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is repealed and the following is substituted in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repealed and the following is substituted in lieu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