Bill Text: CT SB00479 | 2014 | General Assembly | Introduced
Bill Title: An Act Concerning The Enforcement Of Payments Of Assessments And User Fees To The Connecticut Health Insurance Exchange.
Spectrum: Committee Bill
Status: (Introduced - Dead) 2014-04-23 - Favorable Report, Tabled for the Calendar, Senate [SB00479 Detail]
Download: Connecticut-2014-SB00479-Introduced.html
General Assembly |
Raised Bill No. 479 | ||
February Session, 2014 |
LCO No. 2573 | ||
*02573_______INS* | |||
Referred to Committee on INSURANCE AND REAL ESTATE |
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Introduced by: |
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(INS) |
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AN ACT CONCERNING THE AUTHORITY AND DUTIES OF THE CONNECTICUT HEALTH INSURANCE EXCHANGE AND ESTABLISHING CERTAIN STANDARDS FOR CERTAIN STOP LOSS INSURANCE POLICIES.
Be it enacted by the Senate and House of Representatives in General Assembly convened:
Section 1. Subsection (b) of section 38a-1091 of the 2014 supplement to the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2014):
(b) (1) There is established an all-payer claims database program. The exchange shall: (A) Oversee the planning, implementation and administration of the all-payer claims database program for the purpose of collecting, assessing and reporting health care information relating to safety, quality, cost-effectiveness, access and efficiency for all levels of health care; (B) ensure that data received from reporting entities is securely collected, compiled and stored in accordance with state and federal law; and (C) conduct audits of data submitted by reporting entities in order to verify its accuracy.
(2) The exchange shall seek funding from the federal government, other public sources and other private sources to cover costs associated with the planning, implementation and administration of the all-payer claims database program.
(3) (A) Upon the adoption of reporting requirements as set forth in section 38a-1082, a reporting entity shall report health care information for inclusion in the all-payer claims database in a form and manner prescribed by the exchange. The exchange may, after notice and hearing, impose a civil penalty on any reporting entity that fails to report health care information as prescribed. Such civil penalty shall not exceed one thousand dollars per day for each day of violation and shall not be imposed as a cost for the purpose of rate determination or reimbursement by a third-party payer.
(B) The chief executive officer may provide the name of any reporting entity on which such penalty has been imposed to the commissioner. After consultation with said officer, the commissioner may request the Attorney General to bring an action in the superior court for the judicial district of Hartford to recover any penalty imposed pursuant to subparagraph (A) of this subdivision.
(4) The exchange: [shall: (A) Utilize] (A) Shall utilize data in the all-payer claims database to provide health care consumers in the state with information concerning the cost and quality of health care services that allows such consumers to make economically sound and medically appropriate health care decisions; and (B) may make data in the all-payer claims database available in such form as the chief executive officer of the exchange deems appropriate to [any state agency, insurer, employer, health care provider, consumer of health care services or researcher for the purpose of allowing such person or entity to review such data as it relates to] health care consumers and to any public and private entity engaged in the review of health care utilization, health care costs or quality of health care services, including community and public health assessments. Such disclosure shall be made in accordance with subdivision (2) of subsection (b) of section 38a-1090. The exchange may set a fee to be charged to each person or entity [requesting] for access to data stored in the all-payer claims database.
(5) The exchange may (A) in consultation with the All-Payer Claims Database Advisory Group set forth in subsection (c) of this section, enter into a contract with a person or entity to plan, implement or administer the all-payer claims database program, (B) enter into a contract or take any action that is necessary to obtain fee-for-service health claims data under the state medical assistance program or Medicare Part A or Part B, and (C) enter into a contract for the collection, management or analysis of data received from reporting entities. Any such contract for the collection, management or analysis of such data shall expressly prohibit the disclosure of such data for purposes other than the purposes described in this subdivision.
Sec. 2. (NEW) (Effective October 1, 2014) (a) Unless expressly specified, nothing in this section or sections 38a-1080 to 38a-1091, inclusive, of the general statutes, as amended by this act, and no action taken by the exchange pursuant to said sections shall be construed to preempt, supersede or affect the authority of the commissioner to regulate the business of insurance in the state.
(b) All health carriers in the state shall comply with all applicable health insurance laws of the state and regulations adopted and orders issued by the commissioner, and all applicable provisions of sections 38a-1083 and 38a-1091 of the general statutes, as amended by this act, and procedures adopted by the board pursuant to section 38a-1082 of the general statutes.
