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Connecticut Senate Bill SB00210

Connecticut 2024 Regular Session

Connecticut Senate Bill SB00210 Compare Versions

Only one version of the bill is available at this time.
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33 LCO No. 1097 1 of 18
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55 General Assembly Raised Bill No. 210
66 February Session, 2024
77 LCO No. 1097
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1010 Referred to Committee on INSURANCE AND REAL ESTATE
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1313 Introduced by:
1414 (INS)
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1919 AN ACT CONCERNING A STATE -OPERATED REINSURANCE
2020 PROGRAM, HEALTH CARE COST GROWTH AND SITE OF SERVICE
2121 BILLING REQUIREMENTS.
2222 Be it enacted by the Senate and House of Representatives in General
2323 Assembly convened:
2424
2525 Section 1. (NEW) (Effective from passage) (a) For the purposes of this 1
2626 section: 2
2727 (1) "Affordable Care Act" has the same meaning as provided in 3
2828 section 38a-1080 of the general statutes; 4
2929 (2) "Exchange" means the Connecticut Health Insurance Exchange 5
3030 established under section 38a-1081 of the general statutes; 6
3131 (3) "Health benefit plan" has the same meaning as provided in section 7
3232 38a-1080 of the general statutes; and 8
3333 (4) "Office" means the Office of Health Strategy established under 9
3434 section 19a-754a of the general statutes, as amended by this act. 10
3535 (b) The office shall, in conjunction with the Office of Policy and 11
3636 Management, the Insurance Department and the Health Reinsurance 12 Raised Bill No. 210
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4242 Association created under section 38a-556 of the general statutes, seek a 13
4343 state innovation waiver under Section 1332 of the Affordable Care Act 14
4444 to establish a reinsurance program pursuant to subsection (d) of this 15
4545 section. 16
4646 (c) Subject to the approval of a waiver described in subsection (b) of 17
4747 this section, the office, not later than September 1, 2025, for plan year 18
4848 2026, and annually thereafter for the subsequent plan year, shall: 19
4949 (1) Determine the amount needed, not to exceed twenty-one million 20
5050 two hundred ten thousand dollars, annually, to fund the reinsurance 21
5151 program established pursuant to subsection (d) of this section; and 22
5252 (2) Inform the Office of Policy and Management of the amount 23
5353 determined pursuant to subdivision (1) of this subsection. 24
5454 (d) The amount set forth in subsection (c) of this section shall be 25
5555 utilized to establish a reinsurance program for the individual health 26
5656 insurance market designed to lower premiums on health benefit plans 27
5757 sold in such market, on and off the exchange, provided the federal 28
5858 government approves the waiver described in subsection (b) of this 29
5959 section. Any such reinsurance program shall be administered by the 30
6060 Health Reinsurance Association. The State Treasurer shall annually pay 31
6161 the amount as described in subsection (c) of this section for the purpose 32
6262 of administering such reinsurance program. 33
6363 (e) If the waiver described in subsection (b) of this section terminates 34
6464 and the office does not obtain another waiver pursuant to subsection (b) 35
6565 of this section, the State Treasurer shall cease paying the amount 36
6666 described in subsection (c) of this section for the purpose of 37
6767 administering the reinsurance program established pursuant to 38
6868 subsection (d) of this section. 39
6969 Sec. 2. Subsection (b) of section 19a-754a of the 2024 supplement to 40
7070 the general statutes is repealed and the following is substituted in lieu 41
7171 thereof (Effective October 1, 2024): 42 Raised Bill No. 210
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7777 (b) The Office of Health Strategy shall be responsible for the 43
7878 following: 44
7979 (1) Developing and implementing a comprehensive and cohesive 45
8080 health care vision for the state, including, but not limited to, a 46
8181 coordinated state health care cost containment strategy; 47
8282 (2) Promoting effective health planning and the provision of quality 48
8383 health care in the state in a manner that ensures access for all state 49
8484 residents to cost-effective health care services, avoids the duplication of 50
8585 such services and improves the availability and financial stability of 51
8686 such services throughout the state; 52
8787 (3) Directing and overseeing the State Innovation Model Initiative 53
8888 and related successor initiatives; 54
8989 (4) (A) Coordinating the state's health information technology 55
9090 initiatives, (B) seeking funding for and overseeing the planning, 56
9191 implementation and development of policies and procedures for the 57
9292 administration of the all-payer claims database program established 58
9393 under section 19a-775a, (C) establishing and maintaining a consumer 59
