negative 936
1150+impact from any such adverse selection on the sustainability of the 937
1151+exchange, including recommendations to ensure that regulation of 938
1152+insurers and health benefit plans are similar for qualified health plans 939
1153+offered through the exchange and health benefit plans offered outside 940
1154+the exchange. The exchange shall evaluate whether adverse selection is 941
1155+occurring with respect to health benefit plans that are grandfathered 942
1156+under the Affordable Care Act, self-insured plans, plans sold through 943
1157+the exchange and plans sold outside the exchange; [and] 944
1158+(26) Consult with the Commissioner of Social Services, Insurance 945
1159+Commissioner and Office of Health Strategy, established under section 946
1160+19a-754a, as amended by this act, for the purposes set forth in section 947
1161+19a-754c; and 948
1162+(27) (A) Notwithstanding the provisions of section 12-15, the 949
1163+exchange shall make a written request to the Commissioner of 950
1164+Revenue Services, for return or return information, as such terms are 951
1165+defined in section 12-15, for use in conducting targeted outreach to 952
1166+uninsured residents of this state. If the Commissioner of Revenue 953
1167+Services deems such return or return information to be relevant to the 954
1168+targeted outreach to uninsured residents, said commissioner may 955
1169+disclose such information to the exchange. To effectuate the disclosure 956
1170+of such information, the Commissioner of Revenue Services and the 957
1171+exchange shall enter into a memorandum of understanding that sets 958
1172+forth the specific information to be disclosed and contains the terms 959
1173+and conditions under which said commissioner will disclose such 960
1174+information to the exchange. Any return or return information 961
1175+disclosed by the Commissioner of Revenue Services shall not be 962 Committee Bill No. 10
11691176
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11741181
1175-(a) To protect the integrity and accuracy of vital records, a certificate 964
1176-registered under chapter 93 may be amended only in accordance with 965
1177-sections 19a-41 to 19a-45, inclusive, chapter 93, regulations adopted by 966
1178-the Commissioner of Public Health pursuant to chapter 54 and uniform 967
1179-procedures prescribed by the commissioner. Only the commissioner 968
1180-may amend birth certificates to reflect changes concerning parentage or 969
1181-the legal name of a parent or birth or marriage certificates to reflect 970
1182-changes concerning gender. [change.] Amendments related to 971
1183-parentage, [or] gender change or the legally changed name of a parent 972
1184-shall result in the creation of a replacement certificate that supersedes 973
1185-the original, and shall in no way reveal the original language changed 974
1186-by the amendment. Any amendment to a vital record made by the 975
1187-registrar of vital statistics of the town in which the vital event occurred 976
1188-or by the commissioner shall be in accordance with such regulations and 977
1189-uniform procedures. 978
1190-(b) The commissioner and the registrar of vital statistics shall 979
1191-maintain sufficient documentation, as prescribed by the commissioner, 980
1192-to support amendments and shall ensure the confidentiality of such 981
1193-documentation as required by law. The date of amendment and a 982
1194-summary description of the evidence submitted in support of the 983
1195-amendment shall be endorsed on or made part of the record and the 984
1196-original certificate shall be marked "Amended", except for amendments 985
1197-[due to] concerning parentage, [or] gender change or the legally 986
1198-changed name of a parent. When the registrar of the town in which the 987
1199-vital event occurred amends a certificate, such registrar shall, within ten 988
1200-days of making such amendment, forward an amended certificate to the 989
1201-commissioner and to any registrar having a copy of the certificate. When 990
1202-the commissioner amends a birth certificate, including changes [due to] 991
1203-concerning parentage, [or] gender change or the legally changed name 992
1204-of a parent, the commissioner shall forward an amended certificate to 993
1205-the registrars of vital statistics affected and their records shall be 994
1206-amended accordingly. 995
1207-(c) An amended certificate shall supersede the original certificate that 996 Substitute Bill No. 10
1182+redisclosed by the recipient to a third party without permission from 963
1183+the commissioner and shall only be used by the exchange in the 964
1184+manner prescribed in the memorandum of understanding. Any person 965
1185+who violates the provisions of this subparagraph shall be fined not 966
1186+more than five thousand dollars. 967
1187+(B) To assist the exchange in conducting targeted outreach to 968
1188+uninsured residents of this state, the Commissioner of Revenue 969
1189+Services shall revise the tax return form prescribed under chapter 229 970
1190+to include space on the tax return for residents to authorize the 971
1191+exchange to contact such residents regarding enrollment through the 972
1192+exchange. The Commissioner of Revenue Services and the exchange 973
1193+shall develop language to be included on the tax return form and shall 974
1194+include in the instructions accompanying the tax return a description 975
1195+of how the authorization provided will be relayed to the exchange. 976
1196+Sec. 16. Section 19a-42 of the general statutes is repealed and the 977
1197+following is substituted in lieu thereof (Effective July 1, 2023): 978
1198+(a) To protect the integrity and accuracy of vital records, a certificate 979
1199+registered under chapter 93 may be amended only in accordance with 980
1200+sections 19a-41 to 19a-45, inclusive, chapter 93, regulations adopted by 981
1201+the Commissioner of Public Health pursuant to chapter 54 and 982
1202+uniform procedures prescribed by the commissioner. Only the 983
1203+commissioner may amend birth certificates to reflect changes 984
1204+concerning parentage or the legal name of a parent or birth or marriage 985
1205+certificates to reflect changes concerning gender. [change.] 986
1206+Amendments related to parentage, [or] gender change or the legally 987
1207+changed name of a parent shall result in the creation of a replacement 988
1208+certificate that supersedes the original, and shall in no way reveal the 989
1209+original language changed by the amendment. Any amendment to a 990
1210+vital record made by the registrar of vital statistics of the town in 991
1211+which the vital event occurred or by the commissioner shall be in 992
1212+accordance with such regulations and uniform procedures. 993
1213+(b) The commissioner and the registrar of vital statistics shall 994 Committee Bill No. 10
12081214
12091215
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12131219
1214-has been changed and shall be marked "Amended", except for 997
1215-amendments [due to] concerning parentage, [or] gender change or the 998
1216-legally changed name of a parent. The original certificate in the case of 999
1217-amendments concerning parentage, [or] gender change or the legally 1000
1218-changed name of a parent shall be physically or electronically sealed 1001
1219-and kept in a confidential file by the department and the registrar of any 1002
1220-town in which the birth was recorded, and may be unsealed for issuance 1003
1221-only as provided in section 7-53 with regard to an original birth 1004
1222-certificate or upon a written order of a court of competent jurisdiction. 1005
1223-The amended certificate shall become the official record. 1006
1224-(d) (1) Upon receipt of (A) an acknowledgment of parentage executed 1007
1225-in accordance with the provisions of sections 46b-476 to 46b-487, 1008
1226-inclusive, by both parents of a child, or (B) a certified copy of an order 1009
1227-of a court of competent jurisdiction establishing the parentage of a child, 1010
1228-the commissioner shall include on or amend, as appropriate, such 1011
1229-child's birth certificate to show such parentage if parentage is not 1012
1230-already shown on such birth certificate and to change the name of the 1013
1231-child under eighteen years of age if so indicated on the acknowledgment 1014
1232-of parentage form or within the certified court order as part of the 1015
1233-parentage action. If a person who is the subject of a voluntary 1016
1234-acknowledgment of parentage, as described in this subdivision, is 1017
1235-eighteen years of age or older, the commissioner shall obtain a notarized 1018
1236-affidavit from such person affirming that such person agrees to the 1019
1237-commissioner's amendment of such person's birth certificate as such 1020
1238-amendment relates to the acknowledgment of parentage. The 1021
1239-commissioner shall amend the birth certificate for an adult child to 1022
1240-change the child's name only pursuant to a court order. 1023
