Sen. White, Dist. 9
Rep. Manuse, Rock. 5
April 23, 2012
Amendment to HB 1297
Amend the bill by replacing all after the enacting clause with the following:
1 Purpose and Scope. Amend RSA 420-N:1 to read as follows:
420-N:1 Purpose and Scope.
[I.] The intent of this chapter is to preserve the state’s status as the primary regulator of the business of insurance within New Hampshire and the constitutional integrity and sovereignty of the state of New Hampshire under the Tenth Amendment to the United States Constitution and part I, article 7 of the New Hampshire constitution [by creating] and to create a legislative oversight committee to supervise the insurance commissioner’s [implementation] administration of the insurance reforms required under the Patient Protection and Affordable Care Act of 2009, Public Law 111-148, as amended by the Health Care and Education Reconciliation Act of 2010, Public Law 111-152, including any federal regulations, interpretations, standards, or guidance issued thereunder (hereinafter “the Act”).
[II. Further, it is the intent of this chapter to prevent the state of New Hampshire from defaulting into federal oversight regarding the Act by not meeting certain federally-mandated time frames for state implementation of the Act. It is the intent of this chapter to preserve the state’s flexibility by allowing consideration of each state implementation requirement as it arises.]
420-N:7 Prohibition on State-Based Health Exchange; Guidelines for Interaction With Federally-Facilitated Health Exchange.
I. No New Hampshire state agency, department, or political subdivision shall plan, create, participate in or enable a state-based exchange for health insurance under the Act, or contract with any private entity to do so.
II. State agencies or departments may interact with the federal government with respect to the creation of a federally-facilitated exchange for New Hampshire.
III. Subject to the requirements of this chapter with respect to oversight committee approval, state agencies or departments may operate specific functions of a federally-facilitated exchange consistent with this subdivision to enable the continuation of traditional areas of state regulation and authority.
IV. State agency activities relating to any federally-facilitated exchange for New Hampshire shall be consistent with the following objectives:
(a) Promoting preservation of the private, commercial delivery of health coverage through carriers and producers to the greatest degree possible under the Act and minimizing interference with the operation of commercial markets.
(b) Minimizing overhead and administrative expenses.
(c) Promoting competition and consumer choice, for example by advocating for allowing all health and dental plans that meet the minimum requirements necessary to be certified as qualified plans under the Act to be offered in the exchange.
(d) Preserving to the greatest extent possible the state’s insurance regulatory authority and the state’s flexibility in determining Medicaid eligibility standards and program design and operation.
420-N:8 Federally-Facilitated Exchange; Authority of the Commissioner.
I. In the event a federally-facilitated exchange is established for New Hampshire, the commissioner shall retain authority with respect to insurance products sold in New Hampshire on the federally-facilitated exchange to the maximum extent possible by law as provided in title XXXVII, including but not limited to producer and insurer licensing, form and rate approval, reinsurance and other risk-sharing mechanisms, network adequacy, industry assessments, internal grievance standards, external review, and unfair trade practices.
II. Any person who sells, solicits, or negotiates insurance within the meaning of RSA 402-J:3 through a federally-facilitated exchange shall be licensed as a producer under RSA 402-J; provided, that nothing in this subdivision shall prohibit the sale of health coverage by an exchange or health carrier directly to the consumer without the use of a producer. This paragraph shall not be interpreted to require that all navigators as defined under the Act be licensed as producers, but rather that any individual who in fact performs a producer function be licensed, whether or not that person is employed by a navigator.
III. The commissioner may establish standards and training requirements for navigators on a federally-facilitated exchange consistent with section 1311(i) of the Act and regulations implemented under the Act, including provisions to ensure that any private or public entity that is selected as a navigator avoids conflicts of interest and is appropriately qualified to engage in navigator activities.
IV. The commissioner shall, consistent with the requirements of the Act, allow producers to enroll individuals, employers, or employees in qualified health plans offered through a federally-facilitated exchange in this state, including enrollment using Internet websites.
V. The commissioner may adopt rules, pursuant to RSA 541-A and in accordance with RSA 420-N:4, II, as necessary to perform the duties specified in this section and to protect against adverse selection by creating a level playing field between a federally-facilitated exchange and the commercial health insurance market.
