SB 10 — AN ACT PROMOTING ACCESS TO AFFORDABLE PRESCRIPTION DRUGS, HEALTH CARE COVERAGE, TRANSPARENCY IN HEALTH CARE COSTS, HOME AND COMMUNITY-BASED SUPPORT FOR VULNERABLE PERSONS AND RIGHTS REGARDING GENDER IDENTITY AND EXPRESSION.

The Comptroller may LCOdraw {\\PRDFS1\SCOUSERS\ANTONAKOSM\WS\2023SB-his 11order ofon 48the 00010-R03-SB.docxTreasurer }for Substitutea Billpetty cash fund for any budgeted sSB10 / File No.

10735 draw11 hissSB10 orderFile onNo. the Treasurer for a petty cash fund for any budgeted agency.Expendituresfromsuchpettycashfundsshallbesubjecttosuch procedures as the Comptroller establishes.

735 agency.Expendituresfromsuchpettycashfundsshallbesubjecttosuch procedures as the Comptroller establishes.

LCO(2) {\\PRDFS1\SCOUSERS\ANTONAKOSM\WS\2023SB-12"Anti-steering clause" means a provision of 48a 00010-R03-SB.docxhealth }care Substitutecontract Billthat restricts the ability of the health insurance carrier or health plan sSB10 / File No.

10735 (2)12 "Anti-steeringsSB10 clause"File meansNo. a provision of a health care contract that restricts the ability of the health insurance carrier or health plan administrator from encouraging an enrollee to obtain a health care service from a competitor of the hospital or health system, including offering incentives to encourage enrollees to utilize specific health care providers.

735 administrator from encouraging an enrollee to obtain a health care service from a competitor of the hospital or health system, including offering incentives to encourage enrollees to utilize specific health care providers.

LCO(b) {\\PRDFS1\SCOUSERS\ANTONAKOSM\WS\2023SB-(1) 13Each ofcontract 48entered 00010-R03-SB.docxinto, }renewed Substituteor Billamended No.on or after January 1, 2017, between a health carrier and a participating provider shall include:

10sSB10 (b)/ (1)File EachNo. contract entered into, renewed or amended on or after January 1, 2017, between a health carrier and a participating provider shall include:

(A)735 A13 holdsSB10 harmlessFile provisionNo. that specifies protections for covered persons.

735 (A) A hold harmless provision that specifies protections for covered persons.

(B) A provision that in the event of a health carrier or intermediary insolvency or other cessation of operations, the participating provider's obligation to deliver covered health care services to covered persons without requesting payment from a covered person other than a coinsurance, copayment, deductible or other out-of-pocket expense for such services will continue until the earlier of (i) the termination of the covered person's coverage under the network plan, including any extension of coverage provided under the contract terms or applicable LCOstate {\\PRDFS1\SCOUSERS\ANTONAKOSM\WS\2023SB-14or federal law for covered persons who are in an active course of 48treatment, 00010-R03-SB.docxas }set Substituteforth Billin subdivision (2) of subsection (g) of section 38a- 472f, or are totally disabled, or (ii) the date the contract between the health carrier and the participating provider would have terminated if the health carrier or intermediary had remained in operation, including sSB10 / File No.

10735 state14 orsSB10 federalFile lawNo. for covered persons who are in an active course of treatment, as set forth in subdivision (2) of subsection (g) of section 38a- 472f, or are totally disabled, or (ii) the date the contract between the health carrier and the participating provider would have terminated if the health carrier or intermediary had remained in operation, including any extension of coverage required under applicable state or federallaw for covered persons who are in an active course of treatment or are totally disabled;

735 any extension of coverage required under applicable state or federallaw for covered persons who are in an active course of treatment or are totally disabled;

(2) The contract terms set forth in subparagraphs (A) and (B) of subdivision (1) of this subsection shall (A) be construed in favor of the covered person, (B) survive the termination of the contract regardless of the reason for the termination, including the insolvency of the health carrier, and (C) supersede any oral or written agreement between a LCOhealth {\\PRDFS1\SCOUSERS\ANTONAKOSM\WS\2023SB-care 15provider ofand 48a 00010-R03-SB.docxcovered }person Substituteor Billa No.covered person's authorized representative that is contrary to or inconsistent with the requirements set forth in subdivision (1) of this subsection.

10(3) healthNo carecontract providersubject andto athis coveredsubsection personshall orinclude aany coveredprovision person's authorized representative that isconflicts contrarywith tothe orprovisions inconsistentcontained within the requirementsnetwork setplan forthor insSB10 subdivision/ (1)File ofNo. this subsection.

(3)735 No15 contractsSB10 subjectFile toNo. this subsection shall include any provision that conflicts with the provisions contained in the network plan or required under this section, section 38a-472f or section 38a-477h.

735 required under this section, section 38a-472f or section 38a-477h.

or (B) If such contract is entered into, renewed or amended on or after July 1, 2022, provide to a participating provider at least ninety days' advance written notice of any change to the provisions or other documents specified under subparagraph (A) of subdivision (1) of this subsection, and any change to the provider manuals and policies LCOspecified {\\PRDFS1\SCOUSERS\ANTONAKOSM\WS\2023SB-16under subparagraph (B) of 48subdivision 00010-R03-SB.docx(1) }of Substitutethis Billsubsection, No.that will result in a material change to such contract or the procedures that a participating provider must follow pursuant to such contract.

10 specified under subparagraph (B) of subdivision (1) of this subsection, that will result in a material change to such contract or the procedures that a participating provider must follow pursuant to such contract.

(B)sSB10 Each/ intermediaryFile andNo. participating providers with whom such intermediary contracts shall comply with the applicable requirements of this subsection.

735 16 sSB10 File No.

735 (B) Each intermediary and participating providers with whom such intermediary contracts shall comply with the applicable requirements of this subsection.

(5) (A) Each intermediary shall, if applicable, (i) transmit to the health carrier documentation of health care services utilization and claims paid, and (ii) maintain at its principal place of business in this state, for a period of time prescribed by the commissioner, the books, records, financial information and documentation of health care services received by covered persons, in a manner that facilitates regulatory LCOreview, {\\PRDFS1\SCOUSERS\ANTONAKOSM\WS\2023SB-and 17shall ofallow 48the 00010-R03-SB.docxcommissioner }access Substituteto Billsuch No.books, records, financial information and documentation as necessary for the commissioner to determine compliance with this section and section 38a-472f.

10 review, and shall allow the commissioner access to such books, records, financial information and documentation as necessary for the commissioner to determine compliance with this section and section 38a-472f.

(6)sSB10 In/ theFile eventNo. of the intermediary's insolvency, a health carrier shall have the right to require the assignment to the health carrier of the provisions of a participating provider's contract that address such participating provider's obligation to provide covered benefits.

735 17 sSB10 File No.

735 (6) In the event of the intermediary's insolvency, a health carrier shall have the right to require the assignment to the health carrier of the provisions of a participating provider's contract that address such participating provider's obligation to provide covered benefits.

LCO(3) {\\PRDFS1\SCOUSERS\ANTONAKOSM\WS\2023SB-18An ofanti-tiering 48clause; 00010-R03-SB.docx } Substitute Bill No.

10 (3) An anti-tiering clause;

(h)sSB10 Nothing/ inFile thisNo. section shall be construed to prohibit value-based care.

735 18 sSB10 File No.

735 (h) Nothing in this section shall be construed to prohibit value-based care.

The commissioner shall include in the fee schedule not less than LCOtwo {\\PRDFS1\SCOUSERS\ANTONAKOSM\WS\2023SB-19licensed ofclinical 48social 00010-R03-SB.docxworker }visits Substituteto Billeach No.individual enrolled in the Connecticut home-care program for the elderly or any home and community-based Medicaid waiver program administered by the Department of Social Services.

10The twocommissioner licensedmay clinicalincrease socialany workerfee visitspayable to eacha individualhome enrolledhealth incare theagency Connecticut home-care program for the elderly or any home andhealth community-basedaide Medicaidagency waiverupon programtheapplicationofsuch administeredanagency byevidencing theextraordinary Departmentcostsrelated ofto Social(1)serving Services.personswithAIDS;(2)high-risk maternalandchildhealth care;

The commissioner may increase any fee payable to a home health care agency or home health aide agency upon theapplicationofsuch anagency evidencing extraordinary costsrelated to (1)serving personswithAIDS;(2)high-risk maternaland childhealth care;

A home health care agency or home health aide agency which, duesSB10 to/ anyFile materialNo. change in circumstances, is aggrieved by a rate determined pursuant to this subsection may, within ten days of receipt of written notice of such rate from the Commissioner of Social Services, request in writing a hearing on all items of aggrievement.

735 19 sSB10 File No.

735 due to any material change in circumstances, is aggrieved by a rate determined pursuant to this subsection may, within ten days of receipt of written notice of such rate from the Commissioner of Social Services, request in writing a hearing on all items of aggrievement.

(3) prenatal, birth, lactation and postpartum LCOsupports; {\\PRDFS1\SCOUSERS\ANTONAKOSM\WS\2023SB-20 of 48 00010-R03-SB.docx } Substitute Bill No.

10 supports;

(c) The commissioner and the commissioner's designees shall consult with certified community health workers and others throughout the design and implementation of the certified community health worker reimbursement program in a manner that (1) is inclusive of community- basedsSB10 and/ clinic-basedFile certifiedNo. community health workers;

735 20 sSB10 File No.