1241-(2) If the birth certificate lists the information of a parent other than 1024
1242-the parent who gave birth, the commissioner shall not remove or replace 1025
1243-the parent's information unless presented with a certified court order 1026
1244-that meets the requirements specified in section 7-50, or upon the proper 1027
1245-filing of a rescission, in accordance with the provisions of section 46b-1028
1246-570. The commissioner shall thereafter amend such child's birth 1029 Substitute Bill No. 10
1220+maintain sufficient documentation, as prescribed by the commissioner, 995
1221+to support amendments and shall ensure the confidentiality of such 996
1222+documentation as required by law. The date of amendment and a 997
1223+summary description of the evidence submitted in support of the 998
1224+amendment shall be endorsed on or made part of the record and the 999
1225+original certificate shall be marked "Amended", except for 1000
1226+amendments [due to] concerning parentage, [or] gender change or the 1001
1227+legally changed name of a parent. When the registrar of the town in 1002
1228+which the vital event occurred amends a certificate, such registrar 1003
1229+shall, within ten days of making such amendment, forward an 1004
1230+amended certificate to the commissioner and to any registrar having a 1005
1231+copy of the certificate. When the commissioner amends a birth 1006
1232+certificate, including changes [due to] concerning parentage, [or] 1007
1233+gender change or the legally changed name of a parent , the 1008
1234+commissioner shall forward an amended certificate to the registrars of 1009
1235+vital statistics affected and their records shall be amended accordingly. 1010
1236+(c) An amended certificate shall supersede the original certificate 1011
1237+that has been changed and shall be marked "Amended", except for 1012
1238+amendments [due to] concerning parentage, [or] gender change or the 1013
1239+legally changed name of a parent. The original certificate in the case of 1014
1240+parentage, [or] gender change or the legally changed name of a parent 1015
1241+shall be physically or electronically sealed and kept in a confidential 1016
1242+file by the department and the registrar of any town in which the birth 1017
1243+was recorded, and may be unsealed for issuance only as provided in 1018
1244+section 7-53 with regard to an original birth certificate or upon a 1019
1245+written order of a court of competent jurisdiction. The amended 1020
1246+certificate shall become the official record. 1021
1247+(d) (1) Upon receipt of (A) an acknowledgment of parentage 1022
1248+executed in accordance with the provisions of sections 46b-476 to 46b-1023
1249+487, inclusive, by both parents of a child, or (B) a certified copy of an 1024
1250+order of a court of competent jurisdiction establishing the parentage of 1025
1251+a child, the commissioner shall include on or amend, as appropriate, 1026
1252+such child's birth certificate to show such parentage if parentage is not 1027 Committee Bill No. 10
12471253
12481254
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12521258
1253-certificate to remove or change the name of the parent other than the 1030
1254-person who gave birth and, if relevant, to change the name of the child, 1031
1255-as requested at the time of the filing of a rescission, in accordance with 1032
1256-the provisions of section 46b-570. Birth certificates amended under this 1033
1257-subsection shall not be marked "Amended". 1034
1258-(e) When the parent or parents of a child request the amendment of 1035
1259-the child's birth certificate to reflect a new name of the parent who gave 1036
1260-birth because the name on the original certificate is fictitious, such 1037
1261-parent or parents shall obtain an order of a court of competent 1038
1262-jurisdiction declaring the person who gave birth to be the child's parent. 1039
1263-Upon receipt of a certified copy of such order, the department shall 1040
1264-amend the child's birth certificate to reflect the parent's true name. 1041
1265-(f) Upon receipt of a certified copy of an order of a court of competent 1042
1266-jurisdiction changing the name of a person born in this state and upon 1043
1267-request of such person or such person's parents, guardian, or legal 1044
1268-representative, the commissioner or the registrar of vital statistics of the 1045
1269-town in which the vital event occurred shall amend the birth certificate 1046
1270-to show the new name by a method prescribed by the department. 1047
1271-(g) When an applicant submits the documentation required by the 1048
1272-regulations to amend a vital record, the commissioner shall hold a 1049
1273-hearing, in accordance with chapter 54, if the commissioner has 1050
1274-reasonable cause to doubt the validity or adequacy of such 1051
1275-documentation. 1052
1276-(h) When an amendment under this section involves the changing of 1053
1277-existing language on a death certificate due to an error pertaining to the 1054
1278-cause of death, the death certificate shall be amended in such a manner 1055
1279-that the original language is still visible. A copy of the death certificate 1056
1280-shall be made. The original death certificate shall be sealed and kept in 1057
1281-a confidential file at the department and only the commissioner may 1058
1282-order it unsealed. The copy shall be amended in such a manner that the 1059
1283-language to be changed is no longer visible. The copy shall be a public 1060
1284-document. 1061 Substitute Bill No. 10
1259+already shown on such birth certificate and to change the name of the 1028
1260+child under eighteen years of age if so indicated on the 1029
1261+acknowledgment of parentage form or within the certified court order 1030
1262+as part of the parentage action. If a person who is the subject of a 1031
1263+voluntary acknowledgment of parentage, as described in this 1032
1264+subdivision, is eighteen years of age or older, the commissioner shall 1033
1265+obtain a notarized affidavit from such person affirming that such 1034
1266+person agrees to the commissioner's amendment of such person's birth 1035
1267+certificate as such amendment relates to the acknowledgment of 1036
1268+parentage. The commissioner shall amend the birth certificate for an 1037
1269+adult child to change the child's name only pursuant to a court order. 1038
1270+(2) If the birth certificate lists the information of a parent other than 1039
1271+the parent who gave birth, the commissioner shall not remove or 1040
1272+replace the parent's information unless presented with a certified court 1041
1273+order that meets the requirements specified in section 7-50, or upon the 1042
1274+proper filing of a rescission, in accordance with the provisions of 1043
1275+section 46b-570. The commissioner shall thereafter amend such child's 1044
1276+birth certificate to remove or change the name of the parent other than 1045
1277+the person who gave birth and, if relevant, to change the name of the 1046
1278+child, as requested at the time of the filing of a rescission, in 1047
1279+accordance with the provisions of section 46b-570. Birth certificates 1048
1280+amended under this subsection shall not be marked "Amended". 1049
1281+(e) When the parent or parents of a child request the amendment of 1050
1282+the child's birth certificate to reflect a new name of the parent who 1051
1283+gave birth because the name on the original certificate is fictitious, such 1052
1284+parent or parents shall obtain an order of a court of competent 1053
1285+jurisdiction declaring the person who gave birth to be the child's 1054
1286+parent. Upon receipt of a certified copy of such order, the department 1055
1287+shall amend the child's birth certificate to reflect the parent's true 1056
1288+name. 1057
1289+(f) Upon receipt of a certified copy of an order of a court of 1058
1290+competent jurisdiction changing the name of a person born in this state 1059
1291+and upon request of such person or such person's parents, guardian, or 1060 Committee Bill No. 10
12851292
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12901297
1291-(i) The commissioner shall issue a new birth certificate to reflect a 1062
1292-gender change upon receipt of the following documents submitted in 1063
1293-the form and manner prescribed by the commissioner: (1) A written 1064
1294-request from the applicant, signed under penalty of law, for a 1065
1295-replacement birth certificate to reflect that the applicant's gender differs 1066
1296-from the sex designated on the original birth certificate; (2) a notarized 1067
1297-affidavit by a physician licensed pursuant to chapter 370 or holding a 1068
1298-current license in good standing in another state, a physician assistant 1069
1299-licensed pursuant to chapter 370 or holding a current license in good 1070
1300-standing in another state, an advanced practice registered nurse 1071
1301-licensed pursuant to chapter 378 or holding a current license in good 1072
1302-standing in another state, or a psychologist licensed pursuant to chapter 1073
