AN ACT ESTABLISHING THE CONNECTICUT SAVES HEALTH CARE PROGRAM.

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

Section 1. (NEW) (Effective from passage) As used in sections 1 to 10, inclusive, of this act:

(1) "Policy" means a health insurance policy as described in section 4 of this act.

(2) "Commission" means the Connecticut Saves Health Care Commission established under section 2 of this act.

(3) "Eligible individual" means an individual who is (A) a resident of the state, and (B) under sixty-five years of age, except that "eligible individual" does not include an individual who has been a resident of the state for less than six consecutive months prior to the date of application for such program.

(4) "Program" means the Connecticut Saves Health Care program.

Sec. 2. (Effective from passage) (a) There is established the Connecticut Saves Health Care Commission to implement and administer the Connecticut Saves Health Care program.

(b) The commission shall consist of the following members:

(1) Two appointed by the speaker of the House of Representatives;

(2) Two appointed by the president pro tempore of the Senate;

(3) One appointed by the majority leader of the House of Representatives;

(4) One appointed by the majority leader of the Senate;

(5) One appointed by the minority leader of the House of Representatives;

(6) One appointed by the minority leader of the Senate;

(7) One each appointed by the chairpersons of the joint standing committee of the General Assembly having cognizance of matters relating to insurance; and

(8) Two appointed by the Governor.

(c) Any member of the commission appointed under subdivision (1), (2), (3), (4), (5), (6) or (7) of subsection (b) of this section may be a member of the General Assembly.

(d) All appointments to the commission shall be made not later than July 1, 2007. Each member shall serve for a term of three years and no member shall serve for more than two consecutive terms. Any vacancy shall be filled by the appointing authority.

(e) The speaker of the House of Representatives and the president pro tempore of the Senate shall select the chairpersons of the commission from among the members of the commission. Such chairpersons shall schedule the first meeting of the commission, which shall be held not later than sixty days after the effective date of this section.

(f) Not later than January 1, 2008, and annually thereafter, the commission shall submit a report on its findings and recommendations to the joint standing committees of the General Assembly having cognizance of matters relating to insurance, human services and public health, in accordance with the provisions of section 11-4a of the general statutes. Such report shall address the progress in implementing the program and include any modifications in employer or resident contribution levels or state-funding levels.

Sec. 3. (NEW) (Effective from passage) (a) There is established the Connecticut Saves Health Care program to provide health insurance policies, as defined in section 38a-469 of the general statutes, to ensure affordable health care for eligible individuals.

(b) The commission shall arrange and procure health insurance policies for enrollees in the program. The commission shall negotiate and contract with insurance companies and health care centers authorized to do insurance business in the state, in accordance with the provisions of section 38a-41 of the general statutes, to provide health insurance policies to the program. Such health insurance policies shall be approved by the Insurance Commissioner in accordance with the provisions of title 38a of the general statutes. The commission shall:

(1) Determine covered benefits and out-of-pocket cost-sharing to assure affordable access to necessary health care;

(2) Survey employer-based health coverage in New England to assist in determining such benefits and cost-sharing;

(3) Reimburse health care providers;

(4) Credential health care providers for participation in the program;

(5) Issue or arrange for the issuance of the same Connecticut Saves card to all enrollees in the program;

(6) Improve quality of care through measures that include, but are not limited to:

(A) Obtaining and publishing data pertinent to quality of care,

(B) Encouraging the development of integrated health care systems, incorporating such procedures as case management, registries, feedback to physicians and team-based approach to patient-centered care, and

(C) Preventing and managing of chronic disease;

(7) Reduce unnecessary health care spending and control health care cost growth through measures that include, but are not limited to:

(A) Administrative simplification;

(B) Provider reimbursement policies;

(C) Prevention and management of chronic disease;

(D) Consumer quality report cards;

(E) Error reporting;

(F) Strengthening certificate of need procedures; and

(G) E-health initiatives;

(8) Devise and implement systems for voluntary and automatic enrollment;

(9) Establish and implement policies and procedures for interstate coverage issues involving state residents who work or receive health care in other states and residents of other states who work or receive health care in this state;

(10) Establish arrangements with the Department of Revenue Services through which employers and state residents have their contributions sent automatically to said department, via payroll withholding or otherwise, which in turn provides those contributions to the Comptroller; and

(11) Educate state residents concerning the use of the program, the importance of preventive care and assessments, and communicate general public health messages.

