House Bill No. 6002
               House Bill No. 6002

     May Special Session, PUBLIC ACT NO. 94-3

AN ACT CONCERNING HEALTH CARE ACCESS.


    Section 1. (a)  Notwithstanding the provisions
of subsection (a)  of  section  1  of  special act
92-20, there shall  be established a department of
health effective July 1, 1995, which shall include
(1)  all programs  of  the  department  of  public
health and addiction  services  as  set  forth  in
public act 93-381  and  (2)  all  programs  of the
department of mental  health.  (A) Said department
shall be organized  so as to enhance, the specific
disciplines of substance  abuse, mental health and
public health. The  department  shall  be  charged
with  developing  a   coordinated  and  integrated
approach for promoting  the health and wellness of
the citizens of  Connecticut  and for implementing
community   based   efforts   toward   prevention,
education and treatment  in  the  areas  of mental
health,  public health  and  substance  abuse.  In
identifying and providing  for  service needs, the
department shall strive  to enhance client access,
assure effective service  and  promote  management
efficiencies. The department  shall  serve  as the
lead agency for  substance  abuse issues and shall
work  in  conjunction   with  other  state  agency
providers of substance  abuse services to ensure a
coordinated  and comprehensive  approach  to  such
issues. (B) The  secretary of the office of policy
and management, in directing the implementation of
the reorganization of  health  and  human services
agencies, pursuant to  the  provisions  of special
act 92-20, shall  develop  an  implementation plan
for  the  department   of   health  involving  the
commissioners of mental  health, public health and
addiction services, social  services, children and
families,  education and  corrections,  the  chief
court administrator of  the  judicial  department,
agency staff, service  providers and others in the
public  health,  mental  health,  substance  abuse
sectors  and other  individuals  as  he  may  deem
necessary. In developing  such plan, the secretary
shall consult with  advisory  councils established
by the relevant  commissioner for each such sector
and with a  joint  advisory council established by
the secretary, that  represents  equally all three
sectors. The secretary  shall  also  report on the
progress of the  planning  process  at least three
times to a  legislative  oversight group comprised
of the cochairpersons  and  ranking members of the
joint standing committee  of  the general assembly
have  cognizance of  matters  relating  to  public
health and the  cochairpersons and ranking members
of the subcommittee  on  hospitals and health care
of the joint  standing  committee  of  the general
assembly having cognizance  of matters relating to
appropriations and the  budgets of state agencies.
Such   planning   process   shall   consider   the
requirements  of  potential  revenue  maximization
efforts in determining  the  structure  of the new
agency.   The   secretary    shall   submit   this
implementation plan for  the  department of health
to the joint  standing  committees  of the general
assembly having cognizance  of matters relating to
appropriations, human services  and public health,
on or before  January 1, 1995, including suggested
legislation for the  merger  of  the department of
health to be effective July 1, 1995.
    (b)  The  department   of   developmental  and
rehabilitative services shall  not  be  created on
July 1, 1995. The department of mental retardation
shall remain an  independent agency. The bureau of
rehabilitation services shall  remain  within  the
department of social  services.  The commission on
the deaf and  hearing  impaired  and  the board of
education and services  for the blind shall remain
for   administrative  purposes   only   with   the
department of social  services.  The developmental
disabilities    council    shall     remain    for
administrative purposes only  with  the department
of mental retardation.
    Sec. 2. Section  2  of  special  act 92-20, as
amended by section  6  of  public  act  93-262, is
amended to read as follows:
    The implementation plan  shall provide for the
following: (1) The  department  of social services
to which shall be transferred: (A) All programs of
the department on  aging;  (B) all programs of the
department of income maintenance; (C) all programs
of the department  of human resources, except [(i)
the bureau of  rehabilitation services which shall
be  transferred  to   the   department  of  social
services for the  fiscal  years  ending  June  30,
1994, and June 30, 1995, (ii) other programs which
provide   specific  services   to   persons   with
disabilities which shall  be  transferred  to  the
department of social  services for the fiscal year
ending June 30,  1994,  and  June  30,  1995,  and
(iii)]  the head  start  program  which  shall  be
transferred to the  department  of  education; (D)
the  state  rental   assistance  program  and  the
federal Section 8  certificate and voucher program
in the department  of  housing;  (E) the licensure
and regulation of child day care in the department
of health services,  and (F) the powers and duties
of the commission  on  hospitals  and  health care
concerning the determination  of  rates  for  home
health  care agencies  and  homemaker-home  health
aide agencies and certificates of need for nursing
homes, homes for  the aged and rest homes; (2) the
department of public health and addiction services
to which shall be transferred: (A) All programs of
the  department of  health  services,  except  the
licensure and regulation of child day care and (B)
all programs of  the  Connecticut alcohol and drug
abuse   commission;   (3)   [the   department   of
developmental and rehabilitative services to which
shall be transferred:  (A)  All  programs  of  the
department of mental  health;  (B) all programs of
the department of mental retardation; (C) programs
in the department of human resources which provide
specific services to  persons  with  disabilities,
including the bureau  of  rehabilitation services;
(D) all programs of the commission on the deaf and
hearing impaired, and  (E)  all  programs  of  the
board of education  and  services  for  the blind;
(4)] the change  in  name  of  the  department  of
children and youth  services  to the department of
children and families;  [(5)  the  transfer of the
developmental disabilities council  to  the office
of  policy  and   management   for  administrative
purposes only pursuant  to  42  USC 6022;] (4) THE
DEPARTMENT   OF   HEALTH   TO   WHICH   SHALL   BE
TRANSFERRED: (A) ALL PROGRAMS OF THE DEPARTMENT OF
PUBLIC HEALTH AND  ADDICTION SERVICES; AND (B) ALL
PROGRAMS OF THE  DEPARTMENT  OF  MENTAL HEALTH and
[(6)] (5) the  establishment  of  a  commission on
aging, the duties  of which shall include, but not
be limited to,  (A)  conducting  studies,  holding
public   hearings   and    issuing   reports   and
recommendations  on matters  of  interest  to  the
elderly, (B) meeting monthly with the commissioner
and the head  of  the division of elderly services
of the department of social services to review and
comment on the  policies  and  procedures  of said
department concerning the  elderly,  (C) reviewing
and commenting on  the  budget  of the division of
elderly  services  of  the  department  of  social
services; and (D)  advising  the governor, general
assembly, local government  leaders and the public
on matters concerning the elderly.