9494 health information Internet web site under section 19a-755b, and (D) 60
9595 designating an unclassified individual from the office to perform the 61
9696 duties of a health information technology officer as set forth in sections 62
9797 17b-59f and 17b-59g; 63
9898 (5) Directing and overseeing the Health Systems Planning Unit 64
9999 established under section 19a-612 and all of its duties and 65
100100 responsibilities as set forth in chapter 368z; 66
101101 (6) Convening forums and meetings with state government and 67
102102 external stakeholders, including, but not limited to, the Connecticut 68
103103 Health Insurance Exchange, to discuss health care issues designed to 69
104104 develop effective health care cost and quality strategies; 70
105105 (7) Consulting with the Commissioner of Social Services, Insurance 71
106106 Commissioner and Connecticut Health Insurance Exchange on the 72 Raised Bill No. 210
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108108
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112112 Covered Connecticut program described in section 19a-754c; 73
113113 (8) (A) Setting an annual health care cost growth benchmark and 74
114114 primary care spending target pursuant to section 19a-754g, as amended 75
115115 by this act, (B) developing and adopting health care quality benchmarks 76
116116 pursuant to section 19a-754g, as amended by this act, (C) developing 77
117117 strategies, in consultation with stakeholders, to meet such benchmarks 78
118118 and targets developed pursuant to section 19a-754g, as amended by this 79
119119 act, (D) enhancing the transparency of hospitals, as defined in section 80
120120 19a-490, (E) enhancing the transparency of provider entities, as defined 81
121121 in subdivision [(13)] (14) of section 19a-754f, as amended by this act, [(E)] 82
122122 (F) monitoring the development of accountable care organizations and 83
123123 patient-centered medical homes in the state, and [(F)] (G) monitoring 84
124124 the adoption of alternative payment methodologies in the state; and 85
125125 (9) Assist local and regional boards of education in enrolling 86
126126 paraeducators for coverage under (A) the qualified health plans for 87
127127 which such paraeducator may be eligible under section 3-123l, (B) the 88
128128 Covered Connecticut program, established pursuant to section 19a-89
129129 754c, or (C) Medicaid. 90
130130 Sec. 3. Section 19a-754f of the general statutes is repealed and the 91
131131 following is substituted in lieu thereof (Effective October 1, 2024): 92
132132 For the purposes of this section and sections 19a-754g to 19a-754k, 93
133133 inclusive, as amended by this act: 94
134134 (1) "Drug manufacturer" means the manufacturer of a drug that is: 95
135135 (A) Included in the information and data submitted by a health carrier 96
136136 pursuant to section 38a-479qqq, (B) studied or listed pursuant to 97
137137 subsection (c) or (d) of section 19a-754b, or (C) in a therapeutic class of 98
138138 drugs that the executive director determines, through public or private 99
139139 reports, has had a substantial impact on prescription drug expenditures, 100
140140 net of rebates, as a percentage of total health care expenditures; 101
141141 (2) "Executive director" means the executive director of the Office of 102
142142 Health Strategy; 103 Raised Bill No. 210
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148148 (3) "Health care cost growth benchmark" means the annual 104
149149 benchmark established pursuant to section 19a-754g, as amended by 105
150150 this act; 106
151151 (4) "Health care quality benchmark" means an annual benchmark 107
152152 established pursuant to section 19a-754g, as amended by this act; 108
153153 (5) "Health care provider" has the same meaning as provided in 109
154154 subdivision (1) of subsection (a) of section 19a-17b; 110
155155 (6) "Hospital" means any health care facility, as defined in section 19a-111
156156 630, that is licensed as a short-term general hospital by the Department 112
157157 of Public Health; 113
158158 [(6)] (7) "Net cost of private health insurance" means the difference 114
159159 between premiums earned and benefits incurred, and includes insurers' 115
160160 costs of paying bills, advertising, sales commissions, and other 116
161161 administrative costs, net additions or subtractions from reserves, rate 117
162162 credits and dividends, premium taxes and profits or losses; 118
163163 [(7)] (8) "Office" means the Office of Health Strategy established 119
164164 under section 19a-754a, as amended by this act; 120
165165 [(8)] (9) "Other entity" means a drug manufacturer, pharmacy 121
166166 benefits manager or other health care provider that is not considered a 122
167167 provider entity; 123
168168 [(9)] (10) "Payer" means a payer, including Medicaid, Medicare and 124
169169 governmental and nongovernment health plans, and includes any 125
170170 organization acting as payer that is a subsidiary, affiliate or business 126
171171 owned or controlled by a payer that, during a given calendar year, pays 127