735 based and clinic-based certified community health workers;

(1) Developing and implementing a comprehensive and cohesive LCOhealth {\\PRDFS1\SCOUSERS\ANTONAKOSM\WS\2023SB-21care ofvision 48for 00010-R03-SB.docxthe }state, Substituteincluding, Billbut No.not limited to, a coordinated state health care cost containment strategy;

10 health care vision for the state, including, but not limited to, a coordinated state health care cost containment strategy;

(4)sSB10 (A)/ CoordinatingFile theNo. state's health information technology initiatives, (B) seeking funding for and overseeing the planning, implementation and development of policies and procedures for the administration of the all-payer claims database program established under section 19a-775a, (C) establishing and maintaining a consumer health information Internet web site under section 19a-755b, and (D) designating an unclassified individual from the office to perform the duties of a health information technology officer as set forth in sections 17b-59f and 17b-59g;

735 21 sSB10 File No.

735 (4) (A) Coordinating the state's health information technology initiatives, (B) seeking funding for and overseeing the planning, implementation and development of policies and procedures for the administration of the all-payer claims database program established under section 19a-775a, (C) establishing and maintaining a consumer health information Internet web site under section 19a-755b, and (D) designating an unclassified individual from the office to perform the duties of a health information technology officer as set forth in sections 17b-59f and 17b-59g;

[and] (8) (A) Setting an annual health care cost growth benchmark and primary care spending target pursuant to section 19a-754g, (B) LCOdeveloping {\\PRDFS1\SCOUSERS\ANTONAKOSM\WS\2023SB-22and adopting health care quality benchmarks pursuant to section 19a-754g, (C) developing strategies, in consultation with stakeholders, to meet such benchmarks and targets developed pursuant to section 19a-754g, (D) enhancing the transparency of 48provider 00010-R03-SB.docxentities, }as Substitutedefined Billin No.subdivision (13) of section 19a-754f, (E) monitoring the development of accountable care organizations and patient-centered medical homes in the state, and (F) monitoring the adoption of alternative payment methodologies in the state;

10 developing and adopting(9) healthConvening careforums qualityand benchmarksmeetings pursuant to section 19a-754g, (C) developing strategies, in consultation with stakeholders,Access toHealth meetConnecticut, suchthe benchmarksDepartment andof targetsPublic developedHealth, pursuant to section 19a-754g, (D) enhancing the transparencybirth-to-three ofprogram, provider entities, as defined in subdivision (13) of section 19a-754f,17a-248, (E)state monitoringhome thevisiting developmentprograms, ofcommunity accountableaction caresSB10 organizations/ andFile patient-centeredNo. medical homes in the state, and (F) monitoring the adoption of alternative payment methodologies in the state;

and735 (9)22 ConveningsSB10 forumsFile andNo. meetings with Access Health Connecticut, the Department of Public Health, the birth-to-three program, as defined in section 17a-248, state home visiting programs, community action agencies, hospitals, community health centers and other state government and external stakeholders to align community health worker programsfundedby thestate medical assistance program,block grants, health care providers, private insurance carriers and other external stakeholders.

735 agencies, hospitals, community health centers and other state government and external stakeholders to align community health worker programsfundedby thestate medical assistance program,block grants, health care providers, private insurance carriers and other external stakeholders.

(b) Not later than thirty days after the effective date of this section, the commissioner shall amend the waiver submitted in accordance with subsection (a) of this section, to the extent permissible under federal law and in accordance with section 17b-8, to provide coverage through the Covered Connecticut program to persons otherwise qualified for the LCOprogram {\\PRDFS1\SCOUSERS\ANTONAKOSM\WS\2023SB-23whose ofincome 48does 00010-R03-SB.docxnot }exceed Substitutetwo Billhundred No.per cent of the federal poverty level.

10 program whose income does not exceed two hundred per cent of the federal poverty level.

(NEW) (Effective from passage) (a) Not later than sixty days after the effective date of this section, the Commissioner of Social Services, in consultation with the Insurance Commissioner and the executive director of the Office of Health Strategy established under section 19a-754a of the general statutes, as amended by this act, shall develop a plan for a second tier of the Covered Connecticut program establishedpursuanttosection19a-754cofthegeneralstatutes.Theplan shall provide state-assisted health care coverage for persons otherwise qualifiedsSB10 for/ theFile programNo. whose income exceeds two hundred per cent of the federal poverty level but does not exceed three hundred per cent of the federal poverty level.

735 23 sSB10 File No.

735 qualified for the program whose income exceeds two hundred per cent of the federal poverty level but does not exceed three hundred per cent of the federal poverty level.

If the joint standing committees advise the commissioner of their denial of approval, the LCOcommissioner {\\PRDFS1\SCOUSERS\ANTONAKOSM\WS\2023SB-24shall ofnot 48implement 00010-R03-SB.docxthe }plan. Substitute Bill No.

10 commissioner shall not implement the plan.

If the joint standing committees accept the report, the committee having cognizance of matters relating to appropriations and the budgets of state agencies shalladvisesSB10 thecommissioneroftheirapproval,denialormodifications,/ ifFile any,No. of the commissioner's plan.

735 24 sSB10 File No.

735 shalladvise thecommissioneroftheirapproval,denialormodifications, if any, of the commissioner's plan.

(2) Commission surveys of individuals, small employers and health LCOcare {\\PRDFS1\SCOUSERS\ANTONAKOSM\WS\2023SB-25providers ofon 48issues 00010-R03-SB.docxrelated }to Substitutehealth Billcare No.and health care coverage;

10 care providers on issues related to health care and health care coverage;

(6) Maintain an Internet web site through which enrollees and prospective enrollees of qualified health plans may obtain standardized comparativesSB10 informationonsuchplansincluding,but/ notFile limitedto,theNo. enrollee satisfaction survey information under Section 1311(c)(4) of the Affordable Care Act and any other information or tools to assist enrollees and prospective enrollees evaluate qualified health plans offered through the exchange;

735 25 sSB10 File No.

735 comparative informationonsuchplansincluding,but not limitedto,the enrollee satisfaction survey information under Section 1311(c)(4) of the Affordable Care Act and any other information or tools to assist enrollees and prospective enrollees evaluate qualified health plans offered through the exchange;

LCO(10) {\\PRDFS1\SCOUSERS\ANTONAKOSM\WS\2023SB-26Inform individuals, in accordance with Section 1413 of 48the 00010-R03-SB.docxAffordable }Care SubstituteAct, Billof No.eligibility requirements for the Medicaid program under Title XIX of the Social Security Act, as amended from time to time, the Children's Health Insurance Program (CHIP) under Title XXI of the Social Security Act, as amended from time to time, or any applicable state or local public program, and enroll an individual in such program if the exchange determines, through screening of the application by the exchange, that such individual is eligible for any such program;

10(11) (10)Collaborate Inform individuals, in accordance with Section 1413 of the AffordableDepartment Care Act, of eligibilitySocial requirementsServices, forto the Medicaidextent programpossible, underto Titleallow XIXan ofenrollee thewho Socialloses Securitypremium Act,tax ascredit amendedeligibility from time to time, the Children's Health Insurance Program (CHIP) under TitleSection XXI36B of the SocialInternal SecurityRevenue Act,Code asand amendedis fromeligible timefor toHUSKY time,A or any applicableother state or local public program, andto enrollremain anenrolled individualsSB10 in/ suchFile programNo. if the exchange determines, through screening of the application by the exchange, that such individual is eligible for any such program;

(11)735 Collaborate26 withsSB10 theFile DepartmentNo. of Social Services, to the extent possible, to allow an enrollee who loses premium tax credit eligibility under Section 36B of the Internal Revenue Code and is eligible for HUSKY A or any other state or local public program, to remain enrolled in a qualified health plan;

735 in a qualified health plan;

(15) Grant a certification, subject to Section 1411 of the Affordable Care Act, attesting that, for purposes of the individual responsibility penalty under Section 5000A of the Internal Revenue Code, an individual is exempt from the individual responsibility requirement or LCOfrom {\\PRDFS1\SCOUSERS\ANTONAKOSM\WS\2023SB-27the ofpenalty 48imposed 00010-R03-SB.docxby }said SubstituteSection Bill5000A No.because:

10 from the penalty imposed by said Section 5000A because:

(B) The name and taxpayer identification number of each individual whosSB10 was/ anFile employeeNo. of an employer but who was determined to be eligible for the premium tax credit under Section 36B of the Internal Revenue Code because:

735 27 sSB10 File No.

735 who was an employee of an employer but who was determined to be eligible for the premium tax credit under Section 36B of the Internal Revenue Code because:

(17) Provide to each employer the name of each employee, as LCOdescribed {\\PRDFS1\SCOUSERS\ANTONAKOSM\WS\2023SB-28in subparagraph (B) of 48subdivision 00010-R03-SB.docx(16) }of Substitutethis Billsection, No.of the employer who ceases coverage under a qualified health plan during a plan year and the effective date of the cessation;

10 described in subparagraph (B) of subdivision (16) of this section, of the employer who ceases coverage under a qualified health plan during a plan year and the effective date of the cessation;

(B) Distribute fair and impartial information concerning enrollment insSB10 qualified/ healthFile plansNo. and the availability of premium tax credits under Section 36B of the Internal Revenue Code and cost-sharing reductions under Section 1402 of the Affordable Care Act;

735 28 sSB10 File No.