    Sec. 3. Section  3  of  special  act  92-20 is
amended to read as follows:
    (a) The department  of  social  services shall
have three units:  Administration,  operations and
programs.  Programs  delivering  similar  services
shall  be  grouped   in  the  same  division.  The
divisions  shall be:  (1)  Economic  support;  (2)
elderly  services; (3)  employment  services;  (4)
community-based  services,  and  (5)  health  care
financing. The division  of  health care financing
shall combine the  Medicaid policy function of the
department of income  maintenance  with the powers
and duties of  the  commission  on  hospitals  and
health care.
    (b)  The  department   of  public  health  and
addiction  services  shall   have   three   units:
Administration,  operations  and   programs.   The
department shall have the following divisions: (1)
Public health, and  (2)  addiction  services.  The
division of addiction  services  shall  include  a
coordinating function with  other  state  agencies
and other branches of state government as provided
in sections 17a-635  and  17a-636  of  the general
statutes.
    [(c)  The  department   of  developmental  and
rehabilitative services shall  have  three  units:
Administration,  operations  and   programs.   The
department shall have the following divisions: (1)
Mental   health;   (2)   developmental   services,
including  services  for   persons   with   mental
retardation;  (3) vocational  rehabilitation,  and
(4)  physical and  other  disabilities,  including
services  for  persons   with  visual  impairment,
hearing impairment, autism, traumatic brain injury
and  learning  disabilities.   The   division   of
vocational rehabilitation, which shall include the
bureau of rehabilitation services, shall carry out
the duties required  by federal law and regulation
that pertain to the bureau's program.
    (d)] (c) The  commissioners  of the department
of social services  [,  the  department  of public
health and addiction  services  and the department
of developmental and  rehabilitative services] AND
THE DEPARTMENT OF  HEALTH  shall  ensure  that the
following  intragency and  interagency  goals  are
addressed and met:  (1)  The  establishment of not
more than six  uniform  regional  service delivery
areas to be  developed  in  consideration  of  (A)
geographical   size;   (B)    general   population
distribution;  (C) agency  target  population  and
caseload; (D) location  of  department facilities;
(E)  the  accessibility   of   transportation  for
clients  to  service   delivery  offices  and  for
workers   to   clients   and   (F)   any   federal
requirements; (2) the coordination of the regional
service delivery areas  of  other  state  agencies
which provide services  closely linked with health
and  human services  programs  with  the  regional
service  delivery  areas   developed  pursuant  to
subdivision  (1)  of   this  subsection;  (3)  the
decentralization   of   the    service    delivery
operations  of each  agency  to  provide  as  much
autonomy  as  possible  to  each  regional  office
enabling the office  to respond effectively to the
particular  service  needs   of  the  region;  (4)
coordinated control and  direction for programs to
ensure  consistency  and   uniformity   among  the
regions  in  the   development  and  provision  of
services;  (5)  the  development  of  a  strategic
planning unit in  the  office of each commissioner
to  centralize  policy  development  and  planning
within   the  agency   and   promote   interagency
coordination of health and human services planning
and  policy  development;  (6)  development  of  a
common intake process  for  entry  into the health
and  human services  system  for  information  and
referral,  screening,  eligibility  determinations
and service delivery; (7) the creation of a single
application form for client intake and eligibility
determinations with a  common  client  identifier;
(8) development of  a commonly-linked computerized
management information system with the capacity to
track  clients and  determine  eligibility  across
programs; (9) the coordination of current advisory
boards and councils to provide input and expertise
from  consumers, advocates  and  other  interested
parties  to  the   commissioners;   and  (10)  the
encouragement of collaborations  that  will foster
the development and  maintain  the  client-focused
structure of the health and human services system,
as well as  involve  partnerships  between clients
and their service providers.
    Sec. 4. Section  5  of  special  act 92-20, as
amended by section  83  of  public  act 93-262, is
amended to read as follows:
    (a) The secretary  of the office of policy and
management shall report the following to the joint
standing committees of the general assembly having
cognizance of matters  relating to appropriations,
human services and public health: (1) On or before
January  1, 1993,  a  plan  for  the  transfer  of
programs to the  department of social services and
the  department of  public  health  and  addiction
services, including suggested  legislation  to  be
effective July 1,  1993;  (2) on or before January
1, 1995, a  plan  for  the transfer of programs to
the    department    of     [developmental     and
rehabilitative    services]   HEALTH,    including
suggested  legislation to  be  effective  July  1,
1995; (3) on or before January 1, 1994, a progress
report detailing the operations of the departments
of social services and public health and addiction
services with a  schedule  for full implementation
to be completed  by  July  1, 1995; AND (4) [on or
before  January  1,   1996,   a   progress  report
detailing  the operations  of  the  department  of
developmental and rehabilitative  services  with a
schedule for implementation  to  be  completed  by
July 1, 1996,  (5)]  on  or before July 1, 1995, a
final report on  the  full  implementation  of the
reorganization.  [of  the   department  of  social
services and the  department  of public health and
addiction services and  (6)  on  or before July 1,
1996, a final report of the full implementation of
the   reorganization   of    the   department   of
developmental and rehabilitative services.]
    (b) The plans and reports required pursuant to
subsection (a) of  this  section shall include, as
appropriate,  (1) an  analysis  of  cost  savings,
costs incurred and projected costs; (2) the impact
of  the  reorganization   on   current  collective
bargaining agreements; (3)  consideration  of  the
impact  of  the  reorganization  on  the  physical
space,   facilities  and   institutions   of   the
agencies; and (4) schedules to fully implement the
reorganization as soon  as reasonably possible but
no later than July 1, 1995.
    Sec. 5. (NEW)  Sections 5 to 18, inclusive, of
this act shall  be  known  and may be cited as the
"Office of Health Care Access Act".
