OLR Bill Analysis

SB 1484

Emergency Certification

AN ACT CONCERNING THE HEALTHFIRST CONNECTICUT AND HEALTHY KIDS INITIATIVES.

SUMMARY:

This bill expands access to public health insurance by making a number of changes in the HUSKY program. Among other things it:

1. raises the income limit for HUSKY A (Medicaid) coverage for caretaker relatives;

2. expands HUSKY A coverage for pregnant women;

3. expands HUSKY B coverage for children in higher income families, with premium assistance for families with access to employer-sponsored coverage;

4. requires automatic enrollment of uninsured newborns in HUSKY;

5. requires the Social Service Department (DSS) and other entities to expand HUSKY outreach;

6. requires DSS to seek a federal waiver to convert the State-Administered General Assistance (SAGA) program from a fully state-funded program to a Medicaid-funded one and potentially raises the income limit for this coverage; and

7. requires DSS, within available appropriations, annually to increase the rates it pays Medicaid providers, including hospitals, beginning in FY 08.

The bill creates two new health-related planning entities, (1) a HealthFirst Connecticut Authority to recommend alternatives for affordable quality health care coverage for un- and underinsured people and cost containment measures and insurance financing mechanisms and (2) a Statewide Primary Care Authority to develop a universal system for providing primary care services, including prescription drugs, to all Connecticut residents.

It establishes a board to govern a network that integrates state and social services data within and across various departments. It requires the Public Health Department (DPH) to develop standards to facilitate the development of a statewide, integrated “electronic health information system” for use by health care providers and institutions that are funded by the state. And it designates a nonprofit entity to act as the state's lead health information exchange organization for five years.

It requires the DSS commissioner to (1) develop and implement a plan for a preventive health services system for children covered by HUSKY A and B and (2) establish a child health quality improvement program to promote the implementation of evidence-based strategies by HUSKY providers to improve the delivery of and access to children's health services.

The bill extends, from age 23 to 26, the age to which group comprehensive and individual health insurance policies that cover children must do so.

The bill permits the Health Reinsurance Association to again sell special health care plans to small employers, and it potentially makes these plans available to a wider range of employers by raising the income eligibility limit for their low-income employees from 200% to 300% of FPL.

It requires (1) DSS to inventory public disease management programs, (2) DPH to develop an electronic license renewal system for certain professions, and (3) the healthcare advocate to create a consumer health information website. It appropriates funds for various school- and community-based health center operations. And the bill makes technical changes.

1 — MEDICAID COVERAGE FOR FOREIGN LANGUAGE INTERPRETERS

The bill requires the DSS commissioner to amend the Medicaid state plan to include foreign language interpreters as a covered service for Medicaid beneficiaries with limited English proficiency.

EFFECTIVE DATE: July 1, 2007

2 — MEDICAID COVERAGE FOR STATE-ADMINISTERED GENERAL ASSISTANCE (SAGA) MEDICAL ASSISTANCE RECIPIENTS

The bill requires DSS, by January 1, 2008, instead of March 1, 2004, to seek a federal Medicaid waiver to get Medicaid coverage for the SAGA medical assistance program. Currently, SAGA medical assistance is funded entirely with state dollars. But it also specifies that this coverage is for people who otherwise qualify for SAGA medical assistance and who have income up to 100% of the FPL. The law, unchanged by the bill, provides that the income limit for SAGA medical assistance recipients is the same as it is for people who are eligible for Medicaid as “medically needy” (currently $ 476 per month for a single resident living in most parts of the state), which is about 56% of the FPL. So the bill appears to establish two different income limits for SAGA medical assistance if Medicaid coverage becomes available for this population.

The bill removes obsolete language pertaining to town-administered General Assistance medical assistance.

It eliminates the deadline (August 20, 2003) by which federally qualified health centers (FQHC) participating in the SAGA medical assistance program must enroll in the federal Office of Pharmacy Affairs Section 340B drug discount program.

EFFECTIVE DATE: July 1, 2007

3 — INCREASE INCOME LIMIT FOR HUSKY A COVERAGE FOR ADULT CARETAKER RELATIVES

The bill increases, from 150% to 185% of the FPL (from $ 25,755 to $ 31,764 annually for a family of three in 2007) the income limit for HUSKY A adult caretaker coverage. This higher limit already applies to children applying for or enrolled in the HUSKY A program.