(c) The commission may delegate the duties of reimbursing and credentialing health care providers and preventing and managing chronic disease to a third-party administrator.

(d) The commission shall educate state residents about the health insurance policies available under the program, by means including, but not limited to, preparation of educational materials; conducting informational sessions or workshops; contracting with nonprofit organizations and community-based organizations for outreach to hard-to-reach populations and training, consulting with and reimbursing licensed health insurance brokers for assistance in educating residents.

(e) The commission shall promote the use of information technology by insurance companies and health care centers providing health insurance policies to the program, individuals applying to, enrolled in or seeking information about the program and persons providing information to the program and shall arrange for the provision of technical support, training and assistance to assure the effective use of such information technology. The commission shall require each insurance company and health care center providing health insurance policies to the program to operate an electronic health record system not later than October 1, 2007, certified by the commission, that meets interoperability standards established by the commission, by regulations adopted in accordance with subsection (f) of this section, for such electronic health record systems.

(f) The commission shall adopt regulations, in accordance with chapter 54 of the general statutes, to implement and administer the Connecticut Saves Health Care program pursuant to sections 1 to 10, inclusive, of this act.

Sec. 4. (NEW) (Effective from passage) (a) The commission shall make available to each eligible individual seeking enrollment in the program a health insurance policy, affordable to most state residents, offering the benefits specified in subdivision (2) of subsection (b) of this section. The commission shall survey employer-based health insurance coverage in New England to determine the actuarial value of policy coverage.

(b) The policy shall:

(1) Have an actuarial value that is not less than the sum of (A) the actuarial value of all coverage, excluding dental coverage, for average New England enrollees in employer-based insurance during the previous year; and (B) the actuarial value of dental coverage for average New England enrollees in employer-based insurance during the previous year; and

(2) Offer benefits including, but not limited to, office visits, inpatient and outpatient hospital care, mental and behavioral health care, including substance abuse treatment, prescription drugs, including brand name and generic drugs, maternity care, including prenatal and postpartum care, oral contraceptives, durable medical equipment, speech, physical and occupational therapy, home health care, hospice services and extended care as alternatives to institutionalization; preventive and restorative dental care, basic vision care and, as prescribed by a physician, personalized nutrition and exercise plans and smoking cessation services; examinations, screenings, and immunizations for every adult and child including, but not limited to, well-child and well-baby care, which shall be exempt from out-of-pocket cost-sharing.

Sec. 5. (NEW) (Effective from passage) (a) The commission shall prospectively adjust payments for each health insurance policy under the program to compensate fully for any differences between the average risk levels of the policy's enrollees and the state's nonelderly population.

(b) Within available appropriations, during the first three years of implementation of the program, the commission may subsidize the cost of reinsurance premiums related to the program. The remainder of the cost of such premiums shall be paid from payments made to the program by or on behalf of enrollees.

(c) The commission shall establish risk corridors and coinsurance percentages for subsidized reinsurance based on best practices from other states.

(d) On or before January 1, 2011, the commission shall submit a report, in accordance with the provisions of section 11-4a of the general statutes, to the joint standing committee of the General Assembly having cognizance of matters relating to insurance and real estate, containing recommendations about future financing for reinsurance. If the General Assembly does not take action to the contrary before the end of the February, 2012 regular session, reinsurance premiums shall, for the third and each subsequent year, be paid entirely by payments made to the program by or on behalf of enrollees.

