Bill Text: CT SB00815 | 2015 | General Assembly | Comm Sub


Bill Title: An Act Establishing A Commission On Health Care Policy, Cost Containment And Price Variation.

Spectrum: Partisan Bill (? 1-0)

Status: (Introduced - Dead) 2015-05-05 - Referred by Senate to Committee on Appropriations [SB00815 Detail]

Download: Connecticut-2015-SB00815-Comm_Sub.html

General Assembly

 

Substitute Bill No. 815

January Session, 2015

 

*_____SB00815GAE___043015____*

AN ACT ESTABLISHING A COMMISSION ON HEALTH CARE POLICY, COST CONTAINMENT AND PRICE VARIATION.

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

Section 1. (NEW) (Effective October 1, 2015) (a) As used in this section:

(1) "Accountable care organization" or "ACO" means an organization of clinically integrated health care providers;

(2) "Health insurance carrier" means any insurer, health care center, hospital service corporation, medical service corporation or other entity delivering, issuing for delivery, renewing, amending or continuing any individual or group health insurance policy in this state providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general statutes;

(3) "Health care provider" means any person, corporation, facility or institution licensed by this state to provide health care services; and

(4) "Provider organization" means a corporation, partnership, business trust, association or organized group of persons that is in the business of health care delivery or management, whether or not incorporated, that represents one or more health care providers in contracting with health insurance carriers for the payments of health care services, including, but not limited to, a physician organization, independent practice association, provider network or accountable care organization.

(b) There is established a Commission on Health Care Policy and Cost Containment, as an independent administrative commission that is not subject to the supervision or control of any other executive officer or agency. The commission shall be governed by a board of directors consisting of the following members:

(1) One appointed by the speaker of the House of Representatives who shall have demonstrated expertise in health care consumer advocacy;

(2) One appointed by the president pro tempore of the Senate who shall have demonstrated expertise in health care delivery or health care management at a senior level;

(3) One appointed by the majority leader of the House of Representatives who shall have expertise as an institutional purchaser of health insurance or health care services;

(4) One appointed by the majority leader of the Senate who shall have expertise in behavioral health and behavioral health reimbursement systems;

(5) One appointed by the minority leader of the House of Representatives who shall have demonstrated expertise in health plan administration and finance, including payment methodologies;

(6) One appointed by the minority leader of the Senate who shall have demonstrated expertise in the development and utilization of innovative medical technologies and treatments for patient care;

(7) One appointed by the House chairperson of the joint standing committee of the General Assembly having cognizance of matters relating to public health who shall be a primary care physician;

(8) One appointed by the Senate chairperson of the joint standing committee of the General Assembly having cognizance of matters relating to public health who shall have expertise in representing the health care workforce as a leader in a labor organization;

(9) One appointed by the House ranking member of the joint standing committee of the General Assembly having cognizance of matters relating to public health who shall be a health economist;

(10) One appointed by the Senate ranking member of the joint standing committee of the General Assembly having cognizance of matters relating to public health who shall have expertise as a purchaser of health insurance representing business management or health benefits administration;

(11) The commissioners of Public Health, Social Services and the Insurance Commissioner, or the commissioners' designees as ex-officio, nonvoting members; and

(12) The Healthcare Advocate, or the Healthcare Advocate's designee as an ex-officio, nonvoting member.

(c) (1) Initially, the members who have expertise in health care delivery or health care management at a senior level, behavioral health and behavioral health reimbursement systems and health plan administration and finance shall serve for five years and until their successors are appointed. The members who have demonstrated expertise in health care consumer advocacy, have demonstrated expertise in the development and utilization of innovative medical technologies and treatments for patient care, a primary care physician, have expertise in representing the health care workforce as a leader in a labor organization, a health economist, and have expertise as a purchaser of health insurance representing business management or health benefits administration shall serve for a term of three years and until their successors are appointed.