Sec. 3. Section 38a-1090 of the 2014 supplement to the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2014):
(a) The exchange 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 exchange, all its rights and properties shall pass to and be vested in the state of Connecticut.
(b) The exchange shall be subject to the Freedom of Information Act, as defined in section 1-200, except that:
(1) The following information under sections 38a-1081 to 38a-1089, inclusive, as amended by this act, shall not be subject to disclosure under section 1-210: (A) The names and applications of individuals and employers seeking coverage through the exchange; (B) individuals' health information; and (C) information exchanged between the exchange and the (i) Departments of Social Services, Public Health and Revenue Services, (ii) Insurance Department, (iii) office of the Comptroller, or (iv) any other state agency that is subject to confidentiality agreements under contracts entered into with the exchange; and
(2) (A) Any disclosures made pursuant to subdivision (4) of subsection (b) of section 38a-1091, as amended by this act, of health information, as defined in 45 CFR 160.103, as amended from time to time, provided such health information is permitted to be disclosed under the Health Insurance Portability and Accountability Act of 1996, P.L. 104-191, as amended from time to time, or regulations adopted thereunder, shall have identifiers removed, as set forth in 45 CFR 164.514, as amended from time to time; and
(B) Any disclosures made pursuant to subdivision (4) of subsection (b) of section 38a-1091, as amended by this act, of information other than health information shall be made in a manner to protect the confidentiality of such other information as required by state and federal law.
[(c) Unless expressly specified, nothing in this section or sections 38a-1080 to 38a-1089, inclusive, and no action taken by the exchange pursuant to said sections shall be construed to preempt, supersede or affect the authority of the commissioner to regulate the business of insurance in the state. All health carriers offering qualified health plans in the state shall comply with all applicable health insurance laws of the state and regulations adopted and orders issued by the commissioner.]
Sec. 4. Section 38a-1083 of the 2014 supplement to the general statutes is amended by adding subsection (d) as follows (Effective October 1, 2014):
(NEW) (d) (1) The chief executive officer of the exchange may provide to the commissioner the name of any health carrier that fails to pay any assessment or user fee to the exchange under subdivision (7) of subsection (c) of this section. The commissioner may, after notice and hearing, suspend, revoke or refuse to renew a health carrier's license if the commissioner finds the health carrier failed to pay such assessment or user fee.
(2) Any health carrier aggrieved by the action of the commissioner in suspending, revoking or refusing to renew a license may appeal therefrom, in accordance with the provisions of section 4-183 of the general statutes, except venue for such appeal shall be in the judicial district of New Britain.
Sec. 5. (NEW) (Effective October 1, 2014) (a) (1) On and after January 1, 2015, no insurance company shall deliver, issue for delivery or renew a stop loss insurance policy in this state for health care or medical benefits that: (A) Has an annual attachment point for claims incurred per individual covered that is less than forty-five thousand dollars; (B) for qualified employers that are small employers, as defined in Section 1304 of the Patient Protection and Affordable Care Act, P.L. 111-148, as amended from time to time, has an annual aggregate attachment point that is less than forty-five thousand dollars or five thousand dollars multiplied by the number of enrolled employees, whichever is greater; (C) for qualified employers that are large employers, as defined in Section 1304 of the Patient Protection and Affordable Care Act, P.L. 111-148, as amended from time to time, has an annual aggregate attachment point that is less than one hundred twenty per cent of expected claims; or (D) provides direct coverage for the health care or medical expenses of an enrollee.
(2) As used in this section, (A) "attachment point" means the claims amount incurred by the insured, above which the insurance company that issued the stop loss insurance policy will incur liability for payment, and (B) "expected claims" means the claims amount that, in the absence of a stop loss insurance policy or other insurance coverage, is projected to be incurred by the insured under its health insurance policy or medical benefits plan.
(b) If an insurance company delivers, issues for delivery or renews an employer's stop loss insurance policy in this state for health care or medical benefits that is not prohibited under subsection (a) of this section, such insurance company shall determine at least annually the number of such employer's employees.