The bill requires the DSS commissioner, when individuals or families apply for Medicaid coverage, to advise them of the (1) effect that having income over the limit has on program eligibility and (2) availability of HUSKY B for those ineligible for HUSKY A. (HUSKY B provides virtually identical subsidized medical coverage to children in families whose income is between 185% and 300% of the FPL. )

EFFECTIVE DATE: July 1, 2007

4 & 12 — COVERAGE FOR PREGNANT WOMEN

The bill requires DSS to increase the income limit for HUSKY A coverage for pregnant women from 185% to 250% of the FPL ($ 2,852 per month for two-person household). It requires DSS, by January 1, 2008, to seek a federal Health Insurance Flexibility and Accountability demonstration waiver to cover pregnant women who do not “otherwise have creditable coverage,” as defined by federal law, with incomes between 185% and 250% of the FPL. The waiver must specify that the expanded coverage will be provided through a re-allocation of the state's unspent State Children's Health Insurance Program (SCHIP) block grant funds. (Federal Medicaid funds match the state's payments for the coverage for pregnant women with incomes under 185% of the FPL. )

EFFECTIVE DATE: July 1, 2007

4 & 6 — HUSKY A AND B ENROLLMENT OF UNINSURED NEWBORNS

The bill requires DSS to implement Medicaid presumptive eligibility for any uninsured newborn born in a Connecticut or border state hospital when (1) the parent or caretaker relative with whom the child resides lives in the state and (2) that relative authorizes the enrollment. Currently, children are eligible for HUSKY A presumptively. Presumptive eligibility allows the child to be determined eligible for assistance immediately and DSS verifies that the child is otherwise eligible once the child is enrolled.

The bill also requires that any uninsured child born in a Connecticut hospital or border state hospital be enrolled in HUSKY B under an expedited process, provided the same two conditions above are met.

It requires the DSS commissioner to pay to the HUSKY B managed care organization (MCO) that the parent or caretaker selects (HUSKY A and B services are provided through MCOs with which DSS contracts) the first two months of the premiums that the family would otherwise have to pay if the children were already enrolled in HUSKY B. Currently, families with incomes between 235% and 300% of the FPL pay $ 30 per month ($ 50 family maximum) in premiums. Lower-income families do not pay premiums.

By law, a newborn child who otherwise meets the HUSKY B eligibility criteria is eligible for benefits retroactive to the child's birth date, provided someone files an application on the child's behalf within 30 days of the birth.

EFFECTIVE DATE: July 1, 2007

6, 7, 10 — INCREASING HUSKY B ELIGIBILITY TO HIGHER INCOME FAMILIES; PREMIUM ASSISTANCE

The bill increases, from 300% to 400% of the FPL, the income limit for children to be eligible for subsidized HUSKY B coverage. (It is not clear whether the federal government will allow the state to use State Children's Health Insurance Program funds to pay the federal share of this coverage (65%)). By extension, it increases the starting income level at which people can purchase unsubsidized coverage from 300% to 400% of the FPL.

Under current law, children in families with income between 185% and 300% of the FPL are eligible for subsidized HUSKY B coverage. Children in lower-income families and some of their caretaker relatives qualify for HUSKY A and pay no cost sharing. Families with incomes above 300% of the FPL can buy into HUSKY B by paying the full monthly premium, which is about $ 200 per month per child.

The bill requires families with incomes between 300% and 400% of the FPL and who have no access to employer-sponsored health insurance to pay monthly premiums of $ 50 per child, with a $ 75 maximum (presumably for the family). Currently, families with incomes below 235% of the FPL pay no premiums and families with incomes between 235% and 300% of the FPL pay $ 30 monthly, with a $ 50 family cap.

Premium Assistance. The bill requires DSS to offer premium assistance to families in the 300% to 400% of FPL income range who have access to employer-sponsored coverage. Individuals choosing to participate in this program must enroll themselves and their dependent children in the employer-sponsored coverage to the maximum extent of available coverage to the extent the coverage is more cost effective than enrolling the child in managed HUSKY B coverage.

The bill requires DSS to do this regardless of the state law that generally prohibits HUSKY B coverage to children whose parents drop employer-sponsored coverage less than two months before HUSKY B eligibility is determined. In general, the federal State Children's Health Insurance Program law prohibits states from providing coverage to children who are enrolled in employer-sponsored coverage.