1303-383 or holding a current license in good standing in another state, stating 1074
1304-that the applicant has undergone surgical, hormonal or other treatment 1075
1305-clinically appropriate for the applicant for the purpose of gender 1076
1306-transition; and (3) if an applicant is also requesting a change of name 1077
1307-listed on the original birth certificate, proof of a legal name change. The 1078
1308-new birth certificate shall reflect the new gender identity by way of a 1079
1309-change in the sex designation on the original birth certificate and, if 1080
1310-applicable, the legal name change. 1081
1311-(j) The commissioner shall issue a new birth certificate to reflect the 1082
1312-legally changed name of a parent of the child who is the subject of such 1083
1313-birth certificate upon receipt of the following documents, submitted in 1084
1314-a form and manner prescribed by the commissioner: (1) A written 1085
1315-request from the parent, signed under penalty of law, for a replacement 1086
1316-birth certificate to reflect that the parent's legal name differs from the 1087
1317-name designated on the original birth certificate, and (2) proof of such 1088
1318-parent's legal name change. 1089
1319-[(j)] (k) The commissioner shall issue a new marriage certificate to 1090
1320-reflect a gender change upon receipt of the following documents, 1091
1321-submitted in a form and manner prescribed by the commissioner: (1) A 1092
1322-written request from the applicant, signed under penalty of law, for a 1093
1323-replacement marriage certificate to reflect that the applicant's gender 1094 Substitute Bill No. 10
1298+legal representative, the commissioner or the registrar of vital statistics 1061
1299+of the town in which the vital event occurred shall amend the birth 1062
1300+certificate to show the new name by a method prescribed by the 1063
1301+department. 1064
1302+(g) When an applicant submits the documentation required by the 1065
1303+regulations to amend a vital record, the commissioner shall hold a 1066
1304+hearing, in accordance with chapter 54, if the commissioner has 1067
1305+reasonable cause to doubt the validity or adequacy of such 1068
1306+documentation. 1069
1307+(h) When an amendment under this section involves the changing of 1070
1308+existing language on a death certificate due to an error pertaining to 1071
1309+the cause of death, the death certificate shall be amended in such a 1072
1310+manner that the original language is still visible. A copy of the death 1073
1311+certificate shall be made. The original death certificate shall be sealed 1074
1312+and kept in a confidential file at the department and only the 1075
1313+commissioner may order it unsealed. The copy shall be amended in 1076
1314+such a manner that the language to be changed is no longer visible. 1077
1315+The copy shall be a public document. 1078
1316+(i) The commissioner shall issue a new birth certificate to reflect a 1079
1317+gender change upon receipt of the following documents submitted in 1080
1318+the form and manner prescribed by the commissioner: (1) A written 1081
1319+request from the applicant, signed under penalty of law, for a 1082
1320+replacement birth certificate to reflect that the applicant's gender 1083
1321+differs from the sex designated on the original birth certificate; (2) a 1084
1322+notarized affidavit by a physician licensed pursuant to chapter 370 or 1085
1323+holding a current license in good standing in another state, a physician 1086
1324+assistant licensed pursuant to chapter 370 or holding a current license 1087
1325+in good standing in another state, an advanced practice registered 1088
1326+nurse licensed pursuant to chapter 378 or holding a current license in 1089
1327+good standing in another state, or a psychologist licensed pursuant to 1090
1328+chapter 383 or holding a current license in good standing in another 1091
1329+state, stating that the applicant has undergone surgical, hormonal or 1092
1330+other treatment clinically appropriate for the applicant for the purpose 1093 Committee Bill No. 10
13241331
13251332
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1330-differs from the sex designated on the original marriage certificate, 1095
1331-along with an affirmation that the marriage is still legally intact; (2) a 1096
1332-notarized statement from the spouse named on the marriage certificate 1097
1333-to be amended, consenting to the amendment; (3) (A) a United States 1098
1334-passport or amended birth certificate or court order reflecting the 1099
1335-applicant's gender as of the date of the request, or (B) a notarized 1100
1336-affidavit by a physician licensed pursuant to chapter 370 or holding a 1101
1337-current license in good standing in another state, physician assistant 1102
1338-licensed pursuant to chapter 370 or holding a current license in good 1103
1339-standing in another state, an advanced practice registered nurse 1104
1340-licensed pursuant to chapter 378 or holding a current license in good 1105
1341-standing in another state or a psychologist licensed pursuant to chapter 1106
1342-383 or holding a current license in good standing in another state stating 1107
1343-that the applicant has undergone surgical, hormonal or other treatment 1108
1344-clinically appropriate for the applicant for the purpose of gender 1109
1345-transition; and (4) if an applicant is also requesting a change of name 1110
1346-listed on the original marriage certificate, proof of a legal name change. 1111
1347-The new marriage certificate shall reflect the new gender identity by 1112
1348-way of a change in the sex designation on the original marriage 1113
1349-certificate and, if applicable, the legal name change. 1114
1350-Sec. 17. (NEW) (Effective from passage) (a) For purposes of this section, 1115
1351-"inmate" and "prisoner" have the same meanings as provided in section 1116
1352-18-84 of the general statutes. 1117
1353-(b) Not later than thirty days after the written request of any inmate 1118
1354-or prisoner whose name has been ordered changed pursuant to section 1119
1355-45a-99 or section 52-11 of the general statutes, the Commissioner of 1120
1356-Correction shall change such inmate or prisoner's name in the records 1121
1357-of the Department of Correction in accordance with such order. Any 1122
1358-such written request shall be accompanied by a certified copy of such 1123
1359-order. 1124
1360-Sec. 18. Section 18-81ii of the general statutes is repealed and the 1125
1361-following is substituted in lieu thereof (Effective July 1, 2023): 1126 Substitute Bill No. 10
1337+of gender transition; and (3) if an applicant is also requesting a change 1094
1338+of name listed on the original birth certificate, proof of a legal name 1095
1339+change. The new birth certificate shall reflect the new gender identity 1096
1340+by way of a change in the sex designation on the original birth 1097
1341+certificate and, if applicable, the legal name change. 1098
1342+(j) The commissioner shall issue a new birth certificate to reflect the 1099
1343+legally changed name of a parent of the child who is the subject of such 1100
1344+birth certificate upon receipt of the following documents, submitted in 1101
1345+a form and manner prescribed by the commissioner: (1) A written 1102
1346+request from the parent, signed under penalty of law, for a 1103
1347+replacement birth certificate to reflect that the parent's legal name 1104
1348+differs from the name designated on the original birth certificate, and 1105
1349+(2) proof of such parent's legal name change. 1106
1350+[(j)] (k) The commissioner shall issue a new marriage certificate to 1107
1351+reflect a gender change upon receipt of the following documents, 1108
1352+submitted in a form and manner prescribed by the commissioner: (1) A 1109
1353+written request from the applicant, signed under penalty of law, for a 1110
1354+replacement marriage certificate to reflect that the applicant's gender 1111
1355+differs from the sex designated on the original marriage certificate, 1112
1356+along with an affirmation that the marriage is still legally intact; (2) a 1113
1357+notarized statement from the spouse named on the marriage certificate 1114
1358+to be amended, consenting to the amendment; (3) (A) a United States 1115
1359+passport or amended birth certificate or court order reflecting the 1116
1360+applicant's gender as of the date of the request or (B) a notarized 1117
1361+affidavit by a physician licensed pursuant to chapter 370 or holding a 1118
1362+current license in good standing in another state, physician assistant 1119
1363+licensed pursuant to chapter 370 or holding a current license in good 1120
1364+standing in another state, an advanced practice registered nurse 1121
1365+licensed pursuant to chapter 378 or holding a current license in good 1122
1366+standing in another state or a psychologist licensed pursuant to 1123
1367+chapter 383 or holding a current license in good standing in another 1124
1368+state stating that the applicant has undergone surgical, hormonal or 1125
