House amendments make the following changes to 3rd edition. Amendment #1 amends GS 58-50-310(b)(1)c.4. by removing a health insurance agent as an area of experience or expertise which may be considered when appointing a certain member to the North Carolina Health Benefit Exchange Advisory Board.
Amendment #2 amends GS 58-50-310(b)(1)b.3. by requiring one member who represents small employers, as defined, to be appointed to the North Carolina Health Benefit Exchange Board.
Amendment #3 deletes GS 58-50-310(b)(7), concerning a member of the North Carolina Health Benefit Exchange Advisory Board using his or her official position to influence decisions of the Board. Rewrites GS 58-50-310(c)(2)(g) to require the Plan of Operation to provide for conflict of interest rules and recusal procedures (deletes conditional language). Rewrites GS 58-50-330(l) to provide that the members of the Board and the Executive Director are public servants under 138A-3(30) and are subject to the provisions of GS Chapter 138A, provided that the exception in GS 138A-38(a)(1) does not apply to members of the Board and the Executive Director.
Bill Summaries: H115 (2011-2012 Session)
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Bill H 115 (2011-2012)Summary date: May 25 2011 - View summary
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Bill H 115 (2011-2012)Summary date: May 10 2011 - View summary
House committee substitute makes the following changes to 2nd edition.
Adds a definition for navigator in proposed GS 58-50-300. Changes the North Carolina Health Benefit Exchange Authority Board (Board) to include 12 members (rather than 11) in addition to the Commissioner of Insurance and the Director of the Division of Medical Assistance (DMA), and specifies the appointing authority and member requirements. States that the Director of DMA will only vote in the case of a tie. Adds that the annual salary for the Executive Director will not exceed 150% of the annual salary for Council of State members. Directs the Exchange Authority to also consider the extent to and the circumstances under which benefits for spiritual care services, as defined, will be made available under the Exchange Authority. Deletes, from the list of the Exchange Authority's duties, the directive to credit the amount of any free choice voucher to the monthly premium of the plan in which a qualified employee is enrolled. Specifies that any insurer offering only catastrophic plans outside of the Exchange Authority without offering any plans in the Exchange will be required to participate and offer identical catastrophic plans inside the Exchange Authority. Adds provision stating that proposals submitted by the Exchange Authority to ensure solvency will not include General Fund appropriations. Clarifies that an annual budget for the Exchange Authority will be submitted to the Commissioner of Insurance (Commissioner) at least 120 days before the beginning of the next fiscal year. Removes directive to the Commissioner to promulgate regulations pursuant to the Administrative Procedure Act. Makes additional clarifying changes.
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Bill H 115 (2011-2012)Summary date: Mar 30 2011 - View summary
House committee substitute makes the following changes to 1st edition.
Adds a new section, stating that the purpose of the act is to establish the North Carolina Health Benefit Exchange Authority (Exchange Authority) to facilitate the purchase and role of qualified health plans in the individual and small employer market through education, outreach, and technical assistance.
Definitions. Clarifies that the SHOP Exchange is the Small Business Health Options Program established in proposed Part 8 to assist NC Qualified Employers who are small employers to facilitate the enrollment of their employees in Qualified Health Plans. Defines Individual Exchange as the Exchange through which Qualified Individuals purchase coverage. Clarifies the definition for Exchange Authority (was, Exchange in previous edition) and makes a conforming change to all references throughout Part 8. Adds new terms applicable to Part 8 and makes clarifying changes to definitions.