The amount of the state subsidy equals the portion of the premium payment that is attributable to the coverage for the dependent children. The employer must verify this cost in a form and manner the department prescribes. The bill prohibits the employer from deducting the cost from weekly income. Instead, the employer must let DSS know the cost and DSS must pay it. DSS must provide coverage for services that are not covered by the employer's plan (“wrap around”).

The bill permits the DSS commissioner to implement policies and procedures necessary to administer the premium assistance while in the process of adopting them as regulation. She must print notice of intent to adopt the regulations in the Connecticut Law Journal no later than 20 days after implementing it. The policy and procedures are valid until final regulations are adopted.

EFFECTIVE DATE: July 1, 2007

6 — CENTRAL DSS UNIT FOR PROCESSING AND MARKETING APPLICATIONS

The bill requires DSS, in consultation with the servicer (enrollment broker with which DSS contacts, currently ACS, Inc. ), to establish a centralized unit to be responsible for processing all HUSKY applications. DSS, through its contract, must ensure that a child determined eligible for HUSKY has uninterrupted coverage for as long as the parent or guardian elects to enroll or re-enroll the child.

The bill requires DSS in consultation with the servicer, instead of the servicer alone, to jointly market the HUSKY A and B as one program. And it requires the servicer to electronically send HUSKY A, as well as HUSKY B, enrollment and disenrollment data to DSS.

The bill makes it clear that the servicer sends DSS all HUSKY applications, not just those for children with family income of 185% of FPL or less.

The bill requires the commissioner or servicer to re-determine the child's eligibility for HUSKY no later than 10, instead of 12, months after he determines initial eligibility. It requires them to send an electronic application if the participant requests. Currently, they must mail the application form. Under the bill, either form of sending the application must be done within available appropriations.

EFFECTIVE DATE: July 1, 2007

8 & 9 — OUTREACH

The bill requires DSS, in consultation with the Children's Health Council (defunct), the Medicaid Managed Care Council, and 2-1-1 Infoline, to develop ways to increase outreach and maximize enrollment of children and adults in HUSKY. Under current law, they must develop outreach. The mechanisms they use must seek to maximize federal funds where appropriate for these activities.

The bill requires the DSS commissioner, in consultation with the Latino and Puerto Rican Affairs Commission, the African-American Affairs Commission, representatives from minority community-based organizations, and any other state and local organization the commissioner deems appropriate, to develop and implement outreach efforts targeting medically underserved children and adults, in particular Latino and other minority children and adults, to increase their enrollment in HUSKY.

These efforts must include, at a minimum, developing culturally appropriate outreach materials, advertising through Latino and other minority media outlets, and the public education, outreach, and recruitment activities already required by law.

EFFECTIVE DATE: July 1, 2007

11 — ON-LINE DPH LICENSE RENEWAL

The bill requires DPH to establish, by July 1, 2008, a secure on-line license renewal system for physicians, surgeons, dentists, and nurses. Nurses include advanced practice registered nurses, registered nurses, and licensed practical nurses. DPH must allow those using the on-line system to pay their fees by credit card or electronic funds transfer from a bank or credit union account. The bill allows DPH to charge a service fee of up to $ 5 for payments made in this manner.

EFFECTIVE DATE: Upon passage

13 — HUSKY PREVENTIVE HEALTH SERVICES

The bill requires the DSS commissioner to develop and implement a plan for a preventive health services system for children covered by HUSKY A and B. He must develop the plan by January 1, 2008 and implement it by July 1, 2008. He must do this in consultation with the DPH commissioner.

The system's goal must be to improve to improve health outcomes for all children enrolled in the HUSKY Plan and to reduce racial and ethnic health disparities among them. The system must ensure that services under the federal Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program are provided to children enrolled in HUSKY A.

The plan must:

1. establish a coordinated preventive health services system for HUSKY beneficiaries including EPSDT services (which are only for HUSKY A children), vision and oral health care, care coordination, chronic disease management, and periodicity schedules based on standards specified by the American Academy of Pediatrics;

2. require DSS to track electronically (a) the use of services in the system of preventive health services by HUSKY beneficiaries to ensure that they receive all available services and (b) their health outcomes; and

3. include ways to create financial incentives and rewards for participating health care providers, such as case management fees, pay for performance, and payment for technical support and data entry associated with patient registries.

By July 1, 2009, the DSS commissioner must report to the Human Services, Insurance, and Public Health committees on the system's implementation. The report must include information on health outcomes, quality of care, and methodologies used to improve the quality of care and health outcomes for children.

