Connecticut Seal

General Assembly

 

Substitute Bill No. 913

    January Session, 2015

 

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AN ACT CONCERNING HEALTH CARE DATA REPORTING AND THE ENROLLMENT OF NONSTATE PUBLIC EMPLOYEES IN THE STATE EMPLOYEE HEALTH PLAN.

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

Section 1. (NEW) (Effective July 1, 2015) (a) Not later than October 1, 2016, and annually thereafter, each municipality that sponsors a group health policy or plan for its active employees, early retirees and retirees that provides coverage of the type specified in subdivisions (1), (2), (4), (11), (12) and (16) of section 38a-469 of the general statutes shall submit electronically to the State Comptroller, in a form prescribed by the Comptroller, the following information for the policy or plan year immediately preceding:

(1) A list of each type of group health policy or plan offered to the municipality's employees, early retirees and retirees and specific details for each such policy or plan, including, but not limited to:

(A) Covered benefits and any limits on such benefits;

(B) (i) The total premium costs or, if applicable, premium equivalent costs for each policy or plan, organized by coverage tier, including, but not limited to, single, two-person and family including dependents for active employees, early retirees and retirees, and (ii) the employee share, the early retiree share and the retiree share of each such total premium cost;

(C) Employee, early retiree and retiree cost-sharing requirements such as coinsurance, copayments, deductibles and other out-of-pocket expenses associated with in-network and out-of-network providers; and

(D) If a municipality sponsors a prescription drug plan, the value of any rebates or cost reductions provided to such municipality for such plan;

(2) A list of the total number of employees, early retirees and retirees in each policy or plan, organized by (A) municipal department, (B) collective bargaining unit, if applicable, (C) coverage tier, including, but not limited to, single, two-person and family, including dependents, and (D) active employee, early retiree or retiree status; and

(3) For the two policy or plan years immediately preceding, the percentage increase or decrease in the policy or plan costs, calculated as the total premium costs, inclusive of any premiums or contributions paid by active employees, early retirees and retirees, divided by the total number of active employees, early retirees and retirees covered by such policy or plan.

(b) No municipality submitting information pursuant to subsection (a) of this section shall include health information in such information.

Sec. 2. Section 38a-513f of the general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2015):

(a) As used in this section:

(1) "Claims paid" means the amounts paid for the covered employees of an employer by an insurer, health care center, hospital service corporation, medical service corporation or other entity as specified in subdivision (1) of subsection (b) of this section for medical services and supplies and for prescriptions filled, but does not include expenses for stop-loss coverage, reinsurance, enrollee educational programs or other cost containment programs or features, administrative costs or profit.

(2) "Employer" means any town, city, borough, school district, taxing district or fire district employing more than fifty employees.

(3) "Utilization data" means (A) the aggregate number of procedures or services performed for the covered employees of the employer, by practice type and by service category, or (B) the aggregate number of prescriptions filled for the covered employees of the employer, by prescription drug name.

(b) (1) Each insurer, health care center, hospital service corporation, medical service corporation or other entity delivering, issuing for delivery, renewing, amending or continuing in this state any group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11), (12) and (16) of section 38a-469 shall:

[(1)] (A) Not later than October first, annually, provide to an employer sponsoring such policy, free of charge, the following information for the most recent thirty-six-month period or for the entire period of coverage, whichever is shorter, ending not more than sixty days prior to the date of the provision of such information, in a format as set forth in [subdivision (3)] subparagraph (C) of this [subsection] subdivision:

[(A)] (i) Complete and accurate medical, dental and pharmaceutical utilization data, as applicable;

[(B)] (ii) Claims paid by year, aggregated by practice type and by service category, each reported separately for in-network and out-of-network providers, and the total number of claims paid;

[(C)] (iii) Premiums paid by such employer by month; and

[(D)] (iv) The number of insureds by coverage tier, including, but not limited to, single, two-person and family including dependents, by month;

[(2)] (B) Include in such information specified in [subdivision (1)] subparagraph (A) of this [subsection] subdivision only health information that has had identifiers removed, as set forth in 45 CFR 164.514, is not individually identifiable, as defined in 45 CFR 160.103, and is permitted to be disclosed under the Health Insurance Portability and Accountability Act of 1996, P.L. 104-191, as amended from time to time, or regulations adopted thereunder; and

[(3)] (C) Provide such information [(A)] (i) in a written report, [(B)] (ii) through an electronic file transmitted by secure electronic mail or a file transfer protocol site, or [(C)] (iii) through a secure web site or web site portal that is accessible by such employer.