Sec. 6. (NEW) (Effective from passage) (a) Any state resident may purchase health insurance coverage under the program at the full cost for such coverage, as determined by the commission, if such resident is sixty-five years of age or older and is employed by, or whose spouse is employed by, an employer that: (1) Offered employer-sponsored insurance on or before October 1, 2006, but no longer offers such insurance, and (2) would have qualified to participate in such employer-sponsored insurance in effect on October 1, 2006.

(b) Any employer may purchase either full or partial coverage under the program for a retired employee who is a state resident at the full cost for such coverage, as determined by the Comptroller.

Sec. 7. (NEW) (Effective from passage) On and after July 1, 2008, any eligible individual, or individual purchasing coverage in the program in accordance with the provisions of section 6 of this act, may apply to the program through the commission or the Department of Social Services.

Sec. 8. (NEW) (Effective from passage) On and after July 1, 2008, an eligible individual not yet enrolled in the program shall be enrolled by default when any of the following occurs:

(1) Such individual's income is reported to the Department of Revenue Services or the Labor Department;

(2) A state income tax form is filed on which such individual is listed as a member of the household; or

(3) Such individual seeks health care.

Sec. 9. (NEW) (Effective from passage) (a) The Department of Social Services shall screen each eligible individual, or individual purchasing coverage in the program in accordance with the provisions of section 6 of this act, at the time such individual applies for the program for eligibility under Title XIX or Title XXI of the Social Security Act. Such screening shall also determine income for purposes of establishing the amount of premium payments under the program for each such individual. Individuals shall be enrolled in the appropriate state Medicaid program or the HUSKY Plan, unless the individual objects to such enrollment. To the maximum extent feasible, relevant information shall be obtained through state-maintained or state-accessible data and through the self-attestation of individuals.

(b) Notwithstanding any provision of the general statutes, the following information shall be made available to the Department of Social Services and the Comptroller for the purposes of determining eligibility under Title XIX or Title XXI of the Social Security Act and for establishing premium payments under the program:

(1) Eligibility and enrollment information for individuals enrolled in means tested assistance programs, other then the HUSKY Plan;

(2) New hire information and quarterly reports provided to the Labor Department;

(3) State income tax information maintained by the Department of Revenue Services;

(4) Information showing United States citizenship of individuals, including, but not limited to, information obtained from birth certificates and other vital records; and

(5) Federal information about new hires, quarterly earnings, Social Security numbers, immigration status and other data pertinent to income or other components of eligibility for Title XIX or XXI of the Social Security Act.

(c) The Comptroller and the Commissioner of Social Services shall enter into agreements with other state agencies providing or receiving information for the program. Such agreements shall require that:

(1) Such information be used only to verify or establish income or eligibility for matching funds under Titles XIX or XXI of the Social Security Act; and

(2) Each state agency providing information to the program train and monitor all staff and contractors who have access to such information and inform such staff and contractors of all applicable state and federal privacy and data security requirements.

(d) Within available appropriations, the Commissioner of Social Services shall develop and operate the information infrastructure required to conduct the screening described in subsection (a) of this section and shall take all feasible steps to maximize the use of federal funds for developing and operating such infrastructure. The commissioner, in consultation with data privacy and security experts, shall develop and implement policies and procedures that maintain data security and prevent inadvertent, improper and unauthorized access to or disclosure, inspection, use or modification of information.

(e) Any individual about whom information is provided to the program shall have the right to (1) obtain, at no cost to the individual, a copy of all such information, which shall identify the agency from which the information was obtained, and (2) correct any misinformation or complete any incomplete information. If any breach of an individual's privacy occurs, such individual shall be promptly informed of such breach and of any rights and remedies available to the individual as a result of such breach.

Sec. 10. (NEW) (Effective from passage) (a) On or before January 1, 2008, the Commissioner of Social Services shall submit to the federal Centers for Medicare and Medicaid Services an amendment to the state Medicaid plan required by Title XIX of the Social Security Act to extend coverage to all parents, guardians and caretaker relatives with incomes at or below three hundred per cent of the federal poverty level, as well as to any other individuals with incomes below such level who are nineteen to sixty-four years of age, inclusive, and who may be covered, at state option, through the state plan amendment.

