House Bill No. 8601
House Bill No. 8601
October 29 Special Session, PUBLIC ACT NO. 97-1
AN ACT ESTABLISHING THE HUSKY PLAN TO PROVIDE
HEALTH CARE FOR UNINSURED CHILDREN.
Be it enacted by the Senate and House of
Representatives in General Assembly convened:
Section 1. (NEW) (a) Sections 1 to 16,
inclusive, of this act shall be known as the
"HUSKY and HUSKY Plus Act".
(b) Children receiving assistance under
section 17b-261 of the general statutes, as
amended by section 3 of public act 97-288, section
70 of public act 97-2 of the June 18 special
session and section 19 of this act, shall be
participants in the HUSKY Plan, Part A and
children receiving assistance under sections 1 to
16, inclusive, of this act shall be participants
in the HUSKY Plan, Part B. For purposes of
marketing and outreach, both parts shall be known
as the HUSKY Plan.
Sec. 2. (NEW) As used in sections 1 to 16,
inclusive, of this act:
(1) "Applicant" means an individual over the
age of eighteen years who is a natural or adoptive
parent or a legal guardian; a caretaker relative,
foster parent or stepparent with whom the child
resides; or a noncustodial parent under order of a
court or family support magistrate to provide
health insurance, who applies for coverage under
the HUSKY Plan, Part B on behalf of a child and
shall include a child who is eighteen years of age
or emancipated in accordance with the provisions
of sections 46b-150 to 46b-150e, inclusive, of the
general statutes, and who is applying on his own
behalf or on behalf of a minor dependent for
coverage under such plan;
(2) "Child" means an individual under
nineteen years of age;
(3) "Coinsurance" means the sharing of health
care expenses by the insured and an insurer in a
specified ratio;
(4) "Commissioner" means the Commissioner of
Social Services;
(5) "Copayment" means a payment made on
behalf of an enrollee for a specified service
under the HUSKY Plan, Part B;
(6) "Cost sharing" means arrangements made on
behalf of an enrollee whereby an applicant pays a
portion of the cost of health services, sharing
costs with the state and includes copayments,
premiums, deductibles and coinsurance;
(7) "Deductible" means the amount of
out-of-pocket expenses that would be paid for
health services on behalf of an enrollee before
becoming payable by the insurer;
(8) "Department" means the Department of
Social Services;
(9) "Durable medical equipment" means durable
medical equipment, as defined in Section 1395x(n)
of the Social Security Act;
(10) "Eligible beneficiary" means a child who
meets the requirements specified in section 4 of
this act, except a child excluded under the
provisions of Subtitle J of Public Law 105-33 or a
child of any municipal employee eligible for
employer-sponsored insurance on or after the
effective date of this act;
(11) "Enrollee" means an eligible beneficiary
who receives services from a managed care plan
under the HUSKY Plan, Part B;
(12) "Family" means any combination of the
following: (A) An individual; (B) the individual's
spouse; (C) any child of the individual or such
spouse; or (D) the legal guardian of any such
child if the guardian resides with the child;
(13) "HUSKY Plan, Part A" means assistance
provided to children pursuant to section 17b-261
of the general statutes, as amended by section 3
of public act 97-288, section 70 of public act
97-2 of the June 18 special session and section 19
of this act;
(14) "HUSKY Plan, Part B" means the health
insurance plan for children established pursuant
to the provisions of sections 1 to 16, inclusive,
of this act;
(15) "HUSKY Plus programs" means two
supplemental health insurance programs established
pursuant to section 6 of this act for medically
eligible enrollees of the HUSKY Plan, Part B whose
medical needs cannot be accommodated within the
basic benefit package offered to enrollees. One
program shall supplement coverage for those
medically eligible enrollees with intensive
physical health needs and the other program shall
supplement coverage for those medically eligible
enrollees with intensive behavioral health needs;
(16) "Income" means income as calculated in
the same manner as under the Medicaid program
pursuant to section 17b-261 of the general
statutes, as amended by section 3 of public act
97-288, section 70 of public act 97-2 of the June
18 special session and section 19 of this act;
(17) "Managed care plan" means a plan offered
by an entity that contracts with the department to
provide benefits to enrollees on a prepaid basis;
(18) "Parent" means a natural parent,
stepparent, adoptive parent, guardian or custodian
of a child;
(19) "Premium" means any required payment
made by an individual to offset or pay in full the
capitation rate under the HUSKY Plan, Part B;
(20) "Preventive care and services" means:
(A) Child preventive care, including periodic and
interperiodic well-child visits, routine
immunizations, health screenings and routine
laboratory tests; (B) prenatal care, including
care of all complications of pregnancy; (C) care
of newborn infants, including attendance at
high-risk deliveries and normal newborn care; (D)
WIC evaluations; (E) child abuse assessment
required under sections 17a-106a and 46b-129a of
the general statutes; (F) preventive dental care
for children; and (G) periodicity schedules and
reporting based on the standards specified by the
American Academy of Pediatrics;
(21) "Primary and preventive health care