[(c)] (2) Such insurer, health care center, hospital service corporation, medical service corporation or other entity shall not be required to provide such information to the employer more than once in any twelve-month period.

[(d) (1)] (3) (A) Except as provided in [subdivision (2)] subparagraph (B) of this [subsection] subdivision, information provided to an employer pursuant to [subsection (b) of this section] subdivision (1) of this subsection shall be used by such employer only for the purposes of obtaining competitive quotes for group health insurance or to promote wellness initiatives for the employees of such employer.

[(2)] (B) Any employer may provide to the Comptroller upon request the information disclosed to such employer pursuant to [subsection (b) of this section] subdivision (1) of this subsection. The Comptroller shall maintain as confidential any such information.

[(e)] (4) Any information provided to an employer in accordance with [subsection (b) of this section] subdivision (1) of this subsection or to the Comptroller in accordance with [subdivision (2)] subparagraph (B) of [subsection (d)] subdivision (3) of this [section] subsection shall not be subject to disclosure under section 1-210. An employee organization, as defined in section 7-467, that is the exclusive bargaining representative of the employees of such employer shall be entitled to receive claim information from such employer in order to fulfill its duties to bargain collectively pursuant to section 7-469.

[(f)] (c) If a subpoena or other similar demand related to information provided pursuant to subsection (b) of this section is issued in connection with a judicial proceeding to an employer that receives such information, such employer shall immediately notify the insurer, health care center, hospital service corporation, medical service corporation or other entity that provided such information to such employer of such subpoena or demand. Such insurer, health care center, hospital service corporation, medical service corporation or other entity shall have standing to file an application or motion with the court of competent jurisdiction to quash or modify such subpoena. Upon the filing of such application or motion by such insurer, health care center, hospital service corporation, medical service corporation or other entity, the subpoena or similar demand shall be stayed without penalty to the parties, pending a hearing on such application or motion and until the court enters an order sustaining, quashing or modifying such subpoena or demand.

(d) (1) Not later than October 1, 2015, and annually thereafter, each insurer, health care center, hospital service corporation, medical service corporation or other entity delivering, issuing for delivery, renewing, amending or continuing in this state any group health insurance policy sponsored by an employer and providing either administrative services only or providing coverage of the type specified in subdivisions (1), (2), (4), (11), (12) and (16) of section 38a-469 shall submit to the Comptroller the information set forth in subparagraphs (A)(i) and (A)(ii) of subdivision (1) of subsection (b) of this section for the policy year immediately preceding for each such employer.

(2) Such information shall be submitted electronically to the Comptroller, in a form prescribed by the Comptroller, regardless of whether an employer requests such information pursuant to subparagraph (A) of subdivision (1) of subsection (b) of this section. Disclosure of any such information to the Comptroller pursuant to this subsection shall be made in compliance with subparagraph (B) of subdivision (1) of subsection (b) of this section.

Sec. 3. (Effective July 1, 2015) (a) With respect to the group hospitalization and medical and surgical insurance plans established under subsection (a) of section 5-259 of the general statutes, on and after July 1, 2015, and until June 30, 2016:

(1) The office of the State Comptroller shall have the authority to convene a working group, including, but not limited to, (A) to the extent applicable, health insurance companies, health care centers, hospital service corporations, medical service corporations or other entities delivering, issuing for delivery, renewing, amending or continuing such plans, (B) third-party administrators providing administrative services only for such plans pursuant to subdivision (2) of subsection (m) of section 5-259 of the general statutes, (C) health care providers, (D) health care facilities, (E) the Office of Policy and Management, and (F) state employees and retirees, to facilitate the development and establishment of health care provider payment reforms for the group hospitalization and medical and surgical insurance plans established under subsection (a) of section 5-259 of the general statutes, including, but not limited to, multipayer initiatives, patient-centered medical homes, primary care case management, value-based purchasing and bundled purchasing. Any participation by such entities and individuals shall be on a voluntary basis.