172172 health care providers or hospitals for health care services or pharmacies 128
173173 or provider entities for prescription drugs designated by the executive 129
174174 director; 130
175175 [(10)] (11) "Performance year" means the most recent calendar year 131
176176 for which data were submitted for the applicable health care cost growth 132
177177 benchmark, primary care spending target or health care quality 133 Raised Bill No. 210
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183183 benchmark; 134
184184 [(11)] (12) "Pharmacy benefits manager" has the same meaning as 135
185185 provided in subdivision (10) of section 38a-479ooo; 136
186186 [(12)] (13) "Primary care spending target" means the annual target 137
187187 established pursuant to section 19a-754g, as amended by this act; 138
188188 [(13)] (14) "Provider entity" means an organized group of clinicians 139
189189 that come together for the purposes of contracting, or are an established 140
190190 billing unit that, at a minimum, includes primary care providers, and 141
191191 that collectively, during any given calendar year, has enough attributed 142
192192 lives to participate in total cost of care contracts, even if they are not 143
193193 engaged in a total cost of care contract; 144
194194 [(14)] (15) "Potential gross state product" means a forecasted measure 145
195195 of the economy that equals the sum of the (A) expected growth in 146
196196 national labor force productivity, (B) expected growth in the state's labor 147
197197 force, and (C) expected national inflation, minus the expected state 148
198198 population growth; 149
199199 [(15)] (16) "Total health care expenditures" means the sum of all 150
200200 health care expenditures in this state from public and private sources 151
201201 for a given calendar year, including: (A) All claims-based spending paid 152
202202 to providers, net of pharmacy rebates, (B) all patient cost-sharing 153
203203 amounts, and (C) the net cost of private health insurance; and 154
204204 [(16)] (17) "Total medical expense" means the total cost of care for the 155
205205 patient population of a payer or provider entity for a given calendar 156
206206 year, where cost is calculated for such year as the sum of (A) all claims-157
207207 based spending paid to providers by public and private payers, and net 158
208208 of pharmacy rebates, (B) all nonclaims payments for such year, 159
209209 including, but not limited to, incentive payments and care coordination 160
210210 payments, and (C) all patient cost-sharing amounts expressed on a per 161
211211 capita basis for the patient population of a payer or provider entity in 162
212212 this state. 163 Raised Bill No. 210
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218218 Sec. 4. Section 19a-754g of the general statutes is repealed and the 164
219219 following is substituted in lieu thereof (Effective October 1, 2024): 165
220220 (a) Not later than July 1, 2022, the executive director shall publish (1) 166
221221 the health care cost growth benchmarks and annual primary care 167
222222 spending targets as a percentage of total medical expenses for the 168
223223 calendar years 2021 to 2025, inclusive, and (2) the annual health care 169
224224 quality benchmarks for the calendar years 2022 to 2025, inclusive, on the 170
225225 office's Internet web site. 171
226226 (b) (1) (A) Not later than July 1, 2025, and every five years thereafter, 172
227227 the executive director shall develop and adopt annual health care cost 173
228228 growth benchmarks and annual primary care spending targets for the 174
229229 succeeding five calendar years for hospitals, provider entities and 175
230230 payers. 176
231231 (B) In developing the health care cost growth benchmarks and 177
232232 primary care spending targets pursuant to this subdivision, the 178
233233 executive director shall consider (i) any historical and forecasted 179
234234 changes in median income for individuals in the state and the growth 180
235235 rate of potential gross state product, (ii) the rate of inflation, and (iii) the 181
236236 most recent report prepared by the executive director pursuant to 182
237237 subsection (b) of section 19a-754h, as amended by this act. 183
238238 (C) (i) The executive director shall hold at least one informational 184
239239 public hearing prior to adopting the health care cost growth benchmarks 185
240240 and primary care spending targets for each succeeding five-year period 186
241241 described in this subdivision. The executive director may hold 187
242242 informational public hearings concerning any annual health care cost 188
243243 growth benchmark and primary care spending target set pursuant to 189
244244 subsection (a) or subdivision (1) of subsection (b) of this section. Such 190
245245 informational public hearings shall be held at a time and place 191
246246 designated by the executive director in a notice prominently posted by 192
247247 the executive director on the office's Internet web site and in a form and 193