services" means the services of licensed
physicians, optometrists, nurses, nurse
practitioners, midwives and other related health
care professionals which are provided on an
outpatient basis, including routine well-child
visits; diagnosis and treatment of illness and
injury; laboratory tests; diagnostic x-rays;
prescription drugs; radiation therapy;
chemotherapy; hemodialysis; emergency room
services; and outpatient alcohol and substance
abuse services, as defined by the commissioner;
(22) "Qualified entity" means any entity (A)
eligible for payments under a state plan approved
under Medicaid and which provides medical services
under the HUSKY Plan, Part A or is authorized to
determine eligibility of: (i) A child to
participate in a Head Start program under the Head
Start Act; (ii) a child to receive child care
services for which financial assistance is
provided under the Child Care and Development
Block Grant Act of 1990; or (iii) a child to
receive assistance under WIC; and (B) that is
determined by the commissioner to be capable of
making the determinations specified in
subparagraph (A) of this subdivision. The
commissioner shall provide qualified entities with
such forms as are necessary for an application to
be made on behalf of a child under the HUSKY Plan,
Part A and information on how to assist parents,
guardians and other persons in completing and
filing such forms;
(23) "WIC" means the federal Special
Supplemental Food Program for Women, Infants and
Children administered by the Department of Public
Health pursuant to section 19a-59c of the general
statutes.
Sec. 3. (NEW) The commissioner shall submit a
state children's health insurance plan to
implement the provisions of sections 1 to 16,
inclusive, of this act to the Health Care
Financing Administration in accordance with the
provisions of Subtitle J of Public Law 105-33.
Such plan and any revisions thereto shall be
submitted to the joint standing committees of the
General Assembly having cognizance of matters
relating to human services, public health,
insurance and appropriations and the budgets of
state agencies. Within fifteen days of receipt of
such plan or revisions thereto, said joint
standing committees of the General Assembly may
advise the commissioner of their approval, denial
or modifications, if any, of the plan or any
revisions thereto. If the joint standing
committees do not concur, the committee chairmen
shall appoint a committee on conference which
shall be comprised of three members from each
joint standing committee. At least one member
appointed from each committee shall be a member of
the minority party. The report of the committee on
conference shall be made to each committee, which
shall vote to accept or reject the report. The
report of the committee on conference may not be
amended. If a joint standing committee rejects the
report of the committee on conference, the plan or
revisions thereto shall be deemed approved. If the
joint standing committees accept the report, the
committee having cognizance of matters relating to
appropriations and the budgets of state agencies
shall advise the commissioner of their approval or
modifications, if any, of the plan or revisions
thereto, provided if the committees do not act
within fifteen days, the plan or revisions thereto
shall be deemed approved.
Sec. 4. (NEW) (a) A child who resides in a
household with a family income which exceeds one
hundred eighty-five per cent of the federal
poverty level and does not exceed three hundred
per cent of the federal poverty level may be
eligible for subsidized benefits under the HUSKY
Plan, Part B.
(b) A child who resides in a household with a
family income over three hundred per cent of the
federal poverty level may be eligible for
unsubsidized benefits under the HUSKY Plan, Part
B.
(c) Whenever a court or family support
magistrate orders a noncustodial parent to provide
health insurance for a child, such parent may
provide for coverage under the HUSKY Plan, Part B.
(d) A child who has been determined to be
eligible for benefits under either the HUSKY Plan,
Part A or Part B shall remain eligible for said
plan for a period of twelve months from such
child's determination of eligibility unless the
child attains the age of nineteen years or is no
longer a resident of the state.
(e) To the extent allowed under federal law,
the commissioner shall not pay for services or
durable medical equipment under the HUSKY Plan,
Part B if the enrollee has other insurance
coverage for the services or such equipment.
(f) A newborn child who otherwise meets the
eligibility criteria for the HUSKY Plan, Part B
shall be eligible for benefits retroactive to his
date of birth, provided an application is filed on
behalf of the child within thirty days of such
date.
(g) The commissioner shall implement
presumptive eligibility for children applying for
Medicaid. Such presumptive eligibility
determinations shall be in accordance with
applicable federal law and regulations. The
commissioner shall adopt regulations, in
accordance with chapter 54 of the general
statutes, to establish standards and procedures
for the designation of organizations as qualified
entities to grant presumptive eligibility. In
establishing such regulations, the commissioner
shall ensure the representation of state-wide and
local organizations that provide services to
children of all ages in each region of the state.
