Bill Text: CT HB06305 | 2011 | General Assembly | Comm Sub

Connecticut House Bill 6305 (Prior Session Legislation)

Bill Title: An Act Concerning Implementation Of The Sustinet Plan.

Spectrum: Moderate Partisan Bill (Democrat 6-1)

Status: (Introduced - Dead) 2011-06-03 - House Recommitted to Human Services [HB06305 Detail]

Download: Connecticut-2011-HB06305-Comm_Sub.html

General Assembly		*Substitute Bill No. 6305*
*January Session, 2011*		_____HB06305INSHS_031011____

AN ACT CONCERNING IMPLEMENTATION OF THE SUSTINET PLAN.

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

Section 1. (NEW) (Effective from passage) It is declared that, for the benefit of the people of the state, the increase of their welfare and prosperity and the improvement of their health and living conditions, it is essential that this and future generations be given the fullest opportunity to obtain health care that is universal, continuous, affordable, sustainable, and that enhances health and well-being by promoting access to high-quality health care that is effective, efficient, safe, timely, patient-centered and equitable and therefore the SustiNet Plan and its governing authority are established herein.

Sec. 2. (NEW) (Effective from passage) As used in sections 1 to 6, inclusive, of this act, section 17b-261 of the general statutes, as amended by this act, section 8 of this act, section 17b-90 of the general statutes, as amended by this act, sections 10 to 17, inclusive, of this act, section 19a-750 of the general statutes, as amended by this act, section 19 of this act, section 1-79 of the general statutes, as amended by this act, section 1-120 of the general statutes, as amended by this act, and sections 1-124 and 1-125 of the general statutes, as amended by this act:

(1) "Authority" or "SustiNet Authority", unless the context otherwise requires, means the SustiNet Plan Authority established pursuant to section 3 of this act;

(2) "Affordable Care Act" means the Patient Protection and Affordable Care Act, P.L. 111-148, as amended from time to time;

(3) "Board of directors" or "board" means the board of directors for the SustiNet Plan Authority, established pursuant to section 3 of this act;

(4) "Exchange" means a health insurance exchange established for the state pursuant to the provisions of Section 1311 of the Affordable Care Act;

(5) "Health Care Cost Containment Committee" means the committee established pursuant to the ratified agreement between the state and State Employees' Bargaining Agent Coalition pursuant to subsection (f) of section 5-278 of the general statutes;

(6) "Municipal-related employee" means any employee of a municipal-related employer;

(7) "Municipal-related employer" means any property management business, food service business or school transportation business that is a party to a contract with a nonstate public employer;

(8) "Nonprofit employee" means any employee of a nonprofit employer;

(9) "Nonprofit employer" means a nonprofit corporation, as defined in subparagraph (B) of subdivision (7) of subsection (i) of section 5-259 of the general statutes;

(10) "Nonstate public employee" means any employee or elected officer of a nonstate public employer;

(11) "Nonstate public employer" means a municipality or other political subdivision of the state, including a board of education, quasi-public agency or public library;

(12) "Northeast states" means the Northeast states, as defined by the United States Census Bureau;

(13) "Patient-centered medical home" has the same meaning as set forth in Section 3502 of the Affordable Care Act;

(14) "Small employer employee" means any employee of a small employer;

(15) "Small employer" means an employer that is qualified to purchase group coverage through a health insurance exchange established in this state pursuant to the Affordable Care Act and any person, firm, corporation, limited liability company, partnership or association actively engaged in business or self-employed for at least three consecutive months that, on at least fifty per cent of its working days during the preceding twelve months, employed no more than fifty employees, the majority of whom were employed within this state. "Small employer" does not include a nonstate public employer. In determining the number of eligible employees, companies that are affiliates, as defined in section 33-840 of the general statutes, or that are eligible to file a combined tax return under chapter 208 of the general statutes, shall be considered one employer;

(16) "State employee plan" or "state plan" means a self-insured group health care benefits plan established under subsection (m) of section 5-259 of the general statutes; and

(17) "SustiNet Plan" or "plan", unless the context otherwise requires, means a health insurance program that consists of multiple, coordinated individual health insurance plans that provide or offer, over a phased-in period of time, health insurance products to state employees, Medicaid enrollees, HUSKY Plan, Part A and Part B enrollees, HUSKY Plus enrollees, municipalities, municipal-related employers, nonprofit employers, small employers, other employers and individuals in the state and which, with respect to all health plans offered, implements innovative, cost-controlling mechanisms and measures to improve the quality of health care services and improve the health of SustiNet Plan enrollees.

Sec. 3. (NEW) (Effective from passage) (a) There is hereby established and created a body politic and corporate, constituting a public instrumentality and political subdivision of the state of Connecticut established and created for the performance of an essential public and governmental function, to be known as the SustiNet Plan Authority. The SustiNet Plan Authority is empowered to carry out the purposes of the SustiNet Plan, which are hereby determined to be public purposes for which public funds may be expended. The authority shall not be construed to be a department, institution or agency of the state.

(b) The powers of the authority shall be vested in and exercised by a board of directors, which shall consist of fifteen directors, appointed on or before September 1, 2011, as follows: The Comptroller, or the Comptroller's designee, and the Commissioner of Social Services, or the commissioner's designee, shall serve as ex-officio voting members of the board; three appointed by the Governor, one of whom shall be a primary care physician who is in active practice, one of whom shall be knowledgeable and experienced in measuring health care quality and one of whom shall have expertise in health care administration; two appointed by the president pro tempore of the Senate, one of whom shall be a representative of hospitals and one of whom shall be a SustiNet Plan member; two appointed by the speaker of the House of Representatives, one of whom shall be a small employer and one of whom shall be a SustiNet Plan member; one appointed by the majority leader of the Senate, who shall be a representative of organized labor; one appointed by the majority leader of the House of Representatives, who shall represent a nonprofit health care center; one appointed by the minority leader of the Senate, who shall be an oral health care provider; and one appointed by the minority leader of the House of Representatives, who shall be a mental health advocate. Thereafter, the thirteen board of directors appointed in accordance with the provisions of this subsection shall, by majority vote, appoint two additional directors to the board. Any person previously appointed to the SustiNet Health Partnership board of directors may be appointed to the board of directors as provided for in this subsection.

(c) Commencing on September 1, 2011, the three directors initially appointed by the Governor and the two directors initially appointed pursuant to a vote of the board shall serve a term of four years. The four directors initially appointed by the speaker of the House of Representatives and the president pro tempore of the Senate shall serve a term of three years. The four directors initially appointed by the majority and minority leaders of the House of Representatives and the majority and minority leaders of the Senate shall serve a term of two years. Thereafter, all members shall be appointed for a term of four years commencing on September first of the year of the appointment. Each director shall serve at the pleasure of his or her appointing authority but no longer than the term of office of the appointing authority or until the director's successor is appointed and qualified, whichever is longer, but in no case may a director serve for longer than three months after the term of his or her appointing authority.

(d) To qualify as a member of the board of directors of the authority, each director of the SustiNet Plan Authority before entering upon his or her duties shall take and subscribe the oath or affirmation required by article XI, section 1, of the State Constitution. A record of each such oath shall be filed in the office of the Secretary of the State. Meetings of the board of directors shall be held at such times as shall be specified in the bylaws adopted by the board and at such other time or times as the chairperson deems necessary.

(e) There shall be two chairpersons of the board selected from the fifteen members, one of whom shall be appointed by the Governor, and one of whom shall be appointed jointly by the president pro tempore of the Senate and the speaker of the House of Representatives. The chairpersons shall be appointed with the advice and consent of both houses of the General Assembly. The board shall annually elect two of its members to serve as vice chairpersons.

(f) Appointed directors may not designate a representative to perform in their absence their respective duties under this section and sections 4, 11, 16, 17 and 19 of this act. Any appointed director who fails to attend three consecutive meetings of the board or who fails to attend fifty per cent of all meetings of the board held during any calendar year shall be deemed to have resigned from the board. Any appointed director may be removed by his or her appointing authority for misfeasance, malfeasance or willful neglect of duty as determined in the sole discretion of the appointing authority. Any appointing authority shall fill any vacancy for the unexpired term of a director appointed by such authority and said director may be reappointed for a full term and subsequent terms. In the event that an appointing authority fails to make an initial appointment to the board or an appointment to fill a board vacancy within ninety days of the date of the vacancy, the appointed directors, by majority vote, shall make such appointment to the board.

(g) Nine directors of the authority shall constitute a quorum for the transaction of any business or the exercise of any power of the authority. For the transaction of any business or the exercise of any power of the authority, the authority may act by a majority of the directors present at any meeting at which a quorum is in attendance. No vacancy in the membership of the board of directors shall impair the right of such directors to exercise all the rights and perform all the duties of the board. Any action taken by the board under the provisions of this section and sections 4, 11, 16, 17 and 19 of this act may be authorized by resolution approved by a majority of the directors present at any regular or special meeting, which resolution shall take effect immediately and need not be published or posted.

