HP0865, LD 1265, item 1, An Act To Implement the Recommendations of the Maine Health Exchange Advisory Committee

An Act To Implement the Recommendations of the Maine Health Exchange Advisory Committee

Emergency preamble. Whereas, acts and resolves of the Legislature do not become effective until 90 days after adjournment unless enacted as emergencies; and

Whereas, this legislation continues on a permanent basis the Maine Health Exchange Advisory Committee as recommended by the committee in its final report to the Legislature; and

Whereas, immediate enactment of this legislation is needed to reestablish the Maine Health Exchange Advisory Committee as Maine's liaison to the Federal Government in the implementation and operation of Maine's federally facilitated marketplace; and

Whereas, a pending United States Supreme Court decision may have a significant impact on the availability and affordability of coverage through the federally facilitated marketplace; and

Whereas, the Maine Health Exchange Advisory Committee may have a role in advising the State's policymakers following the Supreme Court's decision; and

Whereas, in the judgment of the Legislature, these facts create an emergency within the meaning of the Constitution of Maine and require the following legislation as immediately necessary for the preservation of the public peace, health and safety; now, therefore,

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

Sec. 1. 5 MRSA §12004-I, sub-§50-B is enacted to read:

50-B.

Insurance: Health Exchange

Maine Health Exchange Advisory Committee

Legislative Per Diem and Expenses for Legislators and Expenses Only for Other Members upon Demonstration of Financial Hardship

24-A MRSA §4320-J

Sec. 2. 24-A MRSA §4320-J is enacted to read:

§ 4320-J. Maine Health Exchange Advisory Committee

The Maine Health Exchange Advisory Committee, referred to in this section as "the advisory committee" and established pursuant to Title 5, section 12004-I, subsection 50-B, is created to advise the Governor and the Legislature regarding the interests of individuals and employers with respect to any health benefit exchange, referred to in this section as "an exchange," that may be created for this State pursuant to the federal Affordable Care Act.

1. Appointment; composition. The advisory committee consists of 21 members as follows:

A. The following 5 members of the Legislature, of whom 3 members must serve on the joint standing committee of the Legislature having jurisdiction over insurance and financial services matters and 2 members must serve on the joint standing committee of the Legislature having jurisdiction over health and human services matters or the joint standing committee of the Legislature having jurisdiction over appropriations and financial affairs:

(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 of Representatives, including one member recommended by the House Minority Leader;

B. Two persons representing health insurance carriers, one of whom is appointed by the President of the Senate and one of whom is appointed by the Speaker of the House of Representatives;

C. One person representing dental insurance carriers, appointed by the Speaker of the House of Representatives;

D. One person representing insurance producers, appointed by the President of the Senate;

E. One person representing Medicaid recipients, appointed by the Speaker of the House of Representatives;

F. Two persons representing health care providers and health care facilities, including one member representing federally qualified health centers, appointed by the Speaker of the House of Representatives;

G. One person who is an advocate for enrolling hard-to-reach populations in health coverage, including individuals with mental health or substance abuse disorders, appointed by the President of the Senate;

H. One member representing a federally recognized Indian tribe, appointed by the President of the Senate;

I. One member who has expertise in tax matters, appointed by the President of the Senate;

J. Four members representing individuals and small businesses, including:

(1) One person, appointed by the President of the Senate, who can reasonably be expected to purchase individual coverage through an exchange with the assistance of a federal premium tax credit and who can reasonably be expected to represent the interests of individuals purchasing individual coverage through an exchange;

(2) One person, appointed by the Speaker of the House of Representatives, who represents an employer that can reasonably be expected to purchase group coverage through an exchange and who can reasonably be expected to represent the interests of such employers;

(3) One person, appointed by the President of the Senate, who represents navigators or entities likely to be certified as navigators; and

(4) One person, appointed by the Speaker of the House of Representatives, who is employed by an employer that can reasonably be expected to purchase group coverage through an exchange and who can reasonably be expected to represent the interests of such employees;

K. The superintendent, or the superintendent's designee, who serves as an ex officio, nonvoting member; and

L. The Commissioner of Health and Human Services, or the commissioner's designee, who serves as an ex officio, nonvoting member.

2. Term. Except for members who are Legislators and ex officio members, all members are appointed for 3-year terms. A vacancy must be filled by the same appointing authority that made the original appointment. An appointed member may not serve more than 2 terms. A member may designate an alternate to serve on a temporary basis. A member who is a Legislator serves a 2-year term coterminous with the elected term. 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. Chair. The first-named member of the Senate is the Senate chair of the advisory committee, and the first-named member of the House of Representatives is the House chair of the advisory committee.