248248 manner prescribed by the executive director. The executive director 194
249249 shall make available on the office's Internet web site a summary of any 195 Raised Bill No. 210
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255255 such informational public hearing and include the executive director's 196
256256 recommendations, if any, to modify or not to modify any such annual 197
257257 benchmark or target. 198
258258 (ii) If the executive director determines, after any informational 199
259259 public hearing held pursuant to this subparagraph, that a modification 200
260260 to any health care cost growth benchmark or annual primary care 201
261261 spending target is, in the executive director's discretion, reasonably 202
262262 warranted, the executive director may modify such benchmark or 203
263263 target. 204
264264 (iii) The executive director shall annually (I) review the current and 205
265265 projected rate of inflation, and (II) include on the office's Internet web 206
266266 site the executive director's findings of such review, including the 207
267267 reasons for making or not making a modification to any applicable 208
268268 health care cost growth benchmark. If the executive director determines 209
269269 that the rate of inflation requires modification of any health care cost 210
270270 growth benchmark adopted under this section, the executive director 211
271271 may modify such benchmark. In such event, the executive director shall 212
272272 not be required to hold an informational public hearing concerning such 213
273273 modified health care cost growth benchmark. 214
274274 (D) The executive director shall post each adopted health care cost 215
275275 growth benchmark and annual primary care spending target on the 216
276276 office's Internet web site. 217
277277 (E) Notwithstanding the provisions of subparagraphs (A) to (D), 218
278278 inclusive, of this subdivision, if the average annual health care cost 219
279279 growth benchmark for a succeeding five-year period described in this 220
280280 subdivision differs from the average annual health care cost growth 221
281281 benchmark for the five-year period preceding such succeeding five-year 222
282282 period by more than one-half of one per cent, the executive director shall 223
283283 submit the annual health care cost growth benchmarks developed for 224
284284 such succeeding five-year period to the joint standing committee of the 225
285285 General Assembly having cognizance of matters relating to insurance 226
286286 for the committee's review and approval. The committee shall be 227 Raised Bill No. 210
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292292 deemed to have approved such annual health care cost growth 228
293293 benchmarks for such succeeding five-year period, except upon a vote to 229
294294 reject such benchmarks by the majority of committee members at a 230
295295 meeting of such committee called for the purpose of reviewing such 231
296296 benchmarks and held not later than thirty days after the executive 232
297297 director submitted such benchmarks to such committee. If the 233
298298 committee votes to reject such benchmarks, the executive director may 234
299299 submit to the committee modified annual health care cost growth 235
300300 benchmarks for such succeeding five-year period for the committee's 236
301301 review and approval in accordance with the provisions of this 237
302302 subparagraph. The executive director shall not be required to hold an 238
303303 informational public hearing concerning such modified benchmarks. 239
304304 Until the joint standing committee of the General Assembly having 240
305305 cognizance of matters relating to insurance approves annual health care 241
306306 cost growth benchmarks for the succeeding five-year period, such 242
307307 benchmarks shall be deemed to be equal to the average annual health 243
308308 care cost growth benchmark for the preceding five-year period. 244
309309 (2) (A) Not later than July 1, 2025, and every five years thereafter, the 245
310310 executive director shall develop and adopt annual health care quality 246
311311 benchmarks for the succeeding five calendar years for hospitals, 247
312312 provider entities and payers. 248
313313 (B) In developing annual health care quality benchmarks pursuant to 249
314314 this subdivision, the executive director shall consider (i) quality 250
315315 measures endorsed by nationally recognized organizations, including, 251
316316 but not limited to, the National Quality Forum, the National Committee 252
317317 for Quality Assurance, the Centers for Medicare and Medicaid Services, 253
318318 the Centers for Disease Control, the Joint Commission and expert 254
319319 organizations that develop health equity measures, and (ii) measures 255
320320 that: (I) Concern health outcomes, overutilization, underutilization and 256
321321 patient safety, (II) meet standards of patient-centeredness and ensure 257
322322 consideration of differences in preferences and clinical characteristics 258
323323 within patient subpopulations, and (III) concern community health or 259