(c) Not later than March fifteenth annually, each insurance company that delivers, issues for delivery or renews an employer's stop loss insurance policy in this state for health care or medical benefits that is not prohibited under subsection (a) of this section shall submit to the Insurance Commissioner a written certification by an actuary who is a member in good standing of the American Academy of Actuaries. Such certification shall include, but is not limited to, (1) a summary of the records of and actuarial assumptions and methods used by such company and reviewed by such actuary to establish attachment points and other applicable determinations related to the stop loss insurance policy, (2) a statement that the premiums charged by such company for each such stop loss insurance policy are reasonable in connection with the risks borne by such company, and (3) a statement that such company is in compliance with the provisions of this section. Each such company shall retain a copy of such certification at its principal place of business.
(d) The Insurance Commissioner may adopt regulations in accordance with the provisions of chapter 54 to implement the provisions of this section.
Sec. 6. Section 38a-1080 of the 2014 supplement to the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2014):
For purposes of sections 38a-1080 to [38a-1091] 38a-1092, inclusive, as amended by this act, and section 2 of this act:
(1) "Board" means the board of directors of the Connecticut Health Insurance Exchange;
(2) "Commissioner" means the Insurance Commissioner;
(3) "Exchange" means the Connecticut Health Insurance Exchange established pursuant to section 38a-1081;
(4) "Affordable Care Act" means the Patient Protection and Affordable Care Act, P.L. 111-148, as amended by the Health Care and Education Reconciliation Act, P.L. 111-152, as both may be amended from time to time, and regulations adopted thereunder;
(5) (A) "Health benefit plan" means an insurance policy or contract offered, delivered, issued for delivery, renewed, amended or continued in the state by a health carrier to provide, deliver, pay for or reimburse any of the costs of health care services.
(B) "Health benefit plan" does not include:
(i) Coverage of the type specified in subdivisions (5), (6), (7), (8), (9), (14), (15) and (16) of section 38a-469 or any combination thereof;
(ii) Coverage issued as a supplement to liability insurance;
(iii) Liability insurance, including general liability insurance and automobile liability insurance;
(iv) Workers' compensation insurance;
(v) Automobile medical payment insurance;
(vi) Credit insurance;
(vii) Coverage for on-site medical clinics; or
(viii) Other similar insurance coverage specified in regulations issued pursuant to the Health Insurance Portability and Accountability Act of 1996, P.L. 104-191, as amended from time to time, under which benefits for health care services are secondary or incidental to other insurance benefits.
(C) "Health benefit plan" does not include the following benefits if they are provided under a separate insurance policy, certificate or contract or are otherwise not an integral part of the plan:
(i) Limited scope dental or vision benefits;
(ii) Benefits for long-term care, nursing home care, home health care, community-based care or any combination thereof; or
(iii) Other similar, limited benefits specified in regulations issued pursuant to the Health Insurance Portability and Accountability Act of 1996, P.L. 104-191, as amended from time to time;
(iv) Other supplemental coverage, similar to coverage of the type specified in subdivisions (9) and (14) of section 38a-469, provided under a group health plan.
(D) "Health benefit plan" does not include coverage of the type specified in subdivisions (3) and (13) of section 38a-469 or other fixed indemnity insurance if (i) such coverage is provided under a separate insurance policy, certificate or contract, (ii) there is no coordination between the provision of the benefits and any exclusion of benefits under any group health plan maintained by the same plan sponsor, and (iii) the benefits are paid with respect to an event without regard to whether benefits were also provided under any group health plan maintained by the same plan sponsor;
(6) "Health care services" has the same meaning as provided in section 38a-478;
(7) "Health carrier" means an insurance company, fraternal benefit society, hospital service corporation, medical service corporation health care center or other entity subject to the insurance laws and regulations of the state or the jurisdiction of the commissioner that contracts or offers to contract to provide, deliver, pay for or reimburse any of the costs of health care services;
(8) "Internal Revenue Code" means the Internal Revenue Code of 1986, or any subsequent corresponding internal revenue code of the United States, as amended from time to time;
(9) "Person" has the same meaning as provided in section 38a-1;
(10) "Qualified dental plan" means a limited scope dental plan that has been certified in accordance with subsection (e) of section 38a-1086;
(11) "Qualified employer" has the same meaning as provided in Section 1312 of the Affordable Care Act;
(12) "Qualified health plan" means a health benefit plan that has in effect a certification that the plan meets the criteria for certification described in Section 1311(c) of the Affordable Care Act and section 38a-1086;
(13) "Qualified individual" has the same meaning as provided in Section 1312 of the Affordable Care Act;
(14) "Secretary" means the Secretary of the United States Department of Health and Human Services;
(15) "Small employer" has the same meaning as provided in section 38a-564.
