January Session, 2015
LCO No. 9250
SEN. KELLY, 21st Dist.
"AN ACT CONCERNING THE COMMISSION ON HEALTH EQUITY. "
After the last section, add the following and renumber sections and internal references accordingly:
"Sec. 501. Section 38a-1083 of the general statutes are repealed and the following is substituted in lieu thereof (Effective from passage):
(a) For purposes of sections 38a-1080 to [38a-1091] 38a-1092, inclusive, as amended by this act, and section 502 of this act "purposes of the exchange" means the purposes of and the pursuit of the goals of the exchange expressed in and pursuant to this section and the performance of the duties and responsibilities of the exchange set forth in sections 38a-1084 to 38a-1092, inclusive, which are hereby determined to be public purposes for which public funds may be expended. The powers enumerated in this section shall be interpreted broadly to effectuate the purposes of the exchange and shall not be construed as a limitation of powers.
(b) The goals of the exchange shall be to reduce the number of individuals without health insurance in this state and assist individuals and small employers in the procurement of health insurance by, among other services, offering easily comparable and understandable information about health insurance options.
(c) The exchange is authorized and empowered to:
(1) Have perpetual [successions] succession as a body politic and corporate and to adopt bylaws for the regulation of its affairs and the conduct of its business;
(2) Adopt an official seal and alter the same at pleasure;
(3) Maintain an office in the state at such place or places as it may designate;
(4) Employ such assistants, agents, managers and other employees as may be necessary or desirable;
(5) Acquire, lease, purchase, own, manage, hold and dispose of real and personal property, and lease, convey or deal in or enter into agreements with respect to such property on any terms necessary or incidental to the carrying out of these purposes, provided all such acquisitions of real property for the exchange's own use with amounts appropriated by this state to the exchange or with the proceeds of bonds supported by the full faith and credit of this state shall be subject to the approval of the Secretary of the Office of Policy and Management and the provisions of section 4b-23;
(6) Receive and accept, from any source, aid or contributions, including money, property, labor and other things of value;
(7) Charge assessments or user fees to health carriers that are capable of offering a qualified health plan through the exchange or otherwise generate funding necessary to support the operations of the exchange and impose interest and penalties on such health carriers for delinquent payments of such assessments or fees;
(8) Procure insurance against loss in connection with its property and other assets in such amounts and from such insurers as it deems desirable;
(9) Invest any funds not needed for immediate use or disbursement in obligations issued or guaranteed by the United States of America or the state and in obligations that are legal investments for savings banks in the state;
(10) Issue bonds, bond anticipation notes and other obligations of the exchange for any of its corporate purposes, and to fund or refund the same and provide for the rights of the holders thereof, and to secure the same by pledge of revenues, notes and mortgages of others;
(11) Borrow money for the purpose of obtaining working capital;
(12) Account for and audit funds of the exchange and any recipients of funds from the exchange;
(13) Make and enter into any contract or agreement necessary or incidental to the performance of its duties and execution of its powers. The contracts entered into by the exchange shall not be subject to the approval of any other state department, office or agency, provided copies of all contracts of the exchange shall be maintained by the exchange as public records, subject to the proprietary rights of any party to the contract;
(14) To the extent permitted under its contract with other persons, consent to any termination, modification, forgiveness or other change of any term of any contractual right, payment, royalty, contract or agreement of any kind to which the exchange is a party;
(15) Award grants to trained and certified individuals and institutions that will assist individuals, families and small employers and their employees in enrolling in appropriate coverage through the exchange. Applications for grants from the exchange shall be made on a form prescribed by the board;
(16) Limit the number of plans offered, and use selective criteria in determining which plans to offer, through the exchange, provided individuals and employers have an adequate number and selection of choices;
(17) Evaluate jointly with the SustiNet Health Care Cabinet the feasibility of implementing a basic health program option as set forth in Section 1331 of the Affordable Care Act;
(18) Establish one or more subsidiaries, in accordance with section 502 of this act, to further the purposes of the exchange;
(19) (A) Make loans to each subsidiary established pursuant to section 502 of this act from the assets of the exchange and the proceeds of bonds, bond anticipation notes and other obligations issued by the exchange, provided the source and security for the repayment of such loans are derived from the assets, revenues and resources of the subsidiary, and (B) assign or transfer to such subsidiary any of the rights, moneys or other assets of the exchange, provided such assignment or transfer is not in violation of state or federal law;
[(18)] (20) Sue and be sued, plead and be impleaded;
[(19)] (21) Adopt regular procedures that are not in conflict with other provisions of the general statutes, for exercising the power of the exchange; and
[(20)] (22) Do all acts and things necessary and convenient to carry out the purposes of the exchange, provided such acts or things shall not conflict with the provisions of the Affordable Care Act, regulations adopted thereunder or federal guidance issued pursuant to the Affordable Care Act.