420-N:9 Federally-Facilitated Exchange; Authority of the Health and Human Services Commissioner.
I. The commissioner of health and human services shall have authority to establish New Hampshire eligibility standards, enrollment procedures, and outreach mechanisms for persons who are enrolled through a federally-facilitated exchange in this state in the Medicaid program under title XIX of the Social Security Act or the Children’s Health Insurance Program (CHIP) under title XXI of the Social Security Act.
II. The commissioner of health and human services may establish navigator guidelines for New Hampshire consistent with section 1311(i) of the Act, and regulations implemented under the Act, to ensure that navigators are qualified to reach and assist the Medicaid-eligible and other populations served by a federally-facilitated exchange in New Hampshire.
III. The commissioner of health and human services may adopt rules, pursuant to RSA 541-A and subject to oversight committee approval under RSA 161:11, as necessary to fulfill the purposes of this subdivision.
420-N:10 Health Exchange Advisory Board.
I. There is hereby created a health exchange advisory board for the purpose of advising the commissioner and the commissioner of health and human services regarding the interests of New Hampshire businesses and consumers with respect to any federally-facilitated exchange that may be created for New Hampshire. The board shall consist of 12 members, as follows:
(a) Two persons representing health insurance carriers, appointed by the commissioner.
(b) One person representing dental carriers, appointed by the commissioner.
(c) One person representing producers, appointed by the commissioner.
(d) One person representing Medicaid recipients, appointed by the commissioner of health and human services.
(e) One person representing health care providers and health care facilities in New Hampshire, appointed by the commissioner of health and human services.
(f) One person who is an advocate for enrolling hard to reach populations, including individuals with a mental health or substance abuse disorder, appointed by the commissioner of health and human services.
(g) One person who is a public health expert, appointed by the commissioner of health and human services.
(h) Four public members appointed by the governor, with consent of the executive council, who are not employed by or affiliated with a carrier, a producer, or health care provider, other than incidentally as a covered person or purchaser of health coverage or health care, as follows:
(1) One person who can reasonably be expected to purchase individual coverage through the 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;
(2) One person representing 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 employers;
(3) One person representing navigators or entities likely to be licensed as navigators; and
(4) One person employed by an employer who can reasonably be expected to purchase group coverage through an exchange and who can reasonably be expected to represent the interests of such employees.
II. Members of the board may serve up to 2 3-year terms. Of the initial members, 4 members shall serve an initial term of one year, 4 members shall serve an initial term of 2 years, and 4 members shall serve an initial term of 3 years in order to achieve staggered terms.
III. The board shall elect a chairperson annually from among its members. If a vacancy occurs on the board, the vacancy for the unexpired term shall be filled in accordance with the above procedures with a person who has the appropriate qualifications to fill that position on the board.
IV. Initial appointments shall be made within 30 days of the effective date of this subdivision, and subsequent appointments shall be made within 30 days of any vacancy.
V. Meetings of the board shall be held at the call of the chairperson or when 5 members so request.
VI. The board shall be a public body subject to RSA 91-A, and its meetings shall be considered public proceedings.
I. RSA 420-N:6, relative to federal health care reform; consistency.
II. RSA 420-N:8-RSA 420-N:10, relative to health exchange.
4 Contingency. If the exchange provisions under the Patient Protection and Affordable Care Act of 2009, Public Law 111-148, as amended by the Health Care and Education Reconciliation Act of 2010, Public Law 111-152 are found unconstitutional or repealed, paragraph II of section 3 of this act shall take effect on the date certified by the commissioner of the department of insurance to the director of legislative services and the secretary of state.
5 Effective Date.
I. Paragraph II of section 3 of this act shall take effect as provided in section 4 of this act.
II. The remainder of this act shall take effect upon its passage.
This bill clarifies the implementation of certain provisions of the Patient Protection and Affordable care Act. This bill prohibits the state of New Hampshire from planning, creating, or participating in a state health care exchange. The bill also establishes guidelines for interaction with a federally-facilitated exchange created for New Hampshire.