735 in qualified health plans and the availability of premium tax credits under Section 36B of the Internal Revenue Code and cost-sharing reductions under Section 1402 of the Affordable Care Act;

(20) Review the rate of premium growth within and outside the exchange and consider such information in developing LCOrecommendations {\\PRDFS1\SCOUSERS\ANTONAKOSM\WS\2023SB-29on ofwhether 48to 00010-R03-SB.docxcontinue }limiting Substitutequalified Billemployer No.status to small employers;

10 recommendations on whether to continue limiting qualified employer status to small employers;

(B) Individuals and entities with experience in facilitating enrollment insSB10 qualified/ healthFile plans;No.

735 29 sSB10 File No.

735 in qualified health plans;

LCO(i) {\\PRDFS1\SCOUSERS\ANTONAKOSM\WS\2023SB-30Investigate ofthe 48affairs 00010-R03-SB.docxof }the Substituteexchange; Bill No.

10 (i) Investigate the affairs of the exchange;

(24) (A) Seek to include the most comprehensive health benefit plans that offer high quality benefits at the most affordable price in the exchange, (B) encourage health carriers to offer tiered health care provider network plans that have different cost-sharing rates for different health care provider tiers and reward enrollees for choosing low-cost,sSB10 high-quality/ healthFile careNo. providers by offering lower copayments, deductibles or other out-of-pocket expenses, and (C) offer any such tiered health care provider network plans through the exchange;

735 30 sSB10 File No.

735 low-cost, high-quality health care providers by offering lower copayments, deductibles or other out-of-pocket expenses, and (C) offer any such tiered health care provider network plans through the exchange;

[and] (26) Consult with the Commissioner of Social Services, Insurance Commissioner and Office of Health Strategy, established under section LCO19a-754a, {\\PRDFS1\SCOUSERS\ANTONAKOSM\WS\2023SB-31as ofamended 48by 00010-R03-SB.docxthis }act, Substitutefor Billthe No.purposes set forth in section 19a-754c;

10 19a-754a, as amended by this act, for the purposes set forth in section 19a-754c;

Anyreturnorreturninformationdisclosed by the Commissioner of Revenue Services shall not be redisclosed by thesSB10 recipient/ toFile aNo. thirdparty without permission from the commissioner and shall only be used by the exchange in the manner prescribed in the memorandum of understanding.

735 31 sSB10 File No.

735 the recipient to a thirdparty without permission from the commissioner and shall only be used by the exchange in the manner prescribed in the memorandum of understanding.

LCO(a) {\\PRDFS1\SCOUSERS\ANTONAKOSM\WS\2023SB-32To protect the integrity and accuracy of 48vital 00010-R03-SB.docxrecords, }a Substitutecertificate Billregistered No.under chapter 93 may be amended only in accordance with sections 19a-41 to 19a-45, inclusive, chapter 93, regulations adopted by the Commissioner of Public Health pursuant to chapter 54 and uniform procedures prescribed by the commissioner.

10 (a) To protect the integrity and accuracy of vital records, a certificate registered under chapter 93 may be amended only in accordance with sections 19a-41 to 19a-45, inclusive, chapter 93, regulations adopted by the Commissioner of Public Health pursuant to chapter 54 and uniform procedures prescribed by the commissioner.

(b) The commissioner and the registrar of vital statistics shall maintain sufficient documentation, as prescribed by the commissioner, tosSB10 support/ amendmentsFile andNo. shall ensure the confidentiality of such documentation as required by law.

735 32 sSB10 File No.

735 to support amendments and shall ensure the confidentiality of such documentation as required by law.

(c) An amended certificate shall supersede the original certificate that LCOhas {\\PRDFS1\SCOUSERS\ANTONAKOSM\WS\2023SB-33been ofchanged 48and 00010-R03-SB.docxshall }be Substitutemarked Bill"Amended", No.except for amendments [due to] concerning parentage, [or] gender change or the legally changed name of a parent.

10 has been changed and shall be marked "Amended", except for amendments [due to] concerning parentage, [or] gender change or the legally changed name of a parent.

(d)(1)Uponreceipt of(A)anacknowledgment ofparentage executed in accordance with the provisions of sections 46b-476 to 46b-487, inclusive, by both parents of a child, or (B) a certified copy of an order of a court of competent jurisdiction establishing the parentage of achild, the commissioner shall include on or amend, as appropriate, such child's birth certificate to show such parentage if parentage is not already shown on such birth certificate and to change the name of the childunder eighteenyearsofage ifso indicatedontheacknowledgment ofsSB10 parentage/ formFile orNo. within the certified court order as part of the parentage action.

735 33 sSB10 File No.

735 of parentage form or within the certified court order as part of the parentage action.

The commissioner shall thereafter amend such child's birth LCOcertificate {\\PRDFS1\SCOUSERS\ANTONAKOSM\WS\2023SB-34to remove or change the name of 48the 00010-R03-SB.docxparent }other Substitutethan Billthe No.person who gave birth and, if relevant, to change the name of the child, as requested at the time of the filing of a rescission, in accordance with the provisions of section 46b-570.

10 certificate to remove or change the name of the parent other than the person who gave birth and, if relevant, to change the name of the child, as requested at the time of the filing of a rescission, in accordance with the provisions of section 46b-570.

(g)sSB10 When/ anFile applicantNo. submits the documentation required by the regulations to amend a vital record, the commissioner shall hold a hearing, in accordance with chapter 54, if the commissioner has reasonable cause to doubt the validity or adequacy of such documentation.

735 34 sSB10 File No.

735 (g) When an applicant submits the documentation required by the regulations to amend a vital record, the commissioner shall hold a hearing, in accordance with chapter 54, if the commissioner has reasonable cause to doubt the validity or adequacy of such documentation.

LCO(i) {\\PRDFS1\SCOUSERS\ANTONAKOSM\WS\2023SB-35The commissioner shall issue a new birth certificate to reflect a gender change upon receipt of 48the 00010-R03-SB.docxfollowing }documents Substitutesubmitted Billin No.the form and manner prescribed by the commissioner:

10 (i) The commissioner shall issue a new birth certificate to reflect a gender change upon receipt of the following documents submitted in the form and manner prescribed by the commissioner:

(j)sSB10 The/ commissionerFile shallNo. issue a new birth certificate to reflect the legally changed name of a parent of the child who is the subject of such birth certificate upon receipt of the following documents, submitted in a form and manner prescribed by the commissioner:

735 35 sSB10 File No.

735 (j) The commissioner shall issue a new birth certificate to reflect the legally changed name of a parent of the child who is the subject of such birth certificate upon receipt of the following documents, submitted in a form and manner prescribed by the commissioner:

(1) A written request from the applicant, signed under penalty of law, for a replacement marriage certificate to reflect that the applicant's gender LCOdiffers {\\PRDFS1\SCOUSERS\ANTONAKOSM\WS\2023SB-36from ofthe 48sex 00010-R03-SB.docxdesignated }on Substitutethe Billoriginal No.marriage certificate, along with an affirmation that the marriage is still legally intact;

10 differs from the sex designated on the original marriage certificate, along with an affirmation that the marriage is still legally intact;

(NEW) (Effective from passage) (a) For purposes of this section, "inmate"sSB10 and/ "prisoner"File haveNo. the same meanings as provided in section 18-84 of the general statutes.

735 36 sSB10 File No.

735 "inmate" and "prisoner" have the same meanings as provided in section 18-84 of the general statutes.

LCOAny {\\PRDFS1\SCOUSERS\ANTONAKOSM\WS\2023SB-inmate 37of a correctional institution, as described in section 18-78, who has a gender identity that differs from the inmate's assigned sex at birth and has a diagnosis of 48gender 00010-R03-SB.docxdysphoria, }as Substituteset Billforth No.in the most recent editionoftheAmericanPsychiatricAssociation's"Diagnostic and Statistical Manual of Mental Disorders" or gender incongruence, as defined in the 11 revision of the "International Statistical Classification of Diseases and Related Health Problems", shall:

10 Any inmate of a correctional institution, as described in section 18-78, who has a gender identity that differs from the inmate's assigned sex at birth and has a diagnosis of gender dysphoria, as set forth in the most recent editionoftheAmericanPsychiatricAssociation's"Diagnostic and Statistical Manual of Mental Disorders" or gender incongruence, as defined in the 11 revision of the "International Statistical Classification of Diseases and Related Health Problems", shall:

In making determinations pursuant to this section, the inmate's views with respect tosSB10 his/ orFile herNo. safety shall be given serious consideration by the Commissioner of Correction, or the commissioner's designee.

735 37 sSB10 File No.

735 to his or her safety shall be given serious consideration by the Commissioner of Correction, or the commissioner's designee.

(1) "Reproductive health care services" includes all medical, surgical, counseling or referral services relating to the human reproductive system, including, but not limited to, services relating to pregnancy, contraception or the termination of a pregnancy and all medical care relating to treatment of gender dysphoria as set forth in the most recent edition of the American Psychiatric Association's "Diagnostic and LCOStatistical {\\PRDFS1\SCOUSERS\ANTONAKOSM\WS\2023SB-Manual 38of Mental Disorders" and gender incongruence, as th defined in the 11 revision of 48the 00010-R03-SB.docx"International }Statistical SubstituteClassification Billof No.Diseases and Related Health Problems";

10 Statistical Manual of Mental Disorders" and gender incongruence, as defined in the 11 revision of the "International Statistical Classification of Diseases and Related Health Problems";

(c)sSB10 The/ provisionsFile ofNo. this section shall not apply to a judgment entered in another state that is based on:

735 38 sSB10 File No.