(d) Prior to changing the amount of an assessment or user fee charged to any health carrier pursuant to subdivision (7) of subsection (c) of this section, if such change is for more than a ten per cent increase, the board shall file such proposed change with the clerks of the House of Representatives and the Senate. The General Assembly shall vote to approve or reject such proposed change within thirty days after the date of filing. If the General Assembly fails to vote to approve or reject such proposed change within the thirty-day period, the proposed change shall be deemed approved. The thirty-day period shall not begin or expire unless the General Assembly is in regular session.
[(d)] (e) (1) The chief executive officer of the exchange shall provide to the commissioner the name of any health carrier that fails to pay any assessment or user fee under subdivision (7) of subsection (c) of this section to the exchange. The commissioner shall see that all laws respecting the authority of the exchange pursuant to said subdivision (7) are faithfully executed. The commissioner has all the powers specifically granted under this title and all further powers that are reasonable and necessary to enable the commissioner to enforce the provisions of said subdivision (7).
(2) Any health carrier aggrieved by an administrative action taken by the commissioner under subdivision (1) of this subsection may appeal therefrom in accordance with the provisions of section 4-183, except venue for such appeal shall be in the judicial district of New Britain.
Sec. 502. (NEW) (Effective from passage) (a) The exchange may establish one or more subsidiaries for such purposes as prescribed by resolution of the board of directors of the exchange, which purposes shall be consistent with the purposes of the exchange. Each subsidiary shall be deemed a quasi-public agency for the purposes of chapter 12 of the general statutes and shall have all the privileges, immunities, tax exemptions and other exemptions of the exchange. Any such subsidiary may be organized as a stock or nonstock corporation or a limited liability company.
(b) (1) Each subsidiary shall have and may exercise the powers of the exchange and such additional powers as are set forth in such resolution, except the powers of the exchange set forth in subdivisions (7), (12), (15), (16), (17) and (21) of subsection (c) of section 38a-1083 of the general statutes, as amended by this act, shall be reserved to the exchange and shall not be exercisable by any subsidiary of the exchange.
(2) Each subsidiary shall include in any contract with any entity a provision that the subsidiary's liability shall be limited solely to the assets, revenues and resources of such subsidiary without recourse to the general funds, revenues or resources or any other assets of the exchange.
(c) (1) Each subsidiary shall act through a board of directors, at least one-half of which shall be members of the board of directors of the exchange or their designees or officers or employees of the exchange. The provisions of subdivision (2) of subsection (b) of section 38a-1081 of the general statutes and subdivisions (7) and (9) of subsection (c) of section 38a-1081 of the general statutes shall apply to each member of the board of directors of a subsidiary who is not a member of the board of directors of the exchange, an officer of the exchange or an employee of the exchange.
(2) The provisions of section 1-125 of the general statutes shall apply to any member of the board of directors, officer or employee of a subsidiary established under this section. Any such member, officer or employee shall not be personally liable for the debts, obligations or liabilities of any such subsidiary as provided in section 1-125 of the general statutes. Any such subsidiary shall, and the exchange may, save harmless and indemnify any such member, officer or employee as provided in section 1-125 of the general statutes.
(d) (1) Each subsidiary to which the exchange makes a loan pursuant to subdivision (19) of subsection (c) of section 38a-1083 of the general statutes, as amended by this act, shall repay such loan from the assets, revenues and resources of such subsidiary.
(2) Each subsidiary shall be subject to suit, provided its liability shall be limited solely to the assets, revenues and resources of such subsidiary and without recourse to the general funds, revenues or resources or any other assets of the exchange.
(3) Each subsidiary may convey or dispose of its assets and pledge its revenues to secure any borrowing, provided any such borrowing shall be a special obligation of the subsidiary and shall be payable solely from the assets, revenues and resources of the subsidiary.
(4) Each subsidiary or the exchange may take any action necessary to comply with the provisions of the Internal Revenue Code of 1986, or any subsequent corresponding internal revenue code of the United States, as amended from time to time, to qualify and maintain any subsidiary as a corporation exempt from taxation under said code.
