PA 07-185—SB 1484

Emergency Certification

AN ACT CONCERNING THE HEALTHFIRST CONNECTICUT AND HEALTHY KIDS INITIATIVES

SUMMARY: This act expands access to public health insurance by making a number of changes in the HUSKY program. Among other things it:

1. raises the income limits for HUSKY A (Medicaid) coverage for caretaker relatives and pregnant women;

2. expands HUSKY B coverage for children in higher income families, with premium assistance for families with access to employer-sponsored coverage (PA 07-2, June Special Session (JSS), repeals these changes);

3. requires automatic enrollment of uninsured newborns in HUSKY;

4. requires the Department of Social Services (DSS) and other entities to expand HUSKY outreach;

5. requires DSS to seek a federal waiver to convert the State-Administered General Assistance (SAGA) program from a fully state-funded program to a Medicaid-funded one and potentially raises the income limit for this coverage; and

6. requires DSS, within available appropriations, annually to increase the rates it pays Medicaid providers, including hospitals, beginning in FY 08 (PA 07-2, JSS, repeals this increase).

The act creates two new health-related planning entities, (1) a HealthFirst Connecticut Authority to recommend alternatives for affordable quality health care coverage for un- and underinsured people, cost containment measures, and insurance financing mechanisms and (2) a Statewide Primary Care Access Authority to develop a universal system for providing primary care services, including prescription drugs, to all Connecticut residents.

It establishes a board to govern a network that integrates state and social services data within and across various departments. It requires the Department of Public Health (DPH) to develop standards to facilitate the development of a statewide, integrated electronic health information system for use by health care providers and institutions that are funded by the state. And it designates a nonprofit entity to act as the state's lead health information exchange organization for five years. (PA 07-2, JSS, repeals these provisions. )

It requires the DSS commissioner to (1) develop and implement a plan for a preventive health services system for children covered by HUSKY A and B and (2) establish a child health quality improvement program to promote the implementation of evidence-based strategies by HUSKY providers to improve the delivery of and access to children's health services.

The act extends, from age 22 to 26, the age to which group comprehensive and individual health insurance policies that cover children must do so.

The act reinstates insurers' ability to again sell special health care plans to small employers, and it potentially makes these plans available to a wider range of employers by raising the income eligibility limit for their low-income employees from 200% to 300% of the federal poverty level (FPL).

It requires (1) DSS to inventory public disease management programs, (2) DPH to develop an electronic license renewal system for certain professions, and (3) the healthcare advocate to create a consumer health information website. It appropriates funds for various school- and community-based health center operations. And it makes technical changes.

EFFECTIVE DATE: Various, see below.

1 — MEDICAID COVERAGE FOR FOREIGN LANGUAGE INTERPRETERS

The act requires the DSS commissioner to amend the Medicaid state plan to include foreign language interpreters as a covered service for beneficiaries with limited English proficiency.

EFFECTIVE DATE: July 1, 2007

2 — MEDICAID COVERAGE FOR SAGA MEDICAL ASSISTANCE RECIPIENTS

The act requires DSS, by January 1, 2008, to seek a federal waiver to get Medicaid coverage for people enrolled in the SAGA medical assistance program. Currently, SAGA medical assistance is funded entirely with state dollars. Prior law required DSS to do this by March 1, 2004.

But the act also specifies that this coverage is for people who qualify for SAGA medical assistance and have income up to 100% of the FPL. The law, unchanged by the act, provides that the income limit for SAGA medical assistance recipients is the same as it is for people who are eligible for Medicaid as “medically needy” (currently $476 per month for a single resident living in most parts of the state), which is about 56% of the FPL. So the act appears to establish two different income limits for SAGA medical assistance if Medicaid coverage becomes available for this population. (PA 07-2, JSS, indirectly increases the SAGA medical assistance limit by increasing cash welfare (Temporary Family Assistance) benefits. )

The act removes obsolete language pertaining to town-administered General Assistance medical assistance. And it eliminates the deadline (August 20, 2003) by which federally qualified health centers participating in the SAGA medical assistance program had to enroll in the federal Office of Pharmacy Affairs Section 340B drug discount program.