    Sec. 6. (NEW)  As  used  in  sections 5 to 18,
inclusive,  and section  19a-146  of  the  general
statutes, as amended by section 20 of this act:
    (1) "Certified health  plan" means a plan that
provides the standard  benefits  package and meets
the  requirements established  by  the  office  of
health care access;
    (2) "Office" means  the  office of health care
access;
    (3)  "Standard  benefits  package"  means  the
specified set of health services, as determined by
federal law or  in  the absence of such applicable
federal law, as  determined by state law, that are
the minimum which  must  be  available  from  each
certified health plan;
    (4) "Health care provider" or "provider" means
a   state  licensed   or   certified   person   or
state-authorized    facility,    which    delivers
diagnostic,  treatment,  inpatient  or  ambulatory
health care services;
    (5)  "Health  plan"   means  any  hospital  or
medical  policy  or   certificate   or   contract,
hospital  or medical  service  plan  contract,  or
health care center  contract.  The  term  does not
include    accident-only,    specific     disease,
individual     hospital     indemnity,     credit,
dental-only,  vision-only,  Medicare   supplement,
long-term care, or  disability  income  insurance;
coverage  issued  as  a  supplement  to  liability
insurance;   workers'  compensation   or   similar
insurance;    or    automobile     medical-payment
insurance;
    (6) "Institute" means  the  Connecticut health
care  data  institute   established   pursuant  to
section  12  of  this  act  and  operated  by  The
University of Connecticut Health Center.
    Sec. 7. (NEW)  (a)  There  is  established  an
office of health  care  access.  The powers of the
office shall be  vested  in  and  exercised  by  a
board. The membership  of  the board shall consist
of three members,  one  of whom shall be appointed
by the governor, who shall serve as chairperson of
the board, be subject to the provisions of section
4-9a  of  the  general  statutes,  as  amended  by
section 4 of  public  act  93-219,  section  27 of
public act 93-262  and  section  56  of public act
93-435, and serve  a  term  coterminous  with  the
governor.  The  other   members   shall   be   the
commissioner  of  public   health   and  addiction
services  or  his   designee   and  the  insurance
commissioner or his  designee  who  shall serve ex
officio.   Upon   expiration    of   the   initial
appointment, subsequent appointments  made  by the
governor shall be  for terms of four years. At the
end of a term a member may continue to serve until
a successor is  appointed.  Any  vacancy occurring
other than by expiration of a term shall be filled
by appointment by  the governor for the balance of
the unexpired term. Each board member appointed by
the governor shall  serve on a full-time basis and
shall  be  compensated   in  accordance  with  the
provisions  of  section   4-40   of   the  general
statutes.
    (b) No person  who  is an officer, employee or
significant  shareholder or  other  owner  of,  or
serving as an agent or independent contractor for,
a health care  provider,  health  insurer,  health
care center, as  defined in section 38a-175 of the
general statutes, or  certified  health  plan  may
serve as a  member of the board. Nothing contained
in this subsection  shall  prevent any such person
from (1) membership  on  an  advisory committee to
the office or  (2)  entering  into  a  contract to
perform services for the office.
    Sec. 8. (NEW)  (a)  The  office of health care
access  shall  employ   the   most  effective  and
practical means necessary  to fulfill the purposes
of  this  act,   including  but  not  limited  to,
performing the duties  and functions as enumerated
in subsections (b) and (c) of this section.
    (b)  The  office   shall  be  responsible  for
developing a plan  for  a  consolidation  of state
health regulation and  financing. The office shall
be  responsible  for   developing   a   plan   and
recommendations for health  system  reform  in the
state, which reform shall attain the goals of: (1)
Enrolling all residents  not later than January 1,
1997, in a  health  plan  to  receive at least the
care  provided in  a  standard  benefits  package,
regardless of age,  sex,  race, employment, health
condition or economic status; (2) providing access
to all residents  of  the state to appropriate and
timely  health  care;   (3)   consolidating  state
government health care spending; and (4) improving
and enhancing effective cost containment.
    (c)  The  office   shall:  (1)  Authorize  and
oversee the collection  of  data required to carry
out  the  provisions   of   sections   15  to  18,
inclusive, of this act; (2) oversee and coordinate
health system planning  for the state; (3) monitor
health care costs;  and  (4) implement and oversee
health  care reform  as  enacted  by  the  general
assembly.
    (d) The office  may  establish a working group
composed  of  health   care  providers,  insurers,
business representatives, patient  representatives
and  others  to   study  the  feasibility  of  the
development of a  regional  health care plan which
may serve as  a  model for health system reform in
the state. The  office  shall  report to the joint
standing committee of  the general assembly having
cognizance of matters  relating  to  public health
regarding  the  recommendations   of  the  working
group.
    Sec. 9. (NEW)  (a)  The board of the office of
health  care  access  shall  employ  an  executive
director  who  shall  be  exempt  from  classified
service.  He shall  be  the  chief  administrative
officer of the  office  of  health care access and
shall direct and  supervise administrative affairs
and technical activities  in  accordance  with the
directives of the  board.  He  shall  approve  all
accounts for salaries, accountable expenses of the
office or of  any  employee  or consultant thereof
and expenses incidental  to  the  operation of the
office. He shall  perform such other duties as may
be directed by  the  board  in  carrying  out  the
purposes of this act. The executive director shall
attend all meetings of the board, keep a record of
the  proceedings  and   shall   maintain   and  be
custodian of all books, documents and papers filed
with the office  and  of the minute book and other
records of the office.
    (b) The board  may employ and pay professional
and support staff  subject  to  the  provisions of
chapter 67 of  the  general  statutes and contract
with and engage  consultants and other independent
professionals as may  be necessary or desirable to
carry out the functions of the office.
    (c)  The board  shall  establish  an  advisory
committee, composed of  no  more  than twenty-five
members, to provide  such advice and assistance to
the office as  may  be  requested by the office or
directed by statute.  The committee shall include,
but not be  limited  to, representatives of health
care  providers,  employers,  insurers,  insurance
agents,   consumers,  and   affected   industries,
businesses and unions.
    (d)  The  board  shall  establish  a  consumer
education  unit  within   the  office  to  provide
information to residents  of  the state concerning
the availability of public and private health care
coverage.
    Sec. 10. (NEW) The commission on hospitals and
health care shall  be terminated, by July 1, 1995.
The office of  health  care access shall report on
or before January  1,  1995, to the joint standing
committee   of   the   general   assembly   having
cognizance of matters  relating  to  public health
its  recommendations  and   proposed   legislative
changes  to  accomplish   such   termination   and
concerning  which  functions   of  the  commission
should be retained in the office.