(h) The board of directors shall receive no compensation for the performance of their official duties, except that each director shall be entitled to reimbursement for such director's actual and necessary expenses incurred during the performance of such director's official duties.

(i) The board may delegate to three or more directors such board powers and duties as it may deem necessary and proper. The board shall establish such committees, subcommittees or other entities as it deems necessary to further the purposes of the authority, including, but not limited to, a finance committee.

(j) Notwithstanding any provision of the general statutes, it shall not be or constitute a conflict of interest for a director, officer or employee of an institution or business entity, including a health care institution, or for any person having a financial interest in such an institution, to serve as a member of the board of directors of the authority; provided such director, officer, employee or person shall abstain from deliberation, action and vote by the board under sections 4, 7, 11, 16, 17 and 19 of this act, in specific respect to the institution or business entity of which such member is a director, officer or employee or in which such director has a financial interest.

(k) Each member of the board of directors of the authority shall execute a surety bond in the penal sum of fifty thousand dollars, or, in lieu thereof, the chairpersons of the board shall execute a blanket position bond covering each member of the board of directors and the executive director and the employees of the authority, each surety bond to be conditioned upon the faithful performance of the duties of the office or offices covered, to be executed by a surety company authorized to transact business in this state as surety and to be approved by the Attorney General and filed in the office of the Secretary of the State. The cost of each such bond shall be paid by the authority.

(l) The board shall adopt written procedures, in accordance with the provisions of section 1-121 of the general statutes, for: (1) Adopting an annual budget and plan of operations, including a requirement of board approval before the budget or plan may take effect; (2) hiring, dismissing, promoting and compensating employees of the authority, including an affirmative action policy and a requirement of approval by the board or by the executive director of the authority, acting in accordance with the directives of the board, before a position may be created or a vacancy filled; (3) acquiring real and personal property and personal services, including a requirement of board approval for any nonbudgeted expenditure in excess of five thousand dollars; (4) contracting for financial, legal, and other professional services, including a requirement that the authority solicit proposals at least once every three years for each such service which it uses; and (5) the use of surplus funds to the extent authorized under any provision of the general statutes.

(m) The chairpersons of the board, in consultation with the board, shall appoint an executive director of the authority. The executive director of the authority shall not be a member of the board. The executive director of the authority shall serve at the pleasure of the board and receive such compensation as shall be fixed by the board.

(n) The executive director shall supervise the administrative affairs and technical activities of the SustiNet Plan Authority in accordance with the directives of the board. The executive director shall be exempt from the classified service. The executive director shall attend all board meetings and keep a record of the proceedings of the authority and shall be custodian of all books, documents, and papers filed with the authority and of the minute book or journal of the authority and of its official seal. The executive director may give certificates under the official seal of the authority to the effect that such copies are true copies, and all persons dealing with the authority may rely upon such certificates.

(o) The authority shall continue as long as it shall have legal authority to exist pursuant to the general statutes and until its existence is terminated by law. Upon the termination of the existence of the authority, all its rights and properties shall pass to and be vested in the state of Connecticut.

(p) The provisions of chapter 12 of the general statutes shall apply to any officer, director, designee or employee appointed as a member, director or officer of the authority.

(q) The authority shall be subject to chapter 14 of the general statutes, except that the following items shall be exempt from said chapter and not subject to disclosure: (1) The names and applications of SustiNet Plan enrollees; (2) health information of any SustiNet Plan applicant or enrollee; (3) information relating to provider negotiations and provider compensation arrangements, provided information relating to Medicaid, HUSKY Plan, Part A and Part B, HUSKY Plus and the Charter Oak Health Plan shall be subject to disclosure under chapter 14 of the general statutes; and (4) information exchanged between the authority and the Departments of Social Services and Public Health, the Insurance Department, the Comptroller and any other relevant state agency pursuant to confidentiality agreements entered into pursuant to the provisions of section 10 of this act.

Sec. 4. (NEW) (Effective from passage) (a) There is established the SustiNet Plan Consumer Advisory Board. The advisory board shall consist of seven SustiNet Plan consumers, who shall represent the different populations served by the SustiNet Plan. Initially, the advisory board shall consist of two chairpersons, appointed by the chairpersons of the SustiNet Plan Authority board of directors, who shall each serve a one-year term, but who may be reappointed as chairpersons upon the expiration of the one-year term. The advisory board chairpersons shall, not later than thirty days after being appointed, establish procedures for appointing an additional five consumers to the advisory board, who shall serve on a staggered term basis and thereafter be appointed by the advisory board chairpersons. Subsequent to the initial appointment of the advisory board, consumers seeking to serve as successor board members shall be selected to serve on the board by a majority vote of the existing advisory board members. The advisory board shall develop, approve and implement a board member selection process in accordance with the provisions of this section. Not more than two members of the advisory board may be professional consumer advocates.

(b) The advisory board shall be responsible for issuing consumer impact statements which describe the general effects on consumers of major actions, as determined by such board, taken by the SustiNet Plan Authority board of directors. The advisory board shall prepare consumer impact statements that shall accompany the publication of decisions made by the board of directors concerning the SustiNet Plan. The advisory board shall advise the SustiNet Plan Authority board of directors on issues relating to SustiNet Plan consumers. The authority may make staff available to assist advisory board meetings.

Sec. 5. (NEW) (Effective from passage) (a) The purposes of the SustiNet Plan Authority shall be to promote access to high-quality health care that is effective, efficient, safe, timely, patient-centered and equitable, and for such purposes the authority is authorized and empowered to:

(1) Have perpetual 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 at such place or places as it may designate;

(4) Sue and be sued in its own name, and plead and be impleaded;

(5) Employ such assistants, agents and other employees as may be necessary or desirable, and engage consultants, actuaries, attorneys and appraisers as may be necessary or desirable to carry out its purposes in accordance with sections 3 to 6, inclusive, of this act, section 8 of this act, section 17b-90 of the general statutes, as amended by this act, and sections 10 to 17, inclusive, of this act;

(6) Make and enter into all contracts and agreements necessary, incidental or consistent with the purpose of sections 3 to 6, inclusive, of this act, section 8 of this act, section 17b-90 of the general statutes, as amended by this act, and sections 10 to 17, inclusive, of this act, including, but not limited to, the ability to contract with one or more insurers or other entities for administrative purposes, to perform such services that include, but are not limited to, claims processing, credentialing of providers, utilization management, care management, disease management and customer service;

(7) Solicit bids from individual providers and provider organizations and to arrange with insurers and others for access to existing or new provider networks, and take such other steps to provide all SustiNet Plan members with access to timely, high-quality health care throughout the state and, in appropriate cases, health care that is outside the state's borders;

(8) Enter agreements with any state agency to carry out the purposes of sections 3 to 6, inclusive, of this act, section 8 of this act, section 17b-90 of the general statutes, as amended by this act, and sections 10 to 17, inclusive, of this act;

(9) Accept from the state financial assistance, revenues or the right to receive revenues with respect to any program under the supervision of the authority;

(10) Solicit, receive and accept aid, grants or contributions from any source of money, property, labor or other things of value, to be held, used and applied to carry out the purposes of sections 3 to 6, inclusive, of this act, section 8 of this act, section 17b-90 of the general statutes, as amended by this act, and sections 10 to 17, inclusive, of this act, subject to such conditions upon which such aid, grants and contributions may be made, including, but not limited to, gifts or grants from any philanthropic organization, department, agency or instrumentality of the United States or this state;

(11) Acquire, lease, purchase, own, manage, hold and dispose of real 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 authority's own use with amounts appropriated by the state to the authority or with the proceeds of bonds supported by the full faith and credit of the state shall be subject to the approval of the Secretary of the Office of Policy and Management and the provisions of section 4b-23 of the general statutes;

(12) Procure insurance against any liability or loss in connection with its property and other assets, in such amounts and from such insurers as it deems desirable;

(13) Purchase reinsurance or stop loss coverage, to set aside reserves, or to take other prudent steps that avoid excess exposure to risk in the authority's administration of health insurance plans;

(13) Account for and audit funds of the authority and funds of any recipients of funds from the authority;

(14) Establish SustiNet health care plans in accordance with the provisions of sections 3 to 6, inclusive, of this act, section 17b-261 of the general statutes, as amended by this act, section 8 of this act, section 17b-90 of the general statutes, as amended by this act, and sections 10 to 17, inclusive, of this act;

(15) Commission surveys of consumers, employers and providers on issues related to health care and health care coverage; and

(16) Do all acts and things necessary or convenient to carry out the purposes of the authority.