(2) All appointments to full terms subsequent to the initial appointments shall be for three years. Vacancies shall be filled for the expiration of the term of the member being replaced in the same manner as original appointments. Members shall be eligible for reappointment under the same conditions as are applicable to initial appointments. The board shall elect annually one of its members as a chairperson and one as a vice chairperson. Members of the board shall receive no compensation but shall be reimbursed for their actual expenses incurred in service on the board. The board shall meet at least quarterly and more often as its duties require, upon the request of any two members and shall meet at least once each year with those persons and groups that are affected by board policies and procedures. A majority of the board members shall constitute a quorum. A majority vote of a quorum shall be required for any official action of the board. Any tie vote shall be decided by the chairperson of the board. The board shall adopt its own rules for the conduct of its meetings.

(d) The board shall appoint an executive director. The executive director shall not be required to obtain the approval of any other executive agency in connection with the appointment of employees and may establish personnel policies and regulations for the officers and employees of the commission. The executive director shall supervise the administrative affairs and general management and operations of the commission.

(e) The duties and responsibilities of the commission shall include:

(1) Setting health care cost growth goals for the state;

(2) Enhancing the transparency of provider organizations;

(3) Monitoring the development of ACOs and medical homes;

(4) Monitoring the adoption of alternative payment methodologies;

(5) Fostering innovative health care delivery and payment models that lower health care cost growth while improving the quality of patient care;

(6) Monitoring and reviewing the impact of changes within the health care marketplace;

(7) Protecting patient access to necessary health care services;

(8) Reviewing variation in prices and insurance reimbursement rates among health care providers, by payer and provider type, that shall include, but need not be limited to, (A) identifying factors contributing to such price and reimbursement variation, (B) assessing the impact of such variation on health care costs, insurance premiums, safety net providers and access to care, and (C) recommending policy changes to reduce provider price variations that are found to be unrelated to actual cost or quality differences or that unnecessarily contribute to health care cost inflation.

(9) Holding public hearings not less than annually to examine health care provider, provider organization and health insurance carrier costs, prices and cost trends with particular attention to factors that contribute to cost growth within the state's health care system;

(10) Establishing annual health care cost growth benchmarks for the average growth in total health care expenditures for the next calendar year and publishing such benchmarks on an Internet web site maintained by the commission;

(11) Establishing procedures to assist health care providers that exceed such health care cost growth benchmarks to improve efficiency and reduce cost growth, including procedures for such health care providers to implement performance improvement plans;

(12) Providing written notice to any health care provider that exceeds such health care cost growth benchmark and assisting each such health care entity with the implementation of a performance improvement plan;

(13) Developing and administering a registration program for health care providers and provider organizations that shall require each health care provider and provider organization in the state to register under the program or be prohibited from negotiating a network contract with a health insurance carrier or third-party administrator;

(14) Requiring registered provider organizations to report such data as it considers necessary in order to better protect the public's interest in monitoring the financial conditions, organizational structure, business practices and market share of each registered provider organization;

(15) Reviewing and commenting on all capital expenditure projects requiring a certificate of need pursuant to chapter 368z of the general statutes;

(16) Collecting and analyzing such data as it considers necessary to monitor the financial conditions of acute care hospitals, including, but not limited to, (A) gross and net patient service revenues, (B) sources of hospital revenue, (C) trends in the availability and utilization of health care services provided by hospitals, nursing homes and outpatient clinics, (D) total payroll as a percentage of operating expenses and other salary and benefit information, and (E) other relevant measures of financial health or distress of health care facilities;

(17) Ensuring the uniform reporting of revenues, charges, costs, prices and utilization of health care services and other data as the commission may require to analyze changes in (A) health insurance premium levels, (B) benefits and cost-sharing in health insurance plans, (C) measures of health insurance plan cost and utilization, and (D) payment methods;

(18) Entering into such contractual agreements, in accordance with established procedures, as may be necessary to carry out the provisions of this section; and

(19) Taking any other action necessary to carry out the provisions of this section.

(f) (1) The board may request any (A) office, department, board, commission or other agency of the state, or (B) health care provider, health insurance carrier or provider organization to supply such reports, information and assistance as may be necessary or appropriate in order to carry out the commission's duties and responsibilities.