EFFECTIVE DATE: July 1, 2007

3 — INCOME LIMIT FOR HUSKY A COVERAGE FOR ADULT CARETAKER RELATIVES

The act increases, from 150% to 185% of the FPL (from $25,755 to $31,764 annually for a family of three in 2007) the income limit for HUSKY A adult caretaker coverage. This higher limit already applies to children applying for or enrolled in HUSKY A.

The act requires the DSS commissioner, when individuals or families apply for Medicaid coverage, to advise them in writing of the (1) effect that having income over the limit has on program eligibility and (2) availability of HUSKY B for those ineligible for HUSKY A. (HUSKY B provides virtually identical subsidized medical coverage to children in families whose income is between 185% and 300% of the FPL. ) (PA 07-2, JSS, requires that DSS provide information about HUSKY B only when children are determined ineligible for HUSKY A. )

EFFECTIVE DATE: July 1, 2007

4 & 12 — COVERAGE FOR PREGNANT WOMEN

The act requires DSS to increase the income limit for HUSKY A coverage for pregnant women from 185% to 250% of the FPL ($2,852 per month for a two-person household). It also requires DSS, by January 1, 2008, to seek a federal Health Insurance Flexibility and Accountability demonstration waiver to cover pregnant women who do not “otherwise have creditable coverage,” as defined by federal law, with incomes between 185% and 250% of the FPL. The waiver must specify that the expanded coverage will be provided through a re-allocation of the state's unspent State Children's Health Insurance Program (SCHIP) block grant funds. (Federal Medicaid funds match the state's payments for the coverage for pregnant women with incomes under 185% of the FPL. )

PA 07-2, JSS, repeals the waiver provision. Instead, it directs DSS, by September 30, 2007, to submit either a Medicaid state plan or a waiver request to cover these women, and once the plan amendment or waiver is approved, implement the expansion.

EFFECTIVE DATE: July 1, 2007

4 & 6 — HUSKY A AND B ENROLLMENT OF UNINSURED NEWBORNS

The act requires DSS to implement Medicaid presumptive eligibility (and therefore automatic enrollment) for any uninsured newborn born in a Connecticut or border state hospital when the parent or caretaker relative with whom the child resides (1) lives in Connecticut and (2) authorizes the enrollment. Presumptive eligibility allows the child to be determined immediately eligible for assistance. DSS verifies that the child is otherwise eligible once he or she is enrolled.

Currently, children are eligible for HUSKY A presumptively. The act also requires that any uninsured child born in a Connecticut hospital or border state hospital be enrolled in HUSKY B under an expedited process, provided the two conditions above are met.

It requires the DSS commissioner to pay to the HUSKY B managed care organization (MCO) that the parent or caretaker selects (HUSKY A and B services are provided through MCOs with which DSS contracts) the first two months of premiums that the family would otherwise have to pay. Currently, families with incomes between 235% and 300% of FPL pay $30 per month ($50 family maximum) in premiums. Lower-income families do not pay premiums.

By law, a newborn child who otherwise meets the HUSKY B eligibility criteria is eligible for benefits retroactive to the child's birth date, provided someone files an application on the child's behalf within 30 days of the birth.

PA 07-2, JSS, increases, from two to four, the number of months DSS must pay the HUSKY B premiums.

EFFECTIVE DATE: July 1, 2007

6, 7, & 10 — INCREASING HUSKY B ELIGIBILITY TO HIGHER INCOME FAMILIES; PREMIUM ASSISTANCE

The act increases, from 300% to 400% of FPL, the income limit for children to be eligible for subsidized HUSKY B coverage. (It is not clear whether the federal government will allow the state to use State Children's Health Insurance Program funds to pay the federal share of this coverage (65%)). By extension, it increases the starting income level at which people can purchase unsubsidized coverage from 300% to 400% of the FPL.

Under prior law, children in families with income between 185% and 300% of the FPL were eligible for subsidized HUSKY B coverage. Families with incomes above 300% of the FPL could buy into HUSKY B by paying the full monthly premium, which is about $200 per month per child.

