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Substitute House Bill No. 5024

PUBLIC ACT NO. 96-187

AN ACT CONCERNING THE HEALTHY STEPS PROGRAM.

Be it enacted by the Senate and House of Representatives in General Assembly convened:

Section 1. Section 19a-7c of the general statutes, as amended by section 1 of public act 95-205 and sections 12 and 21 of public act 95-257, is repealed and the following is substituted in lieu thereof:

(a) The Commissioner of Public Health, in consultation with the Department of Social Services, may contract within available appropriations, to provide a subsidized nongroup health insurance product for pregnant women who are not eligible for medical assistance under sections 17b-22, 17b-75 to 17b-77, inclusive, 17b-79 to 17b-103, inclusive, AS AMENDED 17b-114, 17b-180 to 17b-183, inclusive, 17b-260 to 17b-262, inclusive, AS AMENDED 17b-264 to 17b-285, inclusive, AS AMENDED 17b-357 to 17b-362, inclusive, AS AMENDED 17b-600 to 17b-604, inclusive, 17b-807 and 17b-808 AS AMENDED and have incomes under two hundred fifty per cent of the federal poverty level. The Commissioner of Public Health, in consultation with the Department of Social Services, may contract, within available appropriations, to provide a subsidized nongroup health insurance product for children under eighteen years of age who are not eligible for such medical assistance and whose families have incomes under two hundred per cent of the federal poverty level. For any children enrolled as of [July 1, 1995] DECEMBER 31, 1994, in a program established by this section, the commissioner shall contract within available appropriations to extend the program to [such currently enrolled] children up to and including age seventeen WHO WERE ENROLLED ON THAT DATE. The products shall be available to such pregnant women and children (1) for whom employer-based insurance is not available or (2) who have employer-based insurance (A) to cover the cost of the premiums, co-payments and deductibles of the employer-based plan provided the cost of the employer-based plan is less than the nongroup product and (B) to provide coverage for benefits not covered by the employer-based plan which are covered under the subsidized non-group product. The Department of Public Health may make such products available to limited populations, as pilot programs, initially to test the impact of program design and administration. The Department of Social Services shall assist in the administration of the programs. The contract may include, but not be limited to, provisions for coinsurance and co-payment and a sliding scale based on income for premiums and shall provide for the use of mechanisms to control costs.

(b) The contract for pregnant women shall include coverage for: (1) Physician visits for diagnosis and treatment; (2) prenatal and postnatal care; and (3) outpatient hospital care; and may include coverage for: (A) Labor and delivery; (B) laboratory and diagnostic tests; (C) prescription drugs; (D) physical therapy; (E) mental health and substance abuse visits; and (F) inpatient care, including mental health and substance abuse treatment, subject to eighty per cent coinsurance on the first two thousand five hundred dollars of expenses.

(c) The contract for children shall include coverage for: (1) Physician visits for diagnosis and treatment; (2) well baby care, immunizations and child health supervision; (3) prenatal and postnatal care; and (4) outpatient hospital care; and may include coverage for: (A) Dental care; (B) laboratory and diagnostic tests; (C) prescription drugs; (D) physical therapy; (E) outpatient mental health and substance abuse visits; and (F) inpatient care.

(d) The commissioner shall establish an outreach program to ensure that eligible persons are aware of the health insurance available pursuant to this section.

(e) The commissioner may adopt regulations, in accordance with the provisions of chapter 54, for purposes of this section.

Sec. 2. This act shall take effect from its passage.

Approved May 31, 1996. Effective May 31, 1996.

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