    Sec. 11. (NEW)  (a)  There  is established for
the period July  1,  1994,  to  January 1, 1996, a
health  care  reform   review  board  which  shall
consist of seven  members,  one  of  whom shall be
appointed by the  president  pro  tempore  of  the
senate, one of  whom  shall  be  appointed  by the
speaker of the  house  of  representatives, one of
whom shall be  appointed by the minority leader of
the senate and  one  of whom shall be appointed by
the   minority   leader    of    the    house   of
representatives.  Such  four   appointees  may  be
members of the  general  assembly. The other three
members of the  health  care  reform  review board
shall be the  board  of  the office of health care
access as established  in  section  7 of this act.
The board shall  receive all data, information and
recommendations necessary to  provide  the reports
required  pursuant  to  subsections  (b)  to  (d),
inclusive, of this  section  and shall approve all
reports prior to  their  submission to the general
assembly. Appointments to  the board shall be made
no later than  July  1, 1994. Failure to appoint a
member shall not  impair  the remaining members of
the  board from  carrying  out  the  function  and
duties of the board under this section. A majority
of members appointed to the board shall constitute
a quorum.
    (b) On or  before  January 1, 1995, the office
of health care  access  shall  report to the joint
standing committees of the general assembly having
cognizance of matters  relating  to  public health
and  insurance  and   real   estate   its   plans,
recommendations and estimates  of  costs,  if any,
for health care reform, including, but not limited
to: (1) Utilization  and  expansion  of  community
health centers and  school-based  health  clinics;
(2) an assessment  of the need for and a structure
for one or more purchasing cooperatives, including
a    state-wide   purchasing    cooperative    and
requirements   for   corporate    alliances    and
multiemployer alliances; (3)  a recommendation for
a standard benefits  package which includes mental
health,   substance   abuse   and   rehabilitation
services;  (4) a  recommendation  regarding  state
mandated  health  insurance   benefits;   (5)   an
appropriate    method   for    health    insurance
regulation; (6) a  proposal  of subsidy levels, if
necessary,   for   low-income    uninsured,    the
unemployed and small  businesses;  (7) an estimate
and recommendation as  to the appropriate role for
state,   employer,   employee    and    individual
participation to achieve universal coverage; (8) a
recommendation concerning employees  of  the state
of Connecticut and  persons  eligible for Medicaid
assistance to obtain  health care coverage through
a state-wide purchasing cooperative; (9) any other
methods or options to achieve the purposes of this
act.
    (c) On or  before  October 1, 1995, the office
shall submit to  the  joint standing committees of
the general assembly  having cognizance of matters
relating to public  health  and insurance and real
estate an analysis of the total public and private
spending  on  health   care   in   the  state  and
recommendations and goals  for  state  health care
spending.
    (d) On or  after  January  1, 1996, the office
shall recommend standards for the certified health
plans to the  joint  standing  committees  of  the
general  assembly  having  cognizance  of  matters
relating to public  health  and insurance and real
estate. Said standards  may include, but shall not
be  limited  to,  offering  the  standard  benefit
package,  as defined  by  the  office,  guaranteed
issuance and renewability,  community  rating on a
state-wide  basis  and  no  preexisting  condition
exclusions.
    (e) As used  in  this section: (1) "State-wide
purchasing  cooperative"  means  an  entity  whose
principal  function  is  to  provide  health  care
purchasing services and  detailed  information  to
enrollees   on   comparative    prices,   enrollee
obligations, usage, medical  outcomes, quality and
enrollee satisfaction with certified health plans;
(2) "Corporate alliance" means an entity formed by
a single employer  in  the  state  which purchases
health care services  for  enrollees  and provides
detailed information to  enrollees  on comparative
prices,  enrollee  obligations,   usage,   medical
outcomes, quality and  enrollee  satisfaction with
health   plans  in   accordance   with   standards
established  by  state   law;  (3)  "Multiemployer
alliance" means an  entity  formed  by  a group of
employers in the state which purchases health care
services  for  enrollees   and  provides  detailed
information to enrollees  on  comparative  prices,
enrollee  obligations,  usage,  medical  outcomes,
quality  and  enrollee  satisfaction  with  health
plans in accordance  with standards established by
state law.
    Sec. 12. (NEW) (a) There is established at The
University  of  Connecticut   Health  Center,  the
Connecticut  health  care   data   institute.  The
institute shall be  a  principal  source of health
care data for  the  office  of health care access.
The institute shall establish a comprehensive data
collection system as  described  in sections 15 to
18, inclusive, of  this  act,  for  the purpose of
maintaining a state-wide database on all inpatient
and ambulatory care  encounters,  to  track health
care expenditures and  health outcomes, developing
a  baseline on  state  health  care  expenditures,
developing  general  baseline   data   on   costs,
distribution of costs and performance and outcomes
reviews    and   evaluating    and    distributing
information concerning certified  health plans and
their  providers.  The   institute  shall  be  the
repository for all  such  data  collected  and may
coordinate   the   uses   of   these   data   with
demographic,    epidemiological,   economic    and
financial  data retained  by  state  agencies  and
other institutions insofar  as they may be used to
carry out the state's responsibilities.
    (b)  The  institute   may   employ   and   pay
professional  and support  staff  subject  to  the
provisions of chapter  67  of the general statutes
and contract with and engage consultants and other
independent professionals as  may  be necessary to
carry out the functions of the institute.
    (c)  The  institute   may   consult  with  the
State-Wide Health Alliance  for  Records Exchange,
the   Connecticut  Electronic   Data   Interchange
Project, the Connecticut Peer Review Organization,
the  Connecticut Hospital  Association,  Insurance
Association of Connecticut,  Blue  Cross  and Blue
Shield  of  Connecticut,  and  other  programs  as
required regarding the  coordination of public and
private efforts of  data collection and management
information systems.
    (d)  The  institute   with   the   advice  and
assistance of the  advisory  board,  shall develop
the data collection  forms,  formats and reporting
schedules   necessary  to   meet   all   reporting
requirements,  submitting these  to  the  advisory
board for review. The forms, formats and reporting
schedules  shall,  to   the  extent  feasible,  be
consistent with the  federal Health Care Financing
Authority,   the   Connecticut   Electronic   Data
Interchange,  the Connecticut  Health  Information
Management  and Exchange,  the  State-Wide  Health
Alliance for Records  Exchange  and the Health and
Employee Data Information  Set.  In  cases where a
majority  of the  advisory  board  object  to  any
actions taken or  proposed  by  the institute, the
matter shall be  referred  to the office of health
care access and its board for resolution.