1369+other treatment clinically appropriate for the applicant for the purpose 1126 Committee Bill No. 10
13621370
13631371
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1368-Any inmate of a correctional institution, as described in section 18-78, 1127
1369-who has a gender identity that differs from the inmate's assigned sex at 1128
1370-birth and has a diagnosis of gender dysphoria, as set forth in the most 1129
1371-recent edition of the American Psychiatric Association's "Diagnostic and 1130
1372-Statistical Manual of Mental Disorders" or gender incongruence, as 1131
1373-defined in the 11
1376+of gender transition; and (4) if an applicant is also requesting a change 1127
1377+of name listed on the original marriage certificate, proof of a legal 1128
1378+name change. The new marriage certificate shall reflect the new gender 1129
1379+identity by way of a change in the sex designation on the original 1130
1380+marriage certificate and, if applicable, the legal name change. 1131
1381+Sec. 17. (NEW) (Effective from passage) (a) For purposes of this 1132
1382+section, "inmate" and "prisoner" have the same meanings as provided 1133
1383+in section 18-84 of the general statutes. 1134
1384+(b) Not later than thirty days after the written request of any inmate 1135
1385+or prisoner whose name has been ordered changed pursuant to section 1136
1386+45a-99 or section 52-11 of the general statutes, the Commissioner of 1137
1387+Correction shall change such inmate or prisoner's name in the records 1138
1388+of the Department of Correction in accordance with such order. Any 1139
1389+such written request shall be accompanied by a certified copy of such 1140
1390+order. 1141
1391+Sec. 18. Section 18-81ii of the general statutes is repealed and the 1142
1392+following is substituted in lieu thereof (Effective July 1, 2023): 1143
1393+Any inmate of a correctional institution, as described in section 18-1144
1394+78, who has a gender identity that differs from the inmate's assigned 1145
1395+sex at birth and has a diagnosis of gender dysphoria, as set forth in the 1146
1396+most recent edition of the American Psychiatric Association's 1147
1397+"Diagnostic and Statistical Manual of Mental Disorders" or gender 1148
1398+incongruence, as defined in the 11
13741399 th
1375- revision of the "International Statistical Classification 1132
1376-of Diseases and Related Health Problems", shall: (1) Be addressed by 1133
1377-correctional staff in a manner that is consistent with the inmate's gender 1134
1378-identity, (2) have access to commissary items, clothing, personal 1135
1379-property, programming and educational materials that are consistent 1136
1380-with the inmate's gender identity, and (3) have the right to be searched 1137
1381-by a correctional staff member of the same gender identity, unless the 1138
1382-inmate requests otherwise or under exigent circumstances. An inmate 1139
1383-who has a birth certificate, passport or driver's license that reflects his 1140
1384-or her gender identity or who can meet established standards for 1141
1385-obtaining such a document to confirm the inmate's gender identity shall 1142
1386-presumptively be placed in a correctional institution with inmates of the 1143
1387-gender consistent with the inmate's gender identity. Such presumptive 1144
1388-placement may be overcome by a demonstration by the Commissioner 1145
1389-of Correction, or the commissioner's designee, that the placement would 1146
1390-present significant safety, management or security problems. In making 1147
1391-determinations pursuant to this section, the inmate's views with respect 1148
1392-to his or her safety shall be given serious consideration by the 1149
1393-Commissioner of Correction, or the commissioner's designee. 1150
1394-Sec. 19. Section 52-571m of the general statutes is repealed and the 1151
1395-following is substituted in lieu thereof (Effective July 1, 2023): 1152
1396-(a) As used in this section: 1153
1397-(1) "Reproductive health care services" includes all medical, surgical, 1154
1398-counseling or referral services relating to the human reproductive 1155
1399-system, including, but not limited to, services relating to pregnancy, 1156
1400-contraception or the termination of a pregnancy and all medical care 1157
1401-relating to treatment of gender dysphoria as set forth in the most recent 1158
1402-edition of the American Psychiatric Association's "Diagnostic and 1159 Substitute Bill No. 10
1400+ edition of the "International 1149
1401+Statistical Classification of Diseases and Related Health Problems", 1150
1402+shall: (1) Be addressed by correctional staff in a manner that is 1151
1403+consistent with the inmate's gender identity, (2) have access to 1152
1404+commissary items, clothing, personal property, programming and 1153
1405+educational materials that are consistent with the inmate's gender 1154
1406+identity, and (3) have the right to be searched by a correctional staff 1155
1407+member of the same gender identity, unless the inmate requests 1156
1408+otherwise or under exigent circumstances. An inmate who has a birth 1157
1409+certificate, passport or driver's license that reflects his or her gender 1158 Committee Bill No. 10
14031410
14041411
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14081415
1409-Statistical Manual of Mental Disorders" and gender incongruence, as 1160
1410-defined in the 11
1416+identity or who can meet established standards for obtaining such a 1159
1417+document to confirm the inmate's gender identity shall presumptively 1160
1418+be placed in a correctional institution with inmates of the gender 1161
1419+consistent with the inmate's gender identity. Such presumptive 1162
1420+placement may be overcome by a demonstration by the Commissioner 1163
1421+of Correction, or the commissioner's designee, that the placement 1164
1422+would present significant safety, management or security problems. In 1165
1423+making determinations pursuant to this section, the inmate's views 1166
1424+with respect to his or her safety shall be given serious consideration by 1167
1425+the Commissioner of Correction, or the commissioner's designee. 1168
1426+Sec. 19. Section 52-571m of the general statutes is repealed and the 1169
1427+following is substituted in lieu thereof (Effective July 1, 2023): 1170
1428+(a) As used in this section: 1171
1429+(1) "Reproductive health care services" includes all medical, 1172
1430+surgical, counseling or referral services relating to the human 1173
1431+reproductive system, including, but not limited to, services relating to 1174
1432+pregnancy, contraception or the termination of a pregnancy and all 1175
1433+medical care relating to treatment of gender dysphoria as set forth in 1176
1434+the most recent edition of the American Psychiatric Association's 1177
1435+"Diagnostic and Statistical Manual of Mental Disorders" and gender 1178
1436+incongruence, as defined in the 11
14111437 th
1412- revision of the "International Statistical Classification 1161
1413-of Diseases and Related Health Problems"; and 1162
1414-(2) "Person" includes an individual, a partnership, an association, a 1163
1415-limited liability company or a corporation. 1164
1416-(b) When any person has had a judgment entered against such 1165
1417-person, in any state, where liability, in whole or in part, is based on the 1166
1418-alleged provision, receipt, assistance in receipt or provision, material 1167
1419-support for, or any theory of vicarious, joint, several or conspiracy 1168
1420-liability derived therefrom, for reproductive health care services that are 1169
1421-permitted under the laws of this state, such person may recover 1170
1422-damages from any party that brought the action leading to that 1171
1423-judgment or has sought to enforce that judgment. Recoverable damages 1172
1424-shall include: (1) Just damages created by the action that led to that 1173
1425-judgment, including, but not limited to, money damages in the amount 1174
1426-of the judgment in that other state and costs, expenses and reasonable 1175
1427-attorney's fees spent in defending the action that resulted in the entry of 1176
1428-a judgment in another state; and (2) costs, expenses and reasonable 1177
1429-attorney's fees incurred in bringing an action under this section as may 1178
1430-be allowed by the court. 1179
1431-(c) The provisions of this section shall not apply to a judgment 1180
1432-entered in another state that is based on: (1) An action founded in tort, 1181
1433-contract or statute, and for which a similar claim would exist under the 1182
1434-laws of this state, brought by the patient who received the reproductive 1183
1435-health care services upon which the original lawsuit was based or the 1184
1436-patient's authorized legal representative, for damages suffered by the 1185
1437-patient or damages derived from an individual's loss of consortium of 1186
1438-the patient; (2) an action founded in contract, and for which a similar 1187
1439-claim would exist under the laws of this state, brought or sought to be 1188