Exchange. Makes organizational and clarifying changes to the provisions establishing the Exchange Authority, the Exchange Authority Board of Directors (Board), and the powers and duties of each. Clarifies that the Exchange Authority is subject to the supervision of the Commissioner of Insurance (Commissioner). Also clarifies that the purpose of the Exchange Authority is to: (1) create and administer an Individual Exchange and a SHOP Exchange as two separate health benefit exchanges; (2) facilitate the purchase and sale of Qualified Health Plans to Qualified Individuals and Qualified Employers; and (3) assist Qualified Individuals and Qualified Employers in enrollment in Qualified Health Plans. Provides that the Board will consist of the Commissioner and the Director of the Division of Medical Assistance as ex officio nonvoting members, and 11 additional, appointed members. Details the appointing authority as follows: (1) four members appointed by the President Pro Tempore of the Senate for three year terms, with appointments made within 30 days after enactment; (2) four members appointed by the Speaker of the House of Representatives for three year terms, with appointments made within 30 days after enactment; and (3) three members appointed by the Governor for two year terms, within 30 days after enactment. Includes additional appointee qualifications and requirements. Details additional powers and duties of the Board.
Requires the Commissioner to review and approve or disapprove the Plan of Operation submitted by the Board within 90 days. Deems the Plan approved if the Commissioner fails to act within 90 days. Allows for resubmission upon disapproval and outlines other procedures related to Plan submission. Clarifies and adds to the list of components included in the Plan of Operation. Clarifies that the Exchange Authority has the authority to contract with an eligible entity, as defined, to perform any functions described in Part 8, take legal action, and enter into information-sharing agreements with federal and state agencies and other state exchanges as specified. Authorizes the Exchange Authority to make a Qualified Health Plan available that may require benefits other than the Essential Health Benefits, as specified. Directs the Executive Director of the Exchange Authority to make an annual report by March 1 of each year to listed parties, summarizing the activities of the Exchange Authority during the preceding calendar year. Makes the Exchange Authority, the Board, and employees, subject to Article 33C of GS Chapter 143 (provisions for meetings of public bodies). Makes all information in the possession of the Exchange Authority, regardless of physical form, subject to GS Chapter 132 (public records), except protected and confidential information. Clarifies other requirements of the Exchange Authority. Provides additional duties for the Exchange Authority, including the duty to establish an Individual Exchange, to meet specified financial integrity requirements, and to conduct a review of the costs and benefits of collecting and distributing premiums for small businesses. Details reporting requirements.
Health Benefit Plan Certification. Clarifies that the Exchange Authority will certify a Health Benefit Plan as a Qualified Health Plan if the Department of Insurance determines the plan satisfies the enumerated requirements, unless the Exchange Authority determines the plan is not in the interest of Qualified Individuals and Employers. Directs the Exchange to establish and publish a transparent, objective process for denying certification or decertifying Qualified Health Plans, as described. Makes other clarifying changes.
Additional Provisions. Permits a Qualified Employer to either designate one or more Qualified Health Plans from which its employees may choose or designate any level of coverage to be made available to employees through the SHOP Exchange. Permits a Qualified Individual enrolled in any Qualified Health Plan to pay any applicable premium owed to the Health Insurer issuing the plan. Establishes the Individual Exchange and the SHOP Exchange risk pools, as detailed. Provides that the statute does not: prohibit a Health Insurer from offering outside of the Individual Exchange or the SHOP Exchange a health plan to a Qualified Individual or Employer; prohibit a Qualified Individual from enrolling in, or a Qualified Employer from selecting, a health plan outside of the Exchange Authority; limit the operation of any state law for any policy or plan outside the Exchange Authority; or otherwise restrict the choice of any individual to enroll or not enroll. Details circumstances under which a Qualified Individual may enroll in a catastrophic plan. Allows Agents and Brokers to enroll and assist Qualified Individuals and Employers, as described. Requires Agent and Broker compensation to be determined by the insurer.
Codifies the utilization of the funding stream from the NC Health Insurance Risk Pool to support the Exchange Authority. Adds that, beginning in 2015, the funding stream supporting the NC Health Insurance Risk Pool will support those operations of the Exchange Authority that serve individuals with incomes less than or equal to 400% of the federal poverty level and Qualified Employers receiving a tax credit for the purchase of insurance under federal law. Requires other costs to be funded by an annual user fee paid by the individual or employer to the Exchange Authority, as specified. Requires the Exchange Authority to examine its potential operating costs and propose any additional funding stream changes before the 2013 General Assembly commences. Directs the Exchange Authority to be self-sustaining by January 1, 2015, as required by federal law. Details additional funding criteria and exempts the Exchange Authority from all state taxes. Directs the Commissioner to promulgate necessary regulations. Requires an annual audit of the Exchange Authority. Makes additional clarifying changes.