    (e)   The  institute   may   adopt   emergency
regulations  and  shall   adopt   regulations   in
accordance with the  provisions  of  chapter 54 of
the general statutes as necessary to implement the
data collection requirements  pursuant to sections
15 to 18, inclusive, of this act.
    Sec. 13. (NEW)  (a)  There  is  established an
advisory  board  to   provide   such   advice  and
assistance to the  health  care  data institute as
may be requested  by  the institute or directed by
statute. Such board  shall advise the institute on
data  collection,  forms   formats  and  reporting
schedules   necessary  to   meet   the   reporting
requirements of the institute.
    (b) The advisory board shall consist of twenty
members to be  appointed  by  the office of health
care access. The  board  shall include, but is not
limited  to,  representatives   of   health   care
providers  including  community-based   providers,
employers, employees, insurers,  insurance agents,
consumers,  affected  industries,  businesses  and
unions. The executive  director  of  the office of
health care access shall serve as chairperson with
the responsibility to  act as presiding officer at
meetings of the advisory board.
    (c) Members of  such board shall serve without
compensation for terms of four years. Vacancies on
the  advisory  board   shall  be  filled  for  the
remainder of the  term  in  the same manner as the
original appointments.
    (d) Such board  shall meet at least once every
calendar quarter and  at  such  other times as the
chairman on his  own  motion  or at the request of
the institute or  of a majority of the board shall
determine.
    (e) The advisory  board shall not be construed
to  be  a  board  or  commission  subject  to  the
provisions  of  section   4-9a   of   the  general
statutes, as amended  by  section  4 of public act
93-219,  section  27  of  public  act  93-262  and
section 56 of  public  act  93-435.  The institute
shall provide such  staff  as is necessary for the
performance of the  functions  and  duties  of the
advisory board.
    Sec. 14. (NEW)  As  used in sections 14 to 18,
inclusive, of this  act:  (1) "Reporter" means any
individual,  group  of  individuals,  health  care
facility or institution,  payer,  certified health
plan, or other business entity, that is engaged in
providing, furnishing, or  insuring  for  medical,
surgical or other health services to persons;
    (2) "Unique patient identifier" means a unique
code for an  individual  patient  that enables the
personal,   medical  and   financial   information
associated with a  patient's  encounter  with  the
health  care  system  to  be  tracked  across  all
occasions of service  experienced  by  the patient
within a health  care system. The identifier shall
provide the ability  to  track  a  patient's  data
across   individual   health    care   encounters,
providers, payers, facilities and time. The unique
patient  identifier  shall  include,  but  not  be
limited to, the  patient's  medical  record number
and  the  patient's  control  number.  The  unique
patient identifier, shall  provide  the ability to
track  records of  individual  patient  encounters
across encounters, providers,  payers,  facilities
and time;
    (3) "Encounter" means  a  professional contact
between a patient  and  a  provider  who  delivers
services  or  is  professionally  responsible  for
services delivered to a patient;
    (4) "Individual health  care provider" means a
health professional who  delivers  services or who
is  professionally responsible  for  the  services
delivered  to  a   patient,   who   is  exercising
independent judgment in  the  care of the patient,
and who is  not under the immediate supervision of
another health care professional;
    (5) "Ambulatory care"  means services provided
to  patients  who  are  neither  hospitalized  nor
institutionalized as inpatients  in  a health care
facility that is the site of the encounter;
    (6)  "Health  care  facility  or  institution"
means any health  care facility or institution and
any state health  care  facility  or  institution,
each as defined  in section 19a-145 of the general
statutes, as amended by section 19 of this act and
rehabilitation  centers  for   which   rates   are
determined  pursuant to  section  17-313a  of  the
general statutes, as  amended  by  section  82  of
public act 93-262  and  section  25  of public act
93-418;
    (7) "Payer" means  any  person,  legal entity,
governmental body, eligible  organization  covered
by the provisions  of 42 USC Section 1395mm(b), or
medical assistance program  provided  pursuant  to
chapter 308 of  the  general  statutes, except for
Medicare provided pursuant  to  chapter 302 of the
general  statutes,  or  any  combination  thereof,
which is or  may  become  legally  responsible, in
whole or in  part,  for  the  payment  of services
rendered  to or  on  behalf  of  a  patient  by  a
hospital,   other   health    care   facility   or
institution, or individual  health  care provider.
Payer includes any third-party payer.
    Sec. 15. (NEW) (a) (1) After consultation with
the advisory board,  the  institute shall identify
those health care  data  elements  relating to the
cost, quality, outcomes,  access  and  the  use of
health care services  by  consumers  it determines
necessary to carry out a comprehensive analysis of
cost,  quality  and   access  to  health  care  in
Connecticut. The institute may collect health care
data from health care facilities and institutions,
payers,  certified  health  plans  and  individual
health  care  providers.  (A)  The  institute  may
collect   from   health    care   facilities   and
institutions, medical record  abstract and billing
data based on  individual  patient  encounters and
discharges,  supplemental  medical   record   data
related to quality  and  risk-adjustment and other
data related to patient outcomes and satisfaction,
discharge abstract and  billing  data  records for
discharges and encounters with patients undergoing
ambulatory   surgery   procedures   or   receiving
services  in  ambulatory  clinics,  including  the
emergency departments, data  identifying revenues,
expenses, contractural allowances,  charity  care,
bad debt, other income, and the number of units of
inpatient   and  outpatient   services   for   the
activities  of  each   health   care  facility  or
institution as a  whole  and  for  purchasers  and
payers. (B) The  institute may collect from payers
data related to  patient claims and reimbursements
to  health  care   providers,   premiums  charged,
benefit    plan   design,    quality,    outcomes,
utilization  and costs,  beneficiary  satisfaction
and medical record  data.  These data may include,
but are not  limited to: Enrollee identifier, date
of birth and  sex; provider identifier; diagnosis;
health  care  services   or  procedures  provided;
provider charges, if any; and amount paid.
    (2) The institute  shall develop a methodology
of quantifying and  collecting data including, but
not  limited  to,   data   on   quality,   service
effectiveness,  outcomes, utilization,  costs  and
spending.