1440-enforced by a party with a contractual relationship with the person that 1189
1441-is the subject of the judgment entered in another state; or (3) an action 1190
1442-where no part of the acts that formed the basis for liability occurred in 1191
1443-this state. 1192 Substitute Bill No. 10
1438+ edition of the "International 1179
1439+Statistical Classification of Diseases and Related Health Problems"; and 1180
1440+(2) "Person" includes an individual, a partnership, an association, a 1181
1441+limited liability company or a corporation. 1182
1442+(b) When any person has had a judgment entered against such 1183
1443+person, in any state, where liability, in whole or in part, is based on the 1184
1444+alleged provision, receipt, assistance in receipt or provision, material 1185
1445+support for, or any theory of vicarious, joint, several or conspiracy 1186
1446+liability derived therefrom, for reproductive health care services that 1187
1447+are permitted under the laws of this state, such person may recover 1188
1448+damages from any party that brought the action leading to that 1189 Committee Bill No. 10
14441449
14451450
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1450-Sec. 20. Section 52-571n of the general statutes is repealed and the 1193
1451-following is substituted in lieu thereof (Effective July 1, 2023): 1194
1452-(a) As used in this section: 1195
1453-(1) "Gender-affirming health care services" means all medical care 1196
1454-relating to the treatment of gender dysphoria as set forth in the most 1197
1455-recent edition of the American Psychiatric Association's "Diagnostic and 1198
1456-Statistical Manual of Mental Disorders" and gender incongruence, as 1199
1457-defined in the 11
1455+judgment or has sought to enforce that judgment. Recoverable 1190
1456+damages shall include: (1) Just damages created by the action that led 1191
1457+to that judgment, including, but not limited to, money damages in the 1192
1458+amount of the judgment in that other state and costs, expenses and 1193
1459+reasonable attorney's fees spent in defending the action that resulted in 1194
1460+the entry of a judgment in another state; and (2) costs, expenses and 1195
1461+reasonable attorney's fees incurred in bringing an action under this 1196
1462+section as may be allowed by the court. 1197
1463+(c) The provisions of this section shall not apply to a judgment 1198
1464+entered in another state that is based on: (1) An action founded in tort, 1199
1465+contract or statute, and for which a similar claim would exist under the 1200
1466+laws of this state, brought by the patient who received the 1201
1467+reproductive health care services upon which the original lawsuit was 1202
1468+based or the patient's authorized legal representative, for damages 1203
1469+suffered by the patient or damages derived from an individual's loss of 1204
1470+consortium of the patient; (2) an action founded in contract, and for 1205
1471+which a similar claim would exist under the laws of this state, brought 1206
1472+or sought to be enforced by a party with a contractual relationship 1207
1473+with the person that is the subject of the judgment entered in another 1208
1474+state; or (3) an action where no part of the acts that formed the basis for 1209
1475+liability occurred in this state. 1210
1476+Sec. 20. Section 52-571n of the general statutes is repealed and the 1211
1477+following is substituted in lieu thereof (Effective July 1, 2023): 1212
1478+(a) As used in this section: 1213
1479+(1) "Gender-affirming health care services" means all medical care 1214
1480+relating to the treatment of gender dysphoria as set forth in the most 1215
1481+recent edition of the American Psychiatric Association's "Diagnostic 1216
1482+and Statistical Manual of Mental Disorders" and gender incongruence, 1217
1483+as defined in the 11
14581484 th
1459- revision of the "International Statistical Classification 1200
1460-of Diseases and Related Health Problems"; 1201
1461-(2) "Reproductive health care services" includes all medical, surgical, 1202
1462-counseling or referral services relating to the human reproductive 1203
1463-system, including, but not limited to, services relating to pregnancy, 1204
1464-contraception or the termination of a pregnancy; and 1205
1465-(3) "Person" includes an individual, a partnership, an association, a 1206
1466-limited liability company or a corporation. 1207
1467-(b) When any person has had a judgment entered against such 1208
1468-person, in any state, where liability, in whole or in part, is based on the 1209
1469-alleged provision, receipt, assistance in receipt or provision, material 1210
1470-support for, or any theory of vicarious, joint, several or conspiracy 1211
1471-liability derived therefrom, for reproductive health care services and 1212
1472-gender-affirming health care services that are permitted under the laws 1213
1473-of this state, such person may recover damages from any party that 1214
1474-brought the action leading to that judgment or has sought to enforce that 1215
1475-judgment. Recoverable damages shall include: (1) Just damages created 1216
1476-by the action that led to that judgment, including, but not limited to, 1217
1477-money damages in the amount of the judgment in that other state and 1218
1478-costs, expenses and reasonable attorney's fees spent in defending the 1219
1479-action that resulted in the entry of a judgment in another state; and (2) 1220
1480-costs, expenses and reasonable attorney's fees incurred in bringing an 1221
1481-action under this section as may be allowed by the court. 1222
1482-(c) The provisions of this section shall not apply to a judgment 1223 Substitute Bill No. 10
1485+ edition of the "International Statistical 1218
1486+Classification of Diseases and Related Health Problems"; 1219
1487+(2) "Reproductive health care services" includes all medical, 1220 Committee Bill No. 10
14831488
14841489
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14871492 41 of 48
14881493
1489-entered in another state that is based on: (1) An action founded in tort, 1224
1490-contract or statute, and for which a similar claim would exist under the 1225
1491-laws of this state, brought by the patient who received the reproductive 1226
1492-health care services or gender-affirming health care services upon which 1227
1493-the original lawsuit was based or the patient's authorized legal 1228
1494-representative, for damages suffered by the patient or damages derived 1229
1495-from an individual's loss of consortium of the patient; (2) an action 1230
1496-founded in contract, and for which a similar claim would exist under 1231
1497-the laws of this state, brought or sought to be enforced by a party with 1232
1498-a contractual relationship with the person that is the subject of the 1233
1499-judgment entered in another state; or (3) an action where no part of the 1234
1500-acts that formed the basis for liability occurred in this state. 1235
1501-Sec. 21. Subsection (b) of section 45a-106a of the general statutes, as 1236
1502-amended by section 52 of public act 22-26, is repealed and the following 1237
1503-is substituted in lieu thereof (Effective July 1, 2023): 1238
1504-(b) The fee to file each of the following motions, petitions or 1239
1505-applications in a Probate Court is two hundred fifty dollars: 1240
1506-(1) With respect to a minor child: (A) Appoint a temporary guardian, 1241
1507-temporary custodian, guardian, coguardian, permanent guardian or 1242
1508-statutory parent, (B) remove a guardian, including the appointment of 1243
1509-another guardian, (C) reinstate a parent as guardian, (D) terminate 1244
1510-parental rights, including the appointment of a guardian or statutory 1245
1511-parent, (E) grant visitation, (F) make findings regarding special 1246
1512-immigrant juvenile status, (G) approve placement of a child for 1247
1513-adoption outside this state, (H) approve an adoption, (I) validate a 1248
1514-foreign adoption, (J) review, modify or enforce a cooperative 1249
1515-postadoption agreement, (K) review an order concerning contact 1250
1516-between an adopted child and his or her siblings, (L) resolve a dispute 1251
1517-concerning a standby guardian, (M) approve a plan for voluntary 1252
1518-services provided by the Department of Children and Families, (N) 1253
1519-determine whether the termination of voluntary services provided by 1254
1520-the Department of Children and Families is in accordance with 1255
1521-applicable regulations, (O) conduct an in-court review to modify an 1256 Substitute Bill No. 10
1494+surgical, counseling or referral services relating to the human 1221
1495+reproductive system, including, but not limited to, services relating to 1222
1496+pregnancy, contraception or the termination of a pregnancy; and 1223
1497+(3) "Person" includes an individual, a partnership, an association, a 1224
1498+limited liability company or a corporation. 1225
1499+(b) When any person has had a judgment entered against such 1226