(2) The board shall consult with the Insurance Commissioner, Commissioner of Public Health and the Connecticut Insurance Exchange to avoid duplicative reporting requirements and to consolidate and simplify such requirements as appropriate.

(g) (1) Each health care provider and provider organization shall, before making any material change to its operations or governance structure submit written notice to the commission. Upon the commission's request, each health care provider and provider organization submitting such notice shall submit information concerning such change as is necessary, as determined in the commission's discretion, for the commission to determine whether such change is likely to result in a significant impact on the state's ability to meet the health care cost growth benchmarks established by the commission in accordance with subsection (e) of this section or on the competitive market.

(2) The commission shall conduct a cost and market impact review relating to such material change in operations or governance structure that shall include, but need not be limited to, consideration of the following: (A) Whether the health care provider or provider organization has a dominant market share for the services it provides; (B) whether the health care provider or provider organization charges prices for services that are materially higher than the median prices charged by other health care providers for the same services in the same market; (C) the quality of services offered by the health care provider or provider organization; (D) the availability and accessibility of services similar to those provided or proposed to be provided in the primary service areas; (E) the impact on competing options for the delivery of health care services in the primary service area; (F) the role of the health care provider or provider organization in serving at-risk and underserved populations, including those receiving state medical assistance; and (G) any consumer concerns or complaints against the health care provider or provider organization.

(3) After completing a cost and market impact review, the commission shall issue a preliminary report. The health care provider or provider organization that is the subject of the report may, not later than thirty days after receiving such report, submit a written response to the commission on the findings contained in the report. After consideration of any response received from the health care provider or provider organization, the commission shall issue a final report and submit such report to the Attorney General for the Attorney General's consideration.

(h) The Attorney General may review and analyze information reported to the commission and may require that any health care provider, health insurance carrier or provider organization submit additional information or provide testimony under oath relating to health care costs, factors that contribute to cost growth within the state's health care system or the relationship between provider costs and health insurance premium rates.

(i) The commission may assess health care providers and health insurance carriers reasonable administrative fees to defray the costs of implementing the provisions of this section.

(j) On or before January 1, 2017, and annually thereafter, the board shall report, in accordance with section 11-4a of the general statutes, on the commission's activities to the joint standing committee of the General Assembly having cognizance of matters relating to public health. The report shall include, but need not be limited to: (1) Information on spending trends and underlying factors; (2) recommendations for strategies to increase the efficiency of the health care system; (3) recommendations to reduce provider price variation; (4) information concerning cost, price, quality, utilization and market power in the state's health care system; (5) cost growth trends for care provided within and outside of accountable care organizations and patient-centered medical homes; (6) cost growth trends by health care provider sector, including, but not limited to, hospitals, hospital systems, non-acute health care providers, pharmaceuticals, medical devices and durable medical equipment; (7) factors that contribute to cost growth within the state's health care system and to the relationship between health care provider costs and health insurance premium rates; (8) the proportion of health care expenditures reimbursed under fee-for-service and alternative payment methodologies; (9) the impact of health care payment and delivery reform efforts on health care costs including, but not limited to, the development of limited and tiered networks, increased price transparency, increased utilization of electronic medical records and other health technology; (10) trends in utilization of unnecessary or duplicative services, with particular emphasis on imaging and other high-cost services; (11) the prevalence and trends in adoption of alternative payment methodologies and impact of alternative payment methodologies on overall health care spending, health insurance premiums and health care provider rates; (12) the development and status of health care provider organizations in the state including, but not limited to, acquisitions, mergers, consolidations and any evidence of excess consolidation or anti-competitive behavior by provider organizations; and (13) the impact of health care payment and delivery reform on the quality of health care services delivered in the state.

(k) The board may adopt regulations, in accordance with chapter 54 of the general statutes, to implement the provisions of this section.

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

Section 1

October 1, 2015

New section

PH

Joint Favorable Subst. -LCO

 

GAE

Joint Favorable

 
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