(b) In addition to the powers vested with the authority pursuant to subsection (a) of this section, the authority shall:

(1) Set payment methods for licensed health care providers that (A) reflect evolving research and experience both within the state and outside the state, (B) promote access to health care and patient health, (C) prevent unnecessary health care spending, and (D) to the extent feasible and consistent with delivery system and payment reforms, ensure fair compensation to cover the reasonable cost of furnishing necessary care;

(2) Facilitate joint contracting efforts on behalf of state agencies wherever possible to achieve administrative savings, including, but not limited to, by facilitating joint negotiation of any administrative service organization contract to provide services to state employees, Medicaid and HUSKY Plan, Part A and Part B, HUSKY Plus and Charter Oak Health Plan enrollees, provided any such joint administrative service organization contract shall not be effective until the State Employee's Bargaining Agent Coalition has provided written consent to the Comptroller that said coalition agrees to incorporate the terms of any change into its collective bargaining agreement;

(3) Ensure that any agreement or contract entered into with an administrative service organization to serve any SustiNet Plan population does not contain payment mechanisms that provide an inherent incentive to deny care;

(4) Negotiate on behalf of providers participating in the SustiNet Plan to obtain discounted prices for vaccines and other health care goods and services;

(5) Establish and maintain an Internet web site that provides for timely posting of all public notices issued by the authority and such other information as the authority deems relevant in educating the public about the SustiNet Plan; and

(6) Make optimum use of opportunities created by the federal government for securing new and increased federal funding, including, but not limited to, increased reimbursement revenues.

Sec. 6. (NEW) (Effective from passage) (a) On and after January 1, 2012, the state employee plan, administered in accordance with the provisions of section 5-259 of the general statutes, and the medical assistance programs administered by the Department of Social Services, in accordance with the provisions of chapter 319v of the general statutes, including, the Medicaid program, HUSKY Plan, Part A and Part B, HUSKY Plus programs, the Charter Oak Health Plan, and the basic health program described in section 17b-261 of the general statutes, as amended by this act, shall also be known as SustiNet Plans. All SustiNet Plan members shall be provided with member identification cards that have an identical design. SustiNet Plan membership categories may be identified by discreet designations on the member identification cards in a format prescribed by the SustiNet Plan Authority.

(1) HUSKY Plan, Part A coverage, provided in accordance with the provisions of sections 17b-261, as amended by this act, 17b-277 and 17b-306 to 17b-307, inclusive, of the general statutes, shall also be known as SustiNet A.

(2) HUSKY Plan, Part B coverage, provided in accordance with the provisions of sections 17b-290 to 17b-307, inclusive, of the general statutes and HUSKY Plus benefits provided in accordance with section 17b-294a of the general statutes shall also be known as SustiNet B.

(3) Charter Oak Health Plan coverage provided in accordance with the provisions of section 17b-311 of the general statutes shall also be known as SustiNet C.

(4) Medicaid coverage, provided in accordance with the provisions of chapter 319v of the general statutes shall also be known as SustiNet D.

(5) State employee health plan coverage, provided in accordance with the provisions of section 5-259 of the general statutes shall also be known as SustiNet E.

(6) The health plan offered by the SustiNet Plan Authority pursuant to subsection (f) of this section and section 15 of this act shall be known as SustiNet G.

(b) Notwithstanding any provision of the general statutes, on and after January 1, 2012, the state employee plan, administered in accordance with the provisions of section 5-259 of the general statutes, shall be part of the SustiNet Plan and shall also be known as SustiNet E. The Comptroller shall administer the state employee plan in accordance with rules established by the SustiNet Plan Authority and in accordance with terms for which written consent has been provided as prescribed in subsection (c) of this section. The authority may establish rules concerning benefits, cost-sharing, utilization management, care coordination, disease management, evidence-based best practices, health care delivery systems, health care pilot programs, provider payment methods, provider network management, provider credentialing and customer service. On and after January 1, 2012, the Comptroller shall continue to procure health insurance in accordance with (1) section 5-259 of the general statutes for state employees and state retirees; and (2) direction from the authority, provided the Comptroller may jointly negotiate agreements with other agencies for services in accordance with sections 10 and 11 of this act. The Comptroller shall continue to make deductions for state employees and to enroll and disenroll employees and retirees and may administer customer relations for such employees and retirees. The Health Care Cost Containment Committee shall continue to advise the Office of the Comptroller on issues relating to state employee health care.

(c) No change in the terms of the state employee health insurance plan shall be effective until the State Employees' Bargaining Agent Coalition has provided written consent to the Comptroller that said coalition agrees to incorporate the terms of any change into its collective bargaining agreement.

(d) Notwithstanding any provision of the general statutes and to the extent permitted by federal law, on and after January 1, 2012, the Department of Social Services, which shall remain as the single state agency administering the Medicaid program, HUSKY Plan, Part A and Part B, HUSKY Plus programs and the Charter Oak Health Plan, may immediately implement recommendations from the SustiNet Plan Authority concerning the administration of such programs, including, but not limited to, rules concerning utilization management, health care coordination, disease management, evidence-based best practices, health care delivery systems, provider payment methods, provider network management, provider credentialing, pilot programs and customer services. At the earliest date feasible, the department shall contract with the SustiNet Plan Authority to provide or manage the provision of all covered health care services to beneficiaries of the Medicaid program, HUSKY Plan, Parts A and B, HUSKY Plus programs and the Charter Oak Health Plan. The department shall immediately seek any federal approval necessary to implement this section, including, but not limited to, delivery system and payment reforms recommended or implemented by the SustiNet Plan Authority. The SustiNet Plan Authority shall not be permitted to establish or amend requirements relating to the Medicaid program, HUSKY Plan, Part A and Part B, HUSKY Plus programs or Charter Oak Health Plan with respect to enrollment, eligibility, cost-sharing, administrative appeal rights, and provider auditing; requirements concerning such matters shall continue to be administered by the department in accordance with applicable statutory requirements. Notwithstanding any provision of the general statutes, on and after January 1, 2012, the Commissioner of Social Services may jointly negotiate agreements with other state agencies for services in accordance with sections 10 and 11 of this act.

(e) Notwithstanding the provisions of title 38a of the general statutes, on and after July 1, 2011, the Comptroller shall offer coverage under the state employee plan to nonstate public employers and their retirees, if applicable, in accordance with section 13 of this act, provided the Comptroller receives an application from such nonstate public employer and the application is approved in accordance with section 13 of this act. The Comptroller shall not offer coverage under the state employee plan pursuant to this subsection until the State Employees' Bargaining Agent Coalition has provided written consent to the Comptroller that said coalition agrees to incorporate the terms of such coverage into its collective bargaining agreement.

(f) (1) At the earliest feasible date, on and after January 1, 2012, notwithstanding the provisions of title 38a of the general statutes, the authority, as feasible, shall offer coverage under a new, independent coverage group, known as "SustiNet G", to employees and retirees of the following employer categories who request such coverage and whose application is approved in accordance with section 15 of this act: (A) Nonstate public employers, (B) municipal-related employers, (C) small employers, and (D) nonprofit employers. SustiNet G shall be a part of the SustiNet Plan but shall be separate from SustiNet coverage groups A to E, inclusive. Nothing in this subdivision shall require the authority to simultaneously offer coverage to all employer categories described in this subdivision. The authority may offer coverage pursuant to this subdivision to different employer categories on a staggered basis.

(2) On and after January 1, 2014, the authority shall offer coverage to all individuals and employers in Connecticut through SustiNet G, provided the authority has determined, after conducted all necessary feasibility studies and risk assessments, that offering such coverage is financially viable and does not require General Fund appropriations. Notwithstanding the provisions of section 5 of this act, the ongoing expenses of SustiNet G coverage shall be funded by premium payments without recourse to any appropriated fund.

(3) The authority shall offer coverage pursuant to subdivisions (1) and (2) of this subsection on any exchange established in accordance with the provisions of the Affordable Care Act and outside of any such exchange including through insurance agents, brokers and other methods of sale approved by the authority.