1500+person, in any state, where liability, in whole or in part, is based on the 1227
1501+alleged provision, receipt, assistance in receipt or provision, material 1228
1502+support for, or any theory of vicarious, joint, several or conspiracy 1229
1503+liability derived therefrom, for reproductive health care services and 1230
1504+gender-affirming health care services that are permitted under the 1231
1505+laws of this state, such person may recover damages from any party 1232
1506+that brought the action leading to that judgment or has sought to 1233
1507+enforce that judgment. Recoverable damages shall include: (1) Just 1234
1508+damages created by the action that led to that judgment, including, but 1235
1509+not limited to, money damages in the amount of the judgment in that 1236
1510+other state and costs, expenses and reasonable attorney's fees spent in 1237
1511+defending the action that resulted in the entry of a judgment in another 1238
1512+state; and (2) costs, expenses and reasonable attorney's fees incurred in 1239
1513+bringing an action under this section as may be allowed by the court. 1240
1514+(c) The provisions of this section shall not apply to a judgment 1241
1515+entered in another state that is based on: (1) An action founded in tort, 1242
1516+contract or statute, and for which a similar claim would exist under the 1243
1517+laws of this state, brought by the patient who received the 1244
1518+reproductive health care services or gender-affirming health care 1245
1519+services upon which the original lawsuit was based or the patient's 1246
1520+authorized legal representative, for damages suffered by the patient or 1247
1521+damages derived from an individual's loss of consortium of the 1248
1522+patient; (2) an action founded in contract, and for which a similar claim 1249
1523+would exist under the laws of this state, brought or sought to be 1250
1524+enforced by a party with a contractual relationship with the person 1251
1525+that is the subject of the judgment entered in another state; or (3) an 1252
1526+action where no part of the acts that formed the basis for liability 1253 Committee Bill No. 10
15221527
15231528
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15261531 42 of 48
15271532
1528-order, (P) grant emancipation, (Q) grant approval to marry, (R) transfer 1257
1529-funds to a custodian under sections 45a-557 to 45a-560b, inclusive, (S) 1258
1530-appoint a successor custodian under section 45a-559c, (T) resolve a 1259
1531-dispute concerning custodianship under sections 45a-557 to 45a-560b, 1260
1532-inclusive, and (U) grant authority to purchase real estate; 1261
1533-(2) Determine parentage; 1262
1534-(3) Validate a genetic surrogacy agreement; 1263
1535-(4) Determine the age and date of birth of an adopted person born 1264
1536-outside the United States; 1265
1537-(5) With respect to adoption records: (A) Appoint a guardian ad litem 1266
1538-for a biological relative who cannot be located or appears to be 1267
1539-incompetent, (B) appeal the refusal of an agency to release information, 1268
1540-(C) release medical information when required for treatment, and (D) 1269
1541-grant access to an original birth certificate; 1270
1542-(6) Approve an adult adoption; 1271
1543-(7) With respect to a conservatorship: (A) Appoint a temporary 1272
1544-conservator, conservator or special limited conservator, (B) change 1273
1545-residence, terminate a tenancy or lease, sell or dispose household 1274
1546-furnishings, or place in a long-term care facility, (C) determine 1275
1547-competency to vote, (D) approve a support allowance for a spouse, (E) 1276
1548-grant authority to elect the spousal share, (F) grant authority to purchase 1277
1549-real estate, (G) give instructions regarding administration of a joint asset 1278
1550-or liability, (H) distribute gifts, (I) grant authority to consent to 1279
1551-involuntary medication, (J) determine whether informed consent has 1280
1552-been given for voluntary admission to a hospital for psychiatric 1281
1553-disabilities, (K) determine life-sustaining medical treatment, (L) transfer 1282
1554-to or from another state, (M) modify the conservatorship in connection 1283
1555-with a periodic review, (N) excuse accounts under rules of procedure 1284
1556-approved by the Supreme Court under section 45a-78, (O) terminate the 1285
1557-conservatorship, and (P) grant a writ of habeas corpus; 1286 Substitute Bill No. 10
1533+occurred in this state. 1254
1534+Sec. 21. Subsection (b) of section 45a-106a of the general statutes is 1255
1535+repealed and the following is substituted in lieu thereof (Effective July 1256
1536+1, 2023): 1257
1537+(b) The fee to file each of the following motions, petitions or 1258
1538+applications in a Probate Court is two hundred fifty dollars: 1259
1539+(1) With respect to a minor child: (A) Appoint a temporary 1260
1540+guardian, temporary custodian, guardian, coguardian, permanent 1261
1541+guardian or statutory parent, (B) remove a guardian, including the 1262
1542+appointment of another guardian, (C) reinstate a parent as guardian, 1263
1543+(D) terminate parental rights, including the appointment of a guardian 1264
1544+or statutory parent, (E) grant visitation, (F) make findings regarding 1265
1545+special immigrant juvenile status, (G) approve placement of a child for 1266
1546+adoption outside this state, (H) approve an adoption, (I) validate a 1267
1547+foreign adoption, (J) review, modify or enforce a cooperative 1268
1548+postadoption agreement, (K) review an order concerning contact 1269
1549+between an adopted child and his or her siblings, (L) resolve a dispute 1270
1550+concerning a standby guardian, (M) approve a plan for voluntary 1271
1551+services provided by the Department of Children and Families, (N) 1272
1552+determine whether the termination of voluntary services provided by 1273
1553+the Department of Children and Families is in accordance with 1274
1554+applicable regulations, (O) conduct an in-court review to modify an 1275
1555+order, (P) grant emancipation, (Q) grant approval to marry, (R) 1276
1556+transfer funds to a custodian under sections 45a-557 to 45a-560b, 1277
1557+inclusive, (S) appoint a successor custodian under section 45a-559c, (T) 1278
1558+resolve a dispute concerning custodianship under sections 45a-557 to 1279
1559+45a-560b, inclusive, and (U) grant authority to purchase real estate; 1280
1560+(2) Determine parentage; 1281
1561+(3) Validate a genetic surrogacy agreement; 1282
1562+(4) Determine the age and date of birth of an adopted person born 1283
1563+outside the United States; 1284 Committee Bill No. 10
15581564
15591565
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15621568 43 of 48
15631569
1564-(8) With respect to a power of attorney: (A) Compel an account by an 1287
1565-agent, (B) review the conduct of an agent, (C) construe the power of 1288
1566-attorney, and (D) mandate acceptance of the power of attorney; 1289
1567-(9) Resolve a dispute concerning advance directives or life-sustaining 1290
1568-medical treatment when the individual does not have a conservator or 1291
1569-guardian; 1292
1570-(10) With respect to an elderly person, as defined in section 17b-450: 1293
1571-(A) Enjoin an individual from interfering with the provision of 1294
1572-protective services to such elderly person, and (B) authorize the 1295
1573-Commissioner of Social Services to enter the premises of such elderly 1296
1574-person to determine whether such elderly person needs protective 1297
1575-services; 1298
1576-(11) With respect to an adult with intellectual disability: (A) Appoint 1299
1577-a temporary limited guardian, guardian or standby guardian, (B) grant 1300
1578-visitation, (C) determine competency to vote, (D) modify the 1301
1579-guardianship in connection with a periodic review, (E) determine life-1302
1580-sustaining medical treatment, (F) approve an involuntary placement, 1303
1581-(G) review an involuntary placement, (H) authorize a guardian to 1304
1582-manage the finances of such adult, and (I) grant a writ of habeas corpus; 1305
1583-(12) With respect to psychiatric disability: (A) Commit an individual 1306
1584-for treatment, (B) issue a warrant for examination of an individual at a 1307
1585-general hospital, (C) determine whether there is probable cause to 1308
1586-continue an involuntary confinement, (D) review an involuntary 1309
1587-confinement for possible release, (E) authorize shock therapy, (F) 1310
1588-authorize medication for treatment of psychiatric disability, (G) review 1311
1589-the status of an individual under the age of sixteen as a voluntary 1312
1590-patient, and (H) recommit an individual under the age of sixteen for 1313
1591-further treatment; 1314
1592-(13) With respect to drug or alcohol dependency: (A) Commit an 1315
1593-individual for treatment, (B) recommit an individual for further 1316
1594-treatment, and (C) terminate an involuntary confinement; 1317 Substitute Bill No. 10
1570+(5) With respect to adoption records: (A) Appoint a guardian ad 1285
1571+litem for a biological relative who cannot be located or appears to be 1286
