Sec. 17b-427. (Formerly Sec. 17a-314). CHOICES health insurance assistance program. Definitions. Requirements. Reports. Responsibilities of hospitals re Medicare patients.
Sec. 17b-427. (Formerly Sec. 17a-314). CHOICES health insurance assistance
program. Definitions. Requirements. Reports. Responsibilities of hospitals re
Medicare patients. (a) As used in this section:
(1) "CHOICES" means Connecticut's programs for health insurance assistance,
outreach, information and referral, counseling and eligibility screening;
(2) "CHOICES health insurance assistance program" means the federally recognized state health insurance assistance program funded pursuant to P.L. 101-508 and
administered by the Department of Social Services, in conjunction with the area agencies
on aging and the Center for Medicare Advocacy, that provides free information and
assistance related to health insurance issues and concerns of older persons and other
Medicare beneficiaries in Connecticut; and
(3) "Medicare organization" means any corporate entity or other organization or
group that contracts with the federal Centers for Medicare and Medicaid Services to
provide health care services to Medicare beneficiaries in this state as an alternative to
the traditional Medicare fee-for-service plan.
(b) The Department of Social Services shall administer the CHOICES health insurance assistance program, which shall be a comprehensive Medicare advocacy program
that provides assistance to Connecticut residents who are Medicare beneficiaries. The
program shall: (1) Maintain a toll-free telephone number to provide advice and information on Medicare benefits, including prescription drug benefits available through the
Medicare Part D program, the Medicare appeals process, health insurance matters applicable to Medicare beneficiaries and long-term care options available in the state at least
five days per week during normal business hours; (2) provide information, advice and
representation, where appropriate, concerning the Medicare appeals process, by a qualified attorney or paralegal at least five days per week during normal business hours; (3)
prepare and distribute written materials to Medicare beneficiaries, their families, senior
citizens and organizations regarding Medicare benefits, including prescription drug benefits available through the Medicare Part D program and long-term care options available
in the state; (4) develop and distribute a Connecticut Medicare consumers guide, after
consultation with the Insurance Commissioner and other organizations involved in servicing, representing or advocating for Medicare beneficiaries, which shall be available
to any individual, upon request, and shall include: (A) Information permitting beneficiaries to compare their options for delivery of Medicare services; (B) information concerning the Medicare plans available to beneficiaries, including the traditional Medicare
fee-for-service plan, Medicare Part D plans and the benefits and services available
through each plan; (C) information concerning the procedure to appeal a denial of care
and the procedure to request an expedited appeal of a denial of care; (D) information
concerning private insurance policies and federal and state-funded programs that are
available to supplement Medicare coverage for beneficiaries; (E) a worksheet for beneficiaries to use to evaluate the various plans, including Medicare Part D programs; and
(F) any other information the program deems relevant to beneficiaries; (5) collaborate
with other state agencies and entities in the development of consumer-oriented websites
that provide information on Medicare plans, including Medicare Part D plans, and long-term care options that are available in the state; and (6) include any functions the department deems necessary to conform to federal grant requirements.
(c) The Insurance Commissioner, in cooperation with, or on behalf of, the Commissioner of Social Services, may require each Medicare organization to: (1) Annually
submit to the commissioner any data, reports or information relevant to plan beneficiaries; and (2) at any other times at which changes occur, submit information to the commissioner concerning current benefits, services or costs to beneficiaries. Such information
may include information required under section 38a-478c.
(d) Each Medicare organization that fails to file the annual data, reports or information requested pursuant to subsection (c) of this section shall pay a late fee of one hundred
dollars per day for each day from the due date of such data, reports or information to
the date of filing. Each Medicare organization that files incomplete annual data, reports
or information shall be so informed by the Insurance Commissioner, shall be given a
date by which to remedy such incomplete filing and shall pay said late fee commencing
from the new due date.
(e) Not later than June 1, 2001, and annually thereafter, the Insurance Commissioner, in conjunction with the Healthcare Advocate, shall submit to the Governor and
to the joint standing committees of the General Assembly having cognizance of matters
relating to human services and insurance and to the select committee of the General
Assembly having cognizance of matters relating to aging, a list of those Medicare organizations that have failed to file any data, reports or information requested pursuant to
subsection (c) of this section.
(f) All hospitals, as defined in section 19a-490, which treat persons covered by
Medicare Part A shall: (1) Notify incoming patients covered by Medicare of the availability of the services established pursuant to subsection (b) of this section, (2) post or
cause to be posted in a conspicuous place therein the toll-free number established pursuant to subsection (b) of this section, and (3) provide each Medicare patient with the toll-free number and information on how to access the CHOICES program.
(P.A. 89-135, S. 1, 6; P.A. 93-262, S. 1, 87; P.A. 01-39, S. 1, 3; P.A. 03-19, S. 46; P.A. 05-102, S. 2; P.A. 07-155, S. 1.)
History: P.A. 93-262 authorized substitution of commissioner and department of social services for commissioner and
department on aging, effective July 1, 1993; Sec. 17a-314 transferred to Sec. 17b-427 in 1995; P.A. 01-39 added new Subsec.
(a) defining "CHOICES", "CHOICES health insurance assistance program" and "Medicare organization", redesignated
existing Subsec. (a) as Subsec. (b) and amended by adding requirements that department administer the CHOICES health
insurance assistance program, that program maintain a toll-free telephone number to provide advice and information on
other health insurance matters applicable to Medicare beneficiaries at least five days per week during normal business
hours, that program provide information, advice and representation concerning Medicare appeals process by a qualified
attorney or paralegal, that program develop and distribute a Connecticut Medicare consumers guide, and that program
include any functions department deems necessary to conform to federal grant requirements, added Subsec. (c) allowing
Insurance Commissioner to require each Medicare organization to submit information, added Subsec. (d) re payment of
late fees, added Subsec. (e) requiring Insurance Commissioner to submit an annual list of Medicare organizations that fail
to file information and redesignated existing Subsec. (b) as Subsec. (f) and amended by changing internal references for
consistency with section and making technical changes, effective May 31, 2001; P.A. 03-19 replaced "Health Care Financing Administration" with "Centers for Medicare and Medicaid Services" in Subsec. (a)(3), effective May 12, 2003; P.A.
05-102 amended Subsec. (e) by renaming the Managed Care Ombudsman the Healthcare Advocate; P.A. 07-155 amended
Subsec. (b) to require CHOICES program to provide information and advice on prescription drug benefits available through
Medicare Part D program and long-term care options available in the state, to prepare and distribute written material, and
to collaborate with other state agencies and entities in the development of a consumer-oriented website, effective July
1, 2007.