SP0376, LD 1094, item 1, An Act To Fully Implement Health Insurance Exchanges and To Make Maine Law Consistent with Federal Law

An Act To Fully Implement Health Insurance Exchanges and To Make Maine Law Consistent with Federal Law

Be it enacted by the People of the State of Maine as follows:

PART A

Sec. A-1. 5 MRSA §12004-I, sub-§31-B is enacted to read:

31-B.

Health Care

Maine Health Exchange Advisory Board

Legislative per diem and travel expenses

24-A MRSA §4347

Sec. A-2. 24-A MRSA c. 56-C is enacted to read:

CHAPTER 56-C

HEALTH EXCHANGE UNDER FEDERAL AFFORDABLE CARE ACT

§ 4347. Maine Health Exchange Advisory Board

The Maine Health Exchange Advisory Board, referred to in this section as "the advisory board," established under Title 5, section 12004-I, subsection 31-B, is established to advise the Federal Government, the Governor, the Legislature, the Department of Health and Human Services and the bureau regarding the interests of individuals and employers with respect to any federally facilitated exchange, partnership exchange or state-based exchange that may be created for this State pursuant to the federal Affordable Care Act.

1. Appointment; composition. The advisory board consists of 17 members appointed pursuant to this subsection.

A. The Governor shall appoint 12 members of the advisory board with the approval of the joint standing committee of the Legislature having jurisdiction over insurance and financial services matters:

(1) Two persons representing health insurance carriers;

(2) One person representing dental insurance carriers;

(3) One person representing insurance producers;

(4) One person representing Medicaid recipients;

(5) One person representing health care providers and health care facilities;

(6) One person who is an advocate for enrolling hard-to-reach populations, including individuals with mental health or substance abuse disorders;

(7) One person who is a public health expert; and

(8) Four members representing individuals and small businesses, including:

(a) One person who can reasonably be expected to purchase individual coverage through an exchange with the assistance of a premium tax credit and who can reasonably be expected to represent the interests of consumers purchasing individual coverage through the exchange;

(b) One person representing an employer that can reasonably be expected to purchase group coverage through an exchange who can reasonably be expected to represent the interests of such employers;

(d) One person employed by an employer that can reasonably be expected to purchase group coverage through an exchange who can reasonably be expected to represent the interests of such employees.

Prior to making appointments to the advisory board, the Governor shall seek nominations from the public statewide associations representing the interests under this paragraph and other entities as appropriate.

B. Five members of the advisory board must be members of the Legislature, of whom at least 3 must serve on the joint standing committee of the Legislature having jurisdiction over insurance and financial services matters:

(1) Two members of the Senate, appointed by the President of the Senate, including one member recommended by the Senate Minority Leader; and

(2) Three members of the House of Representatives, appointed by the Speaker of the House, including one member recommended by the House Minority Leader.

2. Term. Except for members who are Legislators, members of the advisory board serve 3-year terms. A member may not serve more than 2 consecutive terms. Members who are Legislators serve 2-year terms coterminous with their elected terms. Except for a member who is a Legislator, a member may continue to serve after expiration of the member's term until a successor is appointed.

3. Duties. The advisory board shall:

A. Advise the Federal Government, the Governor, the Legislature, the Department of Health and Human Services and the bureau regarding the interests of individuals and employers with respect to any federally facilitated exchange, partnership exchange or state-based exchange that may be created for this State;

B. Serve as a liaison between any exchange and individuals and small businesses enrolled in the exchange;

C. Evaluate the implementation and operation of any federally facilitated exchange, partnership exchange or state-based exchange with respect to the following:

(1) The essential health benefits benchmark plan designated in this State under the federal Affordable Care Act, including whether the State should change its designation;

(2) Whether state laws governing health insurance coverage for wellness programs and smoking cessation programs are in compliance with federal regulations;

(3) The consumer outreach and enrollment conducted by the exchange and whether the navigator program is effective;

(4) The coordination between the state Medicaid program and the exchange;

(5) Whether individual subsidies are adequate;

(6) Whether the exchange is effective in providing access to health insurance coverage for small businesses; and

(7) The implementation of rebates under the federal Affordable Care Act and section 4319.