1572+incompetent, (B) appeal the refusal of an agency to release information, 1287
1573+(C) release medical information when required for treatment, and (D) 1288
1574+grant access to an original birth certificate; 1289
1575+(6) Approve an adult adoption; 1290
1576+(7) With respect to a conservatorship: (A) Appoint a temporary 1291
1577+conservator, conservator or special limited conservator, (B) change 1292
1578+residence, terminate a tenancy or lease, sell or dispose household 1293
1579+furnishings, or place in a long-term care facility, (C) determine 1294
1580+competency to vote, (D) approve a support allowance for a spouse, (E) 1295
1581+grant authority to elect the spousal share, (F) grant authority to 1296
1582+purchase real estate, (G) give instructions regarding administration of 1297
1583+a joint asset or liability, (H) distribute gifts, (I) grant authority to 1298
1584+consent to involuntary medication, (J) determine whether informed 1299
1585+consent has been given for voluntary admission to a hospital for 1300
1586+psychiatric disabilities, (K) determine life-sustaining medical 1301
1587+treatment, (L) transfer to or from another state, (M) modify the 1302
1588+conservatorship in connection with a periodic review, (N) excuse 1303
1589+accounts under rules of procedure approved by the Supreme Court 1304
1590+under section 45a-78, (O) terminate the conservatorship, and (P) grant 1305
1591+a writ of habeas corpus; 1306
1592+(8) With respect to a power of attorney: (A) Compel an account by 1307
1593+an agent, (B) review the conduct of an agent, (C) construe the power of 1308
1594+attorney, and (D) mandate acceptance of the power of attorney; 1309
1595+(9) Resolve a dispute concerning advance directives or life-1310
1596+sustaining medical treatment when the individual does not have a 1311
1597+conservator or guardian; 1312
1598+(10) With respect to an elderly person, as defined in section 17b-450: 1313
1599+(A) Enjoin an individual from interfering with the provision of 1314
1600+protective services to such elderly person, and (B) authorize the 1315 Committee Bill No. 10
15951601
15961602
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15991605 44 of 48
16001606
1601-(14) With respect to tuberculosis: (A) Commit an individual for 1318
1602-treatment, (B) issue a warrant to enforce an examination order, and (C) 1319
1603-terminate an involuntary confinement; 1320
1604-(15) Compel an account by the trustee of an inter vivos trust, 1321
1605-custodian under sections 45a-557 to 45a-560b, inclusive, or treasurer of 1322
1606-an ecclesiastical society or cemetery association; 1323
1607-(16) With respect to a testamentary or inter vivos trust: (A) Construe, 1324
1608-validate, divide, combine, reform, modify or terminate the trust, (B) 1325
1609-enforce the provisions of a pet trust, (C) excuse a final account under 1326
1610-rules of procedure approved by the Supreme Court under section 45a-1327
1611-78, and (D) assume jurisdiction of an out-of-state trust; 1328
1612-(17) Authorize a fiduciary to establish a trust; 1329
1613-(18) Appoint a trustee for a missing person; 1330
1614-[(19) Change a person's name;] 1331
1615-[(20)] (19) Issue an order to amend the birth certificate of an 1332
1616-individual born in another state to reflect a gender change; 1333
1617-[(21)] (20) Require the Department of Public Health to issue a delayed 1334
1618-birth certificate; 1335
1619-[(22)] (21) Compel the board of a cemetery association to disclose the 1336
1620-minutes of the annual meeting; 1337
1621-[(23)] (22) Issue an order to protect a grave marker; 1338
1622-[(24)] (23) Restore rights to purchase, possess and transport firearms; 1339
1623-[(25)] (24) Issue an order permitting sterilization of an individual; 1340
1624-[(26)] (25) Approve the transfer of structured settlement payment 1341
1625-rights; and 1342
1626-[(27)] (26) With respect to any case in a Probate Court other than a 1343 Substitute Bill No. 10
1607+Commissioner of Social Services to enter the premises of such elderly 1316
1608+person to determine whether such elderly person needs protective 1317
1609+services; 1318
1610+(11) With respect to an adult with intellectual disability: (A) Appoint 1319
1611+a temporary limited guardian, guardian or standby guardian, (B) grant 1320
1612+visitation, (C) determine competency to vote, (D) modify the 1321
1613+guardianship in connection with a periodic review, (E) determine life-1322
1614+sustaining medical treatment, (F) approve an involuntary placement, 1323
1615+(G) review an involuntary placement, (H) authorize a guardian to 1324
1616+manage the finances of such adult, and (I) grant a writ of habeas 1325
1617+corpus; 1326
1618+(12) With respect to psychiatric disability: (A) Commit an individual 1327
1619+for treatment, (B) issue a warrant for examination of an individual at a 1328
1620+general hospital, (C) determine whether there is probable cause to 1329
1621+continue an involuntary confinement, (D) review an involuntary 1330
1622+confinement for possible release, (E) authorize shock therapy, (F) 1331
1623+authorize medication for treatment of psychiatric disability, (G) review 1332
1624+the status of an individual under the age of sixteen as a voluntary 1333
1625+patient, and (H) recommit an individual under the age of sixteen for 1334
1626+further treatment; 1335
1627+(13) With respect to drug or alcohol dependency: (A) Commit an 1336
1628+individual for treatment, (B) recommit an individual for further 1337
1629+treatment, and (C) terminate an involuntary confinement; 1338
1630+(14) With respect to tuberculosis: (A) Commit an individual for 1339
1631+treatment, (B) issue a warrant to enforce an examination order, and (C) 1340
1632+terminate an involuntary confinement; 1341
1633+(15) Compel an account by the trustee of an inter vivos trust, 1342
1634+custodian under sections 45a-557 to 45a-560b, inclusive, or treasurer of 1343
1635+an ecclesiastical society or cemetery association; 1344
1636+(16) With respect to a testamentary or inter vivos trust: (A) 1345
1637+Construe, validate, divide, combine, reform, modify or terminate the 1346 Committee Bill No. 10
16271638
16281639
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16311642 45 of 48
16321643
1633-decedent's estate: (A) Compel or approve an action by the fiduciary, (B) 1344
1634-give instruction to the fiduciary, (C) authorize a fiduciary to 1345
1635-compromise a claim, (D) list, sell or mortgage real property, (E) 1346
1636-determine title to property, (F) resolve a dispute between cofiduciaries 1347
1637-or among fiduciaries, (G) remove a fiduciary, (H) appoint a successor 1348
1638-fiduciary or fill a vacancy in the office of fiduciary, (I) approve fiduciary 1349
1639-or attorney's fees, (J) apply the doctrine of cy pres or approximation, (K) 1350
1640-reconsider, modify or revoke an order, and (L) decide an action on a 1351
1641-probate bond. 1352
1642-Sec. 22. (Effective from passage) (a) As used in this section, "gender-1353
1643-affirming procedure" means a medical procedure or treatment to alter 1354
1644-the physical characteristics of a person diagnosed with (1) gender 1355
1645-dysphoria, as described in the most recent edition of the American 1356
1646-Psychiatric Association's "Diagnostic and Statistical Manual of Mental 1357
1647-Disorders", or (2) gender incongruence, as defined in the 11
1648-th
1649- revision of 1358
1650-the "International Statistical Classification of Diseases and Related 1359
1651-Health Problems", in a manner consistent with such person's gender 1360
1652-identity. 1361
1653-(b) The Commissioner of Social Services shall establish a working 1362
1654-group to seek input on amendments to the department's gender-1363
1655-affirming procedures guidelines not later than one hundred twenty 1364
1656-days before amending such guidelines. The working group shall consist 1365
1657-of (1) six health care providers who treat persons seeking gender-1366
1658-affirming procedures or persons who have had such procedures, (2) two 1367
1659-HUSKY Health program members who have had such procedures, and 1368
1660-(3) the commissioner or the commissioner's designee. All appointments 1369
1661-to the working group shall be made by the commissioner. The 1370
1662-commissioner, or the commissioner's designee, shall serve as 1371
1663-cochairperson of the working group with a member chosen by the 1372
1664-majority of working group members to serve as cochairperson. 1373
1665-(c) The commissioner, or the commissioner's designee, shall convene 1374
1666-the working group not later than ninety days before any amendments 1375
1667-planned for the gender-affirming procedures guidelines. The group 1376 Substitute Bill No. 10
1644+trust, (B) enforce the provisions of a pet trust, (C) excuse a final 1347
1645+account under rules of procedure approved by the Supreme Court 1348
1646+under section 45a-78, and (D) assume jurisdiction of an out-of-state 1349
1647+trust; 1350
1648+(17) Authorize a fiduciary to establish a trust; 1351
