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

Be it enacted by the Senate and House of Representatives in General Assembly convened:

Section 1. (NEW) (Effective July 1, 2007) (a) There is established the Charter Oak Health Plan for the purpose of providing access to health insurance coverage for state residents who have been uninsured for at least six months and who are ineligible for other publicly funded health insurance plans. The Commissioner of Social Services may enter into contracts for the provision of comprehensive health care for such uninsured state residents. The commissioner shall conduct outreach to facilitate enrollment in the plan.

(b) The commissioner shall impose cost-sharing requirements in connection with services provided under the Charter Oak Health Plan. Such requirements may include, but not be limited to: (1) A monthly premium; (2) an annual deductible not to exceed one thousand dollars; (3) a coinsurance payment not to exceed twenty per cent after the deductible amount is met; (4) tiered copayments for prescription drugs determined by whether the drug is generic or brand name, formulary or nonformulary and whether purchased through mail order; (5) no fee for emergency visits to hospital emergency rooms; (6) a copayment not to exceed one hundred fifty dollars for nonemergency visits to hospital emergency rooms; and (7) a lifetime benefit not to exceed one million dollars.

(c) The Commissioner of Social Services shall provide premium assistance to eligible state residents whose gross annual income does not exceed three hundred per cent of the federal poverty level. Such premium assistance shall be limited to: (1) One hundred seventy-five dollars per month for individuals whose gross annual income is below one hundred fifty per cent of the federal poverty level; (2) one hundred fifty dollars per month for individuals whose gross annual income is at or above one hundred fifty per cent of the federal poverty level but not more than one hundred eighty-five per cent of the federal poverty level; (3) seventy-five dollars per month for individuals whose gross annual income is above one hundred eighty-five per cent of the federal poverty level but not more than two hundred thirty-five per cent of the federal poverty level; and (4) fifty dollars per month for individuals whose gross annual income is above two hundred thirty-five per cent of the federal poverty level but not more than three hundred per cent of the federal poverty level. Individuals insured under the Charter Oak Health Plan shall pay their share of payment for coverage in the plan directly to the insurer.

(d) The Commissioner of Social Services shall determine minimum requirements on the amount, duration and scope of benefits under the Charter Oak Health Plan, except that there shall be no preexisting condition exclusion. Each participating insurer shall provide an internal grievance process by which an insured may request and be provided a review of a denial of coverage under the plan.

(e) The Commissioner of Social Services may contract with the following entities for the purposes of this section: (1) A health care center subject to the provisions of chapter 698a of the general statutes; (2) a consortium of federally qualified health centers and other community-based providers of health services which are funded by the state; or (3) other consortia of providers of health care services established for the purposes of this section. Providers of comprehensive health care services as described in subdivisions (2) and (3) of this subsection shall not be subject to the provisions of chapter 698a of the general statutes. Any such provider shall be certified by the commissioner to participate in the Charter Oak Health Plan in accordance with criteria established by the commissioner, including, but not limited to, minimum reserve fund requirements.

(f) The Commissioner of Social Services shall seek proposals from entities described in subsection (e) of this section based on the cost sharing and benefits described in subsections (b) and (c) of this section. The commissioner may approve an alternative plan in order to make coverage options available to those eligible to be insured under the plan.

(g) The Commissioner of Social Services, pursuant to section 17b-10 of the general statutes, may implement policies and procedures to administer the provisions of this section while in the process of adopting such policies and procedures as regulation, provided the commissioner prints notice of the intent to adopt the regulation in the Connecticut Law Journal not later than twenty days after the date of implementation. Such policies shall be valid until the time final regulations are adopted and may include: (1) Exceptions to the requirement that a resident be uninsured for at least six months to be eligible for the Charter Oak Health Plan; and (2) requirements for open enrollment and limitations on the ability of enrollees to change plans between such open enrollment periods.