    (3)   The  institute   shall   safeguard   the
confidentiality  of  patient-specific   and   plan
enrollee specific information  from  inappropriate
use or release.
    (b)  (1) The  reporting  requirements  of  the
state-wide  health  care   data  system  shall  be
uniform to the  extent  that  such  uniformity  is
determined  by  the  institute  to  be  useful  to
fulfill the purposes  of  this  section.  The data
system may be coordinated with any requirements of
the  federal  Department   of   Health  and  Human
Services in its  administration  of  the  Medicare
program, the state  in  its  role of administering
the medical assistance  program  and  in gathering
public health statistics  or  any other payer. The
institute shall encourage  reporting by electronic
transmission.
    (2) Following consultation  with  the advisory
board the institute  may  collect  from any health
care  facility  or   institution,  as  defined  in
section  19a-145  of   the  general  statutes,  as
amended by section  19  of  this  act,  financial,
statistical or discharge  and  billing  data.  The
institute may specify  the form, format and timing
of any required submission.
    (c) The health  care data required pursuant to
this section may  be submitted to the institute by
reporters through a  contractual  arrangement with
an intermediary. If  the data is submitted through
an intermediary, the  reporter  shall  ensure that
such submission is  timely  and  that  the data is
accurate. The institute  may  conduct  an audit of
the data submitted  to  such intermediary in order
to verify its accuracy. If the data submitted by a
reporter is erroneous, the reporter shall bear the
cost  of correcting  the  data  and  updating  the
health  care  data   base   as   required  by  the
institute.  The  institute  may  contract  with  a
private vendor for  assistance  in  any work to be
performed pursuant to this section.
    Sec.  16.  (NEW)  (a)  The  health  care  data
institute, with the  approval  of  the  office  of
health care access  may  develop a fee schedule to
cover the cost  of processing requests for data on
behalf of individuals and organizations engaged in
research or for private use.
    (b) The institute  shall,  after  consultation
with the advisory board, provide at its discretion
and  subject  to   the   availability   of  funds,
analyses, reports and studies which are consistent
with the purposes  of  this  act.  These analyses,
reports and studies  shall include any reports the
office  or the  advisory  board  deems  useful  to
assist  the public,  the  government,  purchasers,
providers and payers  of  health  care services in
understanding the prudent  and  cost-effective use
of these services.
    (c) The institute,  in  coordination  with the
office  of  health   care  access,  shall  publish
annually beginning January 1, 1996, a report based
upon analyses of  the  data  reported  pursuant to
this act and other relevant data. The report shall
provide  outcome and  performance  indicators  and
information  on  the   growth   of  inpatient  and
outpatient volumes and  revenues. The report shall
discuss the implications of these analyses on: (1)
The ability of  Connecticut  to  comply  with  any
federal limits on  health  care expenditures which
might be imposed;  (2)  the  affordability  of and
access to health  care  in  Connecticut;  and  (3)
recommended changes to  Connecticut's  health care
regulatory system.
    (d)  The institute  shall  not  use  the  data
collected  pursuant  to   sections   14   to   18,
inclusive, of this  act for any commercial purpose
or allow the  data  to  be used for any commercial
purpose. As used  in  this subsection, "commercial
purpose" means use of any such data for profit.
    Sec. 17. (NEW) (a) Individual patient data and
individual plan enrollee data identified by proper
name  or personal  identification  code  submitted
pursuant to sections  15 to 18, inclusive, of this
act  shall be  kept  confidential,  but  aggregate
reports  from which  individual  patient  or  plan
enrollee  data  cannot   be  identified  shall  be
available to the  public.  Any  records  obtained,
reviewed by, or  on  file  with  the  institute or
office  of  health   care   access   that  contain
information concerning the  medical  treatment  of
individual  patients  or  the  enrollment  of  any
individual shall be  exempt from the provisions of
sections 1-15, as  amended  by section 1 of public
act 93-188 and  section  1  of  public act 94-112,
1-18a, as amended  by  section  1  of  public  act
93-195, 1-19 to  1-19b,  inclusive,  1-21,  1-21a,
1-21b, as amended  by  section  2  of  public  act
93-110, public act 93-304, section 9 of public act
93-381,  section  62  of  public  act  93-435  and
section 2 of  public  act  93-368, 1-21c to 1-21h,
inclusive,  1-21i, as  amended  by  section  1  of
public act 93-191,  1-21l and 1-21k of the general
statutes.
    (b) Any person or any public or private agency
or entity with access to data obtained pursuant to
section 16 of  this  act  shall  comply  with  the
requirements established by  the  office of health
care access and  the  health  care  data institute
relating to the  acquisition  or use of these data
and  shall maintain  the  confidentiality  of  any
information which may identify individual patients
or plan enrollees.
    (c) Disclosure of data pursuant to sections 14
to  18,  inclusive,  of  this  act  shall  not  be
considered  a violation  of  chapter  705  of  the
general statutes.
    (d) Any health  care  facility or institution,
individual  health  care  provider  or  payer  who
discloses or reports  data  or  information to the
Connecticut   health  care   data   institute   in
compliance with sections  14  to 18, inclusive, of
this act, or  regulations adopted thereunder shall
not  be  subject   to   any   civil  liability  in
connection with such disclosure or reporting.
    Sec. 18. (NEW)  The  office may require health
care   facilities   and    institutions,   payers,
certified health plans  and individual health care
providers to file  data with the institute. To the
extent such data  is  provided  to  another  state
agency pursuant to  any  provision  of the general
statutes or regulations adopted thereunder, and is
in a form  and format usable by the institute, the
office may require said agency to provide the data
to the institute.
    Sec.  19.  Section   19a-145  of  the  general
statutes, as amended  by  section  9 of public act
93-381 and section  4  of  public  act  94-174, is
repealed and the  following is substituted in lieu
thereof:
    (a) As used in this chapter, subsection (a) of
section 17-311, AS AMENDED BY SECTION 82 OF PUBLIC
ACT 93-262, and  section  19a-114,  AS  AMENDED BY
SECTION 9 OF  PUBLIC  ACT 93-381: (1) "Health care
facility or institution"  means  any  facility  or
institution   engaged   primarily   in   providing
services   for  the   prevention,   diagnosis   or
treatment of human  health  conditions, including,
but  not  limited  to,  OUTPATIENT  CLINICS,  FREE
STANDING OUTPATIENT SURGICAL  FACILITIES,  IMAGING
CENTERS, home health care agencies, homemaker-home
health  aide  agencies,   as  defined  in  section
19a-490, AS AMENDED  BY  SECTION  9  OF PUBLIC ACT
93-381 AND SECTIONS  1 AND 2 OF PUBLIC ACT 93-415;
clinical laboratory or  central service facilities
serving  one  or   more  health  care  facilities,
practitioners or institutions; hospitals; personal
care  homes;  nursing   homes;   nonprofit  health
centers;  diagnostic  and   treatment  facilities;
rehabilitation  facilities,  and   mental   health
facilities; HEALTH CARE  FACILITY  OR  INSTITUTION
INCLUDES ANY PARENT COMPANY, SUBSIDIARY, AFFILIATE
OR JOINT VENTURE  OR  ANY COMBINATION THEREOF OF A
HEALTH  CARE  FACILITY  OR  INSTITUTION;  but  not
including  any outpatient  clinic  operated  by  a
town,  city  or   borough  or  any  state-operated
hospital or any  rehabilitation center referred to
in section 17-313a,  AS  AMENDED  BY SECTION 82 OF
PUBLIC ACT 93-262,  or  any  health  care facility
operated by a  nonprofit  educational  institution
solely for the students, faculty and staff of such
institution and their dependents, or any Christian
Science  sanatorium  operated,   or   listed   and
certified,  by  the   First   Church   of  Christ,
Scientist,  Boston,  Massachusetts;   (2)   "state
health  care  facility  or  institution"  means  a
hospital or other  such  facility  or  institution
operated by the state providing services which are
eligible for reimbursement  under  Title  XVIII or
XIX of the  federal  Social  Security  Act, 42 USC
Section 301 et  seq., as amended; (3) "commission"
means the commission on hospitals and health care;
and (4) "commissioner"  means  the commissioner of
public health and addiction services.
    (b) As used in this chapter for the purpose of
certificate   of   need,   "clinical   laboratory"
includes any clinical  laboratory  as  defined  in
section 19a-30, as  amended by section 9 of public
act 93-381 and  section 3 of [this act] PUBLIC ACT
94-174, requiring a  separate  clinical laboratory
license from the  department  of public health and
addiction services, except laboratories designated
as  laboratories  performing   waived   tests,  as
defined in 42  CFR  493.15  as  from  time to time
amended,  and  laboratories  performing  tests  of
moderate complexity, as  defined  in 42 CFR 493.20
as from time to time amended.
    Sec.  20.  Section   19a-146  of  the  general
statutes, as amended  by  section 20 of public act
93-229,  is  repealed   and   the   following   is
substituted in lieu thereof:
    There is established  [an  independent] WITHIN
THE OFFICE OF  HEALTH  CARE ACCESS A commission on
hospitals  and  health  care  consisting  of  five
persons appointed by  the governor, subject to the
provisions of section  4-9a, AS AMENDED BY SECTION
4 OF PUBLIC  ACT  93-219, SECTION 27 OF PUBLIC ACT
93-262 AND SECTION 56 OF PUBLIC ACT 93-435, one of
whom shall be  a  health  care professional having
both educational and  professional  experience  in
the health care  field  and  knowledgeable  as  to
current health care issues, one of whom shall have
experience in the  field  of financial management,
one of whom shall be a person having experience in
the field of hospital and health insurance and two
of whom shall  be  members  of the general public.
The terms of  the  commissioners  serving prior to
July 1, 1989,  shall  expire on June 30, 1989. The
governor shall appoint  five  members  to serve as
commissioners from July  1, 1989. All appointments
shall be made  with  the consent of both houses of
the general assembly,  provided  the members first
appointed to serve  on  or after July 1, 1989, may
serve without confirmation  from the date of their
appointment  subject  to   approval  at  the  next
regular  session  of  the  general  assembly.  The
public members of the commission shall be electors
of the state  and shall not, for a period of three
years prior to  appointment  as  a  member  of the
commission, be affiliated  with,  employed  by  or
have any professional  affiliation with any health
care  facility  or   institution,  health  product
manufacturer or corporation  or  insurer providing
coverage for hospital  or  medical  care, provided
having insurance coverage  for hospital or medical
care shall not  be  considered affiliation with an
insurer. No member  of  the  commission  or of the
staff of the  commission  shall participate in any
matter   before   the   commission   involving   a
particular health care  facility or institution in
which the member,  the  member's  spouse or one of
the member's parents or dependents has a fiduciary
or pecuniary interest;  provided  no member of the
commission or of  the  commission's staff shall be
deemed to have  a  fiduciary or pecuniary interest
in a matter  solely by virtue of the fact that the
member, the member's spouse or one of the member's
parents or dependents has or will receive services
from  a  particular   health   care   facility  or
institution, may be  insured  with respect to such
services, may be  liable  for  the  costs  of such
services  or  may  be  liable  for  the  costs  of
insurance covering such services.
    Sec. 21. Subsection  (c) of section 19a-166 of
the general statutes,  as  amended by section 5 of
public act 93-229,  section 9 of public act 93-381
and section 34 of public act 94-9, is repealed and
the following is substituted in lieu thereof:
    (c) (1) Until  September 30, 1993, in addition
to   procedures   available   to   other   private
third-party payers, an  eligible  organization, as
described  in  42   USC   Section  1395mm(b),  may
directly negotiate for a different rate and method
of reimbursement with a hospital.
    (2) Effective October  1,  1993,  to March 31,
1994,  inclusive,  an  eligible  organization,  as
described  in  42   USC   Section  1395mm(b),  may
directly negotiate for a different rate and method
of reimbursement with  a hospital provided (A) the
cost of such  discount is not shifted, in whole or
in part, to  other  payers  not  so covered by the
discount  agreement;  and   (B)  the  charges  and
payment for the  payer  are reported in accordance
with this subsection.
    (3) On and  after April 1, 1994, any payer may
directly negotiate for a different rate and method
of  reimbursement with  a  hospital  provided  the
charges and payments for the payer are reported in
accordance  with  this   subsection.  No  discount
agreement or AGREEMENT  FOR  A  different  rate or
method of reimbursement  shall  be effective until
filed with the commission.