(h) The commissioner shall enter into a
contract with an entity to be a single point of
entry servicer for applicants and enrollees under
the HUSKY Plan, Part A and Part B. The servicer
shall jointly market both Part A and Part B
together as the HUSKY Plan. Such servicer shall
develop and implement public information and
outreach activities with community programs.
(i) To the extent permitted by federal law,
the single point of entry servicer may be one of
the entities authorized to grant presumptive
eligibility under the HUSKY Plan, Part A.
(j) The single point of entry servicer shall
send an application and supporting documents to
the commissioner for determination of eligibility
of a child who resides in a household with a
family income of one hundred eighty-five per cent
or less of the federal poverty level. The servicer
shall enroll eligible beneficiaries in the
applicant's choice of managed care plan.
(k) Not more than twelve months after the
determination of eligibility and annually
thereafter, the servicer shall determine if the
child continues to be eligible for the plan. The
servicer shall mail a form to each participant in
the plan for the purposes of obtaining information
to make a determination on eligibility. The
determination of eligibility shall be coordinated
with health plan open enrolment periods.
(l) The commissioner shall implement the
HUSKY Plan, Part B while in the process of
adopting necessary policies and procedures in
regulation form in accordance with the provisions
of section 17b-10 of the general statutes.
(m) The commissioner shall adopt regulations,
in accordance with chapter 54 of the general
statutes, to establish residency requirements and
income eligibility for participation in the HUSKY
Plan, Part B and procedures for a simplified
mail-in application process.
Sec. 5. (NEW) (a) The HUSKY Plan, Part B
shall provide the following minimum benefit
coverage:
(1) No copayments for preventive care and
services;
(2) No copayments for inpatient physician and
hospital, outpatient surgical, ambulance and for
emergency medical conditions, skilled nursing,
home health, hospice and short-term rehabilitation
and physical therapy, occupational and speech
therapies, lab and x-ray, preadmission testing,
prosthetics, durable medical equipment other than
powered wheelchairs, dental exams every six
months, x-rays, fillings, fluoride treatments and
oral surgery. For purposes of this subdivision, in
accordance with the National Committee for Quality
Assurance, an emergency medical condition is a
condition such that a prudent lay-person, acting
reasonably, would have believed that emergency
medical treatment is needed;
(3) Outpatient physician visits, hearing
examinations, nurse midwives, nurse practitioners,
podiatrists, chiropractors and naturopaths;
(4) Prescription drugs;
(5) Eye care and optical hardware;
(6) Orthodontia;
(7) Mental health inpatient maximum of sixty
days with allowable substitution of alternative
levels of care and outpatient maximum of thirty
visits with supplemental coverage available under
a HUSKY Plus program for medically eligible
enrollees, provided coverage under the HUSKY Plan,
Part B and HUSKY Plus programs shall be consistent
with the provisions of the Mental Health Parity
Act, Public Law 104-204, and section 27 of public
act 97-99;
(8) Substance abuse, detoxification and
inpatient for drugs sixty days and alcohol
forty-five days and outpatient sixty visits per
calendar year maximum with supplemental coverage
available under a HUSKY Plus program for medically
eligible enrollees;
(9) Under the HUSKY Plan, Part B no
deductibles shall be charged; no preexisting
condition exclusion shall be applied and there
shall be no annual or lifetime benefit maximums
and no coinsurance.
(b) The commissioner may establish a schedule
of reasonable copayments for coverage provided
under subdivisions (3) to (8), inclusive, of
subsection (a) of this section.
Sec. 6. (NEW) (a) The commissioner shall,
within available appropriations, establish two
supplemental health insurance programs, to be
known as HUSKY Plus programs, for enrollees of the
HUSKY Plan, Part B, whose medical needs cannot be
accommodated within the basic benefit package
offered enrollees. One program shall supplement
coverage for those medically eligible enrollees
with intensive physical health needs and one shall
supplement coverage for those medically eligible
enrollees with intensive behavioral health needs.
(b) Within available appropriations, the
commissioner shall contract with entities to
administer and operate the HUSKY Plus program for
medically eligible enrollees with intensive
physical health needs. Such entities shall be the
same entities that the Department of Public Health
contracts with to administer and operate the
program under Title V of the Social Security Act.
The advisory committee established by the
Department of Public Health for Title V of the
Social Security Act shall be the steering
committee for such program, except that such
committee shall include representatives of the
Departments of Social Services and Children and
Families.
(c) Within available appropriations, the
commissioner shall contract with one or more
entities to operate the HUSKY Plus program for
medically eligible enrollees with intensive
behavioral health needs. The steering committee
for such program shall be established by the
commissioner, in consultation with the
Commissioner of Children and Families. The
steering committee shall include representatives
of the Departments of Social Services and Children
and Families.
(d) The acuity standards or diagnostic
eligibility criteria, or both, the service
benefits package and the provider network for the
HUSKY Plus program for intensive physical health
needs shall be consistent with that of Title V of
the Social Security Act. Such service benefit
package shall include powered wheelchairs.