Sec. 7. Subsection (a) of section 17b-261 of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

(a) Medical assistance shall be provided for any otherwise eligible person whose income, including any available support from legally liable relatives and the income of the person's spouse or dependent child, is not more than one hundred forty-three per cent, pending approval of a federal waiver applied for pursuant to subsection (e) of this section, of the benefit amount paid to a person with no income under the temporary family assistance program in the appropriate region of residence and if such person is an institutionalized individual as defined in Section 1917(c) of the Social Security Act, 42 USC 1396p(c), and has not made an assignment or transfer or other disposition of property for less than fair market value for the purpose of establishing eligibility for benefits or assistance under this section. Any such disposition shall be treated in accordance with Section 1917(c) of the Social Security Act, 42 USC 1396p(c). Any disposition of property made on behalf of an applicant or recipient or the spouse of an applicant or recipient by a guardian, conservator, person authorized to make such disposition pursuant to a power of attorney or other person so authorized by law shall be attributed to such applicant, recipient or spouse. A disposition of property ordered by a court shall be evaluated in accordance with the standards applied to any other such disposition for the purpose of determining eligibility. The commissioner shall establish the standards for eligibility for medical assistance at one hundred forty-three per cent of the benefit amount paid to a family unit of equal size with no income under the temporary family assistance program in the appropriate region of residence. Except as provided in section 17b-277, the medical assistance program shall provide coverage to persons under the age of nineteen with family income up to one hundred eighty-five per cent of the federal poverty level without an asset limit and to persons under the age of nineteen and their parents and needy caretaker relatives, who qualify for coverage under [Section] Sections 1902 (a)(10)(A)(i)(VIII) and 1931 of the Social Security Act, with family income up to one hundred eighty-five per cent of the federal poverty level without an asset limit. Such levels shall be based on the regional differences in such benefit amount, if applicable, unless such levels based on regional differences are not in conformance with federal law. Any income in excess of the applicable amounts shall be applied as may be required by said federal law, and assistance shall be granted for the balance of the cost of authorized medical assistance. The Commissioner of Social Services shall provide applicants for assistance under this section, at the time of application, with a written statement advising them of (1) the effect of an assignment or transfer or other disposition of property on eligibility for benefits or assistance, (2) the effect that having income that exceeds the limits prescribed in this subsection will have with respect to program eligibility, and (3) the availability of, and eligibility for, services provided by the Nurturing Families Network established pursuant to section 17b-751b. Persons who are determined ineligible for assistance pursuant to this section shall be provided a written statement notifying such persons of their ineligibility and advising such persons of the availability of HUSKY Plan, Part B health insurance benefits. On and after January 1, 2014, medical assistance shall be provided to childless adults and parents and needy caretaker relatives who qualify for coverage under Section 1931 of the Social Security Act, with family income up to one hundred thirty-three per cent of the federal poverty level, without an asset test and as determined in accordance with the provisions of the Affordable Care Act. On and after January 1, 2014, the Commissioner of Social Services shall implement the basic health program option in accordance with the Affordable Care Act. On and after January 1, 2014, all individuals with family income up to two hundred per cent of the federal poverty level, as determined in accordance with the Affordable Care Act, and who are ineligible for medical assistance pursuant to Title XIX of the Social Security Act, shall be eligible for medical assistance under the basic health program. Medical assistance provided through the basic health program shall include all benefits, limits on cost-sharing and other consumer safeguards that apply to medical assistance provided in accordance with Title XIX of the Social Security Act. Individuals enrolled in the basic health program shall include parents with incomes above one hundred thirty-three per cent of the federal poverty level, as determined under the Affordable Care Act, who would otherwise qualify for HUSKY Plan, Part A and individuals described in section 17b-257b. To the extent that federal funds received pursuant to the basic health program exceed the cost of medical assistance that would otherwise be provided to such enrollees pursuant to Title XIX of the Social Security Act, the excess of such federal funds shall be used to increase reimbursement rates for providers serving individuals receiving benefits pursuant to this section. The Commissioner of Social Services shall take all necessary actions to maximize federal funding received in connection with the establishment of a basic health program.

Sec. 8. (NEW) (Effective from passage) There is established an account to be known as the "basic health program account" which shall be a separate, nonlapsing account within the General Fund. The account shall contain any moneys required by law to be deposited in the account. Moneys in the account shall be expended by the SustiNet Plan Authority for the purposes of operating the basic health program in conformance with Section 1331 of the Affordable Care Act.

Sec. 9. Subsection (b) of section 17b-90 of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

(b) No person shall, except for purposes directly connected with the administration of programs of the Department of Social Services and in accordance with the regulations of the commissioner, solicit, disclose, receive or make use of, or authorize, knowingly permit, participate in or acquiesce in the use of, any list of the names of, or any information concerning, persons applying for or receiving assistance from the Department of Social Services or persons participating in a program administered by said department, directly or indirectly derived from the records, papers, files or communications of the state or its subdivisions or agencies, or acquired in the course of the performance of official duties. The Commissioner of Social Services shall disclose (1) to any authorized representative of the Labor Commissioner such information directly related to unemployment compensation, administered pursuant to chapter 567 or information necessary for implementation of sections 17b-688b, 17b-688c and 17b-688h and section 122 of public act 97-2 of the June 18 special session, (2) to any authorized representative of the Commissioner of Mental Health and Addiction Services any information necessary for the implementation and operation of the basic needs supplement program or for the management of and payment for behavioral health services for applicants for and recipients of state-administered general assistance, (3) to any authorized representative of the Commissioner of Administrative Services, or the Commissioner of Public Safety such information as the state Commissioner of Social Services determines is directly related to and necessary for the Department of Administrative Services or the Department of Public Safety for purposes of performing their functions of collecting social services recoveries and overpayments or amounts due as support in social services cases, investigating social services fraud or locating absent parents of public assistance recipients, (4) to any authorized representative of the Commissioner of Children and Families necessary information concerning a child or the immediate family of a child receiving services from the Department of Social Services, including safety net services, if the Commissioner of Children and Families or the Commissioner of Social Services has determined that imminent danger to such child's health, safety or welfare exists to target the services of the family services programs administered by the Department of Children and Families, (5) to a town official or other contractor or authorized representative of the Labor Commissioner such information concerning an applicant for or a recipient of financial or medical assistance under state-administered general assistance deemed necessary by said commissioners to carry out their respective responsibilities to serve such persons under the programs administered by the Labor Department that are designed to serve applicants for or recipients of state-administered general assistance, (6) to any authorized representative of the Commissioner of Mental Health and Addiction Services any information necessary for the purposes of the behavioral health managed care program established by section 17a-453, (7) to any authorized representative of the Commissioner of Public Health any information necessary to carry out his or her respective responsibilities under programs that regulate child day care services or youth camps, [or] (8) to a health insurance provider, in IV-D support cases, as defined in section 46b-231, information concerning a child and the custodial parent of such child that is necessary to enroll such child in a health insurance plan available through such provider when the noncustodial parent of such child is under court order to provide health insurance coverage but is unable to provide such information, provided the Commissioner of Social Services determines, after providing prior notice of the disclosure to such custodial parent and an opportunity for such parent to object, that such disclosure is in the best interests of the child, or (9) to any authorized representative of the SustiNet Plan Authority such information as may be necessary to carry out the purposes of the authority. No such representative shall disclose any information obtained pursuant to this section, except as specified in this section. Any applicant for assistance provided through said department shall be notified that, if and when such applicant receives benefits, the department will be providing law enforcement officials with the address of such applicant upon the request of any such official pursuant to section 17b-16a.

Sec. 10. (NEW) (Effective from passage) The SustiNet Authority may enter confidentiality agreements with the Departments of Social Services and Public Health, the Insurance Department, the Comptroller and any other relevant state agency that conform with the Health Insurance Portability and Accountability Act of 1996, P.L. 104-191 (HIPAA), as from time to time amended and other applicable federal statutes, to obtain necessary information regarding SustiNet Plan members. Any such information shall not be subject to chapter 14 of the general statutes.

Sec. 11. (NEW) (Effective from passage) (a) The SustiNet Plan shall be administered to slow the growth of health care costs, improve the quality of health care services and improve members' health outcomes. To the extent consistent with applicable collective bargaining agreements and the requirements of federal law, the authority may implement, modify and supplement the delivery system and payment reforms described in this section based on evolving evidence.

(b) The authority may work in cooperation with other public and private entities to implement multi-payor initiatives that promote the use of promising delivery system and payment reforms. In the context of such cooperative work, the authority may work with any convener authority established pursuant to section 20 of this act.

