Results Defined by SustiNet Act

Design and establish procedures to implement the SustiNet Plan.  Submit its design and implementation procedures in the form of recommended legislation to the General Assembly. 

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(1/1)

The SustiNet Plan shall be designed to:

• Improve the health of state residents; 
• Improve the quality of health care and access to health care; (
• Provide health insurance coverage to Connecticut residents who would otherwise be uninsured;
• Increase the range of health care insurance coverage options available to residents and employers;
• Slow the growth of per capita health care spending both in the short-term and in the long-term; and
• Implement reforms to the health care delivery system

The procedures and guidelines shall be specific and guided by the Institute of Medicine principles: 

1) Health care coverage should be universal;

2) health care coverage should be continuous;

3) health care coverage should be affordable to individuals and families;

4) the health insurance strategy should be affordable and sustainable for society; and

5) health care coverage should enhance health and well-being by promoting access to high-quality care that is effective, efficient, safe, timely, patient-centered and equitable.

The board of directors shall recommend that the public authority adopt periodic action plans to achieve measurable objectives in areas that include, but are not limited to:

·         effective management of chronic illness,

·         preventive care,

·         reducing racial and ethnic disparities as related to health care and health outcomes,

·         and reducing the number of state residents without insurance

The public authority should monitor the accomplishment of the objectives and modify action plans as necessary

Organizational Tasks

Establish committees, following composition requirements in legislation

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Determine internal communications mechanisms

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Establish meeting schedule

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Identify staffing/consulting/funding needs

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Set up Web site

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Establish ethics/conflicts rules

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Involve relevant state agencies

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Disseminate existing reports/data sources to inform work

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Conduct ongoing literature review

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Collect information on other states’ work

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Develop a public input process

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Implement a public input process

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Submit draft legislation

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Response to Federal Health Care Reform

Track and analyze implications of federal reform for extension of HUSKY eligibility

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Track and analyze reform provisions for changes needed in CT administrative practice &/or law

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Identify federal criteria Connecticut must meet

Track and analyze areas where federal policy may or does pre-empt CT practice, policy or law

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Track & analyze insurance market reforms; identify recommendations potentially needed re: non-group market protections

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Track & analyze rating rules for large employers to prevent adverse selection & potential recommendations needed

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Submit report to governor and legislature w/i 60 days of federal law

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Market Research, Outreach and Enrollment

Commission employer and consumer surveys

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Develop recommendations to ensure state employee inclusion in SustiNet, in conjunction with the state and coalition committee

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Develop recommendations regarding, HUSKY A & B, SAGA, Medicaid  inclusion in SustiNet

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Develop recommendations for enrollment procedures

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Develop recommendations for marketing SustiNet

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Develop recommendations for public education & outreach

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Establish information clearinghouse

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Value-based Benefit Design

Develop model benefits package (Office of Healthcare Advocate)

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Assure the availability of a standard benefits package to employers

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Financing

Identify costs and potential funding sources to establish & administer SustiNet

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Determine the feasibility of funding premium subsidies between 300% and 400% FPL

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Identify and recommend opportunities for new & increased federal funding and reimbursement

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Determine employer-based financing mechanisms to minimize crowd-out & adverse selection

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SustiNet Governance Entity

Develop recommendations on the governance structure best suited to implement and operate SustiNet

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Appoint committees that can assist with implementation

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Recommendations regarding functions of the governance entity

Contract with insurers or other entities for administrative purposes, such as claims processing and credentialing of providers.

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Make and enter into all contracts and agreements for professional services, independent professionals or employees

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Enter into interagency agreements for performance of SustiNet Plan duties that may be implemented more efficiently or effectively by an existing state agency

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Purchase reinsurance, stop loss coverage, set aside reserves or take other prudent steps that avoid excess exposure to risk

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Establish a method for the collection of payments from employers, whose employees would have received employer-sponsored insurance, but instead enroll in the SustiNet

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Arrange for access to existing or new provider networks…to provide all SustiNet Plan members with access to timely, high-quality care throughout the state and, in appropriate cases, outside the state’s borders

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Set payment methods for licensed health care providers that reflect evolving research and experience

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Negotiate on behalf of providers participating in the SustiNet Plan to obtain discounted prices for vaccines and other health care goods and services

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Establish appropriate deductibles, standard benefit packages, and out-of-pocket cost-sharing levels for different providers, that may vary based on quality, cost, provider agreement

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