4. Duties. The advisory committee shall:

A. Advise the Governor and Legislature regarding the interests of individuals and employers with respect to an exchange;

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

C. Evaluate the implementation and operation of an exchange with respect to the following:

(1) Whether the State should transition from a federally facilitated exchange model to a state-based exchange or partnership model;

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

(3) The impact of federal and state laws, rules and regulations governing the health insurance rating for tobacco use and coverage for wellness programs and smoking cessation programs on accessibility and affordability of health insurance;

(4) The consumer outreach and enrollment conducted by the exchange and whether the navigator program is effective and whether navigators or other persons providing assistance to consumers are in compliance with any federal or state certification and training requirements;

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

(6) Whether health insurance coverage through the exchange is affordable for individuals and small businesses, including whether subsidies for individuals are adequate;

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

(8) The implementation of rebates under the federal Affordable Care Act and section 4319;

(9) The coordination of plan management activities between the bureau and the exchange, including the certification of qualified health plans and rate review;

(10) The potential for establishing a basic health program or seeking a Medicaid state plan amendment or state innovation waiver to provide alternative health coverage programs for individuals;

(11) Whether changes should be considered in federal law or regulations to address dental health coverage available through the marketplace, including, but not limited to, premiums and out-of-pocket costs;

(12) Whether the State should consider changes to its designated rating areas for geographic area to the extent permitted by federal law and regulations;

(13) The impact of so-called churn on the effective operation of the marketplace, public health programs and the private health insurance market;

(14) The impact of federal requirements to provide employer-sponsored health coverage;

(15) The impact of any change in the definition of "small group" for health insurance purposes;

(16) The impact of federal transitional risk adjustment programs and whether the State should consider ending the suspension of the Maine Guaranteed Access Reinsurance Association under section 3953;

(17) The impact of health insurance policies continued in the State under the transitional relief granted by the federal Department of Health and Human Services; and

(18) Any issue relating to the implementation of the federal Affordable Care Act agreed upon by a majority of the advisory committee; and

D. Based on the evaluations conducted by the advisory committee pursuant to this subsection, make recommendations for any changes in policy or law that would improve the operation of an exchange for individuals and small businesses in the State.

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

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

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

8. Staffing. The Legislative Council shall provide year-round staff support for the operation of the advisory committee.

9. Accounting; funding for advisory committee activities. All funds appropriated, allocated or otherwise provided to the advisory committee must be deposited in an account separate from all other funds of the Legislature and are nonlapsing. Funds in the account may be used only for the purposes of the advisory committee. The advisory committee may apply for grants and other nongovernmental funds to provide professional support or consultant support to carry out the duties and requirements of this section. Prompt notice of solicitation and acceptance of funds must be sent to the Legislative Council. All funds accepted must be forwarded to the Executive Director of the Legislative Council, along with an accounting that includes the amount received, the date that amount was received, from whom that amount was received, the purpose of the donation and any limitation on use of the funds. The executive director shall administer all funds received in accordance with this section. At the beginning of each fiscal year, and at any other time at the request of the chairs of the advisory committee, the executive director shall provide to the advisory committee an accounting of all funds available to the advisory committee, including funds available for professional support or consultant support.

10. Reports. Beginning February 15, 2016 and annually thereafter, the advisory committee shall report and make specific recommendations, including any necessary legislation, relating to its duties in subsection 4 to the joint standing committee of the Legislature having jurisdiction over insurance and financial services matters and the joint standing committee of the Legislature having jurisdiction over health and human services matters and to any appropriate state agency.

Emergency clause. In view of the emergency cited in the preamble, this legislation takes effect when approved.

summary

This bill proposes to implement the recommendations of the Maine Health Exchange Advisory Committee pursuant to Joint Order 2013, House Paper 1136. The bill establishes the Maine Health Exchange Advisory Committee on a permanent basis.

The Joint Standing Committee on Insurance and Financial Services has not taken a position on the substance of the recommendations or the bill, and by reporting out this bill the committee is not suggesting and does not intend to suggest that it agrees or disagrees with any aspect of the advisory committee's recommendations or this bill. The Joint Standing Committee on Insurance and Financial Services is reporting out the bill for the sole purpose of turning the advisory committee's proposal into a printed bill that can be referred to the Joint Standing Committee on Insurance and Financial Services for an appropriate public hearing and subsequent processing in the normal course. The Joint Standing Committee on Insurance and Financial Services is taking this action to ensure clarity and transparency in the legislative review of the advisory committee's proposal.

HP0865 LD 1265	Session - 127th Maine Legislature		LR 1950 Item 1
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