Substitute Senate Bill No. 558

Public Act No. 99-177

An Act Creating a Medicare Consumers Guide.

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

Section 1. (NEW) (a) As used in this section:

(1) "Beneficiary" means a resident of this state who is enrolled in the Medicare program;

(2) "CHOICES health insurance counseling and assistance program" means the federally recognized state health insurance assistance program managed and operated by the Department of Social Services, in cooperation with the area agencies on aging and the Center for Medicare Advocacy, that provides free information and assistance related to health insurance issues and concerns of older persons and other Medicare beneficiaries in Connecticut;

(3) "Guide" means the Connecticut Medicare consumers guide published by the CHOICES health insurance counseling and assistance program;

(4) "Medicare plan" means a plan offered by a Medicare organization that provides health care services to Medicare beneficiaries in this state;

(5) "Medicare organization" means any corporate entity or other organization or group that contracts with the federal Health Care Financing Administration to provide health care services to Medicare beneficiaries in this state as an alternative to the traditional Medicare fee-for-service plan;

(6) "Medicare" means "Medicare", as defined in section 38a-495a of the general statutes;

(7) "Program" means the CHOICES health insurance counseling and assistance program.

(b) The Department of Social Services shall, through its CHOICES health insurance counseling and assistance program, after consultation with the Insurance Commissioner and other organizations involved in servicing, representing or advocating for Medicare beneficiaries, develop and distribute a Connecticut Medicare consumers guide. The guide shall include: (1) Information permitting beneficiaries to compare their options for delivery of Medicare services; (2) information concerning the Medicare plans available to beneficiaries, including the traditional Medicare fee-for-service plan and the benefits and services available through each plan; (3) information concerning the procedure to appeal denials of care and the procedure to request an expedited appeal of denial of care; (4) information concerning private insurance policies and federal and state funded programs that are available to supplement Medicare coverage for beneficiaries; (5) a worksheet for beneficiaries to use to evaluate the various plans; and (6) any other information the program deems relevant to beneficiaries.

(c) The program may test market a draft of the guide prior to its state-wide publication and distribution. As a result of such test marketing, the program may make any necessary modification to the guide's form or substance.

(d) The Department of Social Services, through the program, shall provide a copy of the guide to any individual who requests one.

(e) The Insurance Commissioner, in cooperation with, or on behalf of the Commissioner of Social Services, may require each Medicare organization to: (1) Annually submit to the commissioner any data, reports or information relevant to plan beneficiaries; and (2) at any other times at which changes occur, submit information to the commissioner concerning current benefits, services or costs to beneficiaries. Such information may include information required under section 38a-478c of the general statutes.

(f) Each Medicare organization that fails to file the annual data, reports or information requested pursuant to subsection (e) of this section shall pay a late fee of one hundred dollars per day for each day from the due date of such data, reports or information to the date of filing. Each Medicare organization that files incomplete annual data, reports or information shall be so informed by the Insurance Commissioner, shall be given a date by which to remedy such incomplete filing and shall pay said late fee commencing from the new due date.

(g) On or before June 1, 2000, and annually thereafter, the Insurance Commissioner shall submit to the Governor and to the joint standing committees of the General Assembly having cognizance of matters relating to public health and insurance and to the select committee of the General Assembly having cognizance of matters relating to aging, a list of those Medicare organizations that have failed to file any data, reports or information requested pursuant to subsection (e) of this section.

Sec. 2. This act shall take effect July 1, 1999.

Approved June 23, 1999

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