1649+(18) Appoint a trustee for a missing person; 1352
1650+[(19) Change a person's name;] 1353
1651+[(20)] (19) Issue an order to amend the birth certificate of an 1354
1652+individual born in another state to reflect a gender change; 1355
1653+[(21)] (20) Require the Department of Public Health to issue a 1356
1654+delayed birth certificate; 1357
1655+[(22)] (21) Compel the board of a cemetery association to disclose 1358
1656+the minutes of the annual meeting; 1359
1657+[(23)] (22) Issue an order to protect a grave marker; 1360
1658+[(24)] (23) Restore rights to purchase, possess and transport 1361
1659+firearms; 1362
1660+[(25)] (24) Issue an order permitting sterilization of an individual; 1363
1661+[(26)] (25) Approve the transfer of structured settlement payment 1364
1662+rights; and 1365
1663+[(27)] (26) With respect to any case in a Probate Court other than a 1366
1664+decedent's estate: (A) Compel or approve an action by the fiduciary, 1367
1665+(B) give instruction to the fiduciary, (C) authorize a fiduciary to 1368
1666+compromise a claim, (D) list, sell or mortgage real property, (E) 1369
1667+determine title to property, (F) resolve a dispute between cofiduciaries 1370
1668+or among fiduciaries, (G) remove a fiduciary, (H) appoint a successor 1371
1669+fiduciary or fill a vacancy in the office of fiduciary, (I) approve 1372
1670+fiduciary or attorney's fees, (J) apply the doctrine of cy pres or 1373 Committee Bill No. 10
16681671
16691672
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16721675 46 of 48
16731676
1674-shall meet not less than two times monthly. 1377
1675-(d) The commissioner shall file a report, in accordance with the 1378
1676-provisions of section 11-4a of the general statutes, to the joint standing 1379
1677-committees of the General Assembly having cognizance of matters 1380
1678-relating to human services and public health not later than thirty days 1381
1679-before any amendments the commissioner has proposed for the gender-1382
1680-affirming procedure guidelines. The report shall include, but not be 1383
1681-limited to, (1) the proposed amendments, and (2) the working group's 1384
1682-recommendations concerning such amendments. The working group 1385
1683-shall terminate on the date such report is issued. 1386
1684-(e) The provisions of this section shall not apply to any changes 1387
1685-required to be made to the gender-affirming procedure guidelines to 1388
1686-comply with federal law or regulations concerning reimbursement for 1389
1687-such procedures under Title XIX or Title XXI of the Social Security Act. 1390
1677+approximation, (K) reconsider, modify or revoke an order, and (L) 1374
1678+decide an action on a probate bond. 1375
1679+Sec. 22. (NEW) (Effective from passage) (a) As used in this section, 1376
1680+"gender-affirming procedure" means a medical procedure or treatment 1377
1681+to alter the physical characteristics of a person diagnosed with (1) 1378
1682+gender dysphoria, as described in the most recent edition of the 1379
1683+American Psychiatric Association's "Diagnostic and Statistical Manual 1380
1684+of Mental Disorders", or (2) gender incongruence, as defined in the 11
1685+th
1686+ 1381
1687+edition of the "International Statistical Classification of Diseases and 1382
1688+Related Health Problems", in a manner consistent with such person's 1383
1689+gender identity. 1384
1690+(b) The Commissioner of Social Services shall establish a working 1385
1691+group to seek input on department guidelines for gender-affirming 1386
1692+procedures not later than one hundred twenty days before amending 1387
1693+such guidelines. The working group shall consist of (1) six health care 1388
1694+providers who treat persons seeking gender-affirming procedures or 1389
1695+persons who have had such procedures, (2) two HUSKY Health 1390
1696+program members who have had such procedures, and (3) the 1391
1697+commissioner or the commissioner's designee. All appointments to the 1392
1698+working group shall be made by the commissioner. The commissioner, 1393
1699+or the commissioner's designee, shall serve as cochairperson of the 1394
1700+working group with a member chosen by the majority of working 1395
1701+group members to serve as cochairperson. 1396
1702+(c) The commissioner, or the commissioner's designee, shall convene 1397
1703+the working group not later than ninety days before any amendments 1398
1704+planned for the gender-affirming procedure guidelines. The group 1399
1705+shall meet not less than two times monthly. 1400
1706+(d) The commissioner shall file a report, in accordance with the 1401
1707+provisions of section 11-4a of the general statutes, to the joint standing 1402
1708+committees of the General Assembly having cognizance of matters 1403
1709+relating to human services and public health not later than thirty days 1404
1710+before any amendments the commissioner has proposed for the 1405 Committee Bill No. 10
1711+
1712+
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1715+47 of 48
1716+
1717+gender-affirming procedure guidelines. The report shall include, but 1406
1718+not be limited to, (1) the proposed amendments, and (2) the working 1407
1719+group's recommendations concerning such amendments. The working 1408
1720+group shall terminate on the date such report is issued. 1409
1721+(e) The provisions of this section shall not apply to any changes 1410
1722+required to be made to the gender-affirming procedure guidelines to 1411
1723+comply with federal law or regulations concerning reimbursement for 1412
1724+such procedures under Title XIX or Title XXI of the Social Security Act. 1413
16881725 This act shall take effect as follows and shall amend the following
16891726 sections:
16901727
16911728 Section 1 July 1, 2023 19a-754b(d)
16921729 Sec. 2 January 1, 2024, and
16931730 applicable to contracts
16941731 entered into, amended or
16951732 renewed on and after
16961733 January 1, 2024
16971734 New section
16981735 Sec. 3 January 1, 2024, and
16991736 applicable to contracts
17001737 entered into, amended or
17011738 renewed on and after
17021739 January 1, 2024
17031740 New section
17041741 Sec. 4 January 1, 2024, and
17051742 applicable to contracts
17061743 entered into, amended or
17071744 renewed on and after
17081745 January 1, 2024
17091746 New section
17101747 Sec. 5 July 1, 2023 New section
17111748 Sec. 6 July 1, 2023 New section
1712-Sec. 7 July 1, 2023 New section Substitute Bill No. 10
1713-
1714-
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1717-47 of 48
1718-
1749+Sec. 7 July 1, 2023 New section
17191750 Sec. 8 July 1, 2023 3-112
17201751 Sec. 9 January 1, 2024 38a-477g
17211752 Sec. 10 July 1, 2023 17b-242(a)
17221753 Sec. 11 from passage New section
17231754 Sec. 12 from passage 19a-754a(b)
17241755 Sec. 13 from passage 17b-312
17251756 Sec. 14 from passage New section
1726-Sec. 15 from passage 38a-1084
1757+Sec. 15 from passage 38a-1084 Committee Bill No. 10
1758+
1759+
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1763+
17271764 Sec. 16 July 1, 2023 19a-42
17281765 Sec. 17 from passage New section
17291766 Sec. 18 July 1, 2023 18-81ii
17301767 Sec. 19 July 1, 2023 52-571m
17311768 Sec. 20 July 1, 2023 52-571n
17321769 Sec. 21 July 1, 2023 45a-106a(b)
17331770 Sec. 22 from passage New section
17341771
1735-Statement of Legislative Commissioners:
1736-In Section 1(d)(3), "wholesale acquisition cost of the drug" was changed
1737-to "wholesale acquisition cost of the drug, less all rebates paid to the
1738-state for such drug during the immediately preceding calendar year,"
1739-for consistency; Section 6 was redrafted for clarity; in Section 7(c), "thirty
1740-days after the effective date of this section" was changed to "August 1,
1741-2023" for clarity; in Section 7(d), "sixty days after the effective date of
1742-this section" was changed to "September 1, 2023" for clarity; in Section
1743-9(b)(1), "[2017] 2024" was changed to "2017" for clarity; in Sections 9(f)
1744-and 9(g) "On and after January, 1 2024," was added for clarity; in Section
1745-16(c), "in the case of parentage" was changed to "in the case of
1746-amendments concerning parentage" for accuracy; in Sections 18 to 20,
1747-inclusive, "11
1748-th
1749- edition of the "International Statistical Classification of
1750-Diseases and Related Health Problems"" was changed to "11
1751-th
1752- revision
1753-of the "International Statistical Classification of Diseases and Related
1754-Health Problems"" for accuracy; and in Section 22, "(NEW)" was
1755-removed for accuracy, "11
1756-th
1757- edition of the "International Statistical
1758-Classification of Diseases and Related Health Problems"" was changed
1759-to "11
1760-th
1761- revision of the "International Statistical Classification of Diseases
1762-and Related Health Problems"" for accuracy, and the first sentence of
1763-Section 22(b) was redrafted for clarity.
1764-
1765-HS Joint Favorable C/R APP Substitute Bill No. 10
1766-
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1771-
1772-APP Joint Favorable Subst.-LCO
1772+HS Joint Favorable C/R APP
17731773