735 (c) The provisions of this section shall not apply to a judgment entered in another state that is based on:

LCOSec. {\\PRDFS1\SCOUSERS\ANTONAKOSM\WS\2023SB-39 of 48 00010-R03-SB.docx } Substitute Bill No.

10 Sec.

(b) When any person has had a judgment entered against such person, in any state, where liability, in whole or in part, is based on the alleged provision, receipt, assistance in receipt or provision, material supportsSB10 for,/ orFile anyNo. theory of vicarious, joint, several or conspiracy liability derived therefrom, for reproductive health care services and gender-affirming health care services that are permitted under the laws of this state, such person may recover damages from any party that broughttheactionleadingtothatjudgmentorhassoughttoenforcethat judgment.

735 39 sSB10 File No.

735 support for, or any theory of vicarious, joint, several or conspiracy liability derived therefrom, for reproductive health care services and gender-affirming health care services that are permitted under the laws of this state, such person may recover damages from any party that broughttheactionleadingtothatjudgmentorhassoughttoenforcethat judgment.

(c) The provisions of this section shall not apply to a judgment LCOentered {\\PRDFS1\SCOUSERS\ANTONAKOSM\WS\2023SB-40in ofanother 48state 00010-R03-SB.docxthat }is Substitutebased Billon: No.

10 entered in another state that is based on:

(A) Appoint a temporary guardian, temporary custodian, guardian, coguardian, permanent guardian or statutory parent, (B) remove a guardian, including the appointment of anothersSB10 guardian,/ (C)File reinstate a parent as guardian, (D) terminate parental rights, including the appointment of a guardian or statutory parent, (E) grant visitation, (F) make findings regarding special immigrant juvenile status, (G) approve placement of a child for adoption outside this state, (H) approve an adoption, (I) validate a foreign adoption, (J) review, modify or enforce a cooperative postadoption agreement, (K) review an order concerning contact between an adopted child and his or her siblings, (L) resolve a dispute concerning a standby guardian, (M) approve a plan for voluntary services provided by the Department of Children and Families, (N) determine whether the termination of voluntary services provided by the Department of Children and Families is in accordance with applicable regulations, (O) conduct an in-court review to modify an LCO {\\PRDFS1\SCOUSERS\ANTONAKOSM\WS\2023SB-41 of 48 00010-R03-SB.docx } Substitute Bill No.

10735 order,40 (P)sSB10 grantFile emancipation,No. (Q) grant approval to marry, (R) transfer funds to a custodian under sections 45a-557 to 45a-560b, inclusive, (S) appoint a successor custodian under section 45a-559c, (T) resolve a dispute concerning custodianship under sections 45a-557 to 45a-560b, inclusive, and (U) grant authority to purchase real estate;

735 another guardian, (C) reinstate a parent as guardian, (D) terminate parental rights, including the appointment of a guardian or statutory parent, (E) grant visitation, (F) make findings regarding special immigrant juvenile status, (G) approve placement of a child for adoption outside this state, (H) approve an adoption, (I) validate a foreign adoption, (J) review, modify or enforce a cooperative postadoption agreement, (K) review an order concerning contact between an adopted child and his or her siblings, (L) resolve a dispute concerning a standby guardian, (M) approve a plan for voluntary services provided by the Department of Children and Families, (N) determine whether the termination of voluntary services provided by the Department of Children and Families is in accordance with applicable regulations, (O) conduct an in-court review to modify an order, (P) grant emancipation, (Q) grant approval to marry, (R) transfer funds to a custodian under sections 45a-557 to 45a-560b, inclusive, (S) appoint a successor custodian under section 45a-559c, (T) resolve a dispute concerning custodianship under sections 45a-557 to 45a-560b, inclusive, and (U) grant authority to purchase real estate;

(A) Appoint a temporary conservator, conservator or special limited conservator, (B) change residence, terminate a tenancy or lease, sell or dispose household furnishings,sSB10 or/ placeFile inNo. a long-term care facility, (C) determine competency to vote, (D) approve a support allowance for a spouse, (E) grantauthoritytoelectthespousalshare,(F)grantauthoritytopurchase real estate, (G) give instructions regarding administration of a joint asset or liability, (H) distribute gifts, (I) grant authority to consent to involuntary medication, (J) determine whether informed consent has been given for voluntary admission to a hospital for psychiatric disabilities, (K) determine life-sustaining medical treatment, (L) transfer to or from another state, (M) modify the conservatorship in connection with a periodic review, (N) excuse accounts under rules of procedure approved by the Supreme Court under section 45a-78, (O) terminate the conservatorship, and (P) grant a writ of habeas corpus;

LCO735 {\\PRDFS1\SCOUSERS\ANTONAKOSM\WS\2023SB-41 42sSB10 ofFile 48 00010-R03-SB.docx } Substitute Bill No.

10735 (8)furnishings, Withor respectplace in a long-term care facility, (C) determine competency to vote, (D) approve a powersupport allowance for a spouse, (E) grantauthoritytoelectthespousalshare, (F)grantauthoritytopurchase real estate, (G) give instructions regarding administration of attorney:a joint asset or liability, (H) distribute gifts, (I) grant authority to consent to involuntary medication, (J) determine whether informed consent has been given for voluntary admission to a hospital for psychiatric disabilities, (K) determine life-sustaining medical treatment, (L) transfer to or from another state, (M) modify the conservatorship in connection with a periodic review, (N) excuse accounts under rules of procedure approved by the Supreme Court under section 45a-78, (O) terminate the conservatorship, and (P) grant a writ of habeas corpus;

(8) With respect to a power of attorney:

(A) Commit an individual forsSB10 treatment,/ (B)File issueNo. a warrant for examination of an individual at a general hospital, (C) determine whether there is probable cause to continue an involuntary confinement, (D) review an involuntary confinement for possible release, (E) authorize shock therapy, (F) authorize medication for treatment of psychiatric disability, (G) review the status of an individual under the age of sixteen as a voluntary patient, and (H) recommit an individual under the age of sixteen for further treatment;

735 42 sSB10 File No.

735 for treatment, (B) issue a warrant for examination of an individual at a general hospital, (C) determine whether there is probable cause to continue an involuntary confinement, (D) review an involuntary confinement for possible release, (E) authorize shock therapy, (F) authorize medication for treatment of psychiatric disability, (G) review the status of an individual under the age of sixteen as a voluntary patient, and (H) recommit an individual under the age of sixteen for further treatment;

LCO(14) {\\PRDFS1\SCOUSERS\ANTONAKOSM\WS\2023SB-43With ofrespect 48to 00010-R03-SB.docxtuberculosis: } Substitute Bill No.

10 (14) With respect to tuberculosis:

[(22)]sSB10 (21)/ CompelFile theNo. board of a cemetery association to disclose the minutes of the annual meeting;

735 43 sSB10 File No.

735 [(22)] (21) Compel the board of a cemetery association to disclose the minutes of the annual meeting;

and [(27)] (26) With respect to any case in a Probate Court other than a LCOdecedent's {\\PRDFS1\SCOUSERS\ANTONAKOSM\WS\2023SB-estate: 44 of 48 00010-R03-SB.docx } Substitute Bill No.

10 decedent's estate:

(Effective from passage) (a) As used in this section, "gender- affirming procedure" means a medical procedure or treatment to alter the physical characteristics of a person diagnosed with (1) gender dysphoria, as described in the most recent edition of the American Psychiatric Association's "Diagnostic and Statistical Manual of Mental th Disorders", or (2) gender incongruence, as defined in the 11 revision of the "International Statistical Classification of Diseases and Related Health Problems", in a manner consistent with such person's gender identity.

The working group shall consist of (1) six health care providers who treat persons seeking gender- affirmingsSB10 proceduresor/ personswhoFile haveNo. hadsuchprocedures,(2)two HUSKY Health program members who have had such procedures, and (3) the commissioner or the commissioner's designee.

735 44 sSB10 File No.

735 affirming proceduresor personswho have hadsuchprocedures,(2)two HUSKY Health program members who have had such procedures, and (3) the commissioner or the commissioner's designee.

The group LCOshall {\\PRDFS1\SCOUSERS\ANTONAKOSM\WS\2023SB-45meet ofnot 48less 00010-R03-SB.docxthan }two Substitutetimes Billmonthly. No.

10 shall meet not less than two times monthly.

2 January 1, 2024, and New section applicable to contracts entered into, amended or renewed on and after January 1, 2024 Sec.sSB10 / File No.

735 45 sSB10 File No.

735 Sec.

4 January 1, 2024, and New section applicable to contracts entered into, amended or renewed on and after January 1, 2024 July 1, 2023 Sec.

5 July 1, 2023 New section Sec.

7 July 1, 2023 New section LCOSec. {\\PRDFS1\SCOUSERS\ANTONAKOSM\WS\2023SB- 46 of 48 00010-R03-SB.docx } Substitute Bill No.

10 Sec.

11 from passage New section from passage Sec.

12 from passage 19a-754a(b) Sec.

13 from passage 17b-312 from passage Sec.

14 from passage New section Sec.

16 July 1, 2023 19a-42 from passage Sec.

17 from passage New section Sec.

Section6wasredrafted for clarity;inclarity;inSection7(c),"thirty Section7(c),"thirty days after the effective date of this section" was changed to "August 1, 2023" for clarity;

in Sections 18 to 20, th inclusive, "11 edition of the "International Statistical Classification of DiseasessSB10 and/ RelatedFile HealthNo. Problems"" was changed to "11 revisionh of the "International Statistical Classification of Diseases and Related Health Problems"" for accuracy;

735 46 sSB10 File No.