Sec. 2. Section 17b-296 of the general statutes is amended by adding subsection (e) as follows (Effective from passage):

(NEW) (e) All contracts between the department and a managed care organization to provide services under the HUSKY Plan, Part A, the HUSKY Plan, Part B, or both, or the Charter Oak Health Plan, pursuant to section 1 of this act, and all documents maintained by a managed care organization related to the performance of its contracts with the department, including, but not limited to, contracts and agreements with providers and subcontractors, documents concerning rates paid to providers and subcontractors, and documents concerning operational standards, shall be deemed public records or files as defined in section 1-200 and shall be subject to disclosure in accordance with chapter 14.

Sec. 3. Section 1-218 of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

Each contract in excess of two million five hundred thousand dollars between a public agency and a person for the performance of a governmental function shall (1) provide that the public agency is entitled to receive a copy of records and files related to the performance of the governmental function, and (2) indicate that such records and files are subject to the Freedom of Information Act and may be disclosed by the public agency pursuant to the Freedom of Information Act. Any contract between the Department of Social Services and a managed care organization to provide services under the HUSKY Plan, Part A, the HUSKY Plan, Part B, or both, or the Charter Oak Health Plan pursuant to section 1 of this act, irrespective of whether such contract is in excess of two million five hundred thousand dollars, shall be subject to the provisions of this section. No request to inspect or copy such records or files shall be valid unless the request is made to the public agency in accordance with the Freedom of Information Act. Any complaint by a person who is denied the right to inspect or copy such records or files shall be brought to the Freedom of Information Commission in accordance with the provisions of sections 1-205 and 1-206.

Sec. 4. Subdivision (11) of section 1-200 of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

(11) "Governmental function" means the administration or management of a program of a public agency, which program has been authorized by law to be administered or managed by a person, where (A) the person receives funding from the public agency for administering or managing the program, (B) the public agency is involved in or regulates to a significant extent such person's administration or management of the program, whether or not such involvement or regulation is direct, pervasive, continuous or day-to-day, and (C) the person participates in the formulation of governmental policies or decisions in connection with the administration or management of the program and such policies or decisions bind the public agency. "Governmental function" includes the provision of services by a managed care organization under the HUSKY Plan, Part A, the HUSKY Plan, Part B, or both, or the Charter Oak Health Plan, pursuant to section 1 of this act. "Governmental function" [shall] does not include the mere provision of goods or services to a public agency without the delegated responsibility to administer or manage a program of a public agency.

Sec. 5. (Effective from passage) (a) There is established a task force to study and make recommendations to increase provider participation in the HUSKY Plan, Part A, the HUSKY Plan, Part B, or both, as defined in section 17a-290 of the general statutes.

(b) The task force shall consist of the following members or their designees: (1) The Commissioners of Social Services, Public Health, Children and Families, Mental Health and Addiction Services, and Health Care Access; (2) the chairperson of the Managed Care Council established pursuant to section 17b-28 of the general statutes; (3) the chairpersons and ranking members of the joint standing committees of the General Assembly having cognizance of matters relating to human services and public health; and (4) ten appointed by the Governor, (A) one of whom shall be a representative from a managed care organization; (B) seven of whom shall be representatives from organizations providing health care services including, but not limited to, hospitals, clinics, dental providers, physicians and nurses; and (C) two of whom shall be consumer representatives.

(c) The Commissioner of Social Services shall serve as chairperson of the task force and shall convene the initial meeting of the task force not later than ninety days after the effective date of this section.

(d) The task force shall identify and analyze strategies to increase provider participation in the HUSKY Plan and explore approaches to increase provider participation, including, but not limited to, medical malpractice coverage issues, alternative reimbursement strategies, member lock-in policies and procedures, geographic issues, provider cultural diversity, administrative simplification, capital investments and recommended policy, regulatory or statutory changes.

(e) The task force shall report its findings and recommendations, in accordance with section 11-4a of the general statutes, to the Governor and the joint standing committees of the General Assembly having cognizance of matters relating to human services and public health not later than January 1, 2008. The task force shall terminate upon submission of the report.

Sec. 6. (NEW) (Effective July 1, 2007) Each local or regional board of education shall require each pupil enrolled in the schools under its jurisdiction to annually report whether the pupil has health insurance. The Commissioner of Social Services, or the commissioner's designee, shall provide information to each local or regional board of education on state-sponsored health insurance programs for children, including application assistance for such programs. Each local or regional board of education shall provide such information to the pupil's parent or guardian, including application assistance for such programs.