(2) (A) The Comptroller, or the Comptroller's designee, may (i) conduct a survey of the entities and individuals specified in subparagraphs (A) to (D), inclusive, of subdivision (1) of this subsection, concerning payment delivery reforms, and (ii) convene meetings of the working group at a time and place that is convenient for the entities and individuals specified in subparagraphs (A) to (F), inclusive, of subdivision (1) of this subsection.

(B) The Comptroller, or the Comptroller's designee, shall ensure that no such survey or working group participants shall solicit, share or discuss pricing information.

(C) (i) Any survey conducted pursuant to subparagraph (A) of this subdivision shall not be a violation of chapter 624 of the general statutes or subject to disclosure under section 1-210 of the general statutes.

(ii) Any meeting convened pursuant to subparagraph (A) of this subdivision shall not be a violation of chapter 624 of the general statutes or constitute a meeting for the purposes of chapter 14 of the general statutes.

(3) (A) If the Comptroller determines that entering a cooperative agreement with any of the entities or individuals specified in subparagraphs (A) to (D), inclusive, of subdivision (1) of this subsection will likely produce efficiencies and improvements in health care outcomes, the Comptroller may enter into one or more such agreements to (i) identify and reward high quality, low-cost health care providers, (ii) create enrollee incentives to receive care from such providers, and (iii) create enrollee incentives to promote personal health behaviors that will prevent or effectively manage chronic diseases, including, but not limited to, tobacco cessation, weight control and physical activity.

(B) The Comptroller may establish guidelines for such cooperative agreements. Any such agreement shall be consistent with federal antitrust laws and regulations promulgated by the Federal Trade Commission and chapter 624 of the general statutes.

(b) Not later than January 1, 2017, the Comptroller shall submit a report, in accordance with section 11-4a of the general statutes, to the joint standing committees of the General Assembly having cognizance of matters relating to appropriations, labor and public health on the recommendations of any working group convened by the Comptroller pursuant to subsection (a) of this section. Such report shall include, but not be limited to, (1) (A) any cost containment measures, and (B) descriptions of any quality measurement or quality improvement initiatives implemented as a result of the recommendations of such working group, and (2) any cost savings or health outcome improvements associated with such measures or initiatives.

Sec. 4. (NEW) (Effective from passage) As used in this section and sections 5 to 8, inclusive, of this act:

(1) "Health Care Costs Containment Committee" means the committee established in accordance with the ratified agreement between the state and the State Employees Bargaining Agent Coalition pursuant to subsection (f) of section 5-278 of the general statutes.

(2) "Nonstate public employee" means any employee or elected officer of a nonstate public employer.

(3) "Nonstate public employer" means a municipality or other political subdivision of the state, including a board of education, quasi-public agency or public library. A municipality and a board of education may be considered separate employers.

(4) "State employee plan" means the group hospitalization, medical, pharmacy and surgical insurance plan offered to state employees and retirees pursuant to section 5-259 of the general statutes.

Sec. 5. (NEW) (Effective October 1, 2015) (a) Notwithstanding any provision of title 38a of the general statutes, the Comptroller shall offer to nonstate public employers and their nonstate public employees, and their retirees, if applicable, coverage under the state employee plan. Such nonstate public employees, or retirees, if applicable, shall be pooled with the state employee plan, provided the Comptroller receives an application from a nonstate public employer and the application is approved in accordance with this section or section 6 of this act. Premium payments for such coverage shall be remitted by the nonstate public employer to the Comptroller and shall be the same as those paid by the state inclusive of any premiums paid by state employees, except as otherwise provided in this section or section 7 of this act. The Comptroller may charge each nonstate public employer participating in the state employee plan an administrative fee calculated on a per member, per month basis.

