Bill Text: CT SB01154 | 2011 | General Assembly | Comm Sub
Bill Title: An Act Concerning The Reporting Of Claims Information To The Comptroller And Additional Duties Of The Comptroller.
Spectrum: Committee Bill
Status: (Introduced - Dead) 2011-05-11 - Favorable Report, Tabled for the Calendar, Senate [SB01154 Detail]
Download: Connecticut-2011-SB01154-Comm_Sub.html
General Assembly |
Raised Bill No. 1154 | ||
January Session, 2011 |
LCO No. 4396 | ||
*_____SB01154PD_PH_032311____* | |||
Referred to Committee on Insurance and Real Estate |
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Introduced by: |
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(INS) |
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AN ACT CONCERNING THE REPORTING OF CLAIMS INFORMATION TO THE COMPTROLLER AND ADDITIONAL DUTIES OF THE COMPTROLLER.
Be it enacted by the Senate and House of Representatives in General Assembly convened:
Section 1. (NEW) (Effective July 1, 2011) (a) Not later than October first annually, each municipality shall submit electronically to the Comptroller, in a form prescribed by the Comptroller, such municipality's claim information for any group health insurance policy or plan such municipality sponsors for its active employees and retirees that provides coverage of the type specified in subdivisions (1), (2), (4), (11), (12) and (16) of section 38a-469 of the general statutes.
(b) (1) Such claim information shall (A) include the information set forth in subdivision (2) of this subsection, (B) be only health information that has had identifiers removed, as set forth in 45 CFR 164.514, is not individually identifiable, as defined in 45 CFR 160.103, and is permitted to be disclosed under the Health Insurance Portability and Accountability Act of 1996, P.L. 104-191, as amended from time to time, or regulations adopted thereunder, and (C) does not disclose the identity of the insurer, health care center, hospital service corporation, medical service corporation or other entity delivering, issuing for delivery, renewing, amending or continuing such policy or plan.
(2) Each municipality shall submit to the Comptroller the following claim information for the policy or plan year immediately preceding:
(A) A list of each type of health insurance policy or plan offered to a municipality's employees and retirees and specific details for each such policy or plan, including, but not limited to:
(i) Covered benefits and any limits on such benefits;
(ii) If a municipality is fully-insured, the total premium costs for each policy or plan, organized by active employees and by retirees, and the employee share and the retiree share of each such total premium cost;
(iii) If the municipality is self-insured, the total dollar amount of claims paid by each policy or plan, organized by active employees and by retirees, and the employee share and the retiree share of each such total amount;
(iv) Employee and retiree cost-sharing requirements such as coinsurance, copayments, deductibles or other out-of-pocket expenses associated with in-network and out-of-network providers;
(v) If a municipality sponsors a prescription drug plan, the value of any rebates or cost reductions provided to such municipality for such plan; and
(vi) The claims experience related to each policy or plan;
(B) A list of the total number of employees and retirees in each policy or plan, organized by (i) municipal department, (ii) collective bargaining unit, if applicable, (iii) coverage tier, including, but not limited to, single, two-person and family including dependents, and (iv) active employee or retiree status; and
(C) For the two policy or plan years immediately preceding, the percentage increase or decrease in the policy or plan costs, calculated as the total premium costs or the total dollar amount of claims paid, as applicable, inclusive of any premiums or contributions paid by active employees and retirees, divided by the total number of active employees and retirees covered by such policy or plan.
(c) Not later than January 1, 2012, and annually thereafter, the Comptroller shall submit a report, in accordance with section 11-4a of the general statutes, to the joint standing committees of the General Assembly having cognizance of matters relating to appropriations, insurance, labor and planning and development, that provides estimated costs or savings for each municipality if such municipality obtains health insurance of the type set forth in subsection (a) of this section from the state employee plan established under subsection (m) of section 5-259 of the general statutes.
Sec. 2. (NEW) (Effective from passage) (a) The Comptroller shall convene a group including, but not limited to, (1) health insurance companies, health care centers, hospital service corporations, medical service corporations or other entities delivering, issuing for delivery, renewing, amending or continuing a health insurance policy or plan of the type set forth in subsection (a) of section 1 of this act, (2) employers, (3) health care providers, (4) health care facilities, and (5) consumers, to facilitate the development and establishment of health care provider payment reforms, including, but not limited to, multipayer initiatives, accountable care organizations, patient-centered medical homes, primary care case management, value-based purchasing and bundled purchasing. Any participation by such entities and individuals shall be on a voluntary basis.
(b) (1) The Comptroller or the Comptroller's designee may (A) conduct a survey of health insurance companies or other entities specified in subdivision (1) of subsection (a) of this section, employers, health care providers and health care facilities concerning payment delivery reforms, and (B) convene meetings at a time and place that is convenient for the entities and individuals set forth in subsection (a) of this section.
(2) The Comptroller or the Comptroller's designee shall ensure that any such survey or meeting shall not solicit, share or discuss pricing information.
(3) Any such survey conducted or meeting held pursuant to this section shall not be: (A) A violation of chapter 624 of the general statutes; or (B) subject to disclosure under section 1-210 of the general statutes.
Sec. 3. Section 19a-654 of the general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2011):
(a) [The Office of Health Care Access division of the Department of Public Health shall require] Each short-term acute care general or children's [hospitals to] hospital and each licensed out-patient surgical facility shall submit such data, including inpatient data, out-patient data, if any, and discharge data [, as it deems] necessary to fulfill the responsibilities of the [office] Office of Health Care Access division of the Department of Public Health. Such data shall include data taken from medical record abstracts and hospital bills. The timing and format of such submission shall be specified by the office. The data may be submitted through a contractual arrangement with an intermediary. If the data is submitted through an intermediary, the hospital shall ensure that such submission is timely and that the data is accurate. The office may conduct an audit of the data submitted to such intermediary in order to verify its accuracy. Individual patient and physician data identified by proper name or personal identification code submitted pursuant to this section shall be kept confidential, but aggregate reports from which individual patient and physician data cannot be identified shall be available to the public.
(b) Not later than October 1, 2011, the Office of Health Care Access shall enter into a memorandum of understanding with the Comptroller that shall permit the Comptroller to access the data set forth in subsection (a) of this section, provided the Comptroller agrees in writing to keep individual patient and physician data identified by proper name or personal identification code and submitted pursuant to this section confidential.
This act shall take effect as follows and shall amend the following sections: | ||
Section 1 |
July 1, 2011 |
New section |
Sec. 2 |
from passage |
New section |
Sec. 3 |
July 1, 2011 |
19a-654 |
INS |
Joint Favorable C/R |
PD |
PD |
Joint Favorable C/R |
PH |