SSSB 1: relative to access to health insurance coverage

SPECIAL SESSION SB 1-FN-A – AS INTRODUCED

2013 SESSION

13-1030

01/10

SPECIAL SESSION SENATE BILL 1-FN-A

AN ACT relative to access to health insurance coverage.

SPONSORS: Sen. Morse, Dist. 22; Sen. Bradley, Dist. 3; Sen. Odell, Dist. 8

COMMITTEE: Committee on Special Session Legislation

ANALYSIS

This bill establishes the New Hampshire health protection program. The bill also establishes the New Hampshire health protection trust and the New Hampshire health protection trust fund to accept federal moneys for the programs established in the bill. The commissioner of the department of health and human services is granted rulemaking authority for the purposes of the bill.

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Explanation: Matter added to current law appears in bold italics.

Matter removed from current law appears [~~in brackets and struckthrough.~~]

Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

13-1030

01/10

STATE OF NEW HAMPSHIRE

In the Year of Our Lord Two Thousand Thirteen

AN ACT relative to access to health insurance coverage.

Be it Enacted by the Senate and House of Representatives in General Court convened:

1 Statement of Purpose. The state of New Hampshire shall develop the New Hampshire health protection program to provide a coordinated strategy to access private insurance coverage for uninsured, low-income citizens with income up to 133 percent of the federal poverty level (FPL) using available, cost-effective health care coverage options for Medicaid newly eligible individuals at the earliest practicable date. The strategy shall promote the improvement of overall health through access to private insurance coverage options and draw appropriate levels of federal funding available through a Medicaid Section 1115 demonstration waiver. Increasing access to private health insurance will increase provider reimbursement rates and reduce the burden of uncompensated care in New Hampshire. The waiver shall be used to allow the state maximum flexibility to redesign Medicaid including establishing premium assistance programs that are customized to the state's reform goals. As part of the waiver application, the state shall request federal matching funds for non-Medicaid services to support designated state and local health programs and activities to create fiscal relief for the state.

2 New Paragraphs; Department of Health and Human Services; Changes to State Medicaid Program. Amend RSA 126-A:5 by inserting after paragraph XXII the following new paragraphs:

XXIII.(a) The commissioner shall provide access to the health insurance premium payment (HIPP) program established by the department pursuant to section 1906 of the Social Security Act of 1935 to Medicaid eligible childless adults from 0 – 133 percent of the federal poverty level (FPL) and parents from 53 – 133 percent of FPL and their spouse and dependents if applicable until December 31, 2016 to maximize the use of private insurance and available federal assistance. The New Hampshire health protection trust shall provide premium assistance to support the purchase of health insurance coverage using federal funds. In order to receive assistance, all Medicaid eligible childless adults from 0 – 133 percent of FPL and parents from 53 – 133 percent of FPL shall participate in employer-sponsored insurance, if available either directly as an employee or indirectly through another individual who is eligible for employer-sponsored insurance and if cost effective as determined by the federal Centers for Medicare and Medicaid Services. The department shall seek any necessary waivers or submit a state plan amendment to implement the provisions of this paragraph, including provisions to address individuals determined to be medically frail after completion of a health questionnaire screening process. The program shall not begin until such waivers or state plan amendments have been approved. Any costs to implement HIPP will be paid from federal funds awarded.

(b) Individuals who participate in the HIPP program shall provide all necessary information regarding financial eligibility, residency, citizenship or immigration status, and insurance coverage to the department of health and human services in accordance with rules adopted under RSA 541-A and shall at the time of enrollment acknowledge that the HIPP program is subject to cancellation upon notice. Eligibility for the HIPP program shall be a qualifying event under the Health Insurance Portability and Accountability Act.

(c) The commissioner may adopt rules or interim rules, pursuant to RSA 541-A, as necessary to implement any changes to the Medicaid program consistent with the 1115 waiver or state plan amendment. Any interim rules shall be effective for a period of one year, within which period the commissioner shall adopt rules pursuant to RSA 541-A.