EFFECTIVE DATE: July 1, 2007

14 & 35 — CHILDREN'S HEALTH QUALITY IMPROVEMENT PROGRAM

The bill requires the DSS commissioner to establish a child health quality improvement program to promote the implementation of evidence-based strategies by HUSKY providers to improve the delivery of and access to children's health services. He must do this in collaboration with the DPH and DCF commissioners.

The evidence-based strategies must focus on physical, dental, and mental health services. They must include: (1) methods for early identification of children with special health care needs; (2) integration of care coordination and care planning into children's health services; (3) implementation of standardized data collection to measure performance improvement; and (4) implementation of family-centered services in patient care, including the development of parent-provider partnerships. The bill defines “evidence-based strategies” as policies, procedures, and tools that are informed by research and supported by empirical evidence, including research developed by organizations such as the American Academy of Pediatrics, the American Academy of Family Physicians, the National Association of Pediatric Nurse Practitioners, and the Institute of Medicine.

The DSS commissioner must seek the participation of various public and private entities including medical, dental, and mental health providers; academic professionals with experience in health services research and performance measurement and improvement; and any other entity the commissioner deems appropriate to promote such strategies. The commissioner shall ensure that the strategies reflect new developments and best practices in the field of children's health services.

The commissioner must annually report to the Human Services, Public Health, and Appropriations committees and the Medicaid Managed Care Council beginning July 1, 2008. The report must address the implementation of any strategies developed and the extent to which they improved delivery of and access to care for HUSKY children.

The bill appropriates $ 150,000 in FY 08 to DSS for this program.

EFFECTIVE DATE: July 1, 2007

15 - 17 — DEPENDENT CHILDREN COVERAGE EXTENSION

The bill extends, from age 23 to 26, the age to which group comprehensive and individual health insurance policies that cover children must do so. Current law requires coverage for unmarried, dependent children until they turn 19, or 23 if the child is a full-time student at an accredited school. The bill eliminates the requirement that children be dependent and limits continuing coverage to those who live in Connecticut.

It applies to:

1. individual health insurance policies delivered, issued, amended, or renewed after September 30, 2007 that cover (a) basic hospital and medical surgical expenses, (b) major medical expenses, (c) accidents, (d) limited benefits, and (e) hospital or medical services; and

2. group comprehensive health care plans (a minimum plan all health insurers must offer). The coverage extension for these plans applies beginning July 1, 2007.

EFFECTIVE DATE: July 1, 2007

18-21 — HEALTH REINSURANCE ASSOCIATION (HRA) PLANS

The bill removes a sunset provision that prohibits the HRA from selling special health care plans to small employers after January 1, 1995. Consequently, it permits such plans to again be sold. By law, each small employer insurer must offer small employers a special health care plan. If the small employer has 10 or fewer employees (including self-employed people), the majority of whom are low-income, then the insurer does not have to offer a plan. Instead, the insurer must refer the employer to the HRA. The bill potentially makes these plans available to a wider range of employers by raising the income eligibility limit for a low-income individual or employee from 200% to 300% of FPL. HRA must develop premium rates and administer the plans without profit or loss.

EFFECTIVE DATE: July 1, 2007

22 — CONSUMER HEALTHCARE WEBSITE

The bill requires the Healthcare Advocate's Office, within available appropriations, to create and maintain a website for consumer health care information. At a minimum, the website must contain (1) information about wellness programs, such as disease prevention and health promotion, available in various regions; (2) hospital quality and experience data; and (3) a link to the Insurance Department's managed care consumer report card.

EFFECTIVE DATE: October 1, 2007

23 — PRE-TAX PREMIUM DEDUCTIONS

The bill requires every employer that deducts health insurance premiums from its employees' pay to give the employees the opportunity to make these payments with pre-tax dollars as permitted under IRS Code section 125.

EFFECTIVE DATE: October 1, 2007

24, 25, 36 — ELECTRONIC HEALTH RECORDS STANDARDS

The bill designates eHealth Connecticut, a nonprofit corporation, as the state's lead health information exchange organization from July 1, 2007 to July 1, 2012. It requires the DPH commissioner to contract with eHealth to develop a statewide health information technology plan that includes standards, protocols, and pilot programs for health information exchange.