324324 population health. 260 Raised Bill No. 210
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330330 (C) (i) The executive director shall hold at least one informational 261
331331 public hearing prior to adopting the health care quality benchmarks for 262
332332 each succeeding five-year period described in this subdivision. The 263
333333 executive director may hold informational public hearings concerning 264
334334 the quality measures the executive director proposes to adopt as health 265
335335 care quality benchmarks. Such informational public hearings shall be 266
336336 held at a time and place designated by the executive director in a notice 267
337337 prominently posted by the executive director on the office's Internet 268
338338 web site and in a form and manner prescribed by the executive director. 269
339339 The executive director shall make available on the office's Internet web 270
340340 site a summary of any such informational public hearing and include 271
341341 the executive director's recommendations, if any, to modify or not 272
342342 modify any such health care quality benchmark. 273
343343 (ii) If the executive director determines, after any informational 274
344344 public hearing held pursuant to this subparagraph, that modifications 275
345345 to any health care quality benchmarks are, in the executive director's 276
346346 discretion, reasonably warranted, the executive director may modify 277
347347 such quality benchmarks. The executive director shall not be required 278
348348 to hold an additional informational public hearing concerning such 279
349349 modified quality benchmarks. 280
350350 (D) The executive director shall post each adopted health care quality 281
351351 benchmark on the office's Internet web site. 282
352352 (c) The executive director may enter into such contractual agreements 283
353353 as may be necessary to carry out the purposes of this section, including, 284
354354 but not limited to, contractual agreements with actuarial, economic and 285
355355 other experts and consultants. The executive director or the executive 286
356356 director's contractors, in carrying out the purposes of this section, 287
357357 section 19a-754f, as amended by this act, and sections 19a-754h to 288
358358 19a754j, inclusive, as amended by this act, shall utilize currently 289
359359 available data sources, including data available through the all-payer 290
360360 claims database established under section 19a-755a. 291
361361 Sec. 5. Section 19a-754h of the general statutes is repealed and the 292 Raised Bill No. 210
362362
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366366
367367 following is substituted in lieu thereof (Effective October 1, 2024): 293
368368 (a) Not later than August 15, 2022, and annually thereafter, each 294
369369 payer shall report to the executive director, in a form and manner 295
370370 prescribed by the executive director, for the preceding or prior years, if 296
371371 the executive director so requests based on material changes to data 297
372372 previously submitted, aggregated data, including aggregated self-298
373373 funded data as applicable, necessary for the executive director to 299
374374 calculate total health care expenditures, primary care spending as a 300
375375 percentage of total medical expenses and net cost of private health 301
376376 insurance. Each payer shall also disclose, as requested by the executive 302
377377 director, payer data required for adjusting total medical expense 303
378378 calculations to reflect changes in the patient population. 304
379379 (b) Not later than March 31, 2023, and annually thereafter, the 305
380380 executive director shall prepare and post on the office's Internet web 306
381381 site, a report concerning the total health care expenditures utilizing the 307
382382 total aggregate medical expenses reported by payers pursuant to 308
383383 subsection (a) of this section, including, but not limited to, a breakdown 309
384384 of such population-adjusted total medical expenses by payer, hospital 310
385385 and provider entities. The report may include, but shall not be limited 311
386386 to, information regarding the following: 312
387387 (1) Trends in major service category spending; 313
388388 (2) Primary care spending as a percentage of total medical expenses; 314
389389 (3) The net cost of private health insurance by payer by market 315
390390 segment, including individual, small group, large group, self-insured, 316
391391 student and Medicare Advantage markets; and 317
392392 (4) Any other factors the executive director deems relevant to 318
393393 providing context on such data, which shall include, but not be limited 319
394394 to, the following factors: (A) The impact of the rate of inflation and rate 320
395395 of medical inflation; (B) impacts, if any, on access to care; and (C) 321
396396 responses to public health crises or similar emergencies. 322 Raised Bill No. 210
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402402 (c) The executive director shall annually submit a request to the 323
