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General Assembly Raised Bill No. 210
February Session, 2024
LCO No. 1097
Referred to Committee on INSURANCE AND REAL ESTATE
Introduced by:
(INS)
AN ACT CONCERNING A STATE -OPERATED REINSURANCE
PROGRAM, HEALTH CARE COST GROWTH AND SITE OF SERVICE
BILLING REQUIREMENTS.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. (NEW) (Effective from passage) (a) For the purposes of this 1
section: 2
(1) "Affordable Care Act" has the same meaning as provided in 3
section 38a-1080 of the general statutes; 4
(2) "Exchange" means the Connecticut Health Insurance Exchange 5
established under section 38a-1081 of the general statutes; 6
(3) "Health benefit plan" has the same meaning as provided in section 7
38a-1080 of the general statutes; and 8
(4) "Office" means the Office of Health Strategy established under 9
section 19a-754a of the general statutes, as amended by this act. 10
(b) The office shall, in conjunction with the Office of Policy and 11
Management, the Insurance Department and the Health Reinsurance 12 Raised Bill No. 210
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Association created under section 38a-556 of the general statutes, seek a 13
state innovation waiver under Section 1332 of the Affordable Care Act 14
to establish a reinsurance program pursuant to subsection (d) of this 15
section. 16
(c) Subject to the approval of a waiver described in subsection (b) of 17
this section, the office, not later than September 1, 2025, for plan year 18
2026, and annually thereafter for the subsequent plan year, shall: 19
(1) Determine the amount needed, not to exceed twenty-one million 20
two hundred ten thousand dollars, annually, to fund the reinsurance 21
program established pursuant to subsection (d) of this section; and 22
(2) Inform the Office of Policy and Management of the amount 23
determined pursuant to subdivision (1) of this subsection. 24
(d) The amount set forth in subsection (c) of this section shall be 25
utilized to establish a reinsurance program for the individual health 26
insurance market designed to lower premiums on health benefit plans 27
sold in such market, on and off the exchange, provided the federal 28
government approves the waiver described in subsection (b) of this 29
section. Any such reinsurance program shall be administered by the 30
Health Reinsurance Association. The State Treasurer shall annually pay 31
the amount as described in subsection (c) of this section for the purpose 32
of administering such reinsurance program. 33
(e) If the waiver described in subsection (b) of this section terminates 34
and the office does not obtain another waiver pursuant to subsection (b) 35
of this section, the State Treasurer shall cease paying the amount 36
described in subsection (c) of this section for the purpose of 37
administering the reinsurance program established pursuant to 38
subsection (d) of this section. 39
Sec. 2. Subsection (b) of section 19a-754a of the 2024 supplement to 40
the general statutes is repealed and the following is substituted in lieu 41
thereof (Effective October 1, 2024): 42 Raised Bill No. 210
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(b) The Office of Health Strategy shall be responsible for the 43
following: 44
(1) Developing and implementing a comprehensive and cohesive 45
health care vision for the state, including, but not limited to, a 46
coordinated state health care cost containment strategy; 47
(2) Promoting effective health planning and the provision of quality 48
health care in the state in a manner that ensures access for all state 49
residents to cost-effective health care services, avoids the duplication of 50
such services and improves the availability and financial stability of 51
such services throughout the state; 52
(3) Directing and overseeing the State Innovation Model Initiative 53
and related successor initiatives; 54
(4) (A) Coordinating the state's health information technology 55
initiatives, (B) seeking funding for and overseeing the planning, 56
implementation and development of policies and procedures for the 57
administration of the all-payer claims database program established 58
under section 19a-775a, (C) establishing and maintaining a consumer 59
health information Internet web site under section 19a-755b, and (D) 60
designating an unclassified individual from the office to perform the 61
duties of a health information technology officer as set forth in sections 62
17b-59f and 17b-59g; 63
(5) Directing and overseeing the Health Systems Planning Unit 64
established under section 19a-612 and all of its duties and 65
responsibilities as set forth in chapter 368z; 66
(6) Convening forums and meetings with state government and 67
external stakeholders, including, but not limited to, the Connecticut 68
Health Insurance Exchange, to discuss health care issues designed to 69
develop effective health care cost and quality strategies; 70
(7) Consulting with the Commissioner of Social Services, Insurance 71
Commissioner and Connecticut Health Insurance Exchange on the 72 Raised Bill No. 210
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Covered Connecticut program described in section 19a-754c; 73
