AN ACT CONCERNING A CATASTROPHIC ILLNESS IN CHILDREN RELIEF PROGRAM.

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

Section 1. (NEW) (Effective July 1, 2008) As used in sections 1 to 9, inclusive, of this act, unless otherwise provided:

(1) "Catastrophic illness" means any illness or condition that requires inpatient or ambulatory care and services for which (A) the medical and related expenses are not covered by any state program, except as provided in sections 1 to 9, inclusive, of this act, or any federal program in which the child is enrolled, or any insurance contract under which the child is a beneficiary, and (B) subject to the provisions of subdivision (5) of section 4 of this act, treatment costs exceed ten per cent of the first one hundred thousand dollars of annual income of a family and fifteen per cent of any income of a family in excess of one hundred thousand dollars.

(2) "Child" means a person twenty-one years of age or under.

(3) "Commission" means the Catastrophic Illness in Children Relief Commission.

(4) "Office" means the Office of the Healthcare Advocate.

(5) "Family" means a child and the child's parent or guardian who is legally responsible for the child's medical expenses.

(6) "Fund" means the Catastrophic Illness in Children Relief Fund established pursuant to section 2 of this act.

(7) "Income" means all income, from whatever source, received by a family, excluding payments received from the fund.

(8) "Program" means the Catastrophic Illness in Children Relief program, established pursuant to sections 1 to 9, inclusive, of this act.

(9) "Resident" means a person legally domiciled within the state for a period of three months immediately preceding the date of application for the program. Resident does not include a person who has a seasonal or temporary residence within the state.

Sec. 2. (NEW) (Effective July 1, 2008) (a) There is established a separate, nonlapsing account within the General Fund to be known as the "Catastrophic Illness in Children Relief Fund". The account shall contain moneys transferred to it pursuant to section 8 of this act and any money required to be deposited in the account under any other provision of the general statutes. Investment earnings from any moneys in the account shall be credited to the account and shall become part of the assets of the account. The account shall be administered by the Treasurer.

(b) Moneys in the account shall be used by the Catastrophic Illness in Children Relief Commission for payment or reimbursement of the medical and related expenses of children with catastrophic illnesses in accordance with sections 1 to 8, inclusive, of this act.

Sec. 3. (NEW) (Effective July 1, 2008) (a) There is established a Catastrophic Illness in Children Relief Commission within the Office of the Healthcare Advocate. The commission shall consist of (1) eleven public members as follows: Three appointed by the Governor, two appointed by the speaker of the House of Representatives, two appointed by the president pro tempore of the Senate, one appointed by the AFL-CIO, and three appointed by the Attorney General, two of whom are providers of health care services to children in the state; and (2) the Healthcare Advocate, the Commissioners of Social Services, and Public Health, the Insurance Commissioner and the Treasurer. The public members shall serve terms of five years, except that the initial three public members appointed by the Governor shall serve for terms of two, three and four years, respectively.

(b) Each public member shall hold office for the term of his appointment and until his successor has been appointed. A public member of the commission is eligible for reappointment.

(c) Each member described in subdivision (2) of subsection (a) of this section of the commission may designate an employee of his agency to represent such member at meetings of the commission, and each such designee may vote and otherwise act on behalf of the member. Any designation shall be in writing, delivered to the commission and filed with the Secretary of the State. The designation shall continue in effect until revoked or amended in the same manner as provided for in the initial designation.

(d) Each public member of the commission may be removed from the office by the official by whom he was appointed for cause, after a public hearing, and may be suspended by the official by whom he was appointed pending the completion of the hearing. Before entering upon their duties, members of the commission shall take and subscribe an oath to perform the duties of the office faithfully, impartially and to the best of their ability. A record of oaths shall be filed with the Secretary of the State.

(e) Any vacancies in the membership of the commission occurring other than by expiration of a term shall be filled in the same manner as the original appointment for the portion of the unexpired term.

(f) The members shall elect a chairperson and chief executive officer of the commission who shall be one of the public members of the commission. The commission shall, by rule, determine the term of office of the chairperson and chief executive officer. The members shall elect a secretary and a treasurer who shall be public members of the commission and the same person may be elected to serve as both secretary and treasurer.

(g) The powers of the commission shall be vested in its members in office from time to time and seven members of the commission shall constitute a quorum at any meeting. Actions may be taken, and motions and resolutions adopted by the commission at any meeting by the affirmative vote of at least seven members of the commission. A vacancy in the membership of the commission shall not impair the right of a quorum to exercise all the powers and perform all the duties of the commission.