(e) The provisions of subsection (b) of section 38a-1090 of the general statutes shall be applicable to each subsidiary established by the exchange.
Sec. 503. Section 38a-1080 of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):
For purposes of sections 38a-1080 to [38a-1091] 38a-1092, inclusive, and section 502 of this act:
(1) "Board" means the board of directors of the Connecticut Health Insurance Exchange;
(2) "Commissioner" means the Insurance Commissioner;
(3) "Exchange" means the Connecticut Health Insurance Exchange established pursuant to section 38a-1081;
(4) "Affordable Care Act" means the Patient Protection and Affordable Care Act, P. L. 111-148, as amended by the Health Care and Education Reconciliation Act, P. L. 111-152, as both may be amended from time to time, and regulations adopted thereunder;
(5) (A) "Health benefit plan" means an insurance policy or contract offered, delivered, issued for delivery, renewed, amended or continued in the state by a health carrier to provide, deliver, pay for or reimburse any of the costs of health care services.
(B) "Health benefit plan" does not include:
(i) Coverage of the type specified in subdivisions (5), (6), (7), (8), (9), (14), (15) and (16) of section 38a-469 or any combination thereof;
(ii) Coverage issued as a supplement to liability insurance;
(iii) Liability insurance, including general liability insurance and automobile liability insurance;
(iv) Workers' compensation insurance;
(v) Automobile medical payment insurance;
(vi) Credit insurance;
(vii) Coverage for on-site medical clinics; or
(viii) Other similar insurance coverage specified in regulations issued pursuant to the Health Insurance Portability and Accountability Act of 1996, P. L. 104-191, as amended from time to time, under which benefits for health care services are secondary or incidental to other insurance benefits.
(C) "Health benefit plan" does not include the following benefits if they are provided under a separate insurance policy, certificate or contract or are otherwise not an integral part of the plan:
(i) Limited scope dental or vision benefits;
(ii) Benefits for long-term care, nursing home care, home health care, community-based care or any combination thereof; or
(iii) Other similar, limited benefits specified in regulations issued pursuant to the Health Insurance Portability and Accountability Act of 1996, P. L. 104-191, as amended from time to time;
(iv) Other supplemental coverage, similar to coverage of the type specified in subdivisions (9) and (14) of section 38a-469, provided under a group health plan.
(D) "Health benefit plan" does not include coverage of the type specified in subdivisions (3) and (13) of section 38a-469 or other fixed indemnity insurance if (i) such coverage is provided under a separate insurance policy, certificate or contract, (ii) there is no coordination between the provision of the benefits and any exclusion of benefits under any group health plan maintained by the same plan sponsor, and (iii) the benefits are paid with respect to an event without regard to whether benefits were also provided under any group health plan maintained by the same plan sponsor;
(6) "Health care services" has the same meaning as provided in section 38a-478;
(7) "Health carrier" means an insurance company, fraternal benefit society, hospital service corporation, medical service corporation, health care center or other entity subject to the insurance laws and regulations of the state or the jurisdiction of the commissioner that contracts or offers to contract to provide, deliver, pay for or reimburse any of the costs of health care services;
(8) "Internal Revenue Code" means the Internal Revenue Code of 1986, or any subsequent corresponding internal revenue code of the United States, as amended from time to time;
(9) "Person" has the same meaning as provided in section 38a-1;
(10) "Qualified dental plan" means a limited scope dental plan that has been certified in accordance with subsection (e) of section 38a-1086;
(11) "Qualified employer" has the same meaning as provided in Section 1312 of the Affordable Care Act;
(12) "Qualified health plan" means a health benefit plan that has in effect a certification that the plan meets the criteria for certification described in Section 1311(c) of the Affordable Care Act and section 38a-1086;
(13) "Qualified individual" has the same meaning as provided in Section 1312 of the Affordable Care Act;
(14) "Secretary" means the Secretary of the United States Department of Health and Human Services;
(15) "Small employer" has the same meaning as provided in section 38a-564.
Sec. 504. (Effective from passage) The board of directors of the Connecticut Health Insurance Exchange established under section 38a-1081 of the general statutes shall examine its long-term plan for self-sustainability and submit a report not later than January 1, 2017, to the joint standing committees of the General Assembly having cognizance of matters relating to insurance and public health, in accordance with the provisions of section 11-4a of the general statutes, summarizing such plan and including an evaluation of its success in meeting its goals for self-sustainability. "
This act shall take effect as follows and shall amend the following sections: