Substitute House Bill No. 5051
          Substitute House Bill No. 5051

               PUBLIC ACT NO. 98-8


AN   ACT  CONCERNING  HEALTH  CARE  FOR  UNINSURED
CHILDREN AND YOUTH.


    Be  it  enacted  by  the  Senate  and House of
Representatives in General Assembly convened:
    Section  1.  Subsection  (a)  of  section 6 of
public act 97-1 of the October 29 special  session
is  repealed  and  the following is substituted in
lieu thereof:
    (a)  The  commissioner shall, within available
appropriations, establish two supplemental  health
insurance  programs,  to  be  known  as HUSKY Plus
programs, for enrollees of the SUBSIDIZED  PORTION
OF  THE  HUSKY  Plan,  Part  B WITH FAMILY INCOMES
WHICH DO NOT EXCEED THREE HUNDRED PER CENT OF  THE
FEDERAL  POVERTY LEVEL, whose medical needs cannot
be accommodated within the basic  benefit  package
offered  enrollees.  One  program shall supplement
coverage for those  medically  eligible  enrollees
with intensive physical health needs and one shall
supplement coverage for those  medically  eligible
enrollees with intensive behavioral health needs.
    Sec.  2. Subsection (a) of section 7 of public
act 97-1 of the  October  29  special  session  is
repealed  and the following is substituted in lieu
thereof:
    (a)  The  commissioner may require the payment
of a  premium  or  copayment  in  connection  with
services  provided under the HUSKY Plan, Part B in
accordance with the following limitations:
    (1)  Until  July  1,  1999, the maximum annual
aggregate cost sharing for a family with an income
(A) which exceeds one hundred eighty-five per cent
of the federal poverty level but does  not  exceed
two  hundred  thirty-five  per cent of the federal
poverty level shall not be more than  six  hundred
fifty  dollars,  and (B) which exceeds two hundred
thirty-five per cent of the federal poverty  level
but  does not exceed three hundred per cent of the
federal poverty level shall not be more  than  one
thousand two hundred fifty dollars;
    (2)   On   and   after   July   1,  1999,  the
commissioner  shall  submit  a  schedule  for  the
maximum annual aggregate cost sharing for families
with an income specified in subparagraphs (A)  and
(B)  of  subdivision (1) of this subsection to the
joint standing committees of the General  Assembly
having  cognizance  of  matters  relating to human
services,    public    health,    insurance    and
appropriations  and the budgets of state agencies.
Within fifteen days of receipt of  such  schedule,
said  joint  standing  committees  of  the General
Assembly may  advise  the  commissioner  of  their
approval,  denial or modifications, if any, of the
schedule; and
    (3)  The commissioner shall require [providers
under]  each  managed   care   plan   to   monitor
copayments  and  premiums  under the provisions of
subdivision (1) of this subsection.
    Sec.  3.  Subsection  (a)  of  section  15  of
public act 97-1 of the October 29 special  session
is  repealed  and  the following is substituted in
lieu thereof:
    (a)  For  purposes  of determining eligibility
for the HUSKY Plan,  Part  B  and  to  the  extent
permitted by federal law and to the extent federal
financial   participation   is   available,    the
commissioner  may  disregard family income. [up to
sixty-five per cent of the federal  poverty  level
for  the  size  of  the family.] Such disregard of
family income shall allow subsidized coverage  for
an eligible beneficiary who resides in a household
with a  family  income  of  not  more  than  three
hundred  per cent of the federal poverty level. No
such income disregard shall  have  the  effect  of
[reducing   family   income   below   two  hundred
thirty-five per cent of the federal poverty level]
GRANTING  ELIGIBILITY  FOR A CHILD UNDER THE HUSKY
PLAN, PART A.
    Sec.   4.   Section   19a-7c  of  the  general
statutes, as amended by section 90 of  public  act
97-2  of  the June 18 special session, is repealed
and the following is substituted in lieu thereof:
    (a)  The  Commissioner  of  Public  Health, in
consultation  with  the   Department   of   Social
Services,    may    contract,   within   available
appropriations, to provide a  subsidized  nongroup
health  insurance  product  for pregnant women who
are not eligible for  Medicaid  and  have  incomes
under  two  hundred  fifty per cent of the federal
poverty level. [The Commissioner of Public Health,
in  consultation  with  the  Department  of Social
Services,   may   contract,    within    available
appropriations,  to  provide a subsidized nongroup
health  insurance  product  for   children   under
eighteen  years  of  age  who are not eligible for
such medical assistance and  whose  families  have
incomes  under two hundred per cent of the federal
poverty level. For any  children  enrolled  as  of
December  31,  1994,  in  a program established by
this  section,  the  commissioner  shall  contract
within  available  appropriations  to  extend  the
program  to  children  up  to  and  including  age
seventeen  who  were  enrolled  on  that date. The
products] THE PRODUCT shall be available  to  such
pregnant   women   [and  children]  (1)  for  whom
employer-based insurance is not available  or  (2)
who have employer-based insurance (A) to cover the
cost of the premiums, copayments  and  deductibles
of  the  employer-based  plan provided the cost of
the employer-based plan is less than the  nongroup
product  and  (B) to provide coverage for benefits
not covered by the employer-based plan  which  are
covered under the subsidized nongroup product. The
Department  of  Public  Health   may   make   such
[products]    PRODUCT    available    to   limited
populations, as pilot programs, initially to  test
the  impact  of program design and administration.
The Department of Social Services shall assist  in
the  administration  of the programs. The contract
may include, but not be limited to, provisions for
coinsurance  and  copayment  and  a  sliding scale
based on income for premiums and shall provide for
the use of mechanisms to control costs.
    (b)  The  contract  for  pregnant  women shall
include coverage for:  (1)  Physician  visits  for
diagnosis   and   treatment;   (2)   prenatal  and
postnatal care; and (3) outpatient hospital  care;
and  may  include  coverage  for:  (A)  Labor  and
delivery; (B) laboratory and diagnostic tests; (C)
prescription  drugs;  (D)  physical  therapy;  (E)
mental health and substance abuse visits; and  (F)
inpatient   care,   including  mental  health  and
substance abuse treatment, subject to  eighty  per
cent  coinsurance  on  the first two thousand five
hundred dollars of expenses.
    [(c)  The  contract for children shall include
coverage for: (1) Physician visits  for  diagnosis
and  treatment;  (2) well baby care, immunizations
and child health  supervision;  (3)  prenatal  and
postnatal  care; and (4) outpatient hospital care;
and may include coverage for: (A) Dental care; (B)
laboratory  and diagnostic tests; (C) prescription
drugs; (D) physical therapy; (E) outpatient mental
health   and   substance  abuse  visits;  and  (F)
inpatient care.]
    [(d)]  (c) The commissioner shall establish an
outreach program to ensure that  eligible  persons
are   aware  of  the  health  insurance  available
pursuant to this section.
    [(e)]   (d)   The   commissioner   may   adopt
regulations, in accordance with the provisions  of
chapter 54, for purposes of this section.
    Sec.  5.  This  act shall take effect from its
passage.

Approved April 7, 1998