Sec. 17b-294. HUSKY Plus programs.
Sec. 17b-294. HUSKY Plus programs. (a) The commissioner shall, within available appropriations, establish two supplemental health insurance programs, to be known
as HUSKY Plus programs, for enrollees of the subsidized portion of the HUSKY Plan,
Part B with family incomes which do not exceed three hundred per cent of the federal
poverty level, whose medical needs cannot be accommodated within the basic benefit
package offered enrollees. One program shall supplement coverage for those medically
eligible enrollees with intensive physical health needs and one shall supplement coverage for those medically eligible enrollees with intensive behavioral health needs.
(b) Within available appropriations, the commissioner shall contract with entities
to administer and operate the HUSKY Plus program for medically eligible enrollees
with intensive physical health needs. Such entities shall be the same entities that the
Department of Public Health contracts with to administer and operate the program under
Title V of the Social Security Act. The advisory committee established by the Department of Public Health for Title V of the Social Security Act shall be the steering committee for such program, except that such committee shall include representatives of the
Departments of Social Services and Children and Families.
(c) Within available appropriations, the commissioner shall contract with one or
more entities to operate the HUSKY Plus program for medically eligible enrollees with
intensive behavioral health needs. The steering committee for such program shall be
established by the commissioner, in consultation with the Commissioner of Children
and Families. The steering committee shall include representatives of the Departments
of Social Services and Children and Families.
(d) The acuity standards or diagnostic eligibility criteria, or both, the service benefits
package and the provider network for the HUSKY Plus program for intensive physical
health needs shall be consistent with that of Title V of the Social Security Act. Such
service benefit package shall include powered wheelchairs.
(e) The steering committee for intensive behavioral health needs shall submit recommendations to the commissioner for acuity standards or diagnostic eligibility criteria,
or both, for admission to the program for intensive behavioral health needs as well as a
service benefits package. The criteria shall reflect the severity of psychiatric or substance
abuse symptoms, the level of functional impairment secondary to symptoms and the
intensity of service needs. The network of community-based providers in the program
shall include the services generally provided by child guidance clinics, family service
agencies, youth service bureaus and other community-based organizations.
(f) The commissioner shall adopt regulations, in accordance with chapter 54, to
establish a procedure for the appeal of a denial of coverage under any of the HUSKY
Plus programs. Such regulations shall provide that (1) an appeal of a denial of coverage
for a medically eligible enrollee with intensive physical health needs shall be taken to
the steering committee for intensive physical health needs, (2) an appeal of a denial of
coverage for a medically eligible enrollee with intensive behavioral health needs shall be
taken to the steering committee for intensive behavioral health needs, and (3) a medically
eligible enrollee with intensive physical or behavioral health needs may appeal the decision of any such steering committee to the commissioner.
(g) The commissioner shall contract for an external quality review of the HUSKY
Plus programs. Not later than January 1, 1999, and annually thereafter, the commissioner
shall submit a report to the Governor and the General Assembly on the HUSKY Plus
programs which shall include an evaluation of the health outcomes and access to care
for medically eligible enrollees in the HUSKY Plus programs.
(h) On and after the date on which any medically eligible enrollee begins receiving
benefits under the HUSKY Plus programs, such enrollee shall not be eligible for services
under Title V of the Social Security Act.
(i) Not later than December 1, 1997, or not less than fifteen days before submission
of the state children's health insurance plan to the joint standing committees of the
General Assembly having cognizance of matters relating to human services, public
health, insurance and appropriations and the budgets of state agencies, whichever is
sooner, the commissioner shall submit to said joint standing committees of the General
Assembly any part of the state children's health insurance plan that refers to the HUSKY
Plus programs. Such submission shall address acuity standards and diagnostic eligibility
criteria, the service benefit package and coordination between the HUSKY Plan, Part
B and the HUSKY Plus programs and coordination with other state agencies. Within
fifteen days of receipt of such submission, said joint standing committees of the General
Assembly may advise the commissioner of their approval, denial or modifications, if
any, of the submission. If the joint standing committees do not concur, the committee
chairmen shall appoint a committee on conference which shall be comprised of three
members from each joint standing committee. At least one member appointed from each
committee shall be a member of the minority party. The report of the committee on
conference shall be made to each committee, which shall vote to accept or reject the
report. The report of the committee on conference may not be amended. If a joint standing
committee rejects the report of the committee on conference, the submission shall be
deemed approved. If the joint standing committees accept the report, the committee
having cognizance of matters relating to appropriations and the budgets of state agencies
shall advise the commissioner of their approval or modifications, if any, of the submission, provided if the committees do not act within fifteen days, the submission shall be
deemed approved.
(j) The commissioner shall adopt regulations, in accordance with the provisions of
chapter 54, to establish criteria and specify services for the HUSKY Plus programs.
Such regulations shall state that the HUSKY Plus programs shall give priority in such
programs to enrollees with family incomes at or below two hundred thirty-five per cent
of the federal poverty level.
(k) As used in this section, "medically eligible enrollee" means any enrollee with
special needs related to either physical or behavioral health who meets the acuity standards or diagnostic eligibility criteria adopted by the commissioner regarding the acuity,
diagnosis, functional impairment and intensive service needs of the enrollee.
(October 29 Sp. Sess. P.A. 97-1, S. 6, 23; P.A. 98-8, S. 1, 5.)
History: Oct. 29 Sp. Sess. P.A. 97-1 effective October 30, 1997; P.A. 98-8 amended Subsec. (a) to limit benefits under
the HUSKY Plus portion of the HUSKY Plan, Part B to children in families with incomes at or below 300% of the federal
poverty level, effective April 7, 1998.