The bill requires DPH to develop electronic data standards to facilitate the development of a statewide, integrated “electronic health information system” for use by health care providers and institutions that are funded by the state. DPH must do this by July 1, 2008 and in consultation with DSS, DOIT, and any other entity the DPH commissioner deems appropriate. DPH may contract for the standards' development through a request for proposal process.

The standards must (1) include provisions relating to security, privacy, data content, structures and format, vocabulary and transmission protocols; (2) be compatible with any national data standards in order to allow for interstate “interoperability”; (3) permit the collection of health information in a “standard electronic format,” and (4) be compatible with the requirements for an electronic health information system (see below).

The bill defines

1. “electronic health information system” as computer hardware and software that includes (a) a patient electronic health record that can be accessed in real time; (b) a personal health record through which individuals and their representatives can manage the person's health information; (c) computerized order entry technology that allows a health care provider to order tests, treatments, and prescriptions; (d) electronic reminders to health care providers concerning screenings, other preventive measures, and best practices; (e) error notification procedures; and (f) tools to collect, analyze, and report adverse event data, quality of care measures;

2. “interoperabilty” as the ability of separate systems to exchange information including (a) physically connecting to a network, (b) enabling a user who presents appropriate permission to conduct transactions over the network, and (c) enabling such a user to access, transmit, receive, and exchange information with other users; and

3. “standard electronic format” as one that (a) enables using health information technology to be used for collecting clinically specific information, (b) promoting interoperability across health care settings, including government agencies at all levels, and (c) facilitating clinical decision support.

The bill appropriate $ 250,000 to DPH in FY 08 to develop the standards. It must report to the Public Health, Human Services, Government Administration and Elections, and Appropriations committees by October 1, 2008 on their development.

EFFECTIVE DATE: July 1, 2007

26-28, 37, 38 — CONNECTICUT HEALTH INFORMATION NETWORK (CHIN)

CHIN Creation and Framework

The bill establishes the Connecticut Health Information Network at the UConn Health Center. The network is to integrate state and social services data within and across the UConn Health Center, Office of Health Care Access (OCHA), DPH, and the Mental Retardation (DMR) and Children and Families (DCF) departments. Data from other departments could be integrated into the network as federal law and funding permits. The CHIN must securely integrate this data, consistent with state and federal privacy laws.

The bill charges the Health Center's Center for Public Health and Health Policy to develop, implement, and administer the CHIN in collaboration with the above offices and departments and the Department of Information Technology (DOIT). The CHIN must develop a framework for creating a network access portal that can provide (1) access to publicly available data on Connecticut residents' health maintained by state and nongovernmental agencies and (2) a way to obtain aggregate data on key state health indicators. The portal must be designed to:

1. provide accurate, timely, and accessible health data to state and local, public and private leaders and policymakers;

2. inform citizens to improve community and individual health;

3. maintain strict confidentiality and privacy standards;

4. support efforts to reduce health disparities;

5. identify the best available data sources; and

6. coordinate the compilation of existing health-related data and statistics.

Confidentiality

The bill permits the participating state agencies to disclose personally identifiable information in their databases to the CHIN administrator and network subcontractors. Any disclosure must be in accordance with federal restrictions. The bill permits disclosure regardless of restrictions contained in state statutes and regulations governing freedom of information and records maintained by DCF, DMR, DPH, and DSS.

Disclosure of personally identifiable information can be made for two purposes: (1) network development and verification and (2) data integration and aggregation in response to queries of the network approved by the commissioner of the department primarily responsible for collecting or maintaining the disclosed information. The bill prohibits a commissioner from denying approval unless disclosure to the network would violate federal law, including the Health Insurance Portability and Protection Act and the Family Educational Rights and Privacy Act and its regulations.

The bill permits the CHIN to use personally identifiable information disclosed to it to (1) match data across and within participating agency databases, including select databases at the Health Center, and (2) provide data without personal identification in response to queries approved by the network's governing board. (The bill does not explicitly authorize the board to approve queries, but it is responsible for performing all functions facilitating the network's coordination and integration, which may encompass such approval, see below. )

Under the bill, the CHIN can redisclose personally identifiable information only when and as expressly permitted by written agreement with state agencies or other entities that contribute information, subject to applicable state and federal law. But neither the CHIN or anyone who receives data from it may redisclose that data in a way that discloses personally identifiable information of the identity of any individual to whom it pertains.

CHIN Governing Board

The bill creates an 12-member board to govern the network. The board

1. establishes and implements policies, procedures, and protocols governing access to, and dissemination of data through, the CHIN;

2. recommends legislation needed to help implement, operate, and maintain the network;

3. performs all functions to facilitate the network's coordination and integration;

4. reports annually to the General Assembly and governor on the CHIN's status, operations, and funding needs.

The board may establish permanent and ad hoc committees to help implement, operate, and maintain the network.

The board consists of the following members: one member appointed by the House speaker; and one by the Senate president pro tempore; a local health director, appointed by the House majority leader; a data user representative, appointed by the House minority leader; a privacy advocate, appointed by the Senate minority leader; one person each appointed by governor and the UConn Health center; and the DCF, DPH, DMR, and OHCA commissioners and the DOIT executive director. All initial appointments must be made by November 1, 2007. Members serve four-year terms. The appointing authority fills a vacancy.

The governor's appointee serves as chairperson and must schedule the first meeting, which must be held by December 31, 2007. The board must meet at least quarterly and more often as the chairperson deems needed. Six members constitute a quorum.

Funding

The bill appropriates $ 1 million in each of FYs 08 and 09 to the UConn Health Center to establish and operate the CHIN.

EFFECTIVE DATE: October 1, 2007, except for the FY 08 and FY 09 appropriations, which are effective July 1, 2007 and 2008, respectively.

29 — DISEASE MANAGEMENT

By January 1, 2008, the bill requires DSS to inventory public disease management initiatives in the HUSKY, SAGA medical assistance, and other Medicaid programs implemented as of the date the bill passes and report to the Human Services and Public Health committees. The report must include a summary, total spent, and number of people served.

EFFECTIVE DATE: Upon passage

30 & 39 — HEALTHFIRST CONNECTICUT AUTHORITY

The bill creates a 12-member HealthFirst Connecticut Authority to:

1. evaluate alternatives for providing quality, affordable, and sustainable health care for all state residents including a single-payer system and employer-sponsored insurance.

2. recommend ways to contain health care costs and improve health care quality, including health information technology; disease management and other incentives to improve care for people with chronic diseases; monitoring and reporting on cost, quality, and utilization; and ways to encourage or require providing health care coverage to certain groups through participation in an insurance pool; and

3. make recommendations on financing insurance for state residents, including ways to maximize federal funding for subsidies; contributions from employers, employees, and individuals; and ways to pay the state's share of costs.

The panel must report its recommendations, including recommended strategies for increasing access, by December 1, 2008. The report goes to the Public Health, Human Services, and Insurance committees.

Legislative leaders and the governor appoint nine members some of whom must represent specific interests as Table 1 shows. The DPH and DSS commissioners and the comptroller, or their designees, are ex-officio, nonvoting. All members must be familiar with the Institute of Medicine's health care reform principles (see BACKGROUND) and be committed to making recommendations consistent with them.

Table 1: HealthFirst Connecticut Appointments

Appointing Authority

Appointments

Appointee

Governor (2)

• Health quality or patient safety advocate

• Person with information technology experience

Senate president pro tempore (2)

• Representative of businesses with fewer than 50 employees

• Person with community-based health experience

House speaker (2)

• Health care provider

• Representative of businesses with 50 or more employees

Senate majority leader (1)

Labor representative

House majority leader (1)

Consumer representative

Senate minority leader (1)

Hospital representative

House minority leader (1)

Insurance company representative

All appointments must be made within 30 days after the bill is enacted, and if a vacancy occurs, the appointing authority must fill it within 30 days. The speaker and president pro tempore each choose one chairperson, and the two must schedule the first panel's meeting no more than 60 day's after the bill's enactment. If an appointing authority fails to make an initial or vacancy appointment within the 30 day-period, the authority chairpeople must do so.

The authority can apply for grants or financial assistance from state and federal agencies, individuals, groups, and corporations. The bill appropriates $ 500,000 to DPH in FY 09 for the authority.

EFFECTIVE DATE: Upon passage, except for the appropriation, which is effective July 1, 2008.

31, 40 — STATEWIDE PRIMARY CARE ACCESS AUTHORITY

Developing a Universal Primary Care System

The bill establishes an 11-member authority to develop, a universal system for providing primary care services, including prescription drugs, to all Connecticut residents. It must develop the system by December 31, 2008 and a plan for implementing it by July 1, 2010. The system must be designed to maximize federal participation in Medicaid and Medicare.