D. Following the release of guidance or regulations from the federal Centers for Medicare and Medicaid Services addressing the basic health program option, as set forth in the federal Affordable Care Act, conduct a study, and make recommendations as appropriate, that examines the following:

(1) The affordability of health insurance coverage for low-income populations earning between 133% and 200% of the federal poverty level, including the impact of premium levels and cost sharing on access to health care by these populations;

(2) The health needs and limited income of these populations;

(3) The potential cost savings to the state Medicaid program as a result of the adoption of a basic health program due to the decrease in the administrative burden associated with individuals churning off and on Medicaid as their incomes fluctuate;

(4) Systems to create automatic and seamless coverage for individuals who transfer between a basic health program and Medicaid coverage;

(5) The impact of a basic health program on the State's ability to negotiate rates or receive rebates under any health insurance coverage offered by or through the State; and

(6) The most cost-effective and affordable method of delivering basic health program health insurance coverage by comparing and contrasting coverage and applicable out-of-pocket costs provided through a Medicaid look-alike program, a standard health plan offered through the Consumer Operated and Oriented Plan program under the federal Affordable Care Act or any other insurance product offered through a state-based exchange or federally facilitated exchange.

E. Based on the evaluation conducted by the advisory board pursuant to paragraphs C and D, recommend whether the State should transition to a partnership model or state-based exchange or implement any other changes in policy or law that would improve the operation of a federally facilitated exchange for consumers and small businesses in the State. If the advisory board recommends that the State transition to an alternative model from a federally facilitated exchange, the advisory board shall recommend a work plan and timeline for the transition, including estimated costs.

4. Compensation. Except for members of the advisory board who are Legislators, members serve as volunteers and without compensation or reimbursement for expenses. Members who are Legislators are entitled to receive the legislative per diem as defined in Title 3, section 2 and reimbursement for travel for attendance at meetings of the board.

5. Quorum. A quorum is a majority of the members of the advisory board.

6. Chair. The advisory board shall annually choose one of its members to serve as chair for a one-year term.

7. Meetings. The advisory board shall meet at least 4 times a year at regular intervals and may meet at other times at the call of the chair. Meetings of the board are public proceedings as provided by Title 1, chapter 13, subchapter 1.

8. Records. Except for information designated as confidential under federal or state law, information obtained by the advisory board is a public record as provided by Title 1, chapter 13, subchapter 1.

Sec. A-3. Maine Health Exchange Advisory Board initial member terms. Notwithstanding the Maine Revised Statutes, Title 24-A, section 4347, subsection 2, except for members who are Legislators, initial appointees to the Maine Health Exchange Advisory Board must include 3 members appointed to one-year terms, 4 members appointed to 2-year terms and 5 members appointed to 3-year terms.

PART B

Sec. B-1. 24-A MRSA §3953, sub-§1, as enacted by PL 2011, c. 90, Pt. B, §8, is amended to read:

1. Guaranteed access reinsurance mechanism established. The Maine Guaranteed Access Reinsurance Association is established as a nonprofit legal entity. As a condition of doing business in the State, an insurer that has issued or administered medical insurance within the previous 12 months or is actively marketing a medical insurance policy or medical insurance administrative services in this State must participate in the association. The Dirigo Health Program established in chapter 87 and any other state-sponsored health benefit program shall also participate in the association. Beginning January 1, 2014 and until December 31, 2016 or until such time as the transitional reinsurance program administered pursuant to the federal Affordable Care Act is terminated, the authority of the association granted by this chapter is suspended.

Sec. B-2. Maine Guaranteed Access Reinsurance Association; amendment to plan of operation. On or before October 1, 2013, the Board of Directors of the Maine Guaranteed Access Reinsurance Association shall submit an amendment to the association's plan of operation to the Superintendent of Insurance for approval as provided in the Maine Revised Statutes, Title 24-A, section 3953, subsection 3 to implement the suspension of the operations of the association pursuant to this Act. In amending the plan of operation, the board of directors shall, at a minimum, explain how operations will be suspended, describe the actions necessary to pay reinsurance on qualified claims attributable to the time period prior to January 1, 2014 and describe the actions necessary to suspend assessments.