(1) Strongly encourage the use of patient-centered medical care by implementing both primary care case management and patient-centered medical homes for all SustiNet Plan members. Working in coordination with other public and private entities as appropriate, the authority shall develop provider capacity to function within these patient-centered models of care. The authority may make or facilitate grants and loans that (A) assist providers in transitioning to a primary care case management system and patient-centered medical home system, including, where appropriate obtaining certification as a patient-centered medical home; (B) provide technical assistance and training for community teams certified or sponsored by the authority; and (C) establish regional pilot programs. Any service delivery plan established pursuant to this subdivision shall include provider eligibility criteria that shall be met by any provider seeking to qualify for reimbursement under a primary care case management system or as a patient-centered medical home. A provider serving as a patient-centered medical home in accordance with the provisions of this subdivision shall provide services that include (i) assisting plan members to safeguard and improve their own health by: (I) Advising plan members with chronic health conditions of methods to monitor and manage their own conditions; (II) working with plan members to set and accomplish goals related to exercise, nutrition, use of tobacco and other addictive substances, sleep and other behaviors that directly affect such member's health; (III) implementing best practices to ensure that plan members understand medical instructions and are able to follow such directions; and (IV) providing translation services and using culturally competent communication strategies in appropriate cases; (ii) providing care coordination that includes: (I) Managing transitions between home and the hospital; (II) proactive monitoring that ensures that a plan member receives all recommended primary and preventive care services; (III) the provision of basic mental health care, including screening for depression, with referral relationships in place for those plan members who require additional assistance; (IV) strategies to address stresses that arise in the workplace, home, school and the community, including coordination with and referrals to available employee assistance programs; (V) referrals, in appropriate cases, to nonmedical services such as housing and nutrition programs, domestic violence resources and other support groups; and (VI) for a plan member with complex health conditions that involve receiving care from multiple providers, ensuring that such providers share information about the plan member, as appropriate, and pursue a single, integrated treatment plan on behalf of the plan member; and (iii) providing readily accessible, twenty-four-hour consultative services by telephone, secure electronic mail and quickly scheduled office appointments for purposes that include reducing the need for hospital emergency room visits;

(2) Establish provider payment mechanisms to encourage payment for quality care and greater access to providers, including multi-payer pilot programs, value-based purchasing pilot programs, bundled payments, global payments, increasing and decreasing Medicaid reimbursement for specific services or other innovations. Such payment mechanisms may involve alternatives to utilization of fee-for-service payments. To the extent warranted by available evidence, the authority shall, not later than July 1, 2012, establish goals for increasing the percentage of SustiNet expenditures made under alternative payment methodologies. The authority shall develop methods to measure the success of each alternative payment method;

(3) Provide community-based preventive care services, including, but not limited to, immunizations, simple tests and health care screenings at locations such as job sites, schools or other community locations. The authority shall develop care standards applicable to the providers of such services;

(4) Require that the SustiNet Plan be subject to the health insurance mandates provided in chapter 700c of the general statutes;

(5) Develop recommendations for public education and outreach campaigns to ensure that state residents are informed about the SustiNet Plan and are encouraged to enroll in the plan. Such public education and outreach campaign shall utilize community-based organizations and shall include a focus on targeting populations that are underserved by the health care delivery system. The public education and outreach campaign shall be based on evidence of the cost and effectiveness of similar efforts in this state and elsewhere. Such campaign shall incorporate an ongoing evaluation of its effectiveness, with corresponding changes in strategy, as needed;

(6) Work with other organizations within the state to minimize the cost to providers of optimizing health information technology. The authority shall take advantage of available federal resources while leveraging the combined purchasing power of the state's health care providers to obtain goods and services of lower cost and higher value. Such efforts shall ensure that privacy and data security are fully protected by all SustiNet Plan member data systems, including, but not limited to, compliance with applicable federal requirements;

(7) Periodically review the authority's coverage of preventive care based on the most current and reliable evidence available, including results of SustiNet Plan prevention initiatives;

(8) Implement multi-year action plans to achieve measurable objectives in areas such as the effective prevention and management of chronic illness, reducing racial and ethnic disparities involving health care and health outcomes, and reducing the number of state residents without insurance. The authority should monitor the accomplishment of such objectives and modify action plans as necessary;

(9) Within available appropriations, develop and implement systematic policies and procedures that are used to identify, qualify for subsidies, enroll and retain in coverage otherwise uninsured individuals. Such policies and procedures may be developed and implemented in collaboration with the Departments of Social Services and Revenue Services, the Labor Department, the Comptroller, the state's health insurance exchange and other local, state and federal agencies, as well as individual health care providers, hospitals, community health centers and other nongovernmental organizations, as the authority deems appropriate;

(10) Establish a pay-for-performance system to reward health care providers for improvements in health care quality and safety, reductions in racial and ethnic disparities in health care access, utilization, quality of care and health outcomes. Such pay-for-performance systems may reward health care providers for (A) making improvements as well as for meeting benchmarks, (B) having an effective plan in place for preventing illness and improving health status, and (C) caring for patients with the most complex and least well-controlled conditions;

(11) Establish procedures concerning the use of preferred drug lists and formularies;

(12) Establish procedures that prevent adverse selection;

(13) Pursue opportunities to negotiate discounts on vaccines or other goods and services for SustiNet Plan providers; and

(14) Comply with the provisions of chapter 699a of the general statutes concerning the preparation of consumer documents in plain language.

(d) With respect to SustiNet G, the authority shall offer a variety of SustiNet G plans to be sold on and off a health insurance exchange developed for the state that offer a variety of benefits, out-of-pocket costs and provider network arrangements, with each plan providing comprehensive, commercial-style benefits, including vision, dental care and parity of coverage for physical and mental health conditions. Such plans shall include, to the extent feasible, patient-centered medical homes, integration of physical and behavioral health care, and emphasis on prevention that includes encouraging individual responsibility for controllable health risks and other design features.

(e) In furtherance of the objectives set forth in subsection (a) of this section, the SustiNet Plan Authority board of directors shall:

(1) Establish a standing committee that shall provide advice on health information technology and establish a long-range plan to optimize quality health care for plan members and slow cost growth through the use of health information technology, which plan shall encourage all SustiNet Plan providers to use interoperable electronic health records to document and manage care;

(2) Establish one or more standing committees to address methods to prevent and control chronic illnesses and significant health risks, including, but not limited to, diabetes, hypertension, tobacco use, childhood asthma and obesity. Such committees shall recommend methods to (A) measure the quality of health care providers' performance and improvement of the plan member's health, and (B) measure and reduce racial and ethnic disparities concerning access to and the provision of quality health care services;

(3) Establish a standing committee that shall develop recommendations to (A) simplify procedures and paperwork for providers, including, but not limited to, provider enrollment in the SustiNet Plan, claims filing and utilization review procedures, and (B) resolve systemic provider issues;

(4) Establish a standing committee that shall advise the board on methods to attract primary care physicians, specialists and nurses to the SustiNet Plan and work in collaboration with other public and private efforts to increase the capacity of the state's health care workforce; and

(5) Implement policies and procedures to encourage the use of evidence-based medicine. Such policies and procedures shall include establishing a committee of clinicians to review and recommend for adoption by the board, clinical care guidelines for the treatment of particular diseases that are promulgated by national or international authorities, after consultation with representatives of SustiNet Plan providers and consumers. Any system that the board may adopt, which rewards providers for meeting such guidelines, shall provide mechanisms for documenting reasons to depart from such guidelines, including, but not limited to, reasons related to an individual patient's clinical condition.

Sec. 12. (NEW) (Effective from passage) (a) There is established an account to be known as the "SustiNet account" which shall be a separate, nonlapsing account within the General Fund. The account shall contain any moneys required by law to be deposited in the account. All SustiNet Plan premiums received pursuant to sections 13 and 15 of this act and all public or private funds provided to the SustiNet Plan Authority shall be placed into the SustiNet account. The Comptroller may make expenditures from the account at the direction of the SustiNet Plan executive director.

(b) On or before January 1, 2012, the SustiNet Plan Authority's executive director shall hire a consultant to determine existing state expenditures on health care funding for each of the categories of SustiNet Plan coverage. The executive director shall determine an appropriate projection for normal health care cost increases for each coverage group. If, after two years of SustiNet Plan operations, the executive director can demonstrate to the satisfaction of the Secretary of the Office of Policy and Management that the SustiNet Plan has reduced overall per capita spending on enrolled coverage groups, the amount of any such agreed to savings shall be placed into the SustiNet account and may be used by the authority to make grants to providers, increase provider rates or take other steps to improve the SustiNet Plan in accordance with the provisions of sections 5, 7 and 11 of this act.

Sec. 13. (NEW) (Effective from passage) (a) With respect to nonstate public employers seeking coverage in the state employee plan, which nonstate public employers are provided coverage in accordance with section 6 of this act:

(1) On and after July 1, 2011, the Comptroller shall offer participation in the state employee plan for not less than two-year intervals, provided the Comptroller may modify such intervals on or after January 1, 2014, if necessary, due to implementation of the Affordable Care Act. An employer may apply for renewal prior to the expiration of each interval.

(2) The Comptroller shall develop procedures by which:

(A) Such employers may apply to participate in the appropriate plan, including procedures for nonstate public employers that are currently self-insured and procedures for nonstate public employers that are currently fully-insured; and

(B) Employers receiving coverage for their employees pursuant to the state plan may (i) apply for renewal, or (ii) withdraw from such coverage, including, but not limited to, the terms and conditions under which such employers may withdraw prior to the expiration of the interval and the procedure by which any premium payments such employers may be entitled to shall be refunded. Any such procedures shall provide that nonstate public employees covered by collective bargaining shall withdraw from such coverage in accordance with chapters 113 and 166 of the general statutes.