The act requires families with incomes between 300% and 400% of FPL and who have no access to employer-sponsored health insurance to pay monthly premiums of $50 per child, with a $75 maximum (presumably for the family). Currently, families with incomes below 235% of FPL pay no premiums and families with incomes between 235% and 300% of FPL pay $30 monthly, with a $50 family cap.

Premium Assistance. The act requires DSS to offer premium assistance to families in the 300% to 400% of FPL income range who have access to employer-sponsored coverage. Individuals choosing to participate in this program must enroll themselves and their dependent children in the employer-sponsored coverage to the maximum extent of available coverage, as long as DSS determines that the coverage is more cost effective than enrolling the child in HUSKY B.

The act requires DSS to do this regardless of the state law that generally prohibits HUSKY B coverage to children whose parents drop employer-sponsored coverage less than two months before HUSKY B eligibility is determined. (In general, the federal State Children's Health Insurance Program law prohibits states from providing coverage to children who are enrolled in employer-sponsored coverage. )

The state subsidy a person will receive is the portion of the premium payment attributable to the dependent children's coverage. The employer must verify this cost in a form and manner DSS prescribes. The act prohibits the employer from deducting the cost from weekly income. Instead, the employer must let DSS know the cost, which DSS must pay. DSS must provide HUSKY B coverage for services that are not covered by the employer's plan (“wrap around”).

The act permits the DSS commissioner to implement policies and procedures necessary to administer the premium assistance while in the process of adopting them as regulations. He must print notice of intent to adopt the regulations in the Connecticut Law Journal no later than 20 days after implementing them. The policy and procedures are valid until final regulations are adopted.

PA 07-2, JSS, eliminates the HUSKY B expansion and all related provisions, thus restoring prior law.

EFFECTIVE DATE: July 1, 2007

6 — CENTRAL DSS UNIT FOR PROCESSING AND MARKETING APPLICATIONS

The act requires DSS, in consultation with the servicer (enrollment broker with which DSS contacts, currently ACS, Inc. ), to establish a centralized unit to be responsible for processing all HUSKY applications. DSS, through its contract, must ensure that a child determined eligible for HUSKY has uninterrupted coverage for as long as the parent or guardian elects to enroll or re-enroll the child.

The act requires DSS in consultation with the servicer, instead of the servicer alone, to jointly market HUSKY A and B as the HUSKY Plan. And it requires the servicer to electronically send HUSKY A, as well as HUSKY B, enrollment and disenrollment data to DSS.

The act specifies that the servicer must send DSS all HUSKY applications, not just those for children with family income of 185% of FPL or less.

The act requires the commissioner or servicer to redetermine the child's eligibility for HUSKY no later than 10, instead of 12, months after determining initial eligibility. It requires them to send an electronic application if the participant requests. Prior law required mailing the application form. Under the act, either form of sending the application must be done within available appropriations. (PA 07-2, JSS, eliminates the 10-month HUSKY eligibility redetermination requirement. )

EFFECTIVE DATE: July 1, 2007

8 & 9 — OUTREACH

The act requires DSS, in consultation with the Children's Health Council (now defunct), the Medicaid Managed Care Council, and 2-1-1 Infoline, to develop ways to increase outreach and maximize enrollment of children and adults in HUSKY. The law already requires them to develop outreach. The mechanisms they use must seek to maximize federal funds where appropriate for these activities.

The act requires the DSS commissioner, in consultation with the Latino and Puerto Rican Affairs Commission, the African-American Affairs Commission, representatives from minority community-based organizations, and any other state and local organization the commissioner deems appropriate, to develop and implement outreach efforts targeting medically underserved children and adults, in particular Latino and other minority children and adults, to increase their enrollment in HUSKY.

These efforts must include, at a minimum, developing culturally appropriate outreach materials; advertising through Latino and other minority media outlets; and the public education, outreach, and recruitment activities already required by law.

EFFECTIVE DATE: July 1, 2007

11 — ONLINE DPH LICENSE RENEWAL

The act requires DPH to establish, by July 1, 2008, a secure online license renewal system for physicians, dentists, and nurses. Nurses include advanced practice, registered, and licensed practical nurses. DPH must allow those using the system to pay their fees by credit card or electronic funds transfer from a bank or credit union account and can charge a service fee of up to $5 for such payments.

EFFECTIVE DATE: Upon passage

13 — HUSKY PREVENTIVE HEALTH SERVICES

The act requires the DSS commissioner to develop and implement a plan for a preventive health services system for children covered by HUSKY A and B. He must develop the plan by January 1, 2008 and implement it by July 1, 2008. He must do this in consultation with the DPH commissioner.

The system's goal must be to improve health outcomes for all children enrolled in HUSKY and to reduce racial and ethnic health disparities. The system must ensure that federal Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program services are provided to children enrolled in HUSKY A.

The plan must:

1. establish a coordinated preventive health services system for HUSKY beneficiaries including EPSDT services, oral health care, care coordination, chronic disease management, periodicity schedules based on American Academy of Pediatrics' standards, and vision care (PA 07-2, JSS, specifies opthamological and optometric services, rather than vision care);

2. require DSS to track electronically (PA 07-2, JSS, removes the electronic requirement) (a) HUSKY beneficiaries' system usage to ensure that they receive all available services and (b) beneficiaries' health outcomes; and

3. include ways to create financial incentives and rewards for participating health care providers, such as case management fees, pay for performance, and payment for technical support and patient registry data entry.

By July 1, 2009, the DSS commissioner must report to the Human Services, Insurance, and Public Health committees on the system's implementation. The report must include information on health outcomes, quality of care, and methods used to improve children's quality of care and health outcomes.

EFFECTIVE DATE: July 1, 2007

14 & 35 — CHILDREN'S HEALTH QUALITY IMPROVEMENT PROGRAM

The act requires the DSS commissioner to establish a child health quality improvement program to promote HUSKY providers' implementation of evidence-based strategies to improve the delivery of and access to children's health services. He must do this in collaboration with the DPH and Department of Children and Families (DCF) commissioners.

The evidence-based strategies must focus on physical, dental, and mental health services. They must include: (1) ways for early identification of children with special health care needs; (2) integration of care coordination and planning into children's health services; (3) implementation of standardized data collection to measure performance improvement; and (4) implementation of family-centered services in patient care, including the development of parent-provider partnerships. The act defines “evidence-based strategies” as policies, procedures, and tools that are informed by research and supported by empirical evidence, including research developed by organizations like the American Academy of Pediatrics, American Academy of Family Physicians, National Association of Pediatric Nurse Practitioners, and Institute of Medicine.

The DSS commissioner must seek the participation of various public and private entities including medical, dental, and mental health providers; academic professionals with experience in health services research and performance measurement and improvement; and any other entity the commissioner deems appropriate to promote such strategies. The commissioner must ensure that the strategies reflect new developments and best practices in children's health services.

The commissioner must annually report to the Human Services, Public Health, and Appropriations committees and the Medicaid Managed Care Council beginning July 1, 2008. The report must address the implementation of any strategies developed and the extent to which they improved delivery of and access to care for HUSKY children.

The act appropriates $150,000 in FY 08 to DSS for this program. (PA 07-2, JSS, repeals this appropriation. )

EFFECTIVE DATE: July 1, 2007

15-17 — DEPENDENT CHILDREN COVERAGE EXTENSION

The act raises, from age 23 to 26, the age to which group comprehensive and individual health insurance policies that cover children must do so. Prior law required coverage for unmarried, dependent children until they turn 19, or 23 for full-time students at an accredited school. The act eliminates the requirements that children be dependent or full-time students and limits the continuing coverage to those who live in Connecticut. (PA 07-2, JSS, extends coverage for children who attend accredited out-of-state colleges or who live in another state with a custodial parent. )

The act applies to:

1. individual health insurance policies delivered, issued, amended, or renewed on or after October 1, 2007 that cover (a) basic hospital and medical surgical expenses; (b) major medical expenses; (c) accidents; (d) limited benefits; and (e) hospital or medical services, including HMO contracts; and

2. group comprehensive health care plans (a minimum plan all health insurers must offer) beginning July 1, 2007.

EFFECTIVE DATE: July 1, 2007 (PA 07-2, JSS, makes these changes effective January 1, 2009)

18-21 — HEALTH REINSURANCE ASSOCIATION (HRA) PLANS

By removing a provision that prohibits the sale of special health care plans to small employers after January 1, 1995, the act permits such plans to be sold again. Small employers are those with 50 or fewer uninsured employees and self-employed people.

By law, each small-employer insurer must offer small employers a special health care plan. A small employer with 10 or fewer employees, most of whom are low-income, does not have to offer a plan. Instead, the insurer must refer the employer to the HRA. The act potentially makes these plans available to more employers by raising the income eligibility limit for a low-income individual or employee from 200% to 300% of FPL. HRA must develop premium rates and administer the plans without profit or loss.

EFFECTIVE DATE: July 1, 2007

22 — CONSUMER HEALTHCARE WEBSITE

The act requires the Healthcare Advocate's Office, by October 1, 2008 and within available appropriations, to create and maintain an Internet website for consumer health care information. At a minimum, the website must contain (1) information about wellness programs, such as disease prevention and health promotion, available in various regions; (2) hospital quality and experience data; and (3) a link to the Insurance Department's managed care consumer report card.

EFFECTIVE DATE: October 1, 2007

23 — PRE-TAX HEALTH INSURANCE PREMIUM DEDUCTIONS

The act requires every employer that deducts health insurance premiums from its employees' pay to allow employees to make these payments with pre-tax earnings to the extent permitted under IRS Code section 125. That section allows employers to offer employees a choice between cash salary and a variety of nontaxable, qualified benefits such as health, disability, and group life insurance. Employee contributions are made before federal and most state income taxes and Social Security taxes are calculated.

EFFECTIVE DATE: October 1, 2007

24, 25, & 36 — ELECTRONIC HEALTH RECORDS STANDARDS

The act designates eHealth Connecticut, a nonprofit corporation, as the state's lead health information exchange organization from July 1, 2007 to July 1, 2012. It requires the DPH commissioner to contract with eHealth Connecticut to develop a statewide health information technology plan that includes standards, protocols, and pilot programs for health information exchange. Health information exchange organizations are typically geographically defined entities that arrange for ways to electronically exchange health information, develop and maintain standards for this process, and develop and manage a set of contractual conventions and terms for exchanges.

The act requires DPH to develop electronic data standards to facilitate the development of a statewide, integrated electronic health information system for use by state-funded health care providers and institutions. DPH must do this by July 1, 2008 in consultation with DSS, the Department of Information Technology (DOIT), and any other entity the DPH commissioner deems appropriate. DPH may contract for the standards' development through a request for proposal process.

The standards must (1) include provisions relating to security, privacy, data content, structures and format, and vocabulary and transmission protocols; (2) be compatible with any national data standards in order to allow for interstate “interoperability; ” (3) permit the collection of health information in a “standard electronic format”; and (4) be compatible with the requirements for an electronic health information system (see below).

The act defines:

1. “electronic health information system” as computer hardware and software that includes (a) a patient electronic health record that can be accessed in real time; (b) a personal health record through which individuals and their representatives can manage the person's health information; (c) computerized order entry technology that allows a health care provider to order tests, treatments, and prescriptions; (d) electronic reminders to health care providers concerning screenings, other preventive measures, and best practices; (e) error notification procedures; and (f) tools to collect, analyze, and report adverse event data, quality of care measures, and patient satisfaction;

2. “interoperability” as the ability of separate systems to exchange information including (a) physically connecting to a network, (b) enabling a user who presents appropriate permission to conduct transactions over the network, and (c) enabling such a user to access, transmit, receive, and exchange information with other users; and

3. “standard electronic format” as one that (a) enables using health information technology for collecting clinically specific information, (b) promotes interoperability across health care settings, including government agencies at all levels, and (c) facilitates clinical decision support.

The act appropriate $250,000 to DPH in FY 08 to develop the standards. It must report to the Public Health, Human Services, Government Administration and Elections, and Appropriations committees by October 1, 2008 on their development.

PA 07-2, JSS, repeals these provisions and instead requires DPH, within available appropriations, to contract for the development of a statewide health information technology plan. The entity awarded the contract must be designated as the lead health information exchange organization for the state between December 1, 2007 and June 30, 2009.