(h) The members of the commission shall serve without compensation, but the commission shall reimburse its members for the reasonable expenses incurred in the performance of their duties, within available funding.

(i) The commission shall be appointed not later than November 1, 2008, and shall organize as soon as may be practicable after the appointment of its members.

Sec. 4. (NEW) (Effective July 1, 2008) The commission shall have the following responsibilities:

(1) To establish a program to administer the fund and authorize the payment or reimbursement of the medical and related expenses of children with catastrophic illnesses;

(2) To establish procedures for applying to the fund, determining the eligibility for the payment or reimbursement of medical expenses for each child and processing claim disputes;

(3) To establish procedures for reimbursement of the fund where a family, after receiving assistance from the fund, recovers the costs for a child's medical expenses from a catastrophic illness pursuant to a settlement or judgment in a legal action;

(4) To establish the amount of reimbursement for the medical expenses of each child using a sliding fee scale based on a family's ability to pay for medical expenses, which takes into account family size, family income and assets and family medical expenses;

(5) To expand the definition of catastrophic illness pursuant to subparagraph (B) of subdivision (1) of section 1 of this act, by adjusting the financial eligibility criteria based upon available funding;

(6) To disseminate information to the public concerning the fund and the program;

(7) To maintain confidential records on each child who applies for assistance from the fund pursuant to section 6 of this act;

(8) To authorize and make payment of all administrative costs that do not exceed five per cent of the total amount transferred into the fund in a fiscal year, and are related to the management of the program, including, but not limited to, costs for staff to manage the program and coordinate the work assigned by the commission and materials development, printing, postage and telephone expenses;

(9) Take all other actions necessary or convenient to carry out the purposes of sections 1 to 9, inclusive, of this act; and

(10) To adopt regulations, in accordance with chapter 54 of the general statutes, necessary to effectuate the purposes of sections 1 to 9, inclusive, of this act.

Sec. 5. (NEW) (Effective July 1, 2008) The commission may negotiate or settle a claim that the fund maintains for reimbursement against a family who has received assistance for the medical expenses of a child with a catastrophic illness and who has recovered damages in a legal action for such expenses. A reimbursement shall be less the expense of any recovery by the family. Money recovered pursuant to this section shall be deposited in the fund.

Sec. 6. (NEW) (Effective July 1, 2008) A child who is a resident of the state shall be eligible, through his or her parent or guardian, to apply to the program. The burden of establishing a legal domicile within the state is upon the parent or legal guardian of a child. As part of the application process, the commission shall screen each applicant for other sources of coverage and for potential eligibility for other state and federal programs, and to document the results of such screening. If the commission determines that an applicant is potentially eligible for Medicaid or other state or federal program, the commission shall assist the applicant in applying for benefits under such program.

Sec. 7. (NEW) (Effective July 1, 2008) Whenever a child has a catastrophic illness and is eligible for the program, the child, through his or her parent or guardian, may receive financial assistance from the fund subject to the regulations established by the commission and available funding. The financial assistance shall include, but need not be limited to, payments or reimbursements for the costs of medical treatment, hospital care, prescription drugs, nursing care and physician services.

Sec. 8. (NEW) (Effective July 1, 2008) Notwithstanding any provision of the general statutes, for the purposes of providing the funding necessary to establish and meet the purposes of the fund, the commission shall establish a one dollar annual surcharge per employee for all employers who are subject to the Connecticut unemployment insurance contribution under chapter 567 of the general statutes. Employers shall pay such surcharge to the Labor Department. The Labor Department shall transfer funds collected pursuant to this section to the Treasurer for deposit in the fund annually as provided by the commission.

Sec. 9. (NEW) (Effective July 1, 2008) The commission shall report, in accordance with section 11-4a of the general statutes, annually to the Governor, and to the joint standing committee of the General Assembly having cognizance of matters relating to human services and to the select committee of the General Assembly having cognizance of matters relating to children on the status of the program. The report shall include information about the number of participants in the program, average expenditures per participant, the nature and type of catastrophic illness for which the fund provided financial assistance, and the average income and expenditures of the families who received assistance under the program. The commission may also make recommendations for statutory changes related to the program and fund.

Statement of Purpose:

To establish the Catastrophic Illness in Children Relief program.

[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.]