In developing the system, the authority must define primary care and inventory the state's existing primary care infrastructure including

1. the number of primary care providers practicing in the state (i. e. , physicians, dentists, nurses, people providing services to people with mental illness and mental retardation, and others providing primary medical, nursing, counseling, or other health cares, substance abuse, or mental health services, including those providing services through an HMO or medical services plan);

2. the total amount spent on public and private primary care services during the last fiscal year; and

3. the number of public and private buildings and offices used primarily for primary care services, including hospitals, mental health facilities, dental offices, community- and school-based health centers, and academic health centers.

The committee must also:

1. estimate the cost of fully implementing a universal primary care system,

2. identify additional personnel or infrastructure needed to implement a system,

3. determine the state's and third parties' role in administering a system,

4. identify funding sources for a system, and

5. determine private insurers' role in a universal system.

Implementation Plan

The authority's implementation plan must (1) include a timetable, (2) establish benchmarks to assess progress toward implementation, and (3) establish ways to assess the system's effectiveness once it begins operating.

Authority Composition, Powers, and Reporting Requirements

The authority is composed of (1) the chairpersons of the HealthFirst Connecticut Authority (see above), who also serve as this authority's chairpersons; (2) the DPH and DSS commissioners; (3) the comptroller; and (4) members appointed by the Connecticut Primary Care Association, State Medical Society, Chapter of the American Academy of Pediatrics, Nurses Association, and Association of School-Based Health Centers, and the Weitzman Center for Innovation in Community Health and Primary Care (which is affiliated with Community Health Center, Inc. All members must be familiar with the Institute of Medicine's health care reform principles (see BACKGROUND) and be committed to making recommendations consistent with them.

All initial appointments must be made by July 15, 2007, and the chairpersons must convene the first meeting by August 1, 2007. Any member who fails to attend three consecutive meetings or 50% of all meetings during a calendar year is deemed to have resigned. Appointing authorities fill vacant positions. Members serve without pay but are reimbursed for their expenses.

The authority can hire consultants or assistants under contracts or other means to render professional, legal, financial, technical, or other assistance or advice.

The authority must report annually to the Public Health, Insurance, and Human Services committees on its progress in developing the universal primary care system and on the system's implementation. The first report is due by February 1, 2008; subsequent reports are due by January 1.

Funding

The bill permits the authority to apply for for grants or financial assistance from state and federal agencies, individuals, groups, and corporations. It appropriates $ 500,000 to DPH in FY 09 for the authority.

EFFECTIVE DATE: Upon passage, except the appropriation, which is effective July 1, 2008.

32-33, 41 — SCHOOL-BASED HEALTH CENTER GRANTS

The bill appropriates $ 2. 5 million in FY 08 for DPH to fund expansion and operating costs of school-based health centers (SBHCs) in priority school districts and federally designated health professional shortage or medically underserved areas or those designated as having medically underserved populations. It makes permanent the ad hoc committee established in 2006 to advise DPH on SBHCs. It requires the committee to meet at least quarterly and annually report recommendations to the Public Health and Education committees for statutory and regulatory changes to improve health care access through SBHCs.

The bill requires any SBHC constructed on or after October 1, 2007 that is located in, or attached to, a school building, to have an entrance separate from the school.

EFFECTIVE DATE: July 1, 2007, except for the provisions concerning the SBHC committee, which is effective upon passage

34—MEDICAID PROVIDER RATES

Annually, beginning in FY 08, the bill requires DSS, within available appropriations, to increase the rates it pays Medicaid providers, including hospitals.

EFFECTIVE DATE: July 1, 2007

42 & 43—COMMUNITY-BASED HEALTH CENTER GRANTS

The bill appropriates to DPH in FY 08 (1) $ 2 million for infrastructure grants to community-based health centers, including health information technology and (2) $ 500,000 for grants to these centers to transport patients to medical appointments. In making the latter grants, DPH must give priority to Federally Qualified Health Centers in areas with limited public transportation options.

EFFECTIVE DATE: July 1, 2007

BACKGROUND

Interpreter Services in Medicaid

The federal Civil Rights Act prohibits discrimination based on race, color, or national origin. The courts and the U. S. Department of Health and Human Services have applied this law to the protection of national origin minorities who do not speak English well. The Office of Civil Rights has issued guidance on this law that essentially says health care providers caring for Medicaid clients must take reasonable steps to ensure meaningful access to care.