(b) The initial open enrollment for nonstate public employers participating in the state employee plan shall be for coverage beginning January 1, 2012. Thereafter, open enrollment for nonstate public employers shall be for coverage periods beginning July first or such other date as may be determined by the Comptroller.

(c) Nothing in this section and section 6 of this act shall require the Comptroller to offer coverage to every employer seeking coverage under this section and section 6 of this act from every plan offered under the state employee plan.

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

(e) No employee shall be enrolled in the state plan if such employee is covered through such employee's employer by 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) If the Comptroller determines that granting coverage to a nonstate public employer under the state employee plan will affect such plan's status as a governmental plan under the Employee Retirement Income Security Act of 1974, as amended from time to time, the Comptroller shall not grant coverage to such employer and shall stop accepting applications for coverage from nonstate public employers. The Comptroller shall resume accepting applications for coverage under the state employee plan from such employers if the Comptroller determines that granting coverage to such employers will not affect such plan's status as a governmental plan under the Employee Retirement Income Security Act of 1974, as amended from time to time. The Comptroller shall make a public announcement of the Comptroller's decision to stop or resume accepting applications for coverage under the state employee plan.

(g) Nonstate public employers may join the state employee plan in accordance with the provisions of this subsection.

(1) Notwithstanding any provision of the general statutes, initial participation in the state employee plan by a nonstate public employer shall be a permissive subject of collective bargaining and shall be subject to binding interest arbitration only if the collective bargaining agent and the employer mutually agree to bargain over such initial participation. Such mutual agreement shall be in writing and signed by authorized representatives of the collective bargaining agent and the employer. Continuation in the state employee plan, after initial participation, shall be a mandatory subject of 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. For purposes of this section, a board of education and a municipality shall be considered separate employers and shall submit separate applications.

(2) (A) If a nonstate public employer submits an application in accordance with this subsection for all of its employees, the Comptroller shall accept such application for the next open enrollment. The Comptroller shall provide written notification to such employer of such acceptance and the date on which such coverage shall begin.

(B) If a nonstate public employer submits an application for less than all of its employees, or indicates in the application that the nonstate public employer will offer other health plans to employees who are offered the state health plan, the Comptroller shall forward such application to a health care actuary not later than five business days after receiving such application. Such actuary may, not later than sixty days after receiving such application, certify to the Comptroller that the application will shift a significantly disproportional part of such employer's employees' medical risks to the state employee plan, and shall provide, in writing, the specific reasons for its finding, including a summary of all information relied upon in making such a finding. If the Comptroller receives such certification, the Comptroller shall not provide coverage to such employer and shall provide written notification and the specific reasons for such denial to such employer and the Health Care Cost Containment Committee. If the Comptroller does not receive such certification, the Comptroller shall accept such application for the next open enrollment. The Comptroller shall provide written notification to the nonstate public employer of such acceptance and the date on which such coverage shall begin.

(C) The Comptroller shall consult with a health care actuary who shall develop actuarial standards to be used to assess the shift in medical risks of a nonstate public employer's employees to the state employee plan. The Comptroller shall present such standards to the Health Care Cost Containment Committee for its review and evaluation prior to the use of such standards.

(D) If a nonstate public employer included less than all of its employees in its application for coverage because of (i) the decision by individual employees to decline coverage from their employer for themselves or their dependents, or (ii) the employer's decision not to offer coverage to temporary, part-time or durational employees, the Comptroller shall not forward such employer's application to a health care actuary.

(h) Nonstate employers eligible to seek coverage for their employees under the state employee plan, pursuant to this section and section 6 of this act, may seek such coverage for their retirees in accordance with this section. Premium payments for such coverage shall be remitted by the nonstate employer to the Comptroller in accordance with the provisions of this section.

(i) (1) If a nonstate public employer seeks coverage for all of such employer's retirees in accordance with this section and all of such employer's employees as provided for in subsection (g) of this section, the Comptroller shall accept such application for the next open enrollment. The Comptroller shall provide written notification to such nonstate public employer of such acceptance and the date on which such coverage shall begin.

(2) If a nonstate public employer seeks coverage for less than all of such employer's retirees, regardless of whether the employer is seeking coverage for all of such employer's active employees, the Comptroller shall forward such application to a health care actuary not later than five business days after receiving such application. Such actuary may, not later than sixty days after receiving such application, certify to the Comptroller that, with respect to such retirees, the application will shift a significantly disproportional part of an employer's retirees' medical risks to the state employee plan and shall provide in writing the specific reasons for its finding, including a summary of all information relied upon in making such a finding. If the Comptroller receives such certification, the Comptroller shall not provide coverage to such employer for such employer's retirees and the Comptroller, with respect to an application for state employee plan benefits, shall provide written notification and the specific reasons for such denial to such employer and the Health Care Cost Containment Committee, as defined in section 2 of this act, in the case of a rejected application for coverage under the state employee plan. If the Comptroller does not receive such certification, the Comptroller shall accept such application for the next open enrollment. The Comptroller or authority, as the case may be, shall provide written notification to such nonstate public employer of such acceptance and the date on which such coverage shall begin.

(3) The Comptroller shall consult with a health care actuary who shall develop actuarial standards to be used to assess the shift in medical risks of a nonstate public employer's retirees to the state employee plan. The Comptroller shall present such standards to the Health Care Cost Containment Committee for its review and evaluation prior to the use of such standards.

(4) If a nonstate public employer included less than all of its retirees in its application for coverage because of (A) the decision by individual retirees to decline health benefits or health insurance coverage from their employer for themselves or their dependents, or (B) the retiree's enrollment in Medicare, the Comptroller shall not forward such employer's application to a health care actuary.

(5) Nothing in this subsection shall diminish any right to retiree health insurance pursuant to a collective bargaining agreement or any other provision of the general statutes.

(j) All premiums paid by employers, employees and retirees pursuant to this section shall be deposited into the SustiNet account established pursuant to section 12 of this act.

(k) Premium payments for the state employee plan shall be remitted by the employer to the Comptroller and shall be the same as those paid by the state, inclusive of any premiums paid by state employees and retired state employees, if applicable, except as otherwise provided in this section. The Comptroller may charge each nonstate public employer participating in the state plan an administrative fee calculated on a per member, per month basis. In addition, the Comptroller may charge a fluctuating reserves fee in an amount which the Comptroller deems necessary to ensure adequate claims reserves.

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

(m) If any payment due by a nonstate public employer under this section is not submitted to the appropriate entity by the tenth day after the date such payment is due, interest to be paid by such employer shall be added, retroactive to the date such payment was due, at the prevailing rate of interest as determined by the appropriate entity.

(1) If a nonstate public employer fails to make premium payments as required by this section, 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, 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.

(2) If no grant, allocation or appropriation is payable to such nonstate public employer or is not withheld, pursuant to subdivision (1) of this subsection, the Comptroller may terminate participation in the state employee plan by a nonstate public employer on the basis of nonpayment of premium, provided not less than ten days' advance notice is given to such employer. The nonstate public employer may continue the coverage and avoid the effect of the termination by remitting payment in full at any time prior to the effective date of termination.

(3) The Comptroller may request the Attorney General to bring an action in the superior court for the judicial district of Hartford to recover any premium and interest costs or equitable relief from a terminated nonstate public employer.

(n) The Comptroller may adopt regulations, in accordance with chapter 54 of the general statutes, to establish the procedures and criteria for any reviews or evaluations performed by the Health Care Cost Containment Committee pursuant to this section.

(o) The SustiNet Plan Authority may adopt procedures necessary to carry out the provisions of this section in accordance with section 1-121 of the general statutes.

(p) The state employee plan shall not be deemed an unauthorized insurer, as defined in section 38a-1 of the general statutes, or a multiple employer welfare arrangement, as defined in Section 3 of the Employee Retirement Income Security Act of 1974, as amended from time to time.

Sec. 14. (NEW) (Effective from passage) There is established a Nonstate Public Health Care Advisory Committee. The committee shall make advisory recommendations to the Health Care Cost Containment Committee, as defined in section 2 of this act, concerning health care coverage for nonstate public employees. The advisory committee shall consist of nonstate public employers and employees participating in the state plan and shall include the following members appointed by the Comptroller: (1) Three municipal employer representatives, one of whom represents towns with populations of one hundred thousand or more, one of whom represents towns with populations of at least twenty thousand but under one hundred thousand, and one of whom represents towns with populations under twenty thousand; (2) three municipal employee representatives, one of whom represents employees in towns with populations of one hundred thousand or more, one of whom represents employees in towns with populations of at least twenty thousand but under one hundred thousand, and one of whom represents employees in towns with populations under twenty thousand; (3) three board of education employers, one of whom represents towns with populations of one hundred thousand or more, one of whom represents towns with populations of at least twenty thousand but under one hundred thousand, and one of whom represents towns with populations under twenty thousand; and (4) three board of education employee representatives, one of whom represents towns with populations of one hundred thousand or more, one of whom represents towns with populations of at least twenty thousand but under one hundred thousand, and one of whom represents towns with populations under twenty thousand.