735 Diseases and Related Health Problems"" was changed to "11 revision of the "International Statistical Classification of Diseases and Related Health Problems"" for accuracy;

HS Joint Favorable C/R APP LCOAPP {\\PRDFS1\SCOUSERS\ANTONAKOSM\WS\2023SB-Joint 47Favorable ofSubst.-LCO 48sSB10 00010-R03-SB.docx/ }File Substitute Bill No.

10735 APP47 JointsSB10 FavorableFile Subst.-LCONo. LCO {\\PRDFS1\SCOUSERS\ANTONAKOSM\WS\2023SB- 48 of 48 00010-R03-SB.docx }

735 The following Fiscal Impact Statement and Bill Analysis are prepared for the benefit of the members of the General Assembly, solely for purposes of information, summarization and explanation and do not represent the intent of the General Assembly or either chamber thereof for any purpose.

In general, fiscal impacts are based upon a variety of informational sources, including the analyst’s professional knowledge.

Whenever applicable, agency data is consulted as part of the analysis, however final products do not necessarily reflect an assessment from any specific department.

OFA Fiscal Note State Impact:

Agency Fund-Effect FY 24 $ FY 25 $ FY 26 $ Affected State GF - Potential None None See Below Comptroller - Savings Fringe Benefits Attorney GF - Revenue None None See Below General Gain Social Services, GF - Cost See Below See Below See Below Dept.

Department of GF - Cost Up to None None Revenue 75,000 Services Public Health, GF - Cost 30,000 None None Dept.

Judicial Dept.

PCAF - Revenue 600,000 600,000 600,000 Loss Note:

GF=General Fund;

PCAF=Probate Court Administration Fund Municipal Impact:

Municipalities Effect FY 24 $ FY 25 $ FY 26 $ Various Savings None None See Below Municipalities Explanation Sections 2-4 may result in savings to the state and retiree health plans, as well as fully insured municipal plans through prescription drug price limitations established in the bill.

Any savings to the plans will be used to reduce prescription drug costs to the insureds.

Savings will begin in 2026 and accumulating in the outyears as the U.S.

Health andHumanServices(HHS)secretarynegotiatesthemaximumfair price for prescription drugs.

sSB10 / File No.

735 48 sSB10 File No.

735 Section 4 also provides the Office of the Attorney General (OAG) with exclusive authority to enforce violations of the provisions contained within Sections 3 and 4 of the bill, which could result in a GeneralFundrevenuegainbeginninginFY26totheextentenforcement results in fines issued.

The bill requires that manufacturers or distributors would be subject to a civil penalty of (1) $500,000, or (2) the purchaser'samountofannualsavingsgeneratedfromthemaximumfair price limits in Section 3.

Section 10 mandates at least two licensed clinical social worker visits for each individual enrolled in home and community-based services waivers administered by the Department of Social Services.

This results in significant costs to DSS and would be based on the number of clients receiving services, the rate paid, and the extent to which individuals are receiving services regardless of need.

Section 11 results in a cost to the Department of Social Services associated with designing and implementing a program to provide Medicaid reimbursement to certified community health workers.

The extent of cost to the state depends on the Medicaid rate to be established and the utilization of services provided by community health workers.

Section 13 results in a cost to the Department of Social Services of $16.5 million in FY 24 and $43.3 million in FY 25 to increase the income limit for the CoveredCT program to 200% of the Federal Poverty Level.

Section 14 results in additional program costs to the Department of Social Services to the extent the plan to expand income eligibility up to 300% FPL is approved and implemented.

Section 15, which requires personal income tax forms and instructions to be revised for certain specified purposes, results in a one- time cost of up to $75,000 to the Department of Revenue Services in FY 24associatedwithprogrammingupdatestotheCTaxtaxadministration system and myconneCT online portal, as well as form modification.

Section 15 may also result in minimal costs to the exchange (i.e., sSB10 / File No.

735 49 sSB10 File No.

735 Access Health CT), to its own resources as a quasi-public agency, associated with using tax return data for targeted outreach and marketing.

The exchange already conducts marketing using its own funds.

Any additional costs resulting from the MOU would be incurred only after a revised tax return form is in use.

Section 16, which requires the Department of Public Health (DPH) and municipal registrars of vital statistics to issue an amended birth certificate to reflect a parent’s legally changed name upon the receipt of certaindocuments, isanticipatedto result inanInformationTechnology consultant cost of approximately $30,000 in FY 24 only to update DPH's Electronic Birth Registry to allow for these names changes.

There is no fee associated with the issuance of amended birth certificates and, therefore, no anticipated revenue gain to the state or municipalities.

Section 21 removes the $250 filing fee that the Probate Court collects for name change petitions resulting in an estimated $600,000 annual loss in revenue to the Probate Court Administration Fund (PCAF).

The bill also makes technical, clarifying, and procedural changes that result in no fiscal impact.

The Out Years The annualized ongoing fiscal impact identified above would continueintothefuture:1)subjecttoprescriptiondrugpricesnegotiated by the U.S.

Health and Human Services (HHS) secretary;

2) based upon the number of name change petitions;

3) to the extent to which enforcement by OAG results in the recoupment of fines;

and 4) subject to inflationary measures.

sSB10 / File No.

735 50 sSB10 File No.

735 OLR Bill Analysis sSB 10 AN ACT PROMOTING ACCESS TO AFFORDABLE PRESCRIPTION DRUGS, HEALTH CARE COVERAGE, TRANSPARENCY IN HEALTH CARE COSTS, HOME AND COMMUNITY-BASED SUPPORT FOR VULNERABLE PERSONS AND RIGHTS REGARDING GENDER IDENTITY AND EXPRESSION.

TABLE OF CONTENTS:

SUMMARY § 1 — OHS OUTPATIENT PRESCRIPTION DRUG LIST Allows a wider range of drugs to be included on OHS’s annual list of drugs that are provided at a substantial state cost, and gives manufacturers the opportunity, following a public comment period, to show that a drug does not meet the inclusion criteria §§ 2-4 — PURCHASER PRICE LIMIT ON PRESCRIPTION DRUGS Prohibits purchasers (e.g., insurance plans) from purchasing prescription drugs for prices above the “maximum fair price” set by federallawfor Medicare;

requirespurchasersto apply related savings towards reducing insureds’ prescription drug costs;

prohibits drug manufacturers and distributors from withdrawing drugs from sale or distribution in the state to avoid revenue loss;

and sets penalties and reporting requirements §§ 5 & 6 — DRUG PRICING AND REPORTING FOR 340B ENTITIES Prohibits 340B covered entities from trying to collect as medical debt any payment for a prescription drug obtained with a rebate or discounted price through the federal 340B drug pricing program if they charged the patient a higher price and establishes a prescription drug reporting requirement for these entities § 7 — PRESCRIPTION DRUG PAYMENT EVALUATION COMMITTEE Establishes a Prescription Drug Payment Evaluation Committee to recommend to OHS upper payment limits on at least eight prescription drugs based on an evaluation of upper payment limits in other jurisdictions sSB10 / File No.

735 51 sSB10 File No.

735 § 8 — PRESCRIPTION DRUG DISCOUNT CARD PROGRAM Requires the comptroller to establish and administers a prescription drug discount card program available to all state residents § 9 — PROHIBITED CONTRACT CLAUSES IN HEALTH CARE Prohibits health insurance carriers, health care providers, and certain others from entering into health care contracts that include all-or- nothing clauses, anti-steering clauses, anti-tiering clauses, or any other clause that results or intends to result in anticompetitive effects § 10 — SOCIAL WORKERS AND HOME CARE Requires DSS to include at least two licensed clinical social worker visits in the fee schedule for people enrolled in CHCPE or any DSS- administered home- and community-based waiver §§ 11 & 12 — COMMUNITY HEALTH WORKERS Requires DSS to provide Medicaid reimbursement to certified community health workers and requires OHS to convene forums and meetings with stakeholders to align community health worker programs funded through various sources §§ 13 & 14 — COVERED CONNECTICUT EXPANSION RequiresDSSto(1)amendtheCoveredConnecticut waiver to expand eligibility to households with incomes up to 200% of FPL and (2) submit a plan to certain legislative committees on further expanding eligibility to households with incomes up to 300% of FPL § 15 — TAX RETURN INFORMATION FOR ACCESS HEALTH OUTREACH Requires Access Health CT and DRS to share tax return information so that Access Health CT may do targetedoutreach to uninsured state residents § 16 — VITAL RECORDS BIRTH CERTIFICATES Allows people who submit certain documentation to change birth certificates to reflect changes to a parent’s legal name § 17 — INMATE NAME CHANGE Requires DOC, within 30 days of receiving an inmate’s or prisoner’s written request, to change the person’s name in department records § 18 — INMATES WITH GENDER INCONGRUENCE Provides inmates with a diagnosis of gender incongruence with certain rights, such as (1) having DOC staff address them based on their gender identity and (2) with exceptions, being placed in a correctional institution consistent with their gender identity sSB10 / File No.

735 52 sSB10 File No.

735 §§ 19 & 20 — REPRODUCTIVE AND GENDER-AFFIRMING HEALTH CARE SERVICES AND GENDER INCONGRUENCE Expands reproductive and gender-affirming health care services to include gender incongruence for the purposes of a cause of action for recovery for persons against whom a judgment was entered in another state for their participation in providing or receiving these services that are legal in Connecticut;

specifies gender dysphoria treatment is set based on the most recent American Psychiatric Association manual § 21 — NAME CHANGE FEE ELIMINATION Eliminates the $250 probate court filing fee to change a person’s name § 22 — DSS GENDER AFFIRMING PROCEDURES WORKGROUP Requires DSS to establish a working group to seek input on department guidelines for gender-affirming procedures at least 120 days before amending the guidelines SUMMARY This bill makes changes in laws affecting prescription drug pricing and reporting, clauses in health care contracts, provider rates for social workers and community health workers, Covered Connecticut eligibility, tax return information sharing, birth certificates and name changes, and gender identity provisions, as described in the section-by- section analysis below.

EFFECTIVE DATE:

Various, see below § 1 — OHS OUTPATIENT PRESCRIPTION DRUG LIST Allows a wider range of drugs to be included on OHS’s annual list of 10 drugs that are provided at a substantial state cost, and gives manufacturers the opportunity, following a public comment period, to show that a drug does not meet the inclusion criteria Existing law requires the Office of Health Strategy (OHS), in consultation with the comptroller and the commissioners of public health and social services, to annually identify up to 10 outpatient prescription drugs that are (1) provided at a substantial state cost, considering their net cost, or (2) critical to public health.

Manufacturers of these identified drugs must give OHS certain information on the (1) factors that led to an increase in the drug’s wholesale acquisition cost sSB10 / File No.

735 53 sSB10 File No.

735 and (2) company’s research and development costs and other capital costs.

Current law sets certain parameters for the drugs OHS may include on this list, requiring both a minimum (1) percentage increase in the drug’s cost over prior years and (2) total cost for a specified supply or course of treatment.

As shown in the table below, the bill lowers the minimum required cost increase and total cost that qualifies a drug for inclusion on the list.

Table:

Minimum Requirements for List of Outpatient Prescription Drugs Current Law Bill Cost increase At least 20% during the prAt least 16% cumulatively year or 50% during the priduring the two prior years three years Cost for course of At least $60 for a 30-day At least $40 for a course of treatment supply or shorter course otreatment of unspecified treatment duration The bill requires OHS to make the list public and to make a preliminary list available for public comment.

Under the bill, the OHS executive director must prepare a preliminary list of outpatient prescription drugs she plans to include on the list.

She must make the preliminarylistavailableforpubliccommentforatleast30days.During the public comment period, any manufacturer of a drug included on the preliminary list may document that the drug’s wholesale acquisition cost, less all rebates paid to the state during the last calendar year, does not exceed the criteria described above.

The OHS executive director must remove the drug from the preliminary list if the manufacturer’s documentation establishes, to the executive director’s satisfaction, that the drug does not meet the criteria for inclusion.

The OHS executive directormustpublishafinallistwithin15daysafterthepubliccomment period closes.

By law, OHS may impose apenalty ofup to $7,500onpharmaceutical manufacturers for violating these provisions.

EFFECTIVE DATE:

July 1, 2023 sSB10 / File No.

735 54 sSB10 File No.

735 Background — Related Bill sHB 6669 (File 453), § 10, favorably reported by the Public Health Committee, contains nearly identical provisions, but is effective October 1, 2023.

§§ 2-4 — PURCHASER PRICE LIMIT ON PRESCRIPTION DRUGS Prohibits purchasers (e.g., insurance plans) from purchasing prescription drugs for prices above the “maximum fair price” set by federal law for Medicare;

requires purchasers to apply related savings towards reducing insureds’ prescription drug costs;

prohibits drug manufacturers and distributors from withdrawing drugs from sale or distribution in the state to avoid revenue loss;

and sets penalties and reporting requirements The billprohibits certainpurchasers(e.g., insurance plans, see below) from purchasing or seeking reimbursement for a prescription drug for a price above its maximum fair price (MFP) as established in federal law for certain drugs (i.e., a “referenced drug”).

The bill applies only to drugs intended to be dispensed, delivered, or administered to an insured in the state, directly or through a distributor.

Maximum Fair Price The federal Inflation Reduction Act (IRA) requires the U.S.

Health and Human Services (HHS) secretary to negotiate the MFP for certain drugs covered under Medicare (generally based on those with the highest Medicare spending) and sets upper limits on the negotiated price.

Under the IRA, the number of drugs subject to this negotiation increases over time (beginning with 10 drugs for the2026 plan year) and certain drugs are exempted (e.g., those with generic versions).

Generally, the MFP for a drug is applicable until a generic version is available (P.L.

117-169, § 1191).

Under the bill, the MFP excludes any dispensing fee paid to a pharmacy to dispense a referenced drug.

Purchasers Subject to the Price Limit A purchaser is any state entity, health benefit plan, or voluntarily participating Employee Retirement Income Security Act (ERISA) plan.

Under the bill, a:

1.

“state entity” is any state agency or anyone acting on the state’s behalf that purchases a prescription drug for someone with sSB10 / File No.

735 55 sSB10 File No.

735 health insurance paid for by the state, including health insurance offered by local, state, or federal agencies or through organizations licensed in the state, but excluding Medicaid;

2.

“health benefit plan” is an insurance policy or contract offered, delivered, issued for delivery, renewed, amended or continued in the state by a health carrier to provide, deliver, pay for, or reimburse any health care services costs (see below for exempted coverage types and benefits);

and 3.

“participating ERISA plan” is any employee welfare benefit plan subject to the federal ERISA that elects to participate in the bill’s price limit requirements.

The bill allows ERISA plans to elect to participate by notifying the Insurance Department in writing by January 1 each calendar year.

Purchasers Exempt From the Price Limit The bill generally excludes single service ancillary health coverages (e.g., dental, vision, prescription drug), long-term care, workers’ compensation, and any other coverages under which health care services are secondary or incidental to other insurance benefits, including those specified in certain federal HIPPA regulations.

Exempted coverage types include:

1.

disability income protection, accident only, long term care, specified accident, Medicare supplement, TriCare supplement, travel health, or single service ancillary health;

2.

liability insurance (e.g., general or automotive) or coverage issued as a supplement to liability insurance;

and 3.

workers compensation, automobile medical payment insurance, credit insurance, and coverage for on-site medical clinics.

The bill also exempts benefits if they are provided under a separate insurance policy, certificate, or contract or are otherwise not an integral part of the plan (e.g., home health care benefits).

It exempts hospital sSB10 / File No.

735 56 sSB10 File No.

735 confinement indemnity coverage, or specified disease coverage if (1) provided under a separate insurance policy, certificate, or contract, (2) there is no coordination between the provision of these benefits and the exclusion of benefits under a group health plan maintained by the same plan sponsor, and (3) the benefits are paid without regard to whether benefits were also provided under any group health plan maintained by the same plan sponsor.

Purchaser Savings and Reporting Requirement The bill requires purchasers to calculate their savings that result from the price limit described above and apply these savings to reduce their insureds’ prescription drugs costs.

(The bill does not describe what higher price purchasers must use to calculate savings.) The bill requires purchasers to report annually by January 15 to the Insurance Department to:

1.

assess the purchaser’s savings for each referenced drug for the previous year, and 2.

identify how the purchaser applied savings to reduce prescription drug costs and decrease cost disparities.

Prohibiting Manufacturers and Distributors From Withdrawing Drugs From the Market The bill prohibits certain manufacturers or distributors from withdrawing a referenced drug from sale or distribution in the state to attempt to avoid revenue loss resulting from the maximum fair price requirement described above.

The bill requires manufacturers and distributors to provide at least 180 days’ notice to the insurance commissioner and the attorney general before withdrawing a referenced drug from sale or distribution in the state.

Under the bill, manufacturers include (1) any entity (a) engaged in the production, preparation, propagation, compounding, conversion, processing, packaging, repackaging, labelling, relabeling or distributing prescription drug products and (b) subject to federal 340B price limits sSB10 / File No.

735 57 sSB10 File No.

735 (see Background) and (2) wholesalers distributing 340B covered drugs to these entities.

A distributor is any entity, including a wholesaler, that supplies drugs, devices, or cosmetics prepared, produced, or packaged by manufacturers, to other wholesalers, manufacturers, distributors, hospitals, clinics, practitioners, or pharmacies or federal, state, and municipal agencies.

The bill prohibits referenced drug manufacturers and distributors from negotiating with a purchaser or seller of a referenced drug at a price that exceeds the MFP.

(The bill does not define “seller.”) The bill deems doing so a violation, but does not prescribe a penalty.

Regulations, Violations, and Penalties The bill subjects purchasers that violate the bill’s maximum fair price provisions to a $1,000 civil penalty for each violation.

For manufacturers and distributors that violate the bill’s provisions on removing referenced drugs from the market, the bill sets a civil penalty of $500,000 or the purchaser’s annual savings generated under the maximum fair price provisions, whichever is greater.

(The amount of the second penalty is unclear as a distributor or wholesaler may work with multiple purchasers.) The bill requires the insurance commissioner to adopt regulations to implement these provisions.

It gives the attorney general exclusive authority to enforce its penalties.

EFFECTIVE DATE:

January 1, 2024, and applicable to contracts entered into, amended, or renewed on and after that date.

Background — Federal 340 Price Limits Under the 340B program, federal law requires the HHS secretary to enter into purchase agreement withdrug manufacturersthat participate in Medicaid.