(b) If needed to access all federal funds allotted to the state under Title XXI of the Social Security Act, the commissioner shall cover individuals over eighteen years of age, including, but not limited to, pregnant women, whether or not such individuals are eligible for coverage under Title XIX of the Social Security Act.

(c) (1) On or before January 1, 2008, the commissioner shall submit an application for a waiver under Section 1115 of the Social Security Act, in accordance with section 17b-8 of the general statutes, to authorize the use of funds received under Title XXI of the Social Security Act for individuals nineteen to sixty-four years of age, inclusive, with incomes at or below one hundred eighty-five per cent of the federal poverty level who do not otherwise qualify under Title XIX of the Social Security Act, either under mandatory eligibility or at state option through state plan amendment. Federal budget neutrality requirements for such waiver may be met through unused uncompensated care payments to hospitals or by taking other measures, provided such measures do not result in any of the following for individuals who would have qualified for coverage under the Medicaid program, the HUSKY Plan or state-administered general assistance:

(A) Any reduction in covered services or access to care;

(B) Any increase in deductibles, premiums or other out-of-pocket costs; or

(C) Any reduction in enforceable, individual guarantees of coverage or services.

(2) If federal budget neutrality requirements do not permit extending Title XIX coverage to the individuals described in subdivision (1) of this subsection, such coverage shall extend to such individuals with incomes under the highest possible percentage of federal poverty level less than one hundred eighty-five per cent.

Sec. 11. (NEW) (Effective from passage) On or before September 1, 2009, the Department of Public Health shall expand the state's network of school-based health clinics so that all public school children in the state have ready access to such clinics. Such school-based health clinics shall be licensed by said department pursuant to chapter 368v of the general statutes and shall provide physical and behavioral health care, including dental care, with appropriate linkages to other services in the state. Such services shall include, but not be limited to, local health departments, community health centers, hospitals, social service providers, mental health and family service agencies, youth service bureaus, pediatricians and other primary care physicians and adolescent medical specialists.

Sec. 12. (NEW) (Effective from passage) (a) On or before July 1, 2009, the Department of Public Health shall establish sufficient primary care clinics to supplement other primary care resources so that all state residents shall have ready access to necessary primary care. Such primary care clinics shall be licensed by said department pursuant to chapter 368v of the general statutes and provide physical and behavioral health care, including dental care, with appropriate linkages to other services in the state, including, but not limited to, specialty care providers, other primary care providers and pharmacies. Each primary care clinic shall be, or be operated by, a federally qualified health center, a health center determined by the Commissioner of Public Health to be substantially similar to a federally qualified health center or a hospital. Each primary care clinic shall provide a wide range of primary care services and shall remain open outside of normal business hours to provide access to urgent but nonemergency care.

(b) Licensed physicians and other health care providers who provide their services for a minimum number of hours to primary care clinics at a reduced rate shall receive incentives that may include, but need not be limited to, reduced cost medical malpractice insurance offered or arranged by the Department of Public Health, loan forgiveness from postsecondary educational institutions that receive funding from the state and partial payment of educational loans.

Sec. 13. (NEW) (Effective from passage) The Commissioner of Public Health shall adopt regulations, in accordance with chapter 54 of the general statutes, to implement the provisions of sections 11 and 12 of this act and to establish requirements for: (1) Services to be provided by and the hours of operation of primary care clinics; and (2) the provisions of services to primary care clinics by physicians and other health care providers, including the number of hours such services shall be provided.