403403 federal Centers for Medicare and Medicaid Services for the unadjusted 324
404404 total medical expenses of Connecticut residents. 325
405405 (d) Not later than August 15, 2023, and annually thereafter, each 326
406406 payer, hospital or provider entity shall report to the executive director 327
407407 in a form and manner prescribed by the executive director, for the 328
408408 preceding year, and for prior years if the executive director so requests 329
409409 based on material changes to data previously submitted, on the health 330
410410 care quality benchmarks adopted pursuant to section 19a-754g, as 331
411411 amended by this act. 332
412412 (e) Not later than March 31, 2024, and annually thereafter, the 333
413413 executive director shall prepare and post on the office's Internet web 334
414414 site, a report concerning health care quality benchmarks reported by 335
415415 payers, hospitals and provider entities pursuant to subsection (d) of this 336
416416 section. 337
417417 (f) The executive director may enter into such contractual agreements 338
418418 as may be necessary to carry out the purposes of this section, including, 339
419419 but not limited to, contractual agreements with actuarial, economic and 340
420420 other experts and consultants. 341
421421 Sec. 6. Subsection (a) of section 19a-754i of the general statutes is 342
422422 repealed and the following is substituted in lieu thereof (Effective October 343
423423 1, 2024): 344
424424 (a) (1) For each calendar year, beginning on January 1, 2023, the 345
425425 executive director shall, if the payer, hospital or provider entity subject 346
426426 to the cost growth benchmark or primary care spending target so 347
427427 requests, meet with such payer, hospital or provider entity to review 348
428428 and validate the total medical expenses data collected pursuant to 349
429429 section 19a-754h, as amended by this act, for such payer, hospital or 350
430430 provider entity. The executive director shall review information 351
431431 provided by the payer, hospital or provider entity and, if deemed 352
432432 necessary, amend findings for such payer, hospital or provider prior to 353
433433 the identification of payer, hospital or provider entities that exceeded 354 Raised Bill No. 210
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439439 the health care cost growth benchmark or failed to meet the primary care 355
440440 spending target for the performance year as set forth in section 19a-754h, 356
441441 as amended by this act. The executive director shall identify, not later 357
442442 than May first of such calendar year, each payer, hospital or provider 358
443443 entity that exceeded the health care cost growth benchmark or failed to 359
444444 meet the primary care spending target for the performance year. 360
445445 (2) For each calendar year beginning on or after January 1, 2024, the 361
446446 executive director shall, if the payer, hospital or provider entity subject 362
447447 to the health care quality benchmarks for the performance year so 363
448448 requests, meet with such payer, hospital or provider entity to review 364
449449 and validate the quality data collected pursuant to section 19a-754h, as 365
450450 amended by this act, for such payer, hospital or provider entity. The 366
451451 executive director shall review information provided by the payer, 367
452452 hospital or provider entity and, if deemed necessary, amend findings 368
453453 for such payer, hospital or provider prior to the identification of payer, 369
454454 hospital or provider entities that exceeded the health care quality 370
455455 benchmark as set forth in section 19a-754h, as amended by this act. The 371
456456 executive director shall identify, not later than May first of such calendar 372
457457 year, each payer, hospital or provider entity that exceeded the health 373
458458 care quality benchmark for the performance year. 374
459459 (3) Not later than thirty days after the executive director identifies 375
460460 each payer, hospital or provider entity pursuant to subdivisions (1) and 376
461461 (2) of this subsection, the executive director shall send a notice to each 377
462462 such payer, hospital or provider entity. Such notice shall be in a form 378
463463 and manner prescribed by the executive director, and shall disclose to 379
464464 each such payer, hospital or provider entity: 380
465465 (A) That the executive director has identified such payer, hospital or 381
466466 provider entity pursuant to subdivision (1) or (2) of this subsection; and 382
467467 (B) The factual basis for the executive director's identification of such 383
468468 payer, hospital or provider entity pursuant to subdivision (1) or (2) of 384
469469 this subsection. 385
470470 Sec. 7. Section 19a-754j of the general statutes is repealed and the 386 Raised Bill No. 210
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476476 following is substituted in lieu thereof (Effective October 1, 2024): 387