These agreements generally limit the price at which manufacturers may sell certain covered outpatient drugs to “covered entities” (e.g., federally qualified health centers, children’s hospitals, and other providers that care for underserved populations) (42 U.S.C.

§ sSB10 / File No.

735 58 sSB10 File No.

735 256b).

§§ 5 & 6 — DRUG PRICING AND REPORTING FOR 340B ENTITIES Prohibits 340B covered entities from trying to collect as medical debt any payment for a prescription drug obtained with a rebate or discounted price through the federal 340B drug pricing program if they charged the patient a higher price and establishes a prescription drug reporting requirement for these entities Section 340B of the federal Public Health Service Act (i.e., the 340B Drug Pricing Program) requires drug manufacturers participating in Medicaidto sell certainoutpatient prescriptiondrugs(“covereddrugs”) at discounted prices to health care organizations that care for uninsured and low-income patients.

These organizations include federally qualified health centers, children’s hospitals, hospitals that serve a disproportionate number of low-income patients, and other safety net providers (“340B covered entities”).

The bill prohibits these covered entities from trying to collect as medical debt a payment for a prescription drug prescribed by a health care provider to a person in the state that the entity gets with a rebate or discounted price through the 340B program that exceeds the entity’s cost for the drug.

Under the bill, a rebate is a discount or concession affecting an outpatient prescription drug price, that a pharmaceutical manufacturer directly provides to a (1) health carrier or (2) pharmacy benefits manager after the manager processes a claim from a pharmacist or pharmacy.

The bill also requires 340B covered entities to annually report by January 15 to the OHS executive director the following information on drugs prescribed by a health care provider to people in the state for the previous calendar year:

1.

a list of all prescription drugs, identified by the national drug code number, purchased through the federal 340B drug pricing program;

2.

the actual price of each prescription drug after any rebate or discount provided through the program;

sSB10 / File No.

735 59 sSB10 File No.

735 3.

the actual payment each 340B covered entity received from any private or public health insurance plan, excluding Medicaid and Medicare, or patient for each of these prescription drugs;

and 4.

the average percentage savings realized by each 340B covered entity on prescriptiondrug costs under the program and how the entity used the savings.

The bill requires the executive director to link to the report on the OHS website.

EFFECTIVE DATE:

July 1, 2023 Background — Related Bill sHB 6669 (File 453), §§ 16-19, favorably reported by the Public Health Committee, makes various changes affecting 340B program participants, including (1) prohibiting pharmacy benefit managers (PBMs) from discriminating against 340B covered entities in connection with dispensing covered drugs, (2) requiring drug manufacturers to comply with specified federal pricing requirements when selling covered drugs to these entities, (3) allowing covered entities or the attorney general to seek relief if a PBM tries to enforce contract provisions that violate the bill, and (4) requiring hospitals that participate in the 340B program to annually report certain information to OHS.

§ 7 — PRESCRIPTION DRUG PAYMENT EVALUATION COMMITTEE Establishes a Prescription Drug Payment Evaluation Committee to recommend to OHS upper payment limits on at least eight prescription drugs based on an evaluation of upper payment limits in other jurisdictions The bill establishes a 23-member Prescription Drug Payment Evaluation Committee to recommend upper payment limits to the OHS executive director for at least eight prescription drugs based on an evaluation of upper payment limits set by other states or foreign jurisdictions.

Under the bill, the committee consists of the (1) Office of Policy and Management (OPM) secretary;

OHS executive director;

Healthcare sSB10 / File No.

735 60 sSB10 File No.

735 Advocate;

Consumer Protection, Insurance, Public Health, and Social Services department commissioners;

or their designees, and (2) appointed members shown in the table below.

Table:

Appointed Members Appointing Authority Members House speaker • Statewide health care advocacy coalition representative • Statewide advocacy organization for elderly persons representative • Statewide organization for diverse communities representative Senate president pro tempore • Labor union representative • Health services researcher • Consumer who experienced cost barriers to obtaining prescription drugs House majority leader • 340 covered entity representatives (2) House minority leader • Private insurer representatives (2) Senate majority leader • Health care provider organization representatives (2) Senate minority leader • Representative of a pharmaceutical company doing business in the state • Representative of an academic institution with health care cost expertise Governor • Pharmacist representative • Pharmacy benefit manager representative The bill requires appointing authorities to make initial appointments to the committee by August 1, 2023, and fill any vacancies.

Under the bill, the House speaker and the Senate president pro tempore select the committee’s chairpersons from among its members.

The chairpersons must schedule the committee’s first meeting, which must be held by September 1, 2023.

The Insurance Committee administrative staff serves as the committee’s administrative staff.

The bill requires the committee to report annually, beginning by sSB10 / File No.

735 61 sSB10 File No.

735 December 1, 2023, to the OHS executive director and the Appropriations, Human Services, Insurance, and Public Health committeesonitsrecommendationsforupperpaymentlimitsonatleast eight prescription drugs.

EFFECTIVE DATE:

July 1, 2023 § 8 — PRESCRIPTION DRUG DISCOUNT CARD PROGRAM Requires the comptroller to establish and administers a prescription drug discount card program available to all state residents The bill requires the comptroller to establish and administer a prescription drug discount card program available to all state residents.

It also authorizes the comptroller to coordinate participation in a multistate prescription drug consortium to pool purchasing power to lower costs by negotiating discounts with drug manufacturers and coordinating volume discount contracting.

EFFECTIVE DATE:

July 1, 2023 Background — Related Bill sHB 6669 (File 453), § 1, favorably reported by the Public Health Committee includes similar provisions.

§ 9 — PROHIBITED CONTRACT CLAUSES IN HEALTH CARE Prohibits health insurance carriers, health care providers, and certain others from entering into health care contracts that include all-or-nothing clauses, anti-steering clauses, anti- tiering clauses, or any other clause that results or intends to result in anticompetitive effects The bill prohibits health insurance carriers (generally, insurers and HMOs), health care providers, health plan administrators, or any agent or entity contracting on their behalf, beginning January 1, 2024, from offering, soliciting, requesting, amending, renewing, or entering a health care contract that directly or indirectly includes all-or-nothing clauses, anti-steering clauses, anti-tiering clauses, or any other clause that results or intends to result in anticompetitive effects.

The bill explicitly does not prohibit “value-based care,” which is a health care coverage model in which providers, including hospitals and physicians, are paid based on patient health outcomes.

sSB10 / File No.

735 62 sSB10 File No.

735 Under the bill, any prohibited clause in a contract, written policy, written procedure, or agreement is null and void, but the contract’s other clauses remain in effect for the contract term.

The bill allows the insurance commissioner to adopt regulations implementing these provisions.

Prohibited Clauses Under the bill, an “all-or-nothing clause” requires health insurance carriers or health plan administrators to (a) include all members of a health care provider in a network plan or (b) contract with a provider’s affiliate as a condition of contracting with the provider.

Under the bill, a health plan administrator is a third-party administrator acting on a plan sponsor’s behalf to administer a health benefit plan.

An “anti-steering clause” restricts a carrier or administrator from encouraging an enrollee to get health care services from a competing hospital or health system, including by offering incentives for enrollees to use specific health care providers.

An “anti-tiering clause” (1) restricts a health carrier’s or plan administrator’s ability to introduce or change a tiered network plan or assign health care providers into tiers or (2) requires a health carrier or plan administrator to place all members of a health care provider in the same tier.

A “tiered network” identifies and groups some or all types of health care providers and facilities into specific groups to which different participating provider reimbursement, covered person cost- sharing, or participating provider access requirements apply for the same health care services.

EFFECTIVE DATE:

January 1, 2024 Background — Related Bills sSB 983 (File 341), favorably reported by the Insurance and Real Estate Committee, contains similar contract provisions.

sHB 6620 (File 326), favorably reported by the Insurance and Real sSB10 / File No.

735 63 sSB10 File No.

735 Estate and Judiciary committees, also contains similar provisions.

§ 10 — SOCIAL WORKERS AND HOME CARE Requires DSS to include at least two licensed clinical social worker visits in the fee schedule for people enrolled in CHCPE or any DSS-administered home- and community- based waiver The bill requires the Department of Social Services (DSS) commissioner to include in the fee schedule for home health services at least two licensed clinical social worker visits to each person enrolled in the Connecticut Home Care Program for Elders (CHCPE) or any home- and community-based Medicaid waiver program DSS administers.

CHCPE is a Medicaid waiver- and state-funded program that provides a range of home- and community-based services for eligible people ages 65 or older who are at risk of inappropriate institutionalization.

DSS administers other home- and community- based waivers serving various populations (e.g., the Acquired Brain Injury waiver).

EFFECTIVE DATE:

July 1, 2023 Background — Related Bills sSB 412, favorably reported by the Appropriations and Human Services committees, requires DSS to increase rates for certain complex care nursing services in the fee schedule for home health services.

sSB 946, favorably reported by the Appropriations and Human Services committees, (1) requires DSS to compensate family caregivers who provide personal care services under CHCPE, (2) reduces cost sharing for the state-funded portion of the program, and (3) makes technical changes.

§§ 11 & 12 — COMMUNITY HEALTH WORKERS Requires DSS to provide Medicaid reimbursement to certified community health workers and requires OHS to convene forums and meetings with stakeholders to align community health worker programs funded through various sources The bill requires DSS to design and implement a program to give Medicaidreimbursementtocertifiedcommunityhealthworkers(CHW) sSB10 / File No.

735 64 sSB10 File No.