    (4) On and  after  April  1, 1994, the charges
and payments for  each  payer receiving a discount
shall be accumulated  by  the  hospital  for  each
payer and reported  as required by the commission.
The  commission  may   require  a  review  by  the
hospital's independent auditor,  at the hospital's
expense, to determine  compliance with subdivision
(3) of this subsection.
    (5) A full  written  copy  of  each  agreement
executed pursuant to this subsection, on and after
October  2,  1991,   shall   be   filed  with  the
Commission on Hospitals  and  Health  Care by each
hospital executing such  an  agreement,  no  later
than ten business  days  after  such  agreement is
executed. Each agreement  filed  shall  specify on
its face that  it  was executed and filed pursuant
to this subsection. Agreements filed in accordance
with this subsection  shall  be  considered  trade
secrets pursuant to  subdivision (5) of subsection
(b) of section 1-19 except that the commission may
utilize  and distribute  data  derived  from  such
agreements INCLUDING THE  NAMES  OF THE PARTIES TO
THE  AGREEMENT, THE  DURATION  AND  DATES  OF  THE
AGREEMENT AND THE  ESTIMATED VALUE OF ANY DISCOUNT
OR ALTERNATE RATE OF PAYMENT.
    Sec. 22. (NEW)  (a)  The  department of public
health and addiction  services  shall  establish a
program  to  purchase   and  maintain  malpractice
liability   insurance   for    retired    licensed
physicians and purchase  and maintain a portion of
the malpractice liability  insurance of physicians
who, on or  after  June  30,  1993, have completed
residency requirements and  have  practiced for at
least one year,  who  provide  primary health care
services at community  health centers and at other
locations  authorized  by   the   department.  The
following conditions shall apply to the program:
    (1) Primary health care services shall only be
provided at community  health  centers or at other
locations as determined by the department, located
in public investment  communities,  as  defined in
subdivision (9) of subsection (a) of section 7-545
of the general  statutes,  as amended by section 1
of public act  93-99  and section 82 of public act
93-262;
    (2)  Primary  health  care  services  provided
shall be offered  to  low-income patients based on
their ability to pay;
    (3) Physicians providing  health care services
shall not receive compensation for their services;
    (4) Physicians must  provide not less than one
hundred  fifty hours  per  year  of  such  primary
health care services; and
    (5) The department  shall contract only with a
liability insurer authorized  to offer malpractice
liability insurance in this state.
    (b) Nothing in  this  section or section 23 of
this  act  shall   be  interpreted  to  require  a
liability  insurer  to   provide   coverage  to  a
physician  should  the   insurer   determine  that
coverage should not  be  offered  to  a  physician
because of past  claims  experience  or  for other
appropriate reasons.
    (c)  The department  may  monitor  the  claims
experience  of  retired   physicians   covered  by
liability    insurers   contracting    with    the
department.
    (d)  The  department   may  provide  liability
insurance under this  act only to the extent funds
are appropriated for  this  purpose by the general
assembly.
    Sec. 23. (NEW)  (a)  The  department of public
health   and  addiction   services   shall   adopt
regulations   concerning   the    conditions    of
participation in the  liability  insurance program
by physicians pursuant  to  section 22 of this act
at  clinics  utilizing  such  physicians  for  the
purposes of this  section  and  section 22 of this
act. These conditions  shall  include, but are not
limited to, the following:
    (1)  The  participating  physician  associated
with the clinic  shall  hold  a  valid  license to
practice medicine and  surgery  in  this state and
otherwise   be   in    conformity   with   current
requirements  for  licensure   as   a   physician,
including any continuing education required by the
medical examining board;
    (2) The participating  physician  shall  limit
the scope of  practice  in  the  clinic to primary
care. Primary care shall be limited to noninvasive
procedures and shall  not include obstetrical care
or any specialized  care or treatment. Noninvasive
procedures include injections,  suturing  of minor
lacerations and incisions  of boils or superficial
abscesses;
    (3)  The  provision   of  liability  insurance
coverage shall not  extend  to  acts  outside  the
scope of rendering  medical  services  pursuant to
this section and section 22 of this act;
    (4) The participating  physician  shall  limit
the  provision  of   health   care   services   to
low-income persons provided  clinics  may, but are
not  required  to,   provide   means   tests   for
eligibility as a  condition  for  obtaining health
care services.
    (b)  The  participating  physician  shall  not
accept  compensation  for  providing  health  care
services from patients  served  pursuant  to  this
section and section  22  of  this  act,  nor  from
clinics serving these  patients.  As  used in this
act,  "compensation"  means  any  remuneration  of
value to the  participating physician for services
provided  by  the  physician,  but  shall  not  be
construed  to  include   any   nominal  copayments
charged  by  the   clinic,  nor  reimbursement  of
related  expenses  of  a  participating  physician
authorized  by the  clinic  in  advance  of  being
incurred.
    (c) The use  of  mediation  or arbitration for
resolving questions of  potential liability may be
used,  however  any   mediation   or   arbitration
agreement format shall be expressed in terms clear
enough for a  person  with  a sixth-grade level of
education to understand  and  on  a form no longer
than one page in length.
    Sec. 24. Subsection  (a)  of  section 2c-2b of
the general statutes,  as  amended by section 1 of
public act 93-91,  section 4 of public act 93-250,
sections  25 and  86  of  public  act  93-262  and
section 7 of  public  act  93-423,  is  amended by
adding subdivision (30) as follows:
    (NEW) (30) The  office  of  health care access
established under section 7 of this act.
    Sec. 25. Funds  appropriated to the department
of public health and addiction services in section
1 of public  act 93-80, as amended by section 1 of
public act 94-1  of  the  May special session, for
the uncompensated care pool self pay account shall
not lapse on  June 30, 1994, and shall continue to
be available during  the  fiscal  year ending June
30, 1995.
    Sec. 26. Funds  appropriated  to the office of
health care access pursuant to section 1 of public
act 93-80, as  amended  by section 1 of public act
94-1 of the  May  special session, may be used for
innovative  hospital  based   pilot  programs  not
otherwise funded.
    Sec.  27.  Section   19a-148  of  the  general
statutes is repealed.
    Sec. 28. This  act  shall  take effect July 1,
1994.