EFFECTIVE DATE: July 1, 2007

26-28, 37, & 38 — CONNECTICUT HEALTH INFORMATION NETWORK

Creation and Framework

The act establishes the Connecticut Health Information Network (CHIN) at the UConn Health Center. The network is to integrate state health and social services data within and across the UConn Health Center, Office of Health Care Access (OCHA), DPH, and the Mental Retardation (DMR) and Children and Families (DCF) departments. Data from other departments could be integrated into the network as federal law and funding permits. The CHIN must securely integrate all data consistent with state and federal privacy laws.

The act charges the Health Center's Center for Public Health and Health Policy to develop, implement, and administer the CHIN in collaboration with the above offices and departments and DOIT. The CHIN must develop a framework for creating a network access portal that can provide (1) access to publicly available data on Connecticut residents' health maintained by state and nongovernmental agencies and (2) a way to obtain aggregate data on key state health indicators. The portal must be designed to:

1. provide accurate, timely, and accessible health data to state and local, public and private leaders and policymakers;

2. inform citizens to improve community and individual health;

3. maintain strict confidentiality and privacy standards;

4. support efforts to reduce health disparities;

5. identify the best available data sources; and

6. coordinate the compilation of existing health-related data and statistics.

Confidentiality

The act permits the participating state agencies to disclose personally identifiable information in their databases to the CHIN administrator and network subcontractors. Any disclosure must be in accordance with federal restrictions. The act permits disclosure regardless of restrictions contained in state statutes and regulations governing freedom of information and records maintained by DCF, DMR, DPH, and DSS.

Disclosure of personally identifiable information can be made for two purposes: (1) network development and verification and (2) data integration and aggregation in response to network queries approved by the commissioner of the department primarily responsible for collecting or maintaining the disclosed information. The act prohibits a commissioner from denying approval unless disclosure to the network would violate federal law, including the Health Insurance Portability and Protection Act and the Family Educational Rights and Privacy Act and its regulations.

The act permits the CHIN to use personally identifiable information disclosed to it to (1) match data across and within participating agency databases, including select databases at the Health Center and (2) provide data without personal identification in response to queries approved by the network's governing board. (The act does not explicitly authorize the board to approve queries, but it is responsible for performing all functions facilitating the network's coordination and integration, which may encompass such approval. )

Under the act, the CHIN can redisclose personally identifiable information only when and as expressly permitted by written agreement with state agencies or other entities that contribute information, subject to applicable state and federal law. But neither the CHIN or anyone who receives data from it may redisclose that data in a way that discloses personally identifiable information or the identity of any individual to whom it pertains.

CHIN Governing Board

The act creates a 13-member board to govern the network. The board:

1. establishes and implements policies, procedures, and protocols governing access to, and dissemination of data through, the CHIN;

2. recommends legislation needed to implement, operate, and maintain the network;

3. performs all functions needed to facilitate the network's implementation, coordination, and integration; and

4. reports annually to the General Assembly and governor on the CHIN's status, operations, and funding needs.

The board may establish permanent and ad hoc committees to help implement, operate, and maintain the network.

The board consists of the following members: one appointed by the House speaker and one by the Senate president pro tempore; a local health director, appointed by the Senate majority leader; a consumer representative, appointed by the House majority leader; a data user representative, appointed by the House minority leader; a privacy advocate, appointed by the Senate minority leader; one person each appointed by the governor and the UConn Health center; and the DCF, DPH, DMR, and OHCA commissioners and the DOIT executive director. All initial appointments must be made by November 30, 2007. Members serve four-year terms. The appointing authority fills a vacancy.

The governor's appointee serves as chairperson and must schedule the first meeting, which must be held by December 31, 2007. The board must meet at least quarterly and more often as the chairperson deems needed. Six members constitute a quorum.

Funding

The act appropriates $1 million in each of FYs 08 and 09 to the UConn Health Center to establish and operate the CHIN.

PA 07-2, JSS, replaces these provisions with (1) an authorization for DPH and the UConn Health Center, within available appropriations, to develop a CHIN plan and (2) a requirement for DPH and UConn Health Center's Center for Public Health and Health Policy to collaborate with DOIT, DMR, DCF, and OHCA in developing the CHIN plan.

EFFECTIVE DATE: October 1, 2007, except for the FY 08 and FY 09 appropriations, which are effective July 1, 2007 and 2008, respectively.

29 — DISEASE MANAGEMENT

By January 1, 2008, the act requires DSS to inventory public disease management initiatives in the HUSKY, SAGA medical assistance, and other Medicaid programs implemented as of the date the act passes and report to the Human Services and Public Health committees. For each program, the report must include a summary, the total spent, and number of people served.

EFFECTIVE DATE: Upon passage

30 & 39 — HEALTHFIRST CONNECTICUT AUTHORITY

The act creates a 13-member HealthFirst Connecticut Authority to:

1. evaluate alternatives for providing quality, affordable, and sustainable health care for all state residents, including a single-payer system and employer-sponsored insurance;

2. recommend (a) ways to contain health care costs and improve health care quality, including health information technology; (b) disease management and other methods to improve care for people with chronic diseases; (c) monitoring and reporting on cost, quality, and care utilization; and (d) ways to encourage or require providing health care coverage to certain groups through participation in an insurance pool; and

3. recommend ways to finance insurance for state residents, including ways to maximize federal funding for subsidies; contributions from employers, employees, and individuals; and ways to pay the state's share of costs.

The panel must report its recommendations, including recommended strategies for increasing health care access, by December 1, 2008, to the Public Health, Human Services, and Insurance committees.

Legislative leaders and the governor appoint 10 members, some of whom must represent specific interests, as Table 1 shows. The DPH and DSS commissioners and the comptroller, or their designees, are ex-officio, nonvoting members. (PA 07-2, JSS, adds the insurance commissioner and health care advocate as ex-officio, nonvoting members. ) All members must be familiar with the Institute of Medicine's health care reform principles and be committed to making recommendations consistent with them.

Table 1: HealthFirst Connecticut Appointments

Appointing Authority

(Number of Appointments)

Appointees

Governor (2)

Health quality or patient safety advocate

Person with information technology experience

Senate president pro tempore (2)

Representative of businesses with fewer than 50 employees

Person with community-based health experience

House speaker (2)

Health care provider

Representative of businesses with 50 or more employees

Senate majority leader (1)

Labor representative

House majority leader (1)

Consumer representative

Senate minority leader (1)

Hospital representative

House minority leader (1)

Insurance company representative

All appointments must be made within 30 days after the act is enacted, and if a vacancy occurs, the appointing authority must fill it within 30 days. The speaker and president pro tempore each choose one chairperson, and the two must schedule the panel's first meeting no more than 60 day's after the act's enactment. If an appointing authority fails to make an initial or vacancy appointment within the 30-day period, the authority chairpeople must do so.

The authority can apply for grants or financial assistance from state and federal agencies, individuals, groups, and corporations. The act appropriates $500,000 to DPH in FY 09 for the authority (PA 07-2, JSS, removes the appropriation).

EFFECTIVE DATE: Upon passage, except for the appropriation, which is effective July 1, 2008.

31 & 40 — STATEWIDE PRIMARY CARE ACCESS AUTHORITY

Developing a Universal Primary Care System

The act establishes an 11-member authority to develop a universal system for providing primary care services, including prescription drugs, to all Connecticut residents. It must develop the system by December 31, 2008 and a plan for implementing it by July 1, 2010. The system must be designed to maximize federal participation in Medicaid and Medicare.

In developing the system, the authority must define primary care services and inventory the state's existing primary care infrastructure, including:

1. the number of primary care providers practicing in the state (which it defines as physicians, dentists, nurses, people providing services to people with mental illness and mental retardation, and others providing primary medical, nursing, counseling, or other health care, substance abuse, or mental health services, including those providing services through an HMO or medical services plan);

2. the total amount spent on public and private primary care services during the last fiscal year; and

3. the number of public and private buildings and offices used primarily for primary care services, including hospitals, mental health facilities, dental offices, community- and school-based health centers, and academic health centers.