(d) The New Hampshire mandatory HIPP program under this paragraph shall be implemented commencing January 1, 2014 or as soon thereafter as is practicable; provided that no eligibility changes shall be taken until:

(1) The federal Centers for Medicare and Medicaid Services has granted the Medicaid waiver or state plan amendment required under subparagraph (a).

(2) The commissioner submits and the fiscal committee of the general court by majority vote accepts written confirmation from the federal Centers for Medicare and Medicaid Services that the state of New Hampshire may end its voluntary change of Medicaid eligibility established pursuant to this paragraph with no financial penalty to the state consistent with the Medicaid waiver.

XXIV.(a) There is hereby established the bridge to marketplace premium assistance program. This will be a voluntary premium assistance program for Medicaid eligible childless adults from 0 – 133 percent of the federal poverty level (FPL) and parents from 53 – 133 percent of FPL who are ineligible for the HIPP program until December 31, 2014 and shall be administered by department of health and human services. The New Hampshire health protection trust shall provide premium assistance to support the purchase of health insurance coverage using federal funds under the Act, as defined in RSA 420-N:2, I. In order to receive assistance, Medicaid eligible childless adults from 0 – 133 percent of FPL and parents from 53 – 133 percent of FPL shall choose health care insurance coverage either from insurance products offered on the federally-facilitated exchange or an alternative benefit plan (ABP) offered by the managed care organizations awarded contracts as vendors to implement Medicaid managed care under RSA 126-A:5, XIX(a). Alternative benefit plans shall reimburse at rates that are sufficient to ensure improved access to and quality of care. The department shall seek any necessary waivers or submit a state plan amendment to implement the provisions of this paragraph, including provisions to address individuals determined to be medically frail after completion of a health questionnaire screening process. The program shall not begin until such waivers or state plan amendments have been approved. Any costs to implement voluntary premium assistance will be paid from federal funds awarded. For the purposes of this section, alternative benefit plan is defined as the Medicaid benchmark or benchmark equivalent coverage in section 1937 of the Federal Social Security Act.

(b) Individuals who participate in the voluntary premium assistance program shall provide all necessary information regarding financial eligibility, residency, citizenship or immigration status, and insurance coverage to the department of health and human services in accordance with rules adopted under RSA 541-A and shall at the time of enrollment acknowledge that the voluntary premium assistance program is subject to cancellation upon notice. Eligibility for the voluntary premium assistance program shall be a qualifying event under the Health Insurance Portability and Accountability Act.

(c) The commissioner may adopt rules or interim rules, pursuant to RSA 541-A, as necessary to implement any changes to the Medicaid program consistent with the Medicaid state plan amendment or necessary waivers. Any interim rules shall be effective for a period of one year, within which period the commissioner shall adopt rules pursuant to RSA 541-A.

(d) The New Hampshire bridge to marketplace premium assistance program under this paragraph shall be implemented commencing January 1, 2014 or as soon thereafter as is practicable; provided that no eligibility changes shall be taken until:

(1) The federal Centers for Medicare and Medicaid Services has granted the Medicaid state plan amendment or necessary waivers required under subparagraph (a).

XXV.(a) There is hereby established the marketplace premium assistance program. This will be a premium assistance program for Medicaid eligible childless adults from 0-133 percent of the federal poverty level (FPL) and parents from 53 – 133 percent of FPL who are ineligible for the HIPP Program until December 31, 2016 and shall be administered by department of health and human services. The New Hampshire health protection trust shall provide premium assistance to support the purchase of health insurance coverage from qualified health plans (QHPs) offered in the federally-facilitated exchange using federal funds. In order to receive assistance, Medicaid eligible childless adults from 0 – 133 percent of the FPL and parents from 53 – 133 percent of FPL who are ineligible for the HIPP Program shall choose health care insurance coverage from insurance products offered on the federally-facilitated exchange. Plans available on the exchange shall reimburse at rates that are sufficient to ensure improved access to and quality of care. On or before May 1, 2014, the commissioner shall submit a comprehensive statewide section 1115 demonstration waiver to implement the provisions of this paragraph, including provisions to address individuals determined to be medically frail after completion of a health questionnaire screening process. The program shall not begin until such waivers have been approved. Any costs to implement the premium assistance program shall be paid from federal funds awarded. The comprehensive statewide section 1115 waiver demonstration shall also request state fiscal relief in the form of federal matching funds for designated state and local health programs as prepared by the commission established by RSA 126-A:5-b. The waiver shall be approved by the Centers for Medicare and Medicaid Services by October 1, 2014.