Sec. 7. (Effective July 1, 2007) (a) The Commissioner of Health Care Access shall convene an electronic health information technology task force to develop and provide recommendations to the Governor on the impact of electronic health information exchange.

(b) The task force shall be comprised of representatives from the public and private sectors and be selected by the Commissioner of Health Care Access. In appointing members to the task force, the commissioner shall consider the representative interests of (1) consumers; (2) providers including clinicians, pharmacists, health plans, hospitals, federally qualified health centers, clinics, laboratories, pharmacies and professional societies or organizations; (3) public health entities; (4) academia; (5) employers; (6) health information exchange organizations; (7) state agencies including the Departments of Social Services, Public Health, Mental Retardation, Mental Health and Addiction Services, Children and Families, Veterans' Affairs, Information Technology, Consumer Protection, the Insurance Department, The University of Connecticut Health Center, the Office of Policy and Management and the Office of the State Comptroller; and (8) municipalities. The Commissioner of Health Care Access shall serve as the chairperson of the task force.

(c) The task force shall: (1) Research and examine the impact of the electronic use of health information to improve the quality and efficiency of health information exchange; (2) inventory the various public and private health information technology initiatives currently underway in Connecticut, including efforts regarding personal health records, electronic health records and health information exchange; (3) identify the appropriate role of state government in the development, use and regulation of health information technology and define the goals and values of health information technology for the purposes of state policy and planning; (4) assess the impact of health information on the state's roles as payor, provider, purchaser, regulator and employer and recommend statutory, regulatory and policy changes including changes required to address privacy, confidentiality and public safety; (5) develop an overall state health information technology policy; (6) develop options for advancing the implementation of health information technology through the state's roles as payor, provider, purchaser, regulator and employer and identify opportunities and strategies for public and private collaboration; and (7) develop policy options for advancing the implementation of health information technology including projected costs and sources of funding.

(d) Not later than September 1, 2008, the Commissioner of Health Care Access shall report to the Governor, in accordance with section 11-4a of the general statutes, on the findings and recommendations of the task force. The electronic health information technology task force shall terminate upon the submission of the report.

Sec. 8. Subsection (e) of section 17b-292 of the general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2007):

(e) A newborn child who otherwise meets the eligibility criteria for the HUSKY Plan, Part B shall be eligible for benefits retroactive to his date of birth, provided an application is filed on behalf of the child [within] not later than thirty days [of] after such date. Any uninsured child born in a hospital in this state or in an eligible border state hospital shall be enrolled by an expedited process in the HUSKY Plan, Part B provided (1) the child's family resides in this state, and (2) a parent of such child authorizes enrollment in the program. The commissioner shall pay any premium cost such family would otherwise incur for the first two months of coverage to the managed care organization selected by the family to provide coverage for such child.

Sec. 9. Section 17b-277 of the general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2007):

(a) The Commissioner of Social Services shall provide, in accordance with federal law and regulations, medical assistance under the Medicaid program to needy pregnant women and children up to one year of age whose families have an income up to one hundred eighty-five per cent of the federal poverty level.

(b) The commissioner shall expedite eligibility for appropriate pregnant women applicants for the Medicaid program. The process for making expedited eligibility determinations concerning needy pregnant women shall ensure that emergency applications for assistance, as determined by the commissioner, shall be processed no later than twenty-four hours after receipt of all required information from the applicant, and that nonemergency applications for assistance, as determined by the commissioner, shall be processed no later than five calendar days after the date of receipt of all required information from the applicant.

(c) Presumptive eligibility for medical assistance shall be implemented for any uninsured newborn child born in a hospital in this state or an eligible border state hospital provided (1) the child's family resides in this state, and (2) a parent of such child authorizes enrollment in the program.

[(c)] (d) The commissioner shall submit biannual reports to the council, established pursuant to section 17b-28, on the department's compliance with the administrative processing requirements set forth in subsection (b) of this section.

Statement of Purpose:

To implement the Governor's budget recommendations.

[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.]