The committee must also:

1. estimate the cost of fully implementing a universal primary care system,

2. identify additional personnel or infrastructure needed to implement a system,

3. determine the state's and third parties' role in administering it,

4. identify system funding sources, and

5. determine private insurers' role in a universal system.

Implementation Plan

The authority's implementation plan must include (1) a timetable and (2) benchmarks to assess implementation progress and ways to assess the system's effectiveness once it begins operating.

Authority Composition, Powers, and Reporting Requirements

The authority is composed of (1) the chairpersons of the HealthFirst Connecticut Authority (see above), who also serve as this authority's chairpersons; (2) the DPH and DSS commissioners; (3) the comptroller; and (4) members appointed by the Connecticut Primary Care Association, State Medical Society, Chapter of the American Academy of Pediatrics, Nurses Association, and Association of School-Based Health Centers and the Weitzman Center for Innovation in Community Health and Primary Care (which is affiliated with Community Health Center, Inc. ). All members must be familiar with the Institute of Medicine's health care reform principles and be committed to making recommendations consistent with them.

All initial appointments must be made by July 15, 2007, and members' four-year terms begin August 1, 2007. The chairpersons must convene the first meeting by October 1, 2007. Any member who fails to attend three consecutive meetings or 50% of all meetings during a calendar year is deemed to have resigned. Appointing authorities fill vacant positions. Members serve without pay but are reimbursed for their expenses.

The authority can hire consultants or assistants under contracts or other means to render professional, legal, financial, technical, or other assistance or advice.

The authority must report annually to the Public Health, Insurance, and Human Services committees on its progress in developing the universal primary care system and on the system's implementation. The first report is due by February 1, 2008; subsequent reports are due by January 1.

Funding

The act permits the authority to apply for grants or financial assistance from state and federal agencies, individuals, groups, and corporations. It appropriates $500,000 to DPH in FY 09 for the authority. (PA 07-2, JSS, removes this appropriation. )

EFFECTIVE DATE: Upon passage, except the appropriation, which is effective July 1, 2008.

32-33, & 41 — SCHOOL-BASED HEALTH CENTER GRANTS

The act appropriates $2. 5 million in FY 08 for DPH to fund expansion and operating costs of school-based health centers (SBHCs) in priority school districts and federally designated health professional shortage or medically underserved areas or those designated as having medically underserved populations. (PA 07-2 JSS, repeals the appropriation and instead requires DPH, within available funding, to expand school-based health clinic services in FY 08 for (1) priority school districts and (2) health professional shortage areas and medically underserved areas. )

The act makes permanent the ad hoc committee established in 2006 to advise DPH on SBHCs. It requires the committee to meet at least quarterly and annually report recommendations to the Public Health and Education committees for statutory and regulatory changes to improve health care access through SBHCs. And it requires any SBHC constructed on or after October 1, 2007 that is located in, or attached to, a school building, to have an entrance separate from the school.

EFFECTIVE DATE: July 1, 2007, except for the provision concerning the SBHC committee, which is effective upon passage.

34 — MEDICAID PROVIDER RATES

Annually, beginning in FY 08, the act requires DSS, within available appropriations, to increase the rates it pays Medicaid providers, including hospitals. (PA 07-2, JSS, repeals this requirement. )

EFFECTIVE DATE: July 1, 2007

42 & 43 — COMMUNITY-BASED HEALTH CENTER GRANTS

The act appropriates to DPH in FY 08 (1) $2 million for infrastructure improvement grants to community-based health centers, including health information technology and (2) $500,000 for grants to these centers to transport patients to medical appointments. In making the latter grants, DPH must give priority to Federally Qualified Health Centers in areas with limited public transportation options. (PA 07-2, JSS, repeals these appropriations. )

EFFECTIVE DATE: July 1, 2007

BACKGROUND

Related Act

PA 07-2, JSS, specifies that HUSKY A is provided to children who are living with caretaker relatives, some of whom also qualify for HUSKY A, as well as others who are not living with a caretaker relative, including those living independently who are under age 19.

OLR Tracking: SS/RC: JLK: CR: TS