Sec. 15. (NEW) (Effective from passage) (a) With respect to nonstate public employers, municipal-related employers, nonprofit employers and other employers, which are provided coverage in accordance with section 6 of this act under SustiNet G:

(1) On and after January 1, 2012, the SustiNet Plan Authority shall offer participation in SustiNet G for not less than two-year intervals to the extent feasible and unless superseded by policies and procedures concerning the implementation of the Affordable Care Act on or after January 1, 2014. An employer may apply for renewal prior to the expiration of each interval.

(2) The authority shall develop procedures by which:

(A) Such employers may apply to participate in the plan, including procedures for employers that are currently self-insured and procedures for employers that are currently fully-insured; and

(B) Employers receiving coverage for their employees pursuant to SustiNet G may (i) apply for renewal, or (ii) withdraw from such coverage, including, but not limited to, the terms and conditions under which such employers may withdraw prior to the expiration of the interval and the procedure by which any premium payments such employers may be entitled to shall be refunded. Any such procedures shall provide that nonstate public employees covered by collective bargaining shall withdraw from such coverage in accordance with chapters 113 and 166 of the general statutes.

(b) (1) The initial open enrollment for nonstate public employers participating in SustiNet G shall be for coverage beginning January 1, 2012. Thereafter, open enrollment for nonstate public employers shall be for coverage periods beginning July first provided that on and after January 1, 2014, the authority may establish a different enrollment period to conform with implementation of the Affordable Care Act.

(2) The initial open enrollment for municipal-related employers, small employers and nonprofit employers participating in SustiNet G shall be for coverage periods beginning January first and July first beginning no sooner than January 1, 2012, if the authority has determined that offering such coverage is feasible.

(c) Nothing in this section or section 6 of this act shall require the authority to offer coverage to every employer seeking coverage under this section or section 6 of this act from every plan offered under SustiNet G.

(d) The authority shall create applications for coverage for the members it serves. An application for participation in the SustiNet G shall require an employer to disclose whether the employer will offer any other health plan to the employees who are offered the state plan.

(e) No employee shall be enrolled in SustiNet G if such employee is covered through such employee's employer by 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) If the authority determines that granting coverage to an employer under SustiNet G will affect such plan's status as a governmental plan under the Employee Retirement Income Security Act of 1974, as amended from time to time, the Comptroller shall not grant coverage to such employer and shall stop accepting applications for coverage from employers. The authority shall resume accepting applications for coverage under SustiNet G from such employers if the authority determines that granting coverage to such employers will not affect such plan's status as a governmental plan under the Employee Retirement Income Security Act of 1974, as amended from time to time. The authority shall make a public announcement of its decision to stop or resume accepting applications for coverage under SustiNet G.

(g) All premiums paid by employers, employees and retirees pursuant to this section shall be deposited into the SustiNet account established pursuant to section 12 of this act.

(h) Premium payments for SustiNet G shall be remitted by the employer to the authority and shall be the amount set by the authority. The authority may charge each employer participating in SustiNet G an administrative fee calculated on a per member, per month basis. In addition, the authority may charge a fluctuating reserves fee in an amount which the authority deems necessary to ensure adequate claims reserves.

(i) The authority may adjust premium rates for small employers to reflect one or more of the characteristics set forth in subparagraph (A) of subdivision (5) of section 38a-567 of the general statutes.

(j) Each employer shall pay monthly the amount determined by the authority pursuant to this section for coverage of its employees or its employees and retirees, as appropriate. An employer may require each covered employee to contribute a portion of the cost of such employee's coverage under the plan, subject to any collective bargaining obligation applicable to such employer.

(k) If any payment due by an employer under this section is not submitted to the authority by the tenth day after the date such payment is due, or such other date as chosen by the authority, interest to be paid by such employer shall be added, retroactive to the date such payment was due, at the prevailing rate of interest as determined by the appropriate entity.

(1) The authority may terminate participation in SustiNet G by the employer on the basis of nonpayment of premium, provided not less than ten days' advance notice is given to such employer. The employer may continue the coverage and avoid the effect of the termination by remitting payment in full at any time prior to the effective date of termination.

(2) (A) If a nonstate public employer fails to make premium payments as required by this section, the authority 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, to withhold the payment of such moneys until the amount of the premium or interest due has been paid to the authority, 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.

(B) If no grant, allocation or appropriation is payable to such nonstate public employer or is not withheld, pursuant to subparagraph (A) of this subdivision, the authority may terminate participation in SustiNet G by a nonstate public employer on the basis of nonpayment of premium, provided not less than ten days' advance notice is given to such nonstate public employer. The nonstate public employer may continue the coverage and avoid the effect of the termination by remitting payment in full consistent with policies and procedures adopted by the authority.

(l) The authority may request the Attorney General to bring an action in the superior court for the judicial district of Hartford to recover any premium and interest costs or equitable relief from a terminated employer.

(m) SustiNet G shall not be deemed an unauthorized insurer, as defined in section 38a-1 of the general statutes, or a multiple employer welfare arrangement, as defined in Section 3 of the Employee Retirement Income Security Act of 1974, as amended from time to time.

(n) On and after January 1, 2014, any provision of this section that is in conflict with the Affordable Care Act, as implemented by the health insurance exchange serving the state, shall not apply to the sale of SustiNet Plan coverage to employers through such exchange.

Sec. 16. (NEW) (Effective from passage) (a) The SustiNet Plan Authority shall establish benefits for all SustiNet plans offered on and off the exchange, which shall be approved by the board of directors, provided no change to the benefits for state employees shall be effective until the State Employees' Bargaining Agent Coalition has provided its written consent to incorporate such change into its agreement with the state. There shall be no change to the benefits of Medicaid, HUSKY Plan, Part A and Part B, HUSKY Plus or Charter Oak Health Plan enrollees unless such change is in conformance with the provisions of the general statutes and federal law.

(b) To the extent that health plans sold on a state established health insurance exchange require coverage of the benefits provided for in chapter 700c of the general statutes, the SustiNet Plan shall also include coverage of the benefits provided for in chapter 700c of the general statutes.

(c) SustiNet plans that are to be sold on the exchange shall be designed to at least meet any benefit requirements to sell insurance on any exchange developed in accordance with the Affordable Care Act. SustiNet Plan benefits shall include, but not be limited to, mental health benefits that are equal to physical health benefits, vision care and dental care coverage that shall be comparable in scope to the median coverage provided by large employers in the Northeast states, provided, in defining large employers, the authority shall give consideration to the capacity of available data to yield, without substantial expense, reliable estimates of median dental coverage offered by such employers. The authority shall take steps necessary to promote the cessation of smoking.

(d) The authority shall review and update benefits not less than every two years and shall base benefit changes on medical evidence and scientific literature.

Sec. 17. (NEW) (Effective from passage) (a) The SustiNet Plan Authority shall establish cost-sharing requirements, which may include deductibles, copayments and coinsurance for SustiNet Plans E and G. Any cost-sharing requirements established by the authority shall first be approved by the SustiNet board of directors. No change to the cost-sharing requirements for state employees shall be effective until the State Employees' Bargaining Agent Coalition has provided its written consent to incorporate such change into its agreement with the state. Notwithstanding the provisions of this subsection, Medicaid, HUSKY Plan, Part A and Part B, HUSKY Plus and Charter Oak Health Plan cost-sharing provisions shall be established by the authority but instead shall be established pursuant to the general statutes. Cost-sharing requirements may vary depending on the type of provider. Under the SustiNet Plan, there shall be no copayments for preventive care, well-baby and well-child visits, prenatal care, annual physical exams, immunizations or health screenings.

(b) Cost-sharing requirements established by the authority pursuant to subsection (a) of this section shall be in conformance with the cost-sharing requirements established by the Affordable Care Act.

(c) SustiNet Plan providers shall be subject to the provisions of section 20-7f of the general statutes and shall be prohibited from balance billing SustiNet Plan members.