(b) Individuals who participate in the marketplace premium assistance program shall provide all necessary information regarding financial eligibility, residency, citizenship or immigration status, and insurance coverage to the department of health and human services in accordance with rules adopted under RSA 541-A and shall at the time of enrollment acknowledge that the marketplace premium assistance program is subject to cancellation upon notice. Eligibility for the marketplace premium assistance program shall be a qualifying event under the Health Insurance Portability and Accountability Act.

(c) The commissioner may adopt rules or interim rules, pursuant to RSA 541-A, as necessary to implement any changes to the Medicaid program consistent with the 1115 waivers. Any interim rules shall be effective for a period of one year, within which period the commissioner shall adopt rules pursuant to RSA 541-A.

(d) The New Hampshire marketplace premium assistance program under this paragraph shall be implemented commencing January 1, 2015 or as soon thereafter as is practicable; provided that no eligibility changes shall be taken until:

(1) The federal Centers for Medicare and Medicaid Services has granted the Medicaid waiver required under subparagraph (a).

XXVI. Any unemployed individual that qualifies for the bridge to marketplace premium assistance program established in paragraph XXIV and the marketplace premium assistance program established in paragraph XXV shall be referred to the department of employment security for the purpose of helping the unemployed individual find suitable employment.

XXVII. For the year 2014, the commissioner shall negotiate an amendment to one or more of its existing managed care contracts to provide new private insurance plans which will qualify for the bridge to marketplace premium assistance program under paragraph XXIV. Such plans shall maximize to the extent allowable wellness programs and cost-sharing mechanisms. For the years 2015 and 2016, the commissioner shall work with any willing managed care organization or accountable care organization to facilitate the creation of private insurance plans which will qualify for the New Hampshire marketplace premium assistance program under paragraph XXV. Such plans shall maximize to the extent allowable wellness programs and cost-sharing mechanisms.

3 New Section; Health Care Reform Commission Established. Amend RSA 126-A by inserting after section 5-a the following new section:

126-A:5-b Health Care Reform Commission Established; Membership; Duties.

I. There is established a health care reform commission, the purpose of which shall be to prepare a comprehensive statewide section 1115 demonstration waiver to be submitted by the department of health and human services pursuant to RSA 126-A:5, XXV by May 1, 2014 in order to obtain federal matching funds for designated state and local health programs to improve access and quality of care for Medicaid-dependent patients.

II. The members of the commission shall be as follows:

(a) The commissioner of the department of health and human services, or designee.

(b) Two representatives of non-critical access hospitals, appointed by the New Hampshire Hospital Association.

(d) A representative of the New Hampshire Medical Society, appointed by the society.

(e) One member of the public representing local government appointed by the New Hampshire Municipal Association.

(f) One member of the public representing county government appointed by the New Hampshire Association of Counties.

III. The first meeting of the commission shall be called by the commissioner and shall be held within 21 days of the effective date of this section. Members of the commission shall elect a chairman of the commission. Five members of the commission shall constitute a quorum.

IV. The commission shall:

(a) Prepare a Medicaid waiver application under section 1115 of the Social Security Act, 42 U.S.C. 1315, to be submitted by the department of health and human services to obtain federal matching funds for designated state and local health programs to improve access and quality of care for Medicaid-dependent patients.