(b) (1) The Comptroller shall offer participation in such plan for not less than three-year intervals. A nonstate public employer may apply for renewal prior to the expiration of each interval.

(2) The Comptroller shall develop procedures by which nonstate public employers receiving coverage for nonstate public employees pursuant to the state employee plan may (A) apply for renewal, or (B) withdraw from such coverage, including, but not limited to, the terms and conditions under which such nonstate public employers may withdraw prior to the expiration of the interval and the procedure by which any premium payments such nonstate public employers may be entitled to or premium equivalent payments made in excess of incurred claims shall be refunded to such nonstate public employer. Any such procedures shall provide that nonstate public employees covered by collective bargaining shall withdraw from such coverage in accordance with chapters 68, 113 and 166 of the general statutes.

(c) Nothing in sections 4 to 8, inclusive, of this act shall (1) require the Comptroller to offer coverage to every nonstate public employer seeking coverage under the state employee plan, or (2) prevent the Comptroller from procuring coverage for nonstate public employees from vendors other than those providing coverage to state employees.

(d) The Comptroller shall create applications for coverage under and for renewal of the state employee plan. Such applications shall require a nonstate public employer to disclose whether such nonstate public employer shall offer any other health care benefits plan to the nonstate public employees who are offered the state employee plan.

(e) No nonstate public employee shall be enrolled in the state employee plan if such nonstate public employee is covered through a nonstate public employer's health insurance plans or insurance arrangements issued to or in accordance with a trust established pursuant to collective bargaining subject to the federal Labor Management Relations Act.

(f) (1) A nonstate public employer may submit an application to the Comptroller to provide coverage under the state employee plan for nonstate public employees employed by such nonstate public employer.

(2) If a nonstate public employer submits an application for coverage of all of its nonstate public employees, the Comptroller shall provide such coverage not later than the first day of the third calendar month following such application.

(3) (A) Except as provided in subsection (g) of this section, if a nonstate public employer submits an application for coverage for fewer than all of its nonstate public employees, or indicates in the application that the nonstate public employer shall offer other health plans to nonstate public employees who are offered the state health plan, the Comptroller shall forward such application to the Health Care Cost Containment Committee not later than five business days after receiving such application. Said committee may, not later than thirty days after receiving such application, certify to the Comptroller that the application will shift a significantly disproportional part of a nonstate public employer's medical risks to the state employee plan.

(B) If the Health Care Cost Containment Committee certifies to the Comptroller that the application will shift a significantly disproportional part of a nonstate public employer's medical risks to the state employee plan, the Comptroller shall not provide coverage to such nonstate public employer. If the Health Care Cost Containment Committee does not certify to the Comptroller that the application will shift a significantly disproportional part of a nonstate public employer's medical risks to the state employee plan, the Comptroller shall provide coverage not later than the first day of the third calendar month following the deadline for receiving the certification.

(4) Notwithstanding any provisions of the general statutes, initial and continuing participation in the state employee plan by a nonstate public employer shall be a mandatory subject of collective bargaining and shall be subject to binding interest arbitration in accordance with the same procedures and standards that apply to any other mandatory subject of bargaining pursuant to chapters 68, 113 and 166 of the general statutes.

(g) If a nonstate public employer included fewer than all of its nonstate public employees in its application for coverage because of (1) the decision by individual nonstate public employees to decline such coverage for themselves or their dependents, or (2) the nonstate public employer's decision to not offer coverage to temporary, part-time or durational employees, the Comptroller shall not forward such nonstate public employer's application to the Health Care Cost Containment Committee pursuant to subdivision (3) of subsection (f) of this section.

(h) Notwithstanding any provision of the general statutes, the state employee plan shall not be deemed (1) an unauthorized insurer, or (2) a multiple employer welfare arrangement. Any licensed insurer in this state may conduct business with the state employee plan.

