CONNECTICUT: The state’s estimated $550 million budget deficit will not slow down the development of SustiNet, the state’s universal health care plan enacted last year over Governor M. Jodi Rell’s veto. The SustiNet Board must design a self-funded plan that will control costs while increasing access, and then submit its recommendations to the legislature by January 1, 2011. Enrollment is set to start in 2012.

However, the revenue to implement sweeping changes is not there. Legislators also will again debate allowing municipalities, nonprofit organizations, and small businesses to buy into the state employee program. In addition, the legislature will likely reintroduce the bill prohibiting disability income insurance from including an offset provision that would reduce benefits based on Social Security Disability Insurance payments made to or on behalf of dependents.

Perennial provider issues, such as standardized contracts, are likely to come up again, as will Medicaid reimbursement levels, assignment of benefits rules, “all products” clauses, prompt-pay requirements, and restrictions on usual, reasonable and customary determinations by health plans. Additionally, lawmakers may consider new taxes or assessments on health plans to pay for reform and mandatory medical benefit ratios for private market coverage.

Other measures likely to be introduced would establish a new external review process for long-term care insurance claim denials, impose restrictions on generic substitution of prescription drugs, and prior approval of premium rates in the individual market.

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