Sec. 7. Section 38a-1092 of the 2014 supplement to the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2014):
(a) Not later than March 31, 2014, and quarterly thereafter, the [Connecticut Health Insurance Exchange board of directors, established pursuant to section 38a-1081,] board shall report to the joint standing committees of the General Assembly having cognizance of matters relating to public health, human services and insurance concerning health care services provided through the exchange. Such reports shall include: (1) The number of persons in households with incomes from one hundred thirty-three per cent up to one hundred fifty per cent of the federal poverty level who were enrolled in a qualified health plan at any time on or after January 1, 2014; (2) the number of persons in households with incomes from one hundred fifty per cent up to and including two hundred per cent of the federal poverty level who were enrolled in a qualified health plan at any time on and after January 1, 2014; (3) the number of persons in households with incomes from one hundred thirty-three per cent up to and including two hundred per cent of the federal poverty level who have been continuously enrolled in a qualified health plan during the current calendar year; (4) the number of persons in households with incomes from one hundred thirty-three per cent up to and including two hundred per cent of the federal poverty level who were enrolled in a qualified health plan and who subsequently became eligible to receive benefits under the Medicaid program or whose household income increased to more than two hundred per cent of the federal poverty level; (5) the number of persons in households with incomes from one hundred thirty-three per cent up to and including two hundred per cent of the federal poverty level who experienced a gap in health care coverage; (6) the cost to the state of providing health care services to persons identified in subdivision (5) of this subsection and the cost to such persons to access health care coverage through the exchange; (7) the cost of the second-lowest-priced silver premium plan in the exchange; and (8) any other information that said board believes would be necessary to allow said committees to evaluate the cost and benefits of a basic health plan.
(b) The [Connecticut Health Insurance Exchange board of directors] board shall include in the first quarterly report submitted each year to said committees in accordance with subsection (a) of this section, the number of persons in households with incomes from one hundred thirty-three up to and including two hundred per cent of the federal poverty level who were enrolled in a qualified health plan at the end of the previous calendar year.
Sec. 8. Subdivisions (3) and (4) of subsection (c) of section 38a-1081 of the 2014 supplement to the general statutes are repealed and the following is substituted in lieu thereof (Effective October 1, 2014):
(3) Appointed board members may not designate a representative to perform in their absence their respective duties under sections 38a-1080 to [38a-1091] 38a-1092, inclusive, as amended by this act. The Governor shall select a chairperson from among the board members and the board members shall annually elect a vice-chairperson. 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. Any board member who fails to attend more than fifty per cent of all meetings held during any calendar year shall be deemed to have resigned from the board.
(4) Six board members shall constitute a quorum for the transaction of any business or the exercise of any power of the exchange. For the transaction of any business or the exercise of any power of the exchange, the exchange may act by a majority of the board members 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 board members to exercise all the rights and perform all the duties of the board. Except as otherwise provided, any action taken by the board under the provisions of sections 38a-1080 to [38a-1091] 38a-1092, inclusive, as amended by this act, may be authorized by resolution approved by a majority of the board members present at any regular or special meeting, which resolution shall take effect immediately unless otherwise provided in the resolution.
This act shall take effect as follows and shall amend the following sections: | ||
Section 1 |
October 1, 2014 |
38a-1091(b) |
Sec. 2 |
October 1, 2014 |
New section |
Sec. 3 |
October 1, 2014 |
38a-1090 |
Sec. 4 |
October 1, 2014 |
38a-1083 |
Sec. 5 |
October 1, 2014 |
New section |
Sec. 6 |
October 1, 2014 |
38a-1080 |
Sec. 7 |
October 1, 2014 |
38a-1092 |
Sec. 8 |
October 1, 2014 |
38a-1081(c)(3) and (4) |
Statement of Purpose:
To (1) allow the Connecticut Health Insurance Exchange to make data in the all-payer claims database available to certain public or private entities, (2) specify that health carriers shall comply with applicable provisions of sections 38a-1083 and 38a-1091 and procedures adopted by the exchange board, (3) authorize the Insurance Commissioner to suspend, revoke or refuse to renew the license of a health carrier that fails to pay an assessment or user fee to the exchange, and (4) establish certain standards for stop loss insurance policies in this state for health care or medical benefits.
[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not underlined.]