(8) (A) Setting an annual health care cost growth benchmark and 74
primary care spending target pursuant to section 19a-754g, as amended 75
by this act, (B) developing and adopting health care quality benchmarks 76
pursuant to section 19a-754g, as amended by this act, (C) developing 77
strategies, in consultation with stakeholders, to meet such benchmarks 78
and targets developed pursuant to section 19a-754g, as amended by this 79
act, (D) enhancing the transparency of hospitals, as defined in section 80
19a-490, (E) enhancing the transparency of provider entities, as defined 81
in subdivision [(13)] (14) of section 19a-754f, as amended by this act, [(E)] 82
(F) monitoring the development of accountable care organizations and 83
patient-centered medical homes in the state, and [(F)] (G) monitoring 84
the adoption of alternative payment methodologies in the state; and 85
(9) Assist local and regional boards of education in enrolling 86
paraeducators for coverage under (A) the qualified health plans for 87
which such paraeducator may be eligible under section 3-123l, (B) the 88
Covered Connecticut program, established pursuant to section 19a-89
754c, or (C) Medicaid. 90
Sec. 3. Section 19a-754f of the general statutes is repealed and the 91
following is substituted in lieu thereof (Effective October 1, 2024): 92
For the purposes of this section and sections 19a-754g to 19a-754k, 93
inclusive, as amended by this act: 94
(1) "Drug manufacturer" means the manufacturer of a drug that is: 95
(A) Included in the information and data submitted by a health carrier 96
pursuant to section 38a-479qqq, (B) studied or listed pursuant to 97
subsection (c) or (d) of section 19a-754b, or (C) in a therapeutic class of 98
drugs that the executive director determines, through public or private 99
reports, has had a substantial impact on prescription drug expenditures, 100
net of rebates, as a percentage of total health care expenditures; 101
(2) "Executive director" means the executive director of the Office of 102
Health Strategy; 103 Raised Bill No. 210
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(3) "Health care cost growth benchmark" means the annual 104
benchmark established pursuant to section 19a-754g, as amended by 105
this act; 106
(4) "Health care quality benchmark" means an annual benchmark 107
established pursuant to section 19a-754g, as amended by this act; 108
(5) "Health care provider" has the same meaning as provided in 109
subdivision (1) of subsection (a) of section 19a-17b; 110
(6) "Hospital" means any health care facility, as defined in section 19a-111
630, that is licensed as a short-term general hospital by the Department 112
of Public Health; 113
[(6)] (7) "Net cost of private health insurance" means the difference 114
between premiums earned and benefits incurred, and includes insurers' 115
costs of paying bills, advertising, sales commissions, and other 116
administrative costs, net additions or subtractions from reserves, rate 117
credits and dividends, premium taxes and profits or losses; 118
[(7)] (8) "Office" means the Office of Health Strategy established 119
under section 19a-754a, as amended by this act; 120
[(8)] (9) "Other entity" means a drug manufacturer, pharmacy 121
benefits manager or other health care provider that is not considered a 122
provider entity; 123
[(9)] (10) "Payer" means a payer, including Medicaid, Medicare and 124
governmental and nongovernment health plans, and includes any 125
organization acting as payer that is a subsidiary, affiliate or business 126
owned or controlled by a payer that, during a given calendar year, pays 127
health care providers or hospitals for health care services or pharmacies 128
or provider entities for prescription drugs designated by the executive 129
director; 130
[(10)] (11) "Performance year" means the most recent calendar year 131
for which data were submitted for the applicable health care cost growth 132
benchmark, primary care spending target or health care quality 133 Raised Bill No. 210
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benchmark; 134
[(11)] (12) "Pharmacy benefits manager" has the same meaning as 135
provided in subdivision (10) of section 38a-479ooo; 136
[(12)] (13) "Primary care spending target" means the annual target 137
established pursuant to section 19a-754g, as amended by this act; 138
[(13)] (14) "Provider entity" means an organized group of clinicians 139
that come together for the purposes of contracting, or are an established 140
billing unit that, at a minimum, includes primary care providers, and 141
that collectively, during any given calendar year, has enough attributed 142
lives to participate in total cost of care contracts, even if they are not 143
engaged in a total cost of care contract; 144
[(14)] (15) "Potential gross state product" means a forecasted measure 145
of the economy that equals the sum of the (A) expected growth in 146
national labor force productivity, (B) expected growth in the state's labor 147
force, and (C) expected national inflation, minus the expected state 148
population growth; 149
[(15)] (16) "Total health care expenditures" means the sum of all 150
health care expenditures in this state from public and private sources 151
for a given calendar year, including: (A) All claims-based spending paid 152
to providers, net of pharmacy rebates, (B) all patient cost-sharing 153
amounts, and (C) the net cost of private health insurance; and 154
[(16)] (17) "Total medical expense" means the total cost of care for the 155
patient population of a payer or provider entity for a given calendar 156
year, where cost is calculated for such year as the sum of (A) all claims-157
based spending paid to providers by public and private payers, and net 158
of pharmacy rebates, (B) all nonclaims payments for such year, 159
including, but not limited to, incentive payments and care coordination 160
payments, and (C) all patient cost-sharing amounts expressed on a per 161
capita basis for the patient population of a payer or provider entity in 162
this state. 163 Raised Bill No. 210
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Sec. 4. Section 19a-754g of the general statutes is repealed and the 164
following is substituted in lieu thereof (Effective October 1, 2024): 165
(a) Not later than July 1, 2022, the executive director shall publish (1) 166
the health care cost growth benchmarks and annual primary care 167
spending targets as a percentage of total medical expenses for the 168
calendar years 2021 to 2025, inclusive, and (2) the annual health care 169
quality benchmarks for the calendar years 2022 to 2025, inclusive, on the 170
office's Internet web site. 171
(b) (1) (A) Not later than July 1, 2025, and every five years thereafter, 172
the executive director shall develop and adopt annual health care cost 173
growth benchmarks and annual primary care spending targets for the 174
succeeding five calendar years for hospitals, provider entities and 175
payers. 176
(B) In developing the health care cost growth benchmarks and 177
primary care spending targets pursuant to this subdivision, the 178
executive director shall consider (i) any historical and forecasted 179
changes in median income for individuals in the state and the growth 180
rate of potential gross state product, (ii) the rate of inflation, and (iii) the 181
most recent report prepared by the executive director pursuant to 182
subsection (b) of section 19a-754h, as amended by this act. 183
(C) (i) The executive director shall hold at least one informational 184
public hearing prior to adopting the health care cost growth benchmarks 185
and primary care spending targets for each succeeding five-year period 186
described in this subdivision. The executive director may hold 187
informational public hearings concerning any annual health care cost 188
growth benchmark and primary care spending target set pursuant to 189
subsection (a) or subdivision (1) of subsection (b) of this section. Such 190
informational public hearings shall be held at a time and place 191
designated by the executive director in a notice prominently posted by 192
the executive director on the office's Internet web site and in a form and 193
manner prescribed by the executive director. The executive director 194
shall make available on the office's Internet web site a summary of any 195 Raised Bill No. 210
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such informational public hearing and include the executive director's 196
recommendations, if any, to modify or not to modify any such annual 197
benchmark or target. 198
(ii) If the executive director determines, after any informational 199
public hearing held pursuant to this subparagraph, that a modification 200
to any health care cost growth benchmark or annual primary care 201
spending target is, in the executive director's discretion, reasonably 202
warranted, the executive director may modify such benchmark or 203
target. 204
(iii) The executive director shall annually (I) review the current and 205
projected rate of inflation, and (II) include on the office's Internet web 206
site the executive director's findings of such review, including the 207
reasons for making or not making a modification to any applicable 208
health care cost growth benchmark. If the executive director determines 209
that the rate of inflation requires modification of any health care cost 210
growth benchmark adopted under this section, the executive director 211
may modify such benchmark. In such event, the executive director shall 212
not be required to hold an informational public hearing concerning such 213
modified health care cost growth benchmark. 214
(D) The executive director shall post each adopted health care cost 215
growth benchmark and annual primary care spending target on the 216
office's Internet web site. 217
(E) Notwithstanding the provisions of subparagraphs (A) to (D), 218
inclusive, of this subdivision, if the average annual health care cost 219
growth benchmark for a succeeding five-year period described in this 220
subdivision differs from the average annual health care cost growth 221
benchmark for the five-year period preceding such succeeding five-year 222
period by more than one-half of one per cent, the executive director shall 223
submit the annual health care cost growth benchmarks developed for 224
such succeeding five-year period to the joint standing committee of the 225
General Assembly having cognizance of matters relating to insurance 226
for the committee's review and approval. The committee shall be 227 Raised Bill No. 210
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deemed to have approved such annual health care cost growth 228
benchmarks for such succeeding five-year period, except upon a vote to 229
reject such benchmarks by the majority of committee members at a 230
meeting of such committee called for the purpose of reviewing such 231
benchmarks and held not later than thirty days after the executive 232
director submitted such benchmarks to such committee. If the 233
committee votes to reject such benchmarks, the executive director may 234
submit to the committee modified annual health care cost growth 235
benchmarks for such succeeding five-year period for the committee's 236
review and approval in accordance with the provisions of this 237
subparagraph. The executive director shall not be required to hold an 238
informational public hearing concerning such modified benchmarks. 239
Until the joint standing committee of the General Assembly having 240
cognizance of matters relating to insurance approves annual health care 241
cost growth benchmarks for the succeeding five-year period, such 242
benchmarks shall be deemed to be equal to the average annual health 243
care cost growth benchmark for the preceding five-year period. 244
(2) (A) Not later than July 1, 2025, and every five years thereafter, the 245
executive director shall develop and adopt annual health care quality 246
benchmarks for the succeeding five calendar years for hospitals, 247
provider entities and payers. 248
(B) In developing annual health care quality benchmarks pursuant to 249
this subdivision, the executive director shall consider (i) quality 250
measures endorsed by nationally recognized organizations, including, 251
but not limited to, the National Quality Forum, the National Committee 252
for Quality Assurance, the Centers for Medicare and Medicaid Services, 253
the Centers for Disease Control, the Joint Commission and expert 254
organizations that develop health equity measures, and (ii) measures 255
that: (I) Concern health outcomes, overutilization, underutilization and 256
patient safety, (II) meet standards of patient-centeredness and ensure 257
consideration of differences in preferences and clinical characteristics 258
within patient subpopulations, and (III) concern community health or 259
population health. 260 Raised Bill No. 210
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(C) (i) The executive director shall hold at least one informational 261
public hearing prior to adopting the health care quality benchmarks for 262
each succeeding five-year period described in this subdivision. The 263
executive director may hold informational public hearings concerning 264
the quality measures the executive director proposes to adopt as health 265
care quality benchmarks. Such informational public hearings shall be 266
held at a time and place designated by the executive director in a notice 267
prominently posted by the executive director on the office's Internet 268
web site and in a form and manner prescribed by the executive director. 269
The executive director shall make available on the office's Internet web 270
site a summary of any such informational public hearing and include 271
the executive director's recommendations, if any, to modify or not 272
modify any such health care quality benchmark. 273
(ii) If the executive director determines, after any informational 274
public hearing held pursuant to this subparagraph, that modifications 275
to any health care quality benchmarks are, in the executive director's 276
discretion, reasonably warranted, the executive director may modify 277
such quality benchmarks. The executive director shall not be required 278
to hold an additional informational public hearing concerning such 279
modified quality benchmarks. 280
(D) The executive director shall post each adopted health care quality 281
benchmark on the office's Internet web site. 282
(c) The executive director may enter into such contractual agreements 283
as may be necessary to carry out the purposes of this section, including, 284
but not limited to, contractual agreements with actuarial, economic and 285
other experts and consultants. The executive director or the executive 286
director's contractors, in carrying out the purposes of this section, 287
section 19a-754f, as amended by this act, and sections 19a-754h to 288
19a754j, inclusive, as amended by this act, shall utilize currently 289
available data sources, including data available through the all-payer 290
claims database established under section 19a-755a. 291
Sec. 5. Section 19a-754h of the general statutes is repealed and the 292 Raised Bill No. 210
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following is substituted in lieu thereof (Effective October 1, 2024): 293
(a) Not later than August 15, 2022, and annually thereafter, each 294
payer shall report to the executive director, in a form and manner 295
prescribed by the executive director, for the preceding or prior years, if 296
the executive director so requests based on material changes to data 297
previously submitted, aggregated data, including aggregated self-298
funded data as applicable, necessary for the executive director to 299
calculate total health care expenditures, primary care spending as a 300
percentage of total medical expenses and net cost of private health 301
insurance. Each payer shall also disclose, as requested by the executive 302
director, payer data required for adjusting total medical expense 303
calculations to reflect changes in the patient population. 304
(b) Not later than March 31, 2023, and annually thereafter, the 305
executive director shall prepare and post on the office's Internet web 306
site, a report concerning the total health care expenditures utilizing the 307
total aggregate medical expenses reported by payers pursuant to 308
subsection (a) of this section, including, but not limited to, a breakdown 309
of such population-adjusted total medical expenses by payer, hospital 310
and provider entities. The report may include, but shall not be limited 311
to, information regarding the following: 312
(1) Trends in major service category spending; 313
(2) Primary care spending as a percentage of total medical expenses; 314
(3) The net cost of private health insurance by payer by market 315
segment, including individual, small group, large group, self-insured, 316
student and Medicare Advantage markets; and 317
(4) Any other factors the executive director deems relevant to 318
providing context on such data, which shall include, but not be limited 319
to, the following factors: (A) The impact of the rate of inflation and rate 320
of medical inflation; (B) impacts, if any, on access to care; and (C) 321
responses to public health crises or similar emergencies. 322 Raised Bill No. 210
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(c) The executive director shall annually submit a request to the 323
federal Centers for Medicare and Medicaid Services for the unadjusted 324
total medical expenses of Connecticut residents. 325
(d) Not later than August 15, 2023, and annually thereafter, each 326
payer, hospital or provider entity shall report to the executive director 327
in a form and manner prescribed by the executive director, for the 328
preceding year, and for prior years if the executive director so requests 329
based on material changes to data previously submitted, on the health 330
care quality benchmarks adopted pursuant to section 19a-754g, as 331
amended by this act. 332
(e) Not later than March 31, 2024, and annually thereafter, the 333
executive director shall prepare and post on the office's Internet web 334
site, a report concerning health care quality benchmarks reported by 335
payers, hospitals and provider entities pursuant to subsection (d) of this 336
section. 337
(f) The executive director may enter into such contractual agreements 338
as may be necessary to carry out the purposes of this section, including, 339
but not limited to, contractual agreements with actuarial, economic and 340
other experts and consultants. 341
Sec. 6. Subsection (a) of section 19a-754i of the general statutes is 342
repealed and the following is substituted in lieu thereof (Effective October 343
1, 2024): 344
(a) (1) For each calendar year, beginning on January 1, 2023, the 345
executive director shall, if the payer, hospital or provider entity subject 346
to the cost growth benchmark or primary care spending target so 347
requests, meet with such payer, hospital or provider entity to review 348
and validate the total medical expenses data collected pursuant to 349
section 19a-754h, as amended by this act, for such payer, hospital or 350
provider entity. The executive director shall review information 351
provided by the payer, hospital or provider entity and, if deemed 352
necessary, amend findings for such payer, hospital or provider prior to 353
the identification of payer, hospital or provider entities that exceeded 354 Raised Bill No. 210
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the health care cost growth benchmark or failed to meet the primary care 355
spending target for the performance year as set forth in section 19a-754h, 356
as amended by this act. The executive director shall identify, not later 357
than May first of such calendar year, each payer, hospital or provider 358
entity that exceeded the health care cost growth benchmark or failed to 359
meet the primary care spending target for the performance year. 360
(2) For each calendar year beginning on or after January 1, 2024, the 361
executive director shall, if the payer, hospital or provider entity subject 362
to the health care quality benchmarks for the performance year so 363
requests, meet with such payer, hospital or provider entity to review 364
and validate the quality data collected pursuant to section 19a-754h, as 365
amended by this act, for such payer, hospital or provider entity. The 366
executive director shall review information provided by the payer, 367
hospital or provider entity and, if deemed necessary, amend findings 368
for such payer, hospital or provider prior to the identification of payer, 369
hospital or provider entities that exceeded the health care quality 370
benchmark as set forth in section 19a-754h, as amended by this act. The 371
executive director shall identify, not later than May first of such calendar 372
year, each payer, hospital or provider entity that exceeded the health 373
care quality benchmark for the performance year. 374
(3) Not later than thirty days after the executive director identifies 375
each payer, hospital or provider entity pursuant to subdivisions (1) and 376
(2) of this subsection, the executive director shall send a notice to each 377
such payer, hospital or provider entity. Such notice shall be in a form 378
and manner prescribed by the executive director, and shall disclose to 379
each such payer, hospital or provider entity: 380
(A) That the executive director has identified such payer, hospital or 381
provider entity pursuant to subdivision (1) or (2) of this subsection; and 382
(B) The factual basis for the executive director's identification of such 383
payer, hospital or provider entity pursuant to subdivision (1) or (2) of 384
this subsection. 385
Sec. 7. Section 19a-754j of the general statutes is repealed and the 386 Raised Bill No. 210
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following is substituted in lieu thereof (Effective October 1, 2024): 387
(a) (1) Not later than June 30, 2023, and annually thereafter, the 388
executive director shall hold an informational public hearing to 389
compare the growth in total health care expenditures in the performance 390
year to the health care cost growth benchmark established pursuant to 391
section 19a-754g, as amended by this act, for such year. Such hearing 392
shall involve an examination of: 393
(A) The report most recently prepared by the executive director 394
pursuant to subsection (b) of section 19a-754h, as amended by this act; 395
(B) The expenditures of hospitals, provider entities and payers, 396
including, but not limited to, health care cost trends, primary care 397
spending as a percentage of total medical expenses and the factors 398
contributing to such costs and expenditures; and 399
(C) Any other matters that the executive director, in the executive 400
director's discretion, deems relevant for the purposes of this section. 401
(2) The executive director may require any payer, hospital or 402
provider entity that, for the performance year, is found to be a 403
significant contributor to health care cost growth in the state or has 404
failed to meet the primary care spending target, to participate in such 405
hearing. Each such payer, hospital or provider entity that is required to 406
participate in such hearing shall provide testimony on issues identified 407
by the executive director and provide additional information on actions 408
taken to reduce such payer's, hospital's or provider entity's contribution 409
to future state-wide health care costs and expenditures or to increase 410
such payer's, hospital's or provider entity's primary care spending as a 411
percentage of total medical expenses. 412
(3) The executive director may require that any other entity that is 413
found to be a significant contributor to health care cost growth in this 414
state during the performance year participate in such hearing. Any other 415
entity that is required to participate in such hearing shall provide 416
testimony on issues identified by the executive director and provide 417 Raised Bill No. 210
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additional information on actions taken to reduce such other entity's 418
contribution to future state-wide health care costs. If such other entity is 419
a drug manufacturer, and the executive director requires that such drug 420
manufacturer participate in such hearing with respect to a specific drug 421
or class of drugs, such hearing may, to the extent possible, include 422
representatives from at least one brand-name manufacturer, one generic 423
manufacturer and one innovator company that is less than ten years old. 424
(4) Not later than October 15, 2023, and annually thereafter, the 425
executive director shall prepare and submit a report, in accordance with 426
section 11-4a, to the joint standing committees of the General Assembly 427
having cognizance of matters relating to insurance and public health. 428
Such report shall be based on the executive director's analysis of the 429
information submitted during the most recent informational public 430
hearing conducted pursuant to this subsection and any other 431
information that the executive director, in the executive director's 432
discretion, deems relevant for the purposes of this section, and shall: 433
(A) Describe health care spending trends in this state, including, but 434
not limited to, trends in primary care spending as a percentage of total 435
medical expense, and the factors underlying such trends; 436
(B) Include the findings from the report prepared pursuant to 437
subsection (b) of section 19a-754h, as amended by this act; 438
(C) Describe a plan for monitoring any unintended adverse 439
consequences, including, but not limited to, any impacts on funding for 440
individuals with developmental disabilities, resulting from the 441
adoption of cost growth benchmarks and primary care spending targets 442
and the results of any findings from the implementation of such plan; 443
and 444
(D) Disclose the executive director's recommendations, if any, 445
concerning strategies to increase the efficiency of the state's health care 446
system, including, but not limited to, any recommended legislation 447
concerning the state's health care system. 448 Raised Bill No. 210
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(b) (1) Not later than June 30, 2024, and annually thereafter, the 449
executive director shall hold an informational public hearing to 450
compare the performance of payers, hospitals and provider entities in 451
the performance year to the quality benchmarks established for such 452
year pursuant to section 19a-754g, as amended by this act. Such hearing 453
shall include an examination of: 454
(A) The report most recently prepared by the executive director 455
pursuant to subsection (e) of section 19a-754h, as amended by this act; 456
and 457
(B) Any other matters that the executive director, in the executive 458
director's discretion, deems relevant for the purposes of this section. 459
(2) The executive director may require any payer, hospital or 460
provider entity that failed to meet any health care quality benchmarks 461
in this state during the performance year to participate in such hearing. 462
Each such payer, hospital or provider entity that is required to 463
participate in such hearing shall provide testimony on issues identified 464
by the executive director and provide additional information on actions 465
taken to improve such payer's, hospital's or provider entity's quality 466
benchmark performance. 467
(3) Not later than October 15, 2024, and annually thereafter, the 468
executive director shall prepare and submit a report, in accordance with 469
section 11-4a, to the joint standing committees of the General Assembly 470
having cognizance of matters relating to insurance and public health. 471
Such report shall be based on the executive director's analysis of the 472
information submitted during the most recent informational public 473
hearing conducted pursuant to this subsection and any other 474
information that the executive director, in the executive director's 475
discretion, deems relevant for the purposes of this section, and shall: 476
(A) Describe health care quality trends in this state and the factors 477
underlying such trends; 478
(B) Include the findings from the report prepared pursuant to 479 Raised Bill No. 210
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subsection (e) of section 19a-754h, as amended by this act; and 480
(C) Disclose the executive director's recommendations, if any, 481
concerning strategies to improve the quality of the state's health care 482
system, including, but not limited to, any recommended legislation 483
concerning the state's health care system. 484
Sec. 8. (NEW) (Effective October 1, 2024) (a) For the purposes of this 485
section: 486
(1) "Campus" and "hospital-based facility" have the same meanings 487
as provided in section 19a-508c of the general statutes; and 488
(2) "National provider identifier" means a standard, unique health 489
identifier for each health care provider issued by the Centers for 490
Medicare and Medicaid Services' National Plan and Prov ider 491
Enumeration System. 492
(b) On and after January 1, 2025, each hospital-based facility in this 493
state located off-site from a hospital campus shall submit with each 494
claim for reimbursement or payment for health care services provided 495
at such facility, such facility's national provider identifier and federal 496
tax identification number. Such national provider identifier and federal 497
tax identification number shall be (1) separate from any national 498
provider identifier and federal tax identification number issued to such 499
hospital campus, and (2) included on any claim for reimbursement or 500
payment for health care services provided at such facility, regardless of 501
whether such claim or reimbursement is filed or submitted by or 502
through a separate facility or hospital. 503
(c) The Insurance Commissioner may adopt regulations, in 504
accordance with the provisions of chapter 54 of the general statutes, to 505
implement the provisions of this section. 506
This act shall take effect as follows and shall amend the following
sections:
Section 1 from passage New section Raised Bill No. 210
LCO No. 1097 18 of 18
Sec. 2 October 1, 2024 19a-754a(b)
Sec. 3 October 1, 2024 19a-754f
Sec. 4 October 1, 2024 19a-754g
Sec. 5 October 1, 2024 19a-754h
Sec. 6 October 1, 2024 19a-754i(a)
Sec. 7 October 1, 2024 19a-754j
Sec. 8 October 1, 2024 New section
Statement of Purpose:
To: (1) Implement a state-operated reinsurance program; (2) include
hospitals in the health care cost growth and primary care spending
target benchmark program administered by the Office of Health
Strategy; and (3) require hospital-based facilities to submit such facility's
national provider identifier and tax identification number with each
claim for reimbursement.
[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except
that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not
underlined.]