(e) The steering committee for intensive
behavioral health needs shall submit
recommendations to the commissioner for acuity
standards or diagnostic eligibility criteria, or
both, for admission to the program for intensive
behavioral health needs as well as a service
benefits package. The criteria shall reflect the
severity of psychiatric or substance abuse
symptoms, the level of functional impairment
secondary to symptoms and the intensity of service
needs. The network of community-based providers in
the program shall include the services generally
provided by child guidance clinics, family service
agencies, youth service bureaus and other
community-based organizations.
(f) The commissioner shall adopt regulations,
in accordance with chapter 54 of the general
statutes, to establish a procedure for the appeal
of a denial of coverage under any of the HUSKY
Plus programs. Such regulations shall provide that
(1) an appeal of a denial of coverage for a
medically eligible enrollee with intensive
physical health needs shall be taken to the
steering committee for intensive physical health
needs, (2) an appeal of a denial of coverage for a
medically eligible enrollee with intensive
behavioral health needs shall be taken to the
steering committee for intensive behavioral health
needs, and (3) a medically eligible enrollee with
intensive physical or behavioral health needs may
appeal the decision of any such steering committee
to the commissioner.
(g) The commissioner shall contract for an
external quality review of the HUSKY Plus
programs. Not later than January 1, 1999, and
annually thereafter, the commissioner shall submit
a report to the Governor and the General Assembly
on the HUSKY Plus programs which shall include an
evaluation of the health outcomes and access to
care for medically eligible enrollees in the HUSKY
Plus programs.
(h) On and after the date on which any
medically eligible enrollee begins receiving
benefits under the HUSKY Plus programs, such
enrollee shall not be eligible for services under
Title V of the Social Security Act.
(i) Not later than December 1, 1997, or not
less than fifteen days before submission of the
state children's health insurance plan to the
joint standing committees of the General Assembly
having cognizance of matters relating to human
services, public health, insurance and
appropriations and the budgets of state agencies,
whichever is sooner, the commissioner shall submit
to said joint standing committees of the General
Assembly any part of the state children's health
insurance plan that refers to the HUSKY Plus
programs. Such submission shall address acuity
standards and diagnostic eligibility criteria, the
service benefit package and coordination between
the HUSKY Plan, Part B and the HUSKY Plus programs
and coordination with other state agencies. Within
fifteen days of receipt of such submission, said
joint standing committees of the General Assembly
may advise the commissioner of their approval,
denial or modifications, if any, of the
submission. If the joint standing committees do
not concur, the committee chairmen shall appoint a
committee on conference which shall be comprised
of three members from each joint standing
committee. At least one member appointed from each
committee shall be a member of the minority party.
The report of the committee on conference shall be
made to each committee, which shall vote to accept
or reject the report. The report of the committee
on conference may not be amended. If a joint
standing committee rejects the report of the
committee on conference, the submission shall be
deemed approved. If the joint standing committees
accept the report, the committee having cognizance
of matters relating to appropriations and the
budgets of state agencies shall advise the
commissioner of their approval or modifications,
if any, of the submission, provided if the
committees do not act within fifteen days, the
submission shall be deemed approved.
(j) The commissioner shall adopt regulations
in accordance with the provisions of chapter 54 of
the general statutes, to establish criteria and
specify services for the HUSKY Plus programs. Such
regulations shall state that the HUSKY Plus
programs shall give priority in such programs to
enrollees with family incomes at or below two
hundred thirty-five per cent of the federal
poverty level.
(k) As used in this section, "medically
eligible enrollee" means any enrollee with special
needs related to either physical or behavioral
health who meets the acuity standards or
diagnostic eligibility criteria adopted by the
commissioner regarding the acuity, diagnosis,
functional impairment and intensive service needs
of the enrollee.
Sec. 7. (NEW) (a) The commissioner may
require the payment of a premium or copayment in
connection with services provided under the HUSKY
Plan, Part B in accordance with the following
limitations:
(1) Until July 1, 1999, the maximum annual
aggregate cost sharing for a family with an income
(A) which exceeds one hundred eighty-five per cent
of the federal poverty level but does not exceed
two hundred thirty-five per cent of the federal
poverty level shall not be more than six hundred
fifty dollars, and (B) which exceeds two hundred
thirty-five per cent of the federal poverty level
but does not exceed three hundred per cent of the
federal poverty level shall not be more than one
thousand two hundred fifty dollars;
(2) On and after July 1, 1999, the
commissioner shall submit a schedule for the
maximum annual aggregate cost sharing for families
with an income specified in subparagraphs (A) and
(B) of subdivision (1) of this subsection to the
joint standing committees of the General Assembly
having cognizance of matters relating to human
services, public health, insurance and
appropriations and the budgets of state agencies.
Within fifteen days of receipt of such schedule,
said joint standing committees of the General
Assembly may advise the commissioner of their
approval, denial or modifications, if any, of the
schedule; and
(3) The commissioner shall require providers
under each managed care plan to monitor copayments
and premiums under the provisions of subdivision
(1) of this subsection.
(b) (1) Except as provided in subdivision (2)
of this subsection, the commissioner may impose
limitations on the amount, duration and scope of
benefits under the HUSKY Plan, Part B.
(2) The limitations adopted by the
commissioner pursuant to subdivision (1) of this
subsection shall not preclude coverage of any item
of durable medical equipment or service that is
medically necessary.
Sec. 8. (NEW) Each managed care plan shall
include sufficient numbers of appropriately
trained and certified clinicians of pediatric
care, including primary, medical subspecialty and
surgical specialty physicians, as well as
providers of necessary related services such as
dental services, mental health services, social
work services, developmental evaluation services,
occupational therapy services, physical therapy
services, speech therapy and language services,
school-linked clinic services and other public
health services to assure enrollees the option of
obtaining benefits through such providers.
Sec. 9. (NEW) (a) The commissioner, in
consultation with the Children's Health Council,
the Medicaid Managed Care Council and Infoline of
Connecticut, shall develop mechanisms for outreach
for the HUSKY Plan, Part A and Part B, including,
but not limited to, development of mail-in
applications and appropriate outreach materials
through the Department of Revenue Services, the
Labor Department, the Department of Social
Services, the Department of Public Health, the
Department of Children and Families and the Office
of Protection and Advocacy for Persons with
Disabilities.
(b) The commissioner shall include in such
outreach efforts information on the Medicaid
program for the purpose of maximizing enrolment of
eligible children and the use of federal funds.
(c) The commissioner shall, within available
appropriations, contract with qualified entities
authorized to grant presumptive eligibility,
severe need schools and community-based
organizations for purposes of public education,
outreach and recruitment of eligible children,
including the distribution of applications and
information regarding enrolment in the HUSKY Plan,
Part A and Part B. In awarding such contracts, the
commissioner shall consider the marketing,
outreach and recruitment efforts of organizations.
For the purposes of this subsection, (1)
"community-based organizations" shall include, but
not be limited to, day care centers, schools,
school-based health clinics, community-based
diagnostic and treatment centers and hospitals,
and (2) "severe need school" means a school in
which forty per cent or more of the lunches served
are served to students who are eligible for free
or reduced price lunches.
(d) All outreach materials shall be approved
by the commissioner pursuant to Subtitle J of
Public Law 105-33.
(e) Not later than January 1, 1999, and
annually thereafter, the commissioner shall submit
a report to the Governor and the General Assembly
on the implementation of and the results of the
community-based outreach program specified in
subsections (a) to (c), inclusive, of this
section.
Sec. 10. (NEW) (a) The commissioner shall
adopt regulations, in accordance with chapter 54
of the general statutes, to establish appropriate
contract standards to oversee and ensure the
quality of care provided under the HUSKY Plan,
Part B. Such regulations shall require the
establishment of an internal quality assurance
plan by each managed care plan which shall be in
writing and available to the public.
(b) The commissioner shall develop criteria
for assessing the outcomes of health care provided
to children under the HUSKY Plan, Part B.
(c) The commissioner shall contract for the
external quality review of the HUSKY Plan, Part B.
Such review shall include, but not be limited to,
an evaluation of access to care, medical record
standards, provider credentialing and individual
case review.
(d) The commissioner may impose the following
sanctions on any managed care plan which does not
meet the quality of care required by standards
adopted pursuant to subsection (a) of this section
or the standards developed for external quality
review by a contract under the provisions of
subsection (c) of this section:
(1) Require the managed care plan to submit
and implement a plan of correction;
(2) Limit new enrolment during any period of
noncompliance;
(3) Withhold state payments that may become
due until the deficiencies are corrected; and
(4) Prohibit the managed care plan from
renewing or entering into new contracts to serve
enrollees.
(e) Not later than January 1, 1999, and
annually thereafter, the commissioner shall submit
a report to the Governor and the General Assembly
which shall outline the overall effect of the
HUSKY Plan, Part B on access to, utilization and
quality of primary and preventive health care
services for children and the impact of such plan
on the health status of enrollees.
(f) Not later than July 1, 1998, or the close
of the calendar quarter following federal approval
of the state children's health insurance plan, and
quarterly thereafter, the commissioner shall
submit a report to the Governor and the General
Assembly which shall analyze enrolment levels in
the HUSKY Plan, Part B in relation to the
availability of state and federal funds for such
plan and, if necessary, establish priorities for
access under the HUSKY Plan, Part B to health
insurance for eligible beneficiaries in families
with income of less than two hundred thirty-five
per cent of the federal poverty level.
Sec. 11. (NEW) (a) The commissioner or, at
the commissioner's discretion, the single point of
entry servicer shall review applications for
eligibility to determine whether applicants or
employers of applicants have discontinued
employer-sponsored dependent coverage for the
purpose of participation in the HUSKY Plan, Part
B.
(b) An application may be disapproved if it
is determined that a child to be covered under the
HUSKY Plan, Part B was covered by an
employer-sponsored insurance within the last six
months. If the commissioner determines that the
time period specified in this subsection is
insufficient to effectively deter applicants or
employers of applicants from discontinuing
employer-sponsored dependent coverage for the
purpose of participation in the HUSKY Plan, Part
B, the commissioner may extend such period for a
maximum of an additional six months.
(c) An application may be approved in cases
where prior employer-sponsored coverage ended less
than six months prior to the determination of
eligibility for reasons unrelated to the
availability of the HUSKY Plan, Part B, including,
but not limited to:
(1) Loss of employment due to factors other
than voluntary termination;
(2) Death of a parent;
(3) Change to a new employer that does not
provide an option for dependent coverage;
(4) Change of address so that no
employer-sponsored coverage is available;
(5) Discontinuation of health benefits to all
employees of the applicant's employer;
(6) Expiration of the coverage periods
established by the Consolidated Omnibus Budget
Reconciliation Act of 1985, (P.L. 99-272) as
amended from time to time, (COBRA);
(7) Self-employment;
(8) Termination of health benefits due to a
long-term disability;
(9) Termination of dependent coverage due to
an extreme economic hardship on the part of either
the employee or the employer, as determined by the
commissioner; or
(10) Substantial reduction in either lifetime
medical benefits or benefit category available to
an employee and dependents under an employer's
health care plan.
Sec. 12. (NEW) The applicant for an enrollee
shall notify the enrollee's managed care plan of
any change in circumstance that could affect the
enrollee's continued eligibility for coverage
under the HUSKY Plan, Part B within thirty days of
such change. An enrollee shall be disenrolled if
the commissioner determines the enrollee is no
longer eligible for participation in such plan for
reasons including, but not limited to, those
specified in section 13 of this act and the
nonpayment of premiums.
Sec. 13. (NEW) Any payment made by the state
on behalf of an enrollee as a result of any false
statement, misrepresentation or concealment of or
failure to disclose income or health insurance
coverage by an applicant responsible for
maintaining insurance may be recovered by the
state.
Sec. 14. (NEW) (a) The commissioner shall
develop a program to involve the public in the
design and implementation of the HUSKY Plan, Part
B and to ensure ongoing public involvement. Such
program shall include the opportunity to submit
written comments and broad distribution of
information and opportunities to the public and to
consumers, consumer advocacy groups, medical
providers and other organizations involved in
children's health. Information available to the
public shall include one or more preliminary
documents identifying the state's options as well
as the HUSKY Plan, Part B and a summary of the
plan. Public notices and HUSKY Plan, Part B
materials shall be available to persons with
disabilities and to those who do not speak
English.
(b) The commissioner shall submit a plan for
such program and any revisions thereto to the
joint standing committees of the General Assembly
having cognizance of matters relating to human
services, public health, insurance and
appropriations and the budgets of state agencies.
Within fifteen days of receipt of the plan, said
joint standing committees of the General Assembly
may advise the commissioner of their approval,
denial or modifications, if any, of the plan.
Sec. 15. (NEW) (a) For purposes of
determining eligibility for the HUSKY Plan, Part B
and to the extent permitted by federal law and to
the extent federal financial participation is
available, the commissioner may disregard family
income up to sixty-five per cent of the federal
poverty level for the size of the family. Such
disregard of family income shall allow subsidized
coverage for an eligible beneficiary who resides
in a household with a family income of not more
than three hundred per cent of the federal poverty
level. No such income disregard shall have the
effect of reducing family income below two hundred
thirty-five per cent of the federal poverty level.
(b) The commissioner may submit an
application for a waiver under Section 1115 of the
Social Security Act (1) to authorize the use of
funds received under Title XXI of the Social
Security Act to establish a non-Medicaid health
insurance program for eligible beneficiaries who
reside in a household with a family income of more
than two hundred thirty-five per cent of the
federal poverty level but less than three hundred
per cent of the federal poverty level, and (2) to
allow families under Section 2105(c)(3) of Title
XXI of the Social Security Act to purchase health
insurance under the HUSKY Plan, Part B with a
sliding fee scale for families with an income up
to three hundred per cent of the federal poverty
level and at full premium for those uninsured
families with an income of over three hundred per
cent of the federal poverty level. The
commissioner may submit an application for a
waiver of allowable expenditures in excess of ten
per cent under the provisions of Section
2105(c)(2) of Subtitle J of Public Law 105-33.
(c) The commissioner shall submit any
application for a federal waiver or proposed
modification of any such waiver in connection with
the HUSKY Plan, Part A and Part B, except the
initial waivers specified under subsection (b) of
this section, to the joint standing committees of
the General Assembly having cognizance of matters
relating to human services, public health,
insurance and appropriations and the budgets of
state agencies prior to the submission of such
application or proposed modification to the
federal government in accordance with the
provisions of section 17b-8 of the general
statutes.
(d) If the waiver specified in subdivision
(1) of subsection (b) of this section is denied
and the income disregard under subsection (a) of
this section is not available, uninsured children
who reside in a household with a family income of
more than two hundred thirty-five per cent of the
federal poverty level but less than three hundred
per cent of the federal poverty level shall be
eligible for unsubsidized benefits under the
provisions of subsection (b) of section 4 of this
act.
Sec. 16. Not later than January 1, 1999, the
commissioner shall present a plan to the General
Assembly to provide affordable, comprehensive
medical insurance coverage to uninsured and
underinsured adults in this state. Such plan shall
include eligibility for individuals and families
to participate in the HUSKY Plan, Part B and shall
propose other programs designed to make health
insurance available and affordable to low and
moderate income adults.
Sec. 17. Section 146 of public act 97-2 of
the June 18 special session is repealed and the
following is substituted in lieu thereof:
Qualified aliens, as defined in section 431
of public law 104-193, admitted into the United
States on or after August 22, 1996, or other
lawfully residing immigrant aliens who have been
determined eligible for Medicaid prior to July 1,
1997, may be eligible until July 1, 1999, for
state-funded medical assistance which shall
provide coverage to the same extent as the
Medicaid program OR THE HUSKY PLAN, PART B. Such
qualified aliens or lawfully residing immigrant
aliens who have not been determined eligible for
Medicaid prior to July 1, 1997, shall be eligible
for state-funded assistance OR THE HUSKY PLAN,
PART B subsequent to six months from establishing
residency in this state until July 1, 1999.
Notwithstanding the provisions of this section,
any qualified alien or other lawfully residing
immigrant alien who is a victim of domestic
violence or who has mental retardation shall be
eligible for state-funded assistance OR THE HUSKY
PLAN, PART B pursuant to this section. Only
individuals who are not eligible for Medicaid
shall be eligible for state-funded assistance
pursuant to this section.
Sec. 18. Section 17b-28 of the general
statutes is repealed and the following is
substituted in lieu thereof:
(a) There is established a council which
shall advise the Commissioner of Social Services
on the planning and implementation of a system of
Medicaid managed care and shall monitor such
planning and implementation and shall advise the
Waiver Application Development Council,
established pursuant to section 17b-28a, on
matters including, but not limited to, eligibility
standards, benefits, access and quality assurance.
The council shall be composed of the chairmen and
ranking members of the joint standing committees
of the General Assembly having cognizance of
matters relating to human services and public
health, or their designees; two members of the
General Assembly, one to be appointed by the
president pro tempore of the Senate and one to be
appointed by the speaker of the House of
Representatives; the director of the Commission on
Aging, or his designee; the director of the
Commission on Children, or his designee; two
community providers of health care, to be
appointed by the president pro tempore of the
Senate; two representatives of the insurance
industry, to be appointed by the speaker of the
House of Representatives; two advocates for
persons receiving Medicaid, one to be appointed by
the majority leader of the Senate and one to be
appointed by the minority leader of the Senate;
one advocate for persons with substance abuse
disabilities, to be appointed by the majority
leader of the House of Representatives; one
advocate for persons with psychiatric
disabilities, to be appointed by the minority
leader of the House of Representatives; TWO
ADVOCATES FOR THE DEPARTMENT OF CHILDREN AND
FAMILIES FOSTER FAMILIES, ONE TO BE APPOINTED BY
THE PRESIDENT PRO TEMPORE OF THE SENATE AND ONE TO
BE APPOINTED BY THE SPEAKER OF THE HOUSE OF
REPRESENTATIVES; two members of the public who are
currently recipients of Medicaid, one to be
appointed by the majority leader of the House of
Representatives and one to be appointed by the
minority leader of the House of Representatives;
two representatives of the Department of Social
Services, to be appointed by the Commissioner of
Social Services; two representatives of the
Department of Public Health, to be appointed by
the Commissioner of Public Health; two
representatives of the Department of Mental Health
and Addiction Services, to be appointed by the
Commissioner of Mental Health and Addiction
Services; TWO REPRESENTATIVES OF THE DEPARTMENT OF
CHILDREN AND FAMILIES, TO BE APPOINTED BY THE
COMMISSIONER OF CHILDREN AND FAMILIES; TWO
REPRESENTATIVES OF THE OFFICE OF POLICY AND
MANAGEMENT, TO BE APPOINTED BY THE SECRETARY OF
THE OFFICE OF POLICY AND MANAGEMENT; ONE
REPRESENTATIVE OF THE OFFICE OF THE STATE
COMPTROLLER, TO BE APPOINTED BY THE STATE
COMPTROLLER and the members of the Health Care
Access Board who shall be ex-officio members and
who may not designate persons to serve in their
place. The council shall choose a chair from among
its members. [, and the staff of the public health
committee shall provide] THE JOINT COMMITTEE ON
LEGISLATIVE MANAGEMENT SHALL PROVIDE
administrative support to such chair. The council
shall convene its first meeting no later than June
1, 1994.