477477 (a) (1) Not later than June 30, 2023, and annually thereafter, the 388
478478 executive director shall hold an informational public hearing to 389
479479 compare the growth in total health care expenditures in the performance 390
480480 year to the health care cost growth benchmark established pursuant to 391
481481 section 19a-754g, as amended by this act, for such year. Such hearing 392
482482 shall involve an examination of: 393
483483 (A) The report most recently prepared by the executive director 394
484484 pursuant to subsection (b) of section 19a-754h, as amended by this act; 395
485485 (B) The expenditures of hospitals, provider entities and payers, 396
486486 including, but not limited to, health care cost trends, primary care 397
487487 spending as a percentage of total medical expenses and the factors 398
488488 contributing to such costs and expenditures; and 399
489489 (C) Any other matters that the executive director, in the executive 400
490490 director's discretion, deems relevant for the purposes of this section. 401
491491 (2) The executive director may require any payer, hospital or 402
492492 provider entity that, for the performance year, is found to be a 403
493493 significant contributor to health care cost growth in the state or has 404
494494 failed to meet the primary care spending target, to participate in such 405
495495 hearing. Each such payer, hospital or provider entity that is required to 406
496496 participate in such hearing shall provide testimony on issues identified 407
497497 by the executive director and provide additional information on actions 408
498498 taken to reduce such payer's, hospital's or provider entity's contribution 409
499499 to future state-wide health care costs and expenditures or to increase 410
500500 such payer's, hospital's or provider entity's primary care spending as a 411
501501 percentage of total medical expenses. 412
502502 (3) The executive director may require that any other entity that is 413
503503 found to be a significant contributor to health care cost growth in this 414
504504 state during the performance year participate in such hearing. Any other 415
505505 entity that is required to participate in such hearing shall provide 416
506506 testimony on issues identified by the executive director and provide 417 Raised Bill No. 210
507507
508508
509509
510510 LCO No. 1097 15 of 18
511511
512512 additional information on actions taken to reduce such other entity's 418
513513 contribution to future state-wide health care costs. If such other entity is 419
514514 a drug manufacturer, and the executive director requires that such drug 420
515515 manufacturer participate in such hearing with respect to a specific drug 421
516516 or class of drugs, such hearing may, to the extent possible, include 422
517517 representatives from at least one brand-name manufacturer, one generic 423
518518 manufacturer and one innovator company that is less than ten years old. 424
519519 (4) Not later than October 15, 2023, and annually thereafter, the 425
520520 executive director shall prepare and submit a report, in accordance with 426
521521 section 11-4a, to the joint standing committees of the General Assembly 427
522522 having cognizance of matters relating to insurance and public health. 428
523523 Such report shall be based on the executive director's analysis of the 429
524524 information submitted during the most recent informational public 430
525525 hearing conducted pursuant to this subsection and any other 431
526526 information that the executive director, in the executive director's 432
527527 discretion, deems relevant for the purposes of this section, and shall: 433
528528 (A) Describe health care spending trends in this state, including, but 434
529529 not limited to, trends in primary care spending as a percentage of total 435
530530 medical expense, and the factors underlying such trends; 436
531531 (B) Include the findings from the report prepared pursuant to 437
532532 subsection (b) of section 19a-754h, as amended by this act; 438
533533 (C) Describe a plan for monitoring any unintended adverse 439
534534 consequences, including, but not limited to, any impacts on funding for 440
535535 individuals with developmental disabilities, resulting from the 441
536536 adoption of cost growth benchmarks and primary care spending targets 442
537537 and the results of any findings from the implementation of such plan; 443
538538 and 444
539539 (D) Disclose the executive director's recommendations, if any, 445
540540 concerning strategies to increase the efficiency of the state's health care 446
541541 system, including, but not limited to, any recommended legislation 447
542542 concerning the state's health care system. 448 Raised Bill No. 210
543543
544544
545545
546546 LCO No. 1097 16 of 18
547547
548548 (b) (1) Not later than June 30, 2024, and annually thereafter, the 449
549549 executive director shall hold an informational public hearing to 450
550550 compare the performance of payers, hospitals and provider entities in 451
551551 the performance year to the quality benchmarks established for such 452