PART C

Sec. C-1. 22 MRSA §3174-G, sub-§1, ¶F, as amended by PL 2011, c. 380, Pt. KK, §2, is further amended to read:

F. A person 20 to 64 years of age who is not otherwise covered under paragraphs A to E when the person's family income is below or equal to 125% of the nonfarm income official poverty line, provided that the commissioner shall adjust the maximum eligibility level in accordance with the requirements of the paragraph.

(2) If the commissioner reasonably anticipates the cost of the program to exceed the budget of the population described in this paragraph, the commissioner shall lower the maximum eligibility level to the extent necessary to provide coverage to as many persons as possible within the program budget.

(3) The commissioner shall give at least 30 days' notice of the proposed change in maximum eligibility level to the joint standing committee of the Legislature having jurisdiction over appropriations and financial affairs and the joint standing committee of the Legislature having jurisdiction over health and human services matters; and

Sec. C-2. 22 MRSA §3174-G, sub-§1, ¶G, as enacted by PL 2011, c. 380, Pt. KK, §3, is amended to read:

G. A person who is a noncitizen legally admitted to the United States to the extent that coverage is allowable by federal law if the person is:

(1) A woman during her pregnancy and up to 60 days following delivery; or

(2) A child under 21 years of age . ;

Sec. C-3. 22 MRSA §3174-G, sub-§1, ¶¶H and I are enacted to read:

H. Beginning January 1, 2014, a person 21 years of age to 64 years of age who is not otherwise eligible for medical assistance under this section, who qualifies for medical assistance pursuant to 42 United States Code, Section 1396a(a)(10)(A)(i)(VIII) and who has income at or below 133% of the nonfarm income official poverty line plus 5% for the applicable family size as required by federal law. A person eligible for medical assistance under this paragraph must receive the same coverage as is provided to a person eligible under paragraph E; and

I. Beginning October 1, 2019, a person 19 years of age and 20 years of age who is not otherwise eligible for medical assistance under this section, who qualifies for medical assistance pursuant to 42 United States Code, Section 1396a(a)(10)(A)(i)(VIII) and who has income at or below 133% of the nonfarm income official poverty line plus 5% for the applicable family size as required by federal law. A person eligible for medical assistance under this paragraph must receive the same coverage as is provided to a person eligible under paragraph E.

summary

Part A of the bill establishes the Maine Health Exchange Advisory Board to advise the Federal Government, Governor and Legislature on the implementation and operation of a health exchange in this State pursuant to the federal Patient Protection and Affordable Care Act. The advisory board is composed of 17 members, including 5 members who are Legislators.

Part B of the bill suspends the authority of the Maine Guaranteed Access Reinsurance Association from January 1, 2014 until December 31, 2016 or until such time as the transitional reinsurance program administered by the federal Department of Health and Human Services pursuant to the federal Patient Protection and Affordable Care Act is no longer operational. This Part also directs the Board of Directors of the Maine Guaranteed Access Reinsurance Association to amend the association's plan of operation and submit an amendment to the plan of operation on or before October 1, 2013 to the Superintendent of Insurance for approval. The amended plan of operation must include, but is not limited to, an explanation of how operations will be suspended, the actions necessary to pay reinsurance on qualified claims attributable to the time period prior to January 1, 2014 and the actions necessary to suspend assessments.

Part C of the bill expands medical coverage under the MaineCare program to adults with family incomes up to 133% of the nonfarm income official poverty line and qualifies Maine to receive federal funding for 100% of the cost of coverage for members who enroll under the expansion. Adults eligible are those 21 years of age to 64 years of age beginning January 1, 2014 and those 19 years of age and 20 years of age beginning October 1, 2019.

SP0376 LD 1094	Session - 126th Maine Legislature		LR 1019 Item 1
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