(b) Create any subcommittees it deems necessary, which may include members of the public appointed by the chairman, to assist with research, analysis, or other work necessary to support the waiver application.

(c) Review state-maintained data concerning the Medicaid program and interview state personnel with knowledge of the Medicaid program.

(d) Respond to questions or inquiries from the Centers for Medicare and Medicaid Services concerning the section 1115 waiver application. Members of the commission selected by the chairman shall attend all meetings with the Centers for Medicare and Medicaid Services during which the 1115 waiver application is to be discussed.

(e) Provide recommendations to the commissioner of the department of health and human services on the implementation of any section 1115 waiver approved.

(f) Prepare for submission through the department of health and human services any applications necessary to extend or modify the section 1115 waiver granted.

V. On or before January 31, 2014, the commission shall make an initial report on the status of its work to the fiscal committee of the general court. On or before September 1, 2014, the commission shall make a final report of its findings and activities, including the form and status of the application for a section 1115 waiver, to the governor, senate president, and the speaker of the house of representatives.

4 New Chapter; New Hampshire Health Protection Trust. Amend RSA by inserting after chapter 420-N the following new chapter:

CHAPTER 420-O

NEW HAMPSHIRE HEALTH PROTECTION TRUST

420-O:1 New Hampshire Health Protection Trust Established.

I. There is hereby established the New Hampshire health protection trust, a body corporate and politic. The main purpose of the New Hampshire health protection trust shall be to receive and expend federal funds to provide access to private insurance coverage for uninsured low-income citizens.

II. The New Hampshire health protection trust shall be governed by a board of trustees composed as follows:

(a) The attorney general.

(b) The state treasurer.

(c) One member of the public, nominated by the Business and Industry Association of New Hampshire and appointed by the governor and council.

(d) One member of the public, nominated by the board of directors of the New Hampshire Hospital Association and appointed by the president of the senate.

(e) One member of the public, nominated by the board of directors of the New Hampshire Behavioral Community Health Association and appointed by the speaker of the house of representatives.

III. Each member appointed under paragraph II shall hold office until a successor is appointed.

IV. All board members shall be New Hampshire residents.

V. Except for the attorney general and state treasurer no person who holds elected public office shall serve on the board.

420-O:2 Operation of Board of Trustees.

I. The board shall elect its own chairperson.

II. The board shall choose a secretary, who shall keep a record of proceedings.

III. Four voting members shall constitute a quorum for the transaction of business.

IV. The board shall meet at such times and places as it may determine, but shall hold regular meetings no less than once every 3 months. The chairperson shall call special meetings upon the written request of any 3 board members or upon the chairperson's own motion.

V. Members of the board shall not receive any compensation for their services.

420-O:3 Authority of the Board of Trustees. The trustees shall have the power to:

I. Enter into any contracts, leases, and any other instruments or arrangements that are necessary or proper to administer the program.

II. Sue or be sued, including taking any legal action necessary or proper.

III. Contract with appropriate legal, actuarial, and other persons as necessary to provide technical assistance in the operation of the programs established under RSA 126-A:5, XXIII - XXV.

IV. Accept any moneys appropriated by or received from the United States government, any grant moneys from federal governmental agencies, public or private corporations, foundations or organizations for the benefit and support of the programs established under RSA 126-A:5, XXIII - XXV.

V. Perform any other functions within the authority of the trust as may be necessary or proper to carry out the programs established under RSA 126-A:5, XXIII - XXV.

420-O:4 Tax Exemption. The trust shall be exempt from payment of all fees and all taxes levied by this state or any of its subdivisions, except taxes levied on real property.

420-O:5 Immunity for Members. There shall be no liability on the part of and no cause of action of any nature shall arise against any member of the board of trustees or the board's agents for any action or omission by them in the performance of their powers and duties under this chapter.