Sec. 14. (NEW) (Effective from passage) (a) On or before January 1, 2008, and biennially thereafter, the Department of Public Health shall publish Plans For A Healthy Connecticut. The department shall develop each such plan with the assistance of state and local agencies, health care experts and members of the public. Each such plan shall include, but not be limited to, information pertaining to the following:

(1) Access to essential health care;

(2) Health care quality;

(3) Health care costs;

(4) Data collection and analysis needs;

(5) Health status and health care disparities, including those based on race, ethnicity, gender, age, sexual orientation, area of residence, health status, diagnosis, immigration status, education, employment, English-language fluency and other relevant factors between different groups of Connecticut residents; and

(6) Preservation of wellness and prevention of health problems.

(b) For each item listed in subsection (a) of this section, and for any other items included in the plan, the plan shall include:

(1) An assessment of the current status of such item in Connecticut;

(2) An analysis of recent public and private efforts to address such item;

(3) Recommendations for future public and private actions to address such item; and

(4) A statement of measurable goals and objectives, with defined time frames, that reasonably can be achieved given sufficient public and private sector commitment and resources.

Sec. 15. (Effective from passage) (a) There is established a Blue Ribbon Commission to study the Connecticut Saves Health Care program. Such study shall include, but not be limited to, an examination of the effect of such program on the cost of providing medical care in the state and the accessibility to medical care for residents of the state. Such commission shall develop recommendations for applying aspects of the program to the state residents who are served by the Medicare program.

(b) The commission shall consist of the following members:

(1) One each to be appointed by the Governor, the speaker of the House of Representatives, the president pro tempore of the Senate, the majority leader of the House of Representatives, the majority leader of the Senate, the minority leader of the House of Representatives and the minority leader of the Senate;.

(2) The Commissioner of Social Services, or said commissioner's designee; and

(3) The Comptroller, or said Comptroller's designee.

(c) Any member of the commission appointed under subdivision (1) of subsection (b) of this section may be a member of the General Assembly.

(d) All appointments to commission shall be made no later than thirty days after the effective date of this section. Any vacancy shall be filled by the appointing authority.

(e) The member appointed by the Governor shall be the chairperson of the commission. The chairperson shall schedule the first meeting of the commission, which shall be held no later than sixty days after the effective date of this section.

(f) The administrative staff of the joint standing committee of the General Assembly having cognizance of matters relating to insurance shall serve as administrative staff of the commission.

(g) Not later than January 30, 2008, the commission shall submit a report on its findings and recommendations to the joint standing committees of the General Assembly having cognizance of matters relating to human services and public health, in accordance with the provisions of section 11-4a of the general statutes. The commission shall terminate on the date that it submits such report or January 30, 2008, whichever is later.

Sec. 16. (Effective July 1, 2007) An amount is appropriated to the Connecticut Saves Health Care Commission, from the General Fund, for the fiscal year ending June 30, 2008, for implementation of the Connecticut Saves Health Care program, established under section 3 of this act.

Sec. 17. (Effective July 1, 2007) An amount is appropriated to the Connecticut Saves Health Care Commission, from the General Fund, for the fiscal year ending June 30, 2008, for the purpose of lowering, by not less than ten per cent, the cost to employers of having employees and dependents receive health insurance coverage through the Connecticut Saves Health Care program, established under section 3 of this act.

Sec. 18. (Effective July 1, 2007) An amount is appropriated to the Connecticut Saves Health Care Commission, from the General Fund, for the fiscal year ending June 30, 2008, for payment of reinsurance premiums for the Connecticut Saves Health Care program, established under section 3 of this act.

Sec. 19. (Effective July 1, 2007) An amount is appropriated to the Department of Social Services, from the General Fund, for the fiscal year ending June 30, 2008, to develop and operate the information technology infrastructure required under section 9 of this act.

Sec. 20. (Effective July 1, 2007) An amount is appropriated to the Department of Public Health, from the General Fund, for the fiscal year ending June 30, 2008, for the purpose of expanding the state's network of school-based health clinics, in accordance with section 11 of this act.

Sec. 21. (Effective July 1, 2007) An amount is appropriated to the Department of Public Health, from the General Fund, for the fiscal year ending June 30, 2008, for the purpose of establishing primary care clinics, in accordance with section 12 of this act.