AN ACT CONCERNING THE CHARTER OAK HEALTH PLAN AND HEALTH CARE ACCESS.

This bill attempts to reduce the number of uninsured state residents in several ways. It:

1. establishes a Charter Oak Health Plan for residents who have been uninsured for at least six months and are ineligible for publicly funded health care,

2. provides premium assistance for the plan for residents with incomes below 300% of the federal poverty level (FPL) (currently $ 51,510 annually for a family of three),

3. provides for automatic enrollment of newborns in HUSKY, and

4. requires local school boards to report the number of students who lack insurance.

The bill also creates two task forces, one addressing the shortage of providers in HUSKY and the other the use of electronic health information technology.

The bill makes the performance of HUSKY and Charter Oak Health Plan managed care contracts a governmental function under the Freedom of Information Act (FOIA), regardless of the value of the contract.

EFFECTIVE DATE: July 1, 2007 except for the provisions concerning the FOIA and task forces, which are effective upon passage.

In establishing the plan, the bill authorizes the Department of Social Services (DSS) commissioner to enter into contracts to provide comprehensive health care for the state's uninsured residents. It requires the commissioner to conduct outreach to facilitate enrollment in the plan.

The bill requires the DSS commissioner to impose cost sharing for plan participants. This may include:

1. monthly premiums;

2. a maximum $ 1,000 annual deductible;

3. coinsurance of no more than 20%, once the deductible is met;

4. tiered co-payments for prescription drugs, depending on whether the drug is on a formulary, is a brand name, or whether it is mail-ordered;

5. no fees for emergency visits to hospital emergency rooms and a maximum $ 150 fee for nonemergency visits; and

6. a $ 1 million lifetime benefit limit.

Residents purchasing the insurance pay premiums directly to the insurer and qualify for premium assistance if their income is less than 300% of the FPL. The assistance amounts are shown below.

*Income Level*	*Monthly Premium Assistance*
Below 150% of FPL	$ 175
150% to 185% of FPL	$ 150
185% to 235% of FPL	$ 75
235% to 300% of FPL	$ 50

The bill requires the DSS commissioner to determine minimum requirements for the plan's amount, duration, and scope of benefits, which cannot include a pre-existing condition exclusion. Each participating insurer must provide an internal grievance process through which an insured person can request and receive a review of any coverage denial.

The bill authorizes DSS to contract with any of the following entities to provide coverage:

1. managed care organizations,

2. a consortium of federally qualified health centers and other state-funded, community-based health care providers; and

3. other health care provider consortia established to serve plan participants.

The bill specifies that the above consortia are not subject to the laws governing MCOs, hospital service corporations, and medical service corporations. These laws include annual financial filings with the Department of Insurance (DOI), DOI rate approval, and investment limitations.

Before these providers may participate in the plan, the DSS commissioner must certify them according to criteria he or she establishes, which must include minimum reserve fund requirements.

The bill requires the commissioner to seek proposals from the entities based on the cost-sharing and benefits (presumably those that the entities offer). It allows the commissioner to approve an alternative plan to make coverage options available to eligible residents.

The bill permits the DSS commissioner to implement policies and procedures for administering the plan while in the process of adopting them as regulations, if notice of intent to adopt the regulations is published in the Connecticut Law Journal within 20 days of implementation. The policies and procedures are valid until the regulations are adopted.

The bill allows the policies and regulations to include an exception to the six-month period of noninsurance and requirements for open enrollment periods, and limiting enrollees' ability to change plans between these periods.

The bill requires that any uninsured child born in a Connecticut hospital or “eligible border hospital” to be enrolled in HUSKY B on an “expedited” basis when (1) the child's family lives in the state and (2) a parent of the child authorizes the enrollment. It requires the DSS commissioner to pay the MCO that the family chooses the first two months of premiums that the family would otherwise have to pay.

Likewise, the bill requires HUSKY A eligibility to be granted “presumptively” to uninsured newborns born in these hospitals if the same two conditions are met.

The bill requires local or regional school boards to require all students in their jurisdiction to report whether they have health insurance. The DSS commissioner, or his designee, must provide information to the boards on state-sponsored health insurance programs for children, including application assistance. The boards must provide this information, and application assistance, to the student's parent or guardian.