420-O:6 The New Hampshire Health Protection Trust Fund. There is hereby established in the office of the treasurer the New Hampshire health protection trust fund which shall be kept distinct and separate from all other funds. The board of trustees of the New Hampshire health protection trust is authorized to accept and expend all federal funds authorized to implement the New Hampshire health protection program. All such federal funds shall be deposited in the fund. All moneys in the trust fund shall be nonlapsing and shall be continually appropriated to the board of trustees of the New Hampshire health protection trust for purposes of implementing the New Hampshire health protection program.

5 New Subparagraph; New Hampshire Health Protection Trust Fund. Amend RSA 6:12, I(b) by inserting after subparagraph (316) the following new subparagraph:

(317) Moneys deposited in the New Hampshire health protection trust fund, established under RSA 420-O:6.

6 Appropriation; Health Care Reform Commission. Amend 2013, 144:130 to read as follows:

144:130 Appropriation. The sum of $200,000 is hereby appropriated to the department of health and human services for the fiscal year ending June 30, 2014, for the purpose of providing administrative support to the commission established in RSA 126-A:66 as inserted by section 129 of this act. Contracts for administrative support or consulting services shall not require governor and council approval. Any unspent balance of the appropriation made under this section shall be extended and shall not lapse until November 1, 2014, and shall be for the use of the commission established in RSA 126-A:5-b. The governor is authorized to draw a warrant for said sum out of any money in the treasury not otherwise appropriated.

7 Department of Health and Human Services; Medicaid Breast and Cervical Cancer Program. Enrollment in the Medicaid breast and cervical cancer program, under 42 U.S.C. section 1396a(aa), shall be suspended effective December 31, 2013 or upon the approval of any waivers or state plan amendments necessary to implement RSA 126-A:5, XXIII and XXIV whichever is later. Any individual covered under the Medicaid breast and cervical cancer program prior to the date the program is suspended shall continue to be covered for the program unless his or her medical treatment has concluded, or until the next redetermination of his or her eligibility by the department, whichever event occurs later. After the date the program is suspended the individual's eligibility for assistance shall be determined by the department pursuant to RSA 126-A:5, XXIII-XXV. Commencing on the date the program is suspended, administrative rule He-W 641.09 shall be limited in its application to only those individuals enrolled in the Medicaid breast and cervical cancer program receiving treatment prior to the date the program is suspended.

8 Applicability. If at any time the federal match rate received for any program under RSA 126-A:5, XXIII-XXV between January 1, 2014 – December 31, 2016 is less than 100 percent, RSA 126-A:5, XXIII, XXIV, XXV shall immediately be repealed upon notification by the commissioner of the department of health and human services to the secretary of state and the director of legislative services.

9 Repeal. The following are repealed:

I. RSA 126-A:5, XXIII, relative to health insurance premium payment (HIPP) program.

II. RSA 126-A:5, XXIV, relative to the bridge to marketplace premium assistance program.

III. RSA 420-O, relative to New Hampshire health protection trust.

IV. RSA 6:12, I(b)(317), relative to the New Hampshire health protection trust fund.

V. RSA 126-A:5-b, relative to the health care reform commission.

VI. 2013, 144:129 and 131, relative to the Medicaid expansion committee and the repeal of the committee.

VII. 2013, 144:130, as amended by section 6 of this act, relative to an appropriation.

10 Effective Date.

I. Section 9, paragraphs I-IV of this act shall take effect December 31, 2016.

II. Section 9, paragraph V of this act shall take effect September 1, 2014.

III. Section 9, paragraph VI of this act shall take effect upon its passage.

IV. Section 9, paragraph VII of this act shall take effect November 1, 2014.

V. The remainder of this act shall take effect upon its passage.

LBAO

13-1030

11/08/13

SPECIAL SESSION SB 1-FN-A - FISCAL NOTE

AN ACT relative to access to health insurance coverage

FISCAL IMPACT:

Due to time constraints, the Office of Legislative Budget Assistant is unable to provide a fiscal note for this bill, as introduced, at this time. When completed, the fiscal note will be forwarded to the Senate Clerk's Office.

See Also: