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