The bill requires that certain language be included in contracts and related documents between DSS and managed care organizations serving individuals receiving HUSKY or Charter Oak Health Plan benefits. It specifies that these include (1) contracts and agreements with providers and subcontractors, (2) documents concerning rates paid to them, and (3) documents concerning operational standards. The requirement applies to contracts of any value.

The bill includes MCOs providing services to HUSKY or Charter Oak Health Plan beneficiaries in the definition of a governmental function. Thus, the contracts must (1) entitle DSS to copies of records and files related to the contract's performance and (2) indicate that the records and files are subject to disclosure under FOIA. Anyone denied access to the records or files must first file a complaint with the Freedom of Information Commission.

The 20-member task force consists of the following individuals or their designees:

1. the commissioners of DSS, public health, children and families, mental health and addiction services, and health care access;

2. the chairperson of the Medicaid Managed Care Council;

3. the chairpersons and ranking members of the Human Services and Public Health committees; and

4. 10 members the governor appoints.

One of the governor's appointments must be an MCO representative; seven must represent health care service provider organizations, including hospitals, clinics, dental providers, physicians, and nurses; and two are consumer representatives.

The DSS commissioner chairs the task force and must convene the first meeting within 90 days of the bill's passage.

The task force must identify and analyze strategies to increase provider participation in HUSKY; explore approaches to increasing provider participation; and recommend policy, regulatory, or statutory changes. It must specifically examine:

1. medical malpractice coverage issues,

2. alternative reimbursement strategies,

3. member lock-in policies and procedures,

4. geographic issues,

5. provider cultural diversity,

6. administrative simplification, and

7. capital investments.

The task force must report its finding and recommendations to the Human Services and Public Health committees by January 1, 2008, at which point the task force terminates.

The bill requires the Office of Health Care Access (OHCA) commissioner to convene and chair this task force, which must develop and provide recommendations to the governor on the effect of electronic health information exchanges.

The OHCA commissioner selects the task force members, who must represent the public and private sectors. In choosing the members, the commissioner must look for individuals to represent the interests of consumers, health care providers and organizations, public health entities, academia, employers, health information exchange organizations, state agencies, and municipalities.

1. research and examine the impact of using electronic information to improve the quality and efficiency of health information exchange;

2. inventory the health information technology initiatives currently underway in the state;

3. identify state government's appropriate role in developing, using, and regulating the technology;

4. define the goals and values of the technology for state policy and planning purposes;

5. assess the information's impact on the state's role as a health care regulator, purchaser, provider, and payor, and employer, and recommend policy and legal changes necessary to address privacy, confidentiality, and public safety;

6. develop options for advancing the technology's implementation through the state's various roles, including projected costs and funding sources, and identify strategies for public and private collaboration; and

7. develop an overall state health information technology policy.

The OHCA commissioner must report to the governor on the task force's findings and recommendations by September 1, 2008, at which time the task force terminates.

HUSKY A (Medicaid) offers subsidized managed health care coverage to children in families with income up to 185% of the FPL, and to their caretaker relatives who have income up to 150% of the FPL. Enrollees do not pay cost-sharing.

HUSKY B offers similar health care coverage to children in families with incomes between 185% and 300% of the FPL, with monthly premiums required from families with incomes over 235% of the FPL. Children whose family income is over 300% of FPL can buy unsubsidized coverage by paying the MCO the full premium amount (about $ 200 per child per month). Participants pay co-payments for certain services.

Under presumptive eligibility, states can grant Medicaid (HUSKY A) to children almost immediately, verifying the information supplied on the application after eligibility is granted. DSS maintains contracts with qualified entities, which can include hospitals, to do these eligibility determinations.

Pregnant women with income up to 185% of the FPL are eligible for Medicaid on an expedited basis. In emergencies, this requires DSS to process applications no later than 24 hours after receiving all required information from the applicant; for nonemergency applicants, DSS can take up to five days.

Several legislative committees have favorably reported bills broadly addressing health care reform. They are:

*Bill Number*	*File #*	*Committee*
sSB 1	472	Public Health
sSB 3	345	Human Services
sSB 70	106	Insurance
sSB 1371	233	Insurance
sHB 6158	246	Children
sHB 6652	219	Insurance
sHB 7314	264	Labor
sHB 7375	296	Human Services

sHB 7322 (File 380) and sSB 1425 (File 357) contain similar provisions concerning FOIA. sSB 1290 (File 446) extends the definition of performing a governmental function.

sSB1 (File 472) designates eHealth Connecticut as the lead health information exchange organization for the state.