552552 year pursuant to section 19a-754g, as amended by this act. Such hearing 453
553553 shall include an examination of: 454
554554 (A) The report most recently prepared by the executive director 455
555555 pursuant to subsection (e) of section 19a-754h, as amended by this act; 456
556556 and 457
557557 (B) Any other matters that the executive director, in the executive 458
558558 director's discretion, deems relevant for the purposes of this section. 459
559559 (2) The executive director may require any payer, hospital or 460
560560 provider entity that failed to meet any health care quality benchmarks 461
561561 in this state during the performance year to participate in such hearing. 462
562562 Each such payer, hospital or provider entity that is required to 463
563563 participate in such hearing shall provide testimony on issues identified 464
564564 by the executive director and provide additional information on actions 465
565565 taken to improve such payer's, hospital's or provider entity's quality 466
566566 benchmark performance. 467
567567 (3) Not later than October 15, 2024, and annually thereafter, the 468
568568 executive director shall prepare and submit a report, in accordance with 469
569569 section 11-4a, to the joint standing committees of the General Assembly 470
570570 having cognizance of matters relating to insurance and public health. 471
571571 Such report shall be based on the executive director's analysis of the 472
572572 information submitted during the most recent informational public 473
573573 hearing conducted pursuant to this subsection and any other 474
574574 information that the executive director, in the executive director's 475
575575 discretion, deems relevant for the purposes of this section, and shall: 476
576576 (A) Describe health care quality trends in this state and the factors 477
577577 underlying such trends; 478
578578 (B) Include the findings from the report prepared pursuant to 479 Raised Bill No. 210
579579
580580
581581
582582 LCO No. 1097 17 of 18
583583
584584 subsection (e) of section 19a-754h, as amended by this act; and 480
585585 (C) Disclose the executive director's recommendations, if any, 481
586586 concerning strategies to improve the quality of the state's health care 482
587587 system, including, but not limited to, any recommended legislation 483
588588 concerning the state's health care system. 484
589589 Sec. 8. (NEW) (Effective October 1, 2024) (a) For the purposes of this 485
590590 section: 486
591591 (1) "Campus" and "hospital-based facility" have the same meanings 487
592592 as provided in section 19a-508c of the general statutes; and 488
593593 (2) "National provider identifier" means a standard, unique health 489
594594 identifier for each health care provider issued by the Centers for 490
595595 Medicare and Medicaid Services' National Plan and Prov ider 491
596596 Enumeration System. 492
597597 (b) On and after January 1, 2025, each hospital-based facility in this 493
598598 state located off-site from a hospital campus shall submit with each 494
599599 claim for reimbursement or payment for health care services provided 495
600600 at such facility, such facility's national provider identifier and federal 496
601601 tax identification number. Such national provider identifier and federal 497
602602 tax identification number shall be (1) separate from any national 498
603603 provider identifier and federal tax identification number issued to such 499
604604 hospital campus, and (2) included on any claim for reimbursement or 500
605605 payment for health care services provided at such facility, regardless of 501
606606 whether such claim or reimbursement is filed or submitted by or 502
607607 through a separate facility or hospital. 503
608608 (c) The Insurance Commissioner may adopt regulations, in 504
609609 accordance with the provisions of chapter 54 of the general statutes, to 505
610610 implement the provisions of this section. 506
611611 This act shall take effect as follows and shall amend the following
612612 sections:
613613
614614 Section 1 from passage New section Raised Bill No. 210
615615
616616
617617
618618 LCO No. 1097 18 of 18
619619
620620 Sec. 2 October 1, 2024 19a-754a(b)
621621 Sec. 3 October 1, 2024 19a-754f
622622 Sec. 4 October 1, 2024 19a-754g
623623 Sec. 5 October 1, 2024 19a-754h
624624 Sec. 6 October 1, 2024 19a-754i(a)
625625 Sec. 7 October 1, 2024 19a-754j
626626 Sec. 8 October 1, 2024 New section
627627
628628 Statement of Purpose:
629629 To: (1) Implement a state-operated reinsurance program; (2) include
630630 hospitals in the health care cost growth and primary care spending
631631 target benchmark program administered by the Office of Health
632632 Strategy; and (3) require hospital-based facilities to submit such facility's
633633 national provider identifier and tax identification number with each
634634 claim for reimbursement.
635635 [Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except
636636 that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not
637637 underlined.]