(a) As used in this section:

(1) “CHOICES” means Connecticut’s programs for health insurance assistance, outreach, information and referral, counseling and eligibility screening; and

(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.

(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.

(c) The program shall provide: (1) Toll-free telephone access for consumers to obtain 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) 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) information through appropriate means and format, including written materials, to Medicare beneficiaries, their families, senior citizens and organizations regarding Medicare benefits, including prescription drug benefits available through Medicare Part D and other pharmaceutical drug company programs and long-term care options available in the state; (4) information concerning Medicare plans and services, private insurance policies and federal and state-funded programs that are available to beneficiaries to supplement Medicare coverage; (5) information permitting Medicare beneficiaries to compare and evaluate their options for delivery of Medicare and supplemental insurance services; (6) information concerning the procedure to appeal a denial of care and the procedure to request an expedited appeal of a denial of care; and (7) any other information the program or the Commissioner of Social Services deems relevant to Medicare beneficiaries.

(d) The Commissioner of Social Services may include any additional functions necessary to conform to federal grant requirements.

(e) 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 (c) of this section, (2) post or cause to be posted in a conspicuous place therein the toll-free number established pursuant to subsection (c) of this section, and (3) provide each Medicare patient with the toll-free number and information on how to access the CHOICES program.

(f) The Commissioner of Social Services may adopt regulations, in accordance with chapter 54, as necessary to implement the provisions of this section.

(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; P.A. 10-32, S. 69; P.A. 13-97, S. 5; 13-125, S. 18; P.A. 16-21, S. 1; June Sp. Sess. P.A. 17-2, S. 298.)

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; P.A. 10-32 made a technical change in Subsec. (b)(5), effective May 10, 2010; P.A. 13-97 amended Subsec. (e) to replace reference to select committee on aging with reference to joint standing committee on aging, effective June 6, 2013; P.A. 13-125 amended Subsecs. (a)(2) and (b) to replace “Department of Social Services” with “Department on Aging”, amended Subsec. (a)(3) to redefine “Medicare organization”, redesignated provisions re program requirements in existing Subsec. (b) as new Subsec. (c) and amended same to replace provision requiring preparation and distribution of written materials with provision re providing information through appropriate means, to add “other pharmaceutical drug company programs”, to delete former Subparas. (A) to (F) and replace provisions re consumers guide with provision re providing information re services, private insurance policies and federal and state-funded programs in Subdiv. (4), to add new Subdiv. (5) re information to compare options for delivery of Medicare and supplemental insurance services, to redesignate provision in former Subdiv. (4)(C) re procedure to appeal as new Subdiv. (6), to redesignate provision re other information in former Subdiv. (4)(F) as Subdiv. (7) and amend same to add references to Commissioner on Aging and Medicare, to delete former Subdiv. (5) re collaboration with other state agencies and to delete former Subdiv. (6) re functions to conform to federal grant requirements, added new Subsec. (d) re functions to conform to federal grant requirements, redesignated existing Subsecs. (c) to (f) as Subsecs. (e) to (h), amended redesignated Subsec. (e) to replace “Commissioner of Social Services” with “Commissioner on Aging” and replace “commissioner” with “Insurance Commissioner” in Subdivs. (1) and (2), amended redesignated Subsec. (g) to add reference to Sec. 11-4a, added new Subsec. (i) re regulations, and made technical and conforming changes, effective June 18, 2013; Sec. 17b-427 transferred to Sec. 17a-314 in 2015; P.A. 16-21 amended Subsec. (a) by deleting former Subdiv. (3) defining Medicare organization, deleted former Subsecs. (e) to (g) re Medicare organizations, redesignated existing Subsecs. (h) and (i) as Subsecs. (e) and (f) and made a technical change; June Sp. Sess. P.A. 17-2 replaced references to Department and Commissioner on Aging with references to Department and Commissioner of Social Services, effective October 31, 2017.