735 for certain services provided to HUSKY Health (i.e., Medicaid and the state children’s health insurance) members.

Under existing law and the bill, a certified CHW is a public health outreach professional who:

1.

has an in-depth understanding of a community’s experience, language, culture, and socioeconomic needs;

2.

provides services that include outreach, engagement, education, coaching, informal counseling, social support, advocacy, care coordination, and research, basic screenings, and risk assessments associated with social determinants of health (i.e., societal factors that contribute to a person’s state of health);

and 3.

is certified by the Department of Public Health (DPH) as a CHW.

Under the bill, services CHWs may provide under DSS’s program include:

1.

coordination of medical, oral, and behavioral health care services and social supports;

2.

connection to, and navigation of, health systems and services;

3.

prenatal, birth, lactation, and postpartum supports;

and 4.

health promotion, coaching, and self-management education.

The bill requires the commissioner to reimburse certified CHW services in a way and at a rate conducive to workforce growth.

Throughout the program’s design and implementation, the commissioner and her designees must consult with certified CHWs and others in a way that (1) includes community-based and clinic-based certified CHWs, (2) represents medical assistance program beneficiary demographics, and (3) helps shape the program’s design and implementation.

The bill also requires DSS to coordinate with OHS to identify opportunities to integrate CHWs into the medical assistance program.

sSB10 / File No.

735 65 sSB10 File No.

735 The bill requires DSS, by January 1, 2024, and annually thereafter, until the program is fully implemented, to report to the Human Services Committee and the Council on Medical Assistance Program Oversight (MAPOC).

The report must provide a program update and evaluate the program’s impact on health outcomes and health equity.

The bill also requires OHS to convene forums and meetings with stakeholders to align CHW programs funded by state medical assistance program, block grants, private insurance carriers, and others.

Stakeholders include Access Health Connecticut, DPH, the Birth-to- Three program, state home visiting programs, community action agencies, hospitals, community health centers, and other state government and external stakeholders.

The bill sets this requirement as part of OHS’s ongoing duties.

EFFECTIVE DATE:

Upon passage Background — Related Bill sSB 991 (File 438), favorably reported by the Human Services Committee, similarly requires DSS to establish a program to reimburse certified CHWs and report to the Human Services Committee and MAPOC.

§§ 13 & 14 — COVERED CONNECTICUT EXPANSION Requires DSS to (1) amend the Covered Connecticut waiver to expand eligibility to households with incomes up to 200% of FPL and (2) submit a plan to certain legislative committees on further expanding eligibility to households with incomes up to 300% of FPL The bill expands eligibility for the Covered Connecticut health coverage program (see Background).

It requires the DSS commissioner, within 30 days of its passage, to amend the state’s Medicaid waiver supporting the program to expand eligibility to people otherwise qualified for the program with income up to 200% of the federal poverty level (FPL), rather than up to 175% of FPL, as under current law.

She must do this to the extent federal law allows and according to existing law’s legislative approval process for Medicaid waivers and waiver amendments (see Background).

The bill also requires her to consult with sSB10 / File No.

735 66 sSB10 File No.

735 the insurance commissioner and the executive director of OHS in submitting this waiver amendment.

The bill further requires the DSS commissioner, within 60 days of its passage and in consultation with the insurance commissioner and OHS executive director, to develop a plan for a second tier of the Covered Connecticut program for people otherwise qualified for the program with income over 200% and up to 300% of FPL.

Under the bill, the developed plan may offer (1) reduced benefits consistent with certain federal requirements and (2) income-based copayments by enrollees.

The DSS commissioner must submit this plan to the Appropriations, Human Services, and Insurance committees, which must then hold a public hearing within 30 days after receiving it.

At the hearing’s conclusion, the committees must advise the commissioner of their approval, denial, or modification of the plan.

If the committees disagree on the plan, the committee chairpersons must appoint a nine-member conference committee composed of three members from each committee.

At least one member from each committee must be from the minority party.

The conference committee must report to the standing committees, which must in turn vote to accept or reject, but not amend, the report.

If a committee rejects the conference report, it must notify the commissioner, and the plan is deemed approved.

If all the committees accept the report, the Appropriations Committee must advise the commissioner of the approval, denial, or modification of the plan.

If the committees advise the commissioner of their denial, she must not implement the plan.

If they do not advise the commissioner within days after receiving the plan, the plan is deemed denied.

Any implementation of the plan must follow the committees’ approval or modifications.

The DSS commissioner may, to the extent permissible under federal law, seek approval of a Medicaid waiver to get federal funds for the developed plan.

EFFECTIVE DATE:

Upon passage sSB10 / File No.

735 67 sSB10 File No.

735 Background — Covered Connecticut Program This program provides no-cost health insurance, dental insurance, and non-emergency medical transportation to eligible adults and their tax dependents.

Generally, program participants must (1) have household incomes too high to qualify for Medicaid but under program limits, (2) be covered by a silver-level health plan offered on the state’s health insurance exchange (Access Health CT), and (3) qualify for federal qualified health plan premium and cost-sharing subsidies (CGS § 19a-754c).

Background — Legislative Approval Process State law requires the DSS commissioner to submit federal waiver applications, renewals, and amendments to the Appropriations and Human Services committees before submitting them to the federal Centers for Medicare and Medicaid Services for approval.

The committees must:

1.

hold a public hearing within 30 days after receiving the application;

2.

approve, deny, or modify a waiver application;

and 3.

appoint a conference committee if the committees do not agree on the decision (CGS § 17b-8).

For waivers on Covered Connecticut, the Insurance and Real Estate Committee also participates in this process (CGS § 19a-754c).

(These requirements do not apply to applications for routine operational issues.) Background — Related Bill sSB 978, favorably reported by the Appropriations and Human Services committees, similarly requires the DSS commissioner to amend theMedicaidwaivertoexpandeligibilityto200%ofFPL,butbyJanuary 1, 2024, rather than within 30 days after the bill’s passage.

§ 15 — TAX RETURN INFORMATION FOR ACCESS HEALTH OUTREACH sSB10 / File No.

735 68 sSB10 File No.

735 Requires Access Health CT and DRS to share tax return information so that Access Health CT may do targeted outreach to uninsured state residents The bill requires Access Health CT (i.e., the Connecticut Health Insurance Exchange) to make a written request to the Department of Revenue Services (DRS) commissioner for returns or return information to use for targeted outreach to uninsured state residents.

By law, a “return” is any tax or information return, estimated tax declaration, or refund claims, among other things.

“Return information” includes a taxpayer’s identity;

the nature, source, or amount of a taxpayer’s income, payments, receipts, deductions, exceptions, credits, assets, liabilities, net worth;

and any other data the DRS commissioner receives on a return (CGS § 12-15(h)).

Under the bill, if the DRS commissioner deems a return or return information relevant to the targeted outreach to uninsured residents, he may disclose it to theexchange.

To make thisdisclosure,thebillrequires the DRS commissioner and the exchange to enter into a memorandum of understanding (MOU) stating the specific information to be disclosed and the terms and conditions for disclosure.

Under the bill, disclosed informationmayonlybeusedbytheexchangeasdescribedintheMOU.

The bill prohibits anyone who receives disclosed information from DRS from redisclosing it to a third party without the commissioner’s permission and sets a $5,000 fine for violating these provisions.

The bill further requires the DRS commissioner to revise the state’s income tax return form to include a space for residents to authorize the exchange to contact them about health insurance enrollment through the exchange.

It also requires the DRS commissioner and the exchange to write language for the tax return form (presumably related to the authorization space) and include, in the form’s instructions, a description of how the authorization will be relayed to the exchange.

EFFECTIVE DATE:

Upon passage § 16 — VITAL RECORDS BIRTH CERTIFICATES Allows people who submit certain documentation to change birth certificates to reflect changes to a parent’s legal name sSB10 / File No.

735 69 sSB10 File No.

735 The bill allows people who submit certain documentation to change birth certificates to reflect changes to a parent’s legal name.

The DPH commissioner must issue a new birth certificate in these instances when she receives (1) a written request from the parent, signed under penalty of law, for a replacement birth certificate with the parent’s new legal name, and (2) proof of the parent’s legal name change.

The bill generally extends to these amended birth certificates existing procedures for amended birth certificates reflecting gender change (e.g., allowing only the DPH commissioner,andnot localregistrars,to amend the certificate, and providing that the replacement certificate is not marked “amended”).

EFFECTIVE DATE:

July 1, 2023 § 17 — INMATE NAME CHANGE Requires DOC, within 30 days of receiving an inmate’s or prisoner’s written request, to change the person’s name in department records The bill requires the Department of Correction (DOC) commissioner to change an inmate or prisoner’s name in department records within days after he or she makes a written request.

The inmate or prisoner must have had his or her name legally changed and provide the name change order.

By law, an “inmate” or “prisoner” includes anyone in DOC custody or confined in any DOC institution or facility until released from custody or control, including anyone on parole.

EFFECTIVE DATE:

Upon passage § 18 — INMATES WITH GENDER INCONGRUENCE Provides inmates with a diagnosis of gender incongruence with certain rights, such as (1) having DOC staff address them based on their gender identity and (2) with exceptions, being placed in a correctional institution consistent with their gender identity By law, DOC must adhere to certain requirements on the treatment and placement of inmates with a diagnosis of gender dysphoria and a genderidentitythatdiffersfromtheirassignedsexatbirth.Forexample, (1) correctional staff must address the inmate according to their gender sSB10 / File No.

735 70 sSB10 File No.