Sec. 18. Subdivision (1) of subsection (c) of section 19a-750 of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

(c) (1) The Health Information Technology Exchange of Connecticut shall be managed by a board of directors. The board shall consist of the following members: The Lieutenant Governor, or his or her designee; the Commissioners of Public Health, Social Services and Consumer Protection, or their designees; the Chief Information Officer of the Department of Information Technology, or his or her designee; the executive director of the SustiNet Plan Authority, or his or her designee; three appointed by the Governor, one of whom shall be a representative of a medical research organization, one of whom shall be an insurer or representative of a health plan and one of whom shall be an attorney with background and experience in the field of privacy, health data security or patient rights; three appointed by the president pro tempore of the Senate, one of whom shall have background and experience with a private sector health information exchange or health information technology entity, one of whom shall have expertise in public health and one of whom shall be a physician licensed under chapter 370 who works in a practice of not more than ten physicians and who is not employed by a hospital, health network, health plan, health system, academic institution or university; three appointed by the speaker of the House of Representatives, one of whom shall be a representative of hospitals, an integrated delivery network or a hospital association, one of whom shall have expertise with federally qualified health centers and one of whom shall be a consumer or consumer advocate; one appointed by the majority leader of the Senate, who shall be a primary care physician whose practice utilizes electronic health records; one appointed by the majority leader of the House of Representatives, who shall be a consumer or consumer advocate; one appointed by the minority leader of the Senate, who shall be a pharmacist or a health care provider utilizing electronic health information exchange; and one appointed by the minority leader of the House of Representatives, who shall be a large employer or a representative of a business group. The Secretary of the Office of Policy and Management and the Healthcare Advocate, or their designees, shall be ex-officio, nonvoting members of the board. The Commissioner of Public Health, or his or her designee, shall serve as the chairperson of the board.

Sec. 19. (NEW) (Effective from passage) The board of directors of the SustiNet Plan Authority shall submit to the joint standing committee of the General Assembly having cognizance of matters relating to appropriations, public health, human services and insurance and real estate a copy of each audit of the authority conducted by an independent auditing firm, not later than seven days after the audit is received by said board of directors.

Sec. 20. (NEW) (Effective from passage) The Comptroller is authorized to serve as a convener authority for health care institutions, facilities and providers in the state. The Comptroller shall comply with all applicable federal law and regulations in the exercise of such authority. The Comptroller shall implement policies and procedures necessary to administer the provisions of this section while in the process of adopting such policies and procedures as regulations, provided the Comptroller prints notice of the intent to adopt the regulations in the Connecticut Law Journal not later than twenty days after the date of implementation of such policies and procedures. Policies and procedures implemented pursuant to this section shall be valid until the time final regulations are adopted.

Sec. 21. Subsection (l) of section 1-79 of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

(l) "Quasi-public agency" means the Connecticut Development Authority, Connecticut Innovations, Incorporated, Connecticut Health and Education Facilities Authority, Connecticut Higher Education Supplemental Loan Authority, Connecticut Housing Finance Authority, Connecticut Housing Authority, Connecticut Resources Recovery Authority, Lower Fairfield County Convention Center Authority, Capital City Economic Development Authority, Connecticut Lottery Corporation, [and] Health Information Technology Exchange of Connecticut and SustiNet Plan Authority.

Sec. 22. Section 1-120 of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

As used in sections 1-120 to 1-123, inclusive:

(1) "Quasi-public agency" means the Connecticut Development Authority, Connecticut Innovations, Incorporated, Connecticut Health and Educational Facilities Authority, Connecticut Higher Education Supplemental Loan Authority, Connecticut Housing Finance Authority, Connecticut Housing Authority, Connecticut Resources Recovery Authority, Capital City Economic Development Authority, Connecticut Lottery Corporation, [and] Health Information Technology Exchange of Connecticut and SustiNet Plan Authority.

(2) "Procedure" means each statement, by a quasi-public agency, of general applicability, without regard to its designation, that implements, interprets or prescribes law or policy, or describes the organization or procedure of any such agency. The term includes the amendment or repeal of a prior regulation, but does not include, unless otherwise provided by any provision of the general statutes, (A) statements concerning only the internal management of any agency and not affecting procedures available to the public and (B) intra-agency memoranda.

(3) "Proposed procedure" means a proposal by a quasi-public agency under the provisions of section 1-121 for a new procedure or for a change in, addition to or repeal of an existing procedure.

Sec. 23. Section 1-124 of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

(a) The Connecticut Development Authority, the Connecticut Health and Educational Facilities Authority, the Connecticut Higher Education Supplemental Loan Authority, the Connecticut Housing Finance Authority, the Connecticut Housing Authority, the Connecticut Resources Recovery Authority, the Health Information Technology Exchange of Connecticut, [and] the Capital City Economic Development Authority and the SustiNet Plan Authority shall not borrow any money or issue any bonds or notes which are guaranteed by the state of Connecticut or for which there is a capital reserve fund of any kind which is in any way contributed to or guaranteed by the state of Connecticut until and unless such borrowing or issuance is approved by the State Treasurer or the Deputy State Treasurer appointed pursuant to section 3-12. The approval of the State Treasurer or said deputy shall be based on documentation provided by the authority that it has sufficient revenues to (1) pay the principal of and interest on the bonds and notes issued, (2) establish, increase and maintain any reserves deemed by the authority to be advisable to secure the payment of the principal of and interest on such bonds and notes, (3) pay the cost of maintaining, servicing and properly insuring the purpose for which the proceeds of the bonds and notes have been issued, if applicable, and (4) pay such other costs as may be required.

(b) To the extent the Connecticut Development Authority, Connecticut Innovations, Incorporated, Connecticut Higher Education Supplemental Loan Authority, Connecticut Housing Finance Authority, Connecticut Housing Authority, Connecticut Resources Recovery Authority, Connecticut Health and Educational Facilities Authority, [the] Health Information Technology Exchange of Connecticut, [or the] Capital City Economic Development Authority or SustiNet Plan Authority is permitted by statute and determines to exercise any power to moderate interest rate fluctuations or enter into any investment or program of investment or contract respecting interest rates, currency, cash flow or other similar agreement, including, but not limited to, interest rate or currency swap agreements, the effect of which is to subject a capital reserve fund which is in any way contributed to or guaranteed by the state of Connecticut, to potential liability, such determination shall not be effective until and unless the State Treasurer or his or her deputy appointed pursuant to section 3-12 has approved such agreement or agreements. The approval of the State Treasurer or his or her deputy shall be based on documentation provided by the authority that it has sufficient revenues to meet the financial obligations associated with the agreement or agreements.

Sec. 24. Section 1-125 of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

The directors, officers and employees of the Connecticut Development Authority, Connecticut Innovations, Incorporated, Connecticut Higher Education Supplemental Loan Authority, Connecticut Housing Finance Authority, Connecticut Housing Authority, Connecticut Resources Recovery Authority, including ad hoc members of the Connecticut Resources Recovery Authority, Connecticut Health and Educational Facilities Authority, Capital City Economic Development Authority, [the] Health Information Technology Exchange of Connecticut, SustiNet Plan Authority and Connecticut Lottery Corporation and any person executing the bonds or notes of the agency shall not be liable personally on such bonds or notes or be subject to any personal liability or accountability by reason of the issuance thereof, nor shall any director or employee of the agency, including ad hoc members of the Connecticut Resources Recovery Authority, be personally liable for damage or injury, not wanton, reckless, wilful or malicious, caused in the performance of his or her duties and within the scope of his or her employment or appointment as such director, officer or employee, including ad hoc members of the Connecticut Resources Recovery Authority. The agency shall protect, save harmless and indemnify its directors, officers or employees, including ad hoc members of the Connecticut Resources Recovery Authority, from financial loss and expense, including legal fees and costs, if any, arising out of any claim, demand, suit or judgment by reason of alleged negligence or alleged deprivation of any person's civil rights or any other act or omission resulting in damage or injury, if the director, officer or employee, including ad hoc members of the Connecticut Resources Recovery Authority, is found to have been acting in the discharge of his or her duties or within the scope of his or her employment and such act or omission is found not to have been wanton, reckless, wilful or malicious.

Sec. 25. Sections 19a-710 to 19a-723, inclusive, of the general statutes are repealed. (Effective from passage)


This act shall take effect as follows and shall amend the following sections:
Section 1	from passage	New section
Sec. 2	from passage	New section
Sec. 3	from passage	New section
Sec. 4	from passage	New section
Sec. 5	from passage	New section
Sec. 6	from passage	New section
Sec. 7	from passage	17b-261(a)
Sec. 8	from passage	New section
Sec. 9	from passage	17b-90(b)
Sec. 10	from passage	New section
Sec. 11	from passage	New section
Sec. 12	from passage	New section
Sec. 13	from passage	New section
Sec. 14	from passage	New section
Sec. 15	from passage	New section
Sec. 16	from passage	New section
Sec. 17	from passage	New section
Sec. 18	from passage	19a-750(c)(1)
Sec. 19	from passage	New section
Sec. 20	from passage	New section
Sec. 21	from passage	1-79(l)
Sec. 22	from passage	1-120
Sec. 23	from passage	1-124
Sec. 24	from passage	1-125
Sec. 25	from passage	Repealer section

PH	Joint Favorable Subst. C/R	INS
*INS*	Joint Favorable C/R	HS

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Bill Text: CT HB06305 | 2011 | General Assembly | Comm Sub

Connecticut House Bill 6305 (Prior Session Legislation)

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