Sec. 6. (NEW) (Effective October 1, 2015) (a) Any nonstate public employer that is eligible to seek coverage under the state employee plan for its nonstate public employees may seek such coverage for such nonstate public employer's retirees in accordance with this section. Premium payments for such coverage shall be remitted by the nonstate public employer to the Comptroller and shall be the same as those paid by the state, inclusive of any premiums paid by retired state employees.

(b) (1) If a nonstate public employer seeks coverage for all of its retirees in accordance with this section and all of the nonstate public employees employed by such nonstate public employer in accordance with section 5 of this act, the Comptroller shall accept such application upon the terms and conditions applicable to the state employee plan and shall provide coverage not later than the first day of the third calendar month following such application.

(2) If a nonstate public employer seeks coverage for fewer than all of its retirees, regardless of whether such nonstate public employer is seeking coverage for all of the nonstate public employees employed by such nonstate public employer, the Comptroller shall forward such application to the Health Care Cost Containment Committee not later than five business days after receiving such application. Said committee may, not later than thirty days after receiving such application, certify to the Comptroller that, with respect to such retirees, the application will shift a significantly disproportional part of such nonstate public employer's medical risks to the state employee plan.

(3) If the Health Care Cost Containment Committee certifies to the Comptroller that the application will shift a significantly disproportional part of a nonstate public employer's medical risks to the state employee plan, the Comptroller shall not provide coverage to such nonstate public employer's retirees. If the Health Care Cost Containment Committee does not certify to the Comptroller that the application will shift a significantly disproportional part of a nonstate public employer's medical risks to the state employee plan, the Comptroller shall provide coverage not later than the first day of the third calendar month following the deadline for receiving the certification.

(c) Nothing in sections 4 to 8, inclusive, of this act shall diminish any right to retiree health insurance pursuant to a collective bargaining agreement or to any other provision of the general statutes.

Sec. 7. (NEW) (Effective October 1, 2015) (a) There is established an account to be known as the "state employee plan premium account", which shall be a separate, nonlapsing account within the General Fund. All premiums paid by nonstate public employers and nonstate public employees pursuant to participation in the state employee plan shall be deposited into said account. The account shall be administered by the Comptroller, with the advice of the Health Care Costs Containment Committee, for payment of claims and administrative fees to entities providing coverage or services under the state employee plan.

(b) Each nonstate public employer shall pay monthly the amount determined by the Comptroller for coverage of its nonstate public employees or its nonstate public employees and retirees, as appropriate, under the state employee plan. A nonstate public employer may require each nonstate public employee to contribute a portion of the cost of his or her coverage under the plan, subject to any collective bargaining obligation applicable to such nonstate public employer.

(c) If any payment due by a nonstate public employer under this subsection is not paid after the date such payment is due, interest to be paid by such nonstate public employer shall be added, retroactive to the date such payment was due, at the prevailing rate of interest as determined by the Comptroller.

(d) If a nonstate public employer fails to make premium payments, the Comptroller may direct the State Treasurer, or any other officer of the state who is the custodian of any moneys made available by grant, allocation or appropriation payable to such nonstate public employer at any time subsequent to such failure, to withhold the payment of such moneys until the amount of the premium or interest due has been paid to the Comptroller, or until the State Treasurer or such custodial officer determines that arrangements have been made, to the satisfaction of the State Treasurer, for the payment of such premium and interest. Such moneys shall not be withheld if such withholding will adversely affect the receipt of any federal grant or aid in connection with such moneys.

Sec. 8. (Effective from passage) The Comptroller shall not offer coverage under the state employee plan pursuant to sections 4 to 7, inclusive, of this act until the State Employees' Bargaining Agent Coalition has provided its consent to the clerks of both houses of the General Assembly to incorporate the terms of sections 4 to 7, inclusive, of this act into its collective bargaining agreement.

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

Section 1

July 1, 2015

New section

Sec. 2

July 1, 2015

38a-513f

Sec. 3

July 1, 2015

New section

Sec. 4

from passage

New section

Sec. 5

October 1, 2015

New section

Sec. 6

October 1, 2015

New section

Sec. 7

October 1, 2015

New section

Sec. 8

from passage

New section

LAB

Joint Favorable Subst.

 

PD

Joint Favorable