(b) The council shall make recommendations
concerning (1) guaranteed access to enrollees and
effective outreach and client education; (2)
available services comparable to those already in
the Medicaid state plan, including those
guaranteed under the federal Early and Periodic
Screening Diagnosis and Treatment Program; (3) the
sufficiency of provider networks; (4) the
sufficiency of capitated rates provider payments,
financing and staff resources to guarantee timely
access to services; (5) participation in managed
care by existing community Medicaid providers; (6)
the linguistic and cultural competency of
providers and other program facilitators; (7)
quality assurance; (8) timely, accessible and
effective client grievance procedures; (9)
coordination of the Medicaid managed care plan
with state and federal health care reforms; (10)
eligibility levels for inclusion in the program;
(11) cost-sharing provisions; (12) a benefit
package; [and] (13) COORDINATION WITH COVERAGE
UNDER THE HUSKY PLAN, PART B; AND (14) other
issues pertaining to the development of a Medicaid
Research and Demonstration Waiver under Section
1115 of the Social Security Act.
(c) The Commissioner of Social Services shall
seek a federal waiver for the Medicaid managed
care plan. Implementation of the Medicaid managed
care plan shall not occur before July 1, 1995.
(d) [On July 1, 1994, and monthly thereafter,
the] THE Commissioner of Social Services shall
provide monthly reports on the plans and
implementation of the Medicaid managed care system
to the council.
(e) [On October 1, 1994, and quarterly
thereafter, the] THE council shall report its
activities and progress ONCE EACH QUARTER to the
General Assembly.
Sec. 19. Subsection (a) of section 17b-261 of
the general statutes, as amended by section 3 of
public act 97-288 and section 70 of public act
97-2 of the June 18 special session is repealed
and the following is substituted in lieu thereof:
(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 his 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
(d) 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 his spouse
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, pending federal
approval, except that the medical assistance
program shall provide coverage to persons under
the age of nineteen born after September 30, 1981,
up to one hundred eighty-five per cent of the
federal poverty level without an asset limit. On
and after [July] JANUARY 1, 1998, said medical
assistance program shall provide coverage to
persons under the age of nineteen [born after June
30, 1981, or if possible within available
appropriations, born after June 30, 1980,] 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. All
contracts entered into on and after the effective
date of public act 97-288 pursuant to this section
shall include provisions for collaboration of
managed care organizations with the Healthy
Families Connecticut Program established pursuant
to section 17a-56, as amended by section 2 of
public act 97-288. 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 the
effect of an assignment or transfer or other
disposition of property on eligibility for
benefits or assistance.
Sec. 20. (NEW) The commissioner shall
implement the policies and procedures necessary to
carry out the provisions of sections 1 to 16,
inclusive, of this act, section 146 of public act
9-2 of the June special session, as amended by
section 17 of this act, and section 17b-261 of the
general statutes, as amended by section 3 of
public act 97-288, section 70 of public act 97-2
of the June 18 special session and section 19 of
this act, while in the process of adopting such
policies and procedures in regulation form,
provided notice of intent to adopt the regulations
is published in the Connecticut Law Journal within
twenty days after implementation. Such policies
and procedures shall be valid until the time final
regulations are effective.
Sec. 21. (NEW) Within available
appropriations, the Commissioner of Public Health
shall extend coverage under Title V of the Social
Security Act for families up to three hundred per
cent of the federal poverty level to cover
underinsured children with family incomes between
two hundred per cent and three hundred per cent of
the federal poverty level. If allowed by federal
regulations, such expansion may be included for
reimbursement under Title XXI of the Social
Security Act.
Sec. 22. The following sums are appropriated
for the purposes herein specified for the fiscal
year ending June 30, 1998:
GENERAL FUND
DEPARTMENT OF SOCIAL SERVICES
Personal Services $431,396
Other Expenses $490,000
Equipment $115,000
HUSKY Program $7,965,716
Medicaid $9,280,463
AGENCY TOTAL $18,282,575
TOTAL - GENERAL FUND $18,282,575
Sec. 23. This act shall take effect from its
passage.
Approved October 30, 1997