hb-5051

STATE OF CONNECTICUT 3 Substitute Bill No. 5051 Page 1 4 LCO No. 5 General Assembly 6 February Session, A.D., 1998 7

AN ACT CONCERNING HEALTH CARE FOR UNINSURED CHILDREN AND YOUTH. 9

Be it enacted by the Senate and House of Representatives in 11 General Assembly convened: 12 Section 1. Subsection (a) of section 6 of public act 97-1 of 13 the October 29 special session is repealed and the following is 14 substituted in lieu thereof: 15 (a) The commissioner shall, within available appropriations, 16 establish two supplemental health insurance programs, to be known 17 as HUSKY Plus programs, for enrollees of the SUBSIDIZED PORTION 18 OF THE HUSKY Plan, Part B WITH FAMILY INCOMES WHICH DO NOT EXCEED 19 THREE HUNDRED PER CENT OF THE FEDERAL POVERTY LEVEL, whose 20 medical needs cannot be accommodated within the basic benefit 21 package offered enrollees. One program shall supplement coverage 22 for those medically eligible enrollees with intensive physical 23 health needs and one shall supplement coverage for those 24 medically eligible enrollees with intensive behavioral health 25 needs. 26 Sec. 2. Subsection (a) of section 7 of public act 97-1 of the 27 October 29 special session is repealed and the following is 28 substituted in lieu thereof: 29 (a) The commissioner may require the payment of a premium or 30 copayment in connection with services provided under the HUSKY 31 Plan, Part B in accordance with the following limitations: 32 (1) Until July 1, 1999, the maximum annual aggregate cost 33 sharing for a family with an income (A) which exceeds one hundred 34 eighty-five per cent of the federal poverty level but does not 35 exceed two hundred thirty-five per cent of the federal poverty 36level shall not be more than six hundred fifty dollars, and (B) 37 which exceeds two hundred thirty-five per cent of the federal 38 poverty level but does not exceed three hundred per cent of the 39 federal poverty level shall not be more than one thousand two 40 hundred fifty dollars; 41

(2) On and after July 1, 1999, the commissioner shall submit 42

a schedule for the maximum annual aggregate cost sharing for 43 families with an income specified in subparagraphs (A) and (B) of 44 subdivision (1) of this subsection to the joint standing 45 committees of the General Assembly having cognizance of matters 46 relating to human services, public health, insurance and 47 appropriations and the budgets of state agencies. Within fifteen 48 days of receipt of such schedule, said joint standing committees 49 of the General Assembly may advise the commissioner of their 50 approval, denial or modifications, if any, of the schedule; and 51 (3) The commissioner shall require [providers under] each 52 managed care plan to monitor copayments and premiums under the 53 provisions of subdivision (1) of this subsection. 54 Sec. 3. Subsection (a) of section 15 of public act 97-1 of 55 the October 29 special session is repealed and the following is 56 substituted in lieu thereof: 57 (a) For purposes of determining eligibility for the HUSKY 58 Plan, Part B and to the extent permitted by federal law and to 59 the extent federal financial participation is available, the 60 commissioner may disregard family income. [up to sixty-five per 61 cent of the federal poverty level for the size of the family.] 62 Such disregard of family income shall allow subsidized coverage 63 for an eligible beneficiary who resides in a household with a family income of not more than three hundred per cent of the 65 federal poverty level. No such income disregard shall have the 66 effect of [reducing family income below two hundred thirty-five 67 per cent of the federal poverty level] GRANTING ELIGIBILITY FOR A 68 CHILD UNDER THE HUSKY PLAN, PART A. 69Sec. 4. Section 19a-7c of the general statutes, as amended by 70 section 90 of public act 97-2 of the June 18 special session, is 71 repealed and the following is substituted in lieu thereof: 72 (a) The Commissioner of Public Health, in consultation with 73 the Department of Social Services, may contract, within available 74 appropriations, to provide a subsidized nongroup health insurance 75 product for pregnant women who are not eligible for Medicaid and 76 have incomes under two hundred fifty per cent of the federal 77 poverty level. [The Commissioner of Public Health, in 78 consultation with the Department of Social Services, may 79 contract, within available appropriations, to provide a 80 subsidized nongroup health insurance product for children under 81 eighteen years of age who are not eligible for such medical 82 assistance and whose families have incomes under two hundred per 83 cent of the federal poverty level. For any children enrolled as 84 of December 31, 1994, in a program established by this section, 85 the commissioner shall contract within available appropriations 86 to extend the program to children up to and including age 87 seventeen who were enrolled on that date. The products] THE 88 PRODUCT shall be available to such pregnant women [and children] (1) for whom employer-based insurance is not available or (2) who 90 have employer-based insurance (A) to cover the cost of the 91 premiums, copayments and deductibles of the employer-based plan 92 provided the cost of the employer-based plan is less than the 93 nongroup product and (B) to provide coverage for benefits not 94 covered by the employer-based plan which are covered under the 95 subsidized nongroup product. The Department of Public Health may 96 make such [products] PRODUCT available to limited populations, as 97 pilot programs, initially to test the impact of program design 98 and administration. The Department of Social Services shall 99 assist in the administration of the programs. The contract may 100 include, but not be limited to, provisions for coinsurance and 101 copayment and a sliding scale based on income for premiums and 102 shall provide for the use of mechanisms to control costs. 103

(b) The contract for pregnant women shall include coverage 104 for: (1) Physician visits for diagnosis and treatment; (2) 105 prenatal and postnatal care; and (3) outpatient hospital care; 106 and may include coverage for: (A) Labor and delivery; (B) 107 laboratory and diagnostic tests; (C) prescription drugs; (D) 108 physical therapy; (E) mental health and substance abuse visits; 109 and (F) inpatient care, including mental health and substance 110 abuse treatment, subject to eighty per cent coinsurance on the 111 first two thousand five hundred dollars of expenses. 112 [(c) The contract for children shall include coverage for: 113 (1) Physician visits for diagnosis and treatment; (2) well baby 114 care, immunizations and child health supervision; (3) prenatal 115 and postnatal care; and (4) outpatient hospital care; and may 116 include coverage for: (A) Dental care; (B) laboratory and 117 diagnostic tests; (C) prescription drugs; (D) physical therapy; 118 (E) outpatient mental health and substance abuse visits; and (F) 119 inpatient care.] 120 [(d)] (c) The commissioner shall establish an outreach 121 program to ensure that eligible persons are aware of the health 122 insurance available pursuant to this section. 123 [(e)] (d) The commissioner may adopt regulations, in 124 accordance with the provisions of chapter 54, for purposes of 125 this section. 126 Sec. 5. This act shall take effect from its passage. 127

HS COMMITTEE VOTE: YEA 15 NAY 0 JFS 129