Connecticut Seal

General Assembly

 

Raised Bill No. 5617

February Session, 2008

 

LCO No. 1532

 

*01532_______HS_*

Referred to Committee on Human Services

 

Introduced by:

 

(HS)

 

AN ACT DELAYING IMPLEMENTATION OF AND MAKING REVISIONS TO THE CHARTER OAK HEALTH PLAN.

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

Section 1. (Effective from passage) Section 23 of public act 07-2 of the June special session shall take effect July 1, 2009.

Sec. 2. Section 17b-311 of the 2008 supplement to the general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2009):

(a) There is established the Charter Oak Health Plan for the purpose of providing access to health insurance coverage for uninsured state residents [who have been uninsured for at least six months and] who are ineligible for other publicly funded health insurance plans. The Commissioner of Social Services may enter into contracts for the provision of comprehensive health care for such uninsured state residents. The commissioner shall conduct outreach to facilitate enrollment in the plan.

(b) The commissioner shall impose cost-sharing requirements in connection with services provided under the Charter Oak Health Plan. Such requirements may include, but not be limited to: (1) A monthly premium not to exceed two hundred fifty dollars; (2) an annual deductible not to exceed one [thousand] hundred dollars; (3) [a coinsurance payment not to exceed twenty per cent after the deductible amount is met; (4)] tiered copayments for prescription drugs determined by whether the drug is generic or brand name, formulary or nonformula and whether purchased through mail order; [(5)] (4) no fee for emergency visits to hospital emergency rooms; [(6)] (5) a copayment not to exceed [one hundred fifty] twenty dollars for no emergency visits to hospital emergency rooms; and [(7) a] (6) no lifetime benefit [not to exceed one million dollars] limitation.

(c) The Commissioner of Social Services shall provide premium assistance to eligible state residents whose gross annual income does not exceed three hundred per cent of the federal poverty level. Such premium assistance shall be limited to: (1) One hundred seventy-five dollars per month for individuals whose gross annual income is below one hundred fifty per cent of the federal poverty level; (2) one hundred fifty dollars per month for individuals whose gross annual income is at or above one hundred fifty per cent of the federal poverty level but not more than one hundred eighty-five per cent of the federal poverty level; (3) seventy-five dollars per month for individuals whose gross annual income is above one hundred eighty-five per cent of the federal poverty level but not more than two hundred thirty-five per cent of the federal poverty level; and (4) fifty dollars per month for individuals whose gross annual income is above two hundred thirty-five per cent of the federal poverty level but not more than three hundred per cent of the federal poverty level. Individuals insured under the Charter Oak Health Plan shall pay their share of payment for coverage in the plan directly to the insurer.

(d) The Commissioner of Social Services shall determine minimum requirements on the amount, duration and scope of benefits under the Charter Oak Health Plan, except that there shall be no preexisting condition exclusion or annual maximum limits on the amount, duration and scope of prescription drugs or durable medical equipment, and the commissioner shall ensure that the plan includes comprehensive coverage for dental, vision and mental health services consistent with the provisions of section 38a-514, prevention incentives, and wellness and disease management programs. Each participating insurer shall provide an internal grievance process by which an insured may request and be provided a review of a denial of coverage under the plan consistent with the provisions of section 38a-226c. An insured shall also have access to an external appeal process consistent with the provisions of section 38a-478n, and each participating insurer shall comply with the notification and other requirements of the external appeal process. The commissioner shall provide monthly reports on the plan and its implementation, including, but not limited to, information on costs and utilization of care, to the Medicaid Managed Care Council.

(e) The Commissioner of Social Services may contract with the following entities for the purposes of this section: (1) A health care center subject to the provisions of chapter 698a; (2) a consortium of federally qualified health centers and other community-based providers of health services which are funded by the state; or (3) other consortia of providers of health care services established for the purposes of this section. Providers of comprehensive health care services as described in subdivisions (2) and (3) of this subsection shall not be subject to the provisions of chapter 698a. Any such provider shall be certified by the commissioner to participate in the Charter Oak Health Plan in accordance with criteria established by the commissioner, including, but not limited to, minimum reserve fund requirements. A contract entered into under this section shall be separate and independent from any contract for the provision of health care services under the HUSKY Plan, Part A or Part B, and shall not contain any provision that requires a provider, as a condition of participating in the Charter Oak Health Plan, to contract for the provision of health care services under the HUSKY Plan, Part A or Part B. A contract under this section shall include a provision that requires a medical loss ratio of at least eighty-five per cent as a condition of participation in the Charter Oak Health Plan.

(f) The Commissioner of Social Services shall seek proposals from entities described in subsection (e) of this section based on the cost sharing and benefits described in subsections (b) and (c) of this section. [The commissioner may approve an alternative plan in order to make coverage options available to those eligible to be insured under the plan.]

(g) The Commissioner of Social Services, pursuant to section 17b-10, may implement policies and procedures to administer the provisions of this section while in the process of adopting such policies and procedures as regulation, provided the commissioner prints notice of the intent to adopt the regulation in the Connecticut Law Journal not later than twenty days after the date of implementation. Such policies shall be valid until the time final regulations are adopted and may include [: (1) Exceptions to the requirement that a resident be uninsured for at least six months to be eligible for the Charter Oak Health Plan; and (2)] requirements for open enrollment and limitations on the ability of enrollees to change plans between such open enrollment periods.

This act shall take effect as follows and shall amend the following sections:

Section 1

from passage

New section

Sec. 2

July 1, 2009

17b-311

Statement of Purpose:

To delay the implementation of and make revisions to the Charter Oak Health Plan.

[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not underlined.]