Changes the title of the act to AN ACT TO PRESERVE STATE-BASED AUTHORITY TO REGULATE THE NORTH CAROLINA HEALTH INSURANCE MARKET AND TO PREVENT FEDERAL ENCROACHMENT ON STATE AUTHORITY BY ESTABLISHING THE NORTH CAROLINA BENEFIT EXCHANGE.
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Bill H 115 (2011-2012)Summary date: Feb 16 2011 - View summary
Enacts new Part 8 in Article 50 of GS Chapter 58, titled the North Carolina Health Benefit Exchange Act, to establish the nonprofit entity of the North Carolina Health Benefit Exchange (Exchange) and provide for its membership, authority, and requirements.
Definitions. Provides definitions applicable to new Part 8. Defines qualified health plan as a health benefit plan that meets certification criteria described in section 1311(c) of the federal Patient Protection and Affordable Care Act, as amended and criteria in GS 58-50-340 (health benefit plan certification requirements in proposed Part 8). A qualified employer is a small employer that elects to make (1) its full-time employees eligible for one or more qualified health plans offered through the SHOP exchange and (2) at the employer's option, some or all of its employees eligible. The SHOP Exchange is the Small Business Health Options Program established in Part 8. Defines qualified individual as an individual, including a minor, who (1) is seeking to enroll in a qualified health plan offered to individuals through the Exchange; (2) resides in NC; (3) is not incarcerated at the time of enrollment, other than incarceration pending disposition of charges; and (4) is, and is reasonably expected to be, for the entire period for which enrollment is sought, a citizen or national of the U.S. or an alien lawfully present in the U.S.
Exchange. Provides that the Exchange, established under Part 8, is not an instrumentality of North Carolina and will operate under the Exchange Board of Directors. Requires the Exchange to make only qualified health plans available to qualified individuals and qualified employers beginning with effective dates on January 1, 2014. Permits the Exchange to allow a health carrier to offer limited dental benefits, as indicated, if the plan also provides pediatric dental benefits, as specified. Prohibits the Exchange and any health carrier from charging a fee or penalty for termination of coverage in specified circumstances. Creates a Board of Directors (Board) of the Exchange, consisting of the Commissioner of Insurance (Commissioner) and 11 appointed members, as listed. Details appointment, term, and meeting guidelines. Includes an indemnification provision for the Board and employees of the Exchange and classifies members of the Board as public servants under GS Chapter 138A. Enumerates the general powers and authority of the Exchange, including the power to enter into contracts to carry out the provisions of Part 8. Lists the duties and operational requirements of the Exchange, including the directive to establish a SHOP Exchange (1) through which qualified employers may access coverage for their employees and (2) which will enable any qualified employer to specify a level of coverage so any employee may enroll in any qualified health plan offered through the SHOP Exchange at the specified level of coverage.
Sets forth duties, including reporting requirements, for the Executive Director of the Exchange. Requires the Board to submit a Plan of Operation for the Exchange to the Commissioner containing specified information.
Health Benefit Plan Certification. Directs the Exchange to certify a health benefit plan as a qualified health plan if the plan meets all of the detailed requirements. Prohibits the Exchange from excluding a health benefit plan by imposing premium price controls. Further prohibits the Exchange from excluding a plan solely because the plan is a fee-for-service plan or because the plan provides treatments necessary to prevent patients' deaths in circumstances the Exchange deems inappropriate or too costly. Provides additional requirements applicable to the certification of qualified health plans and includes criteria related to qualified dental plans.
Additional Provisions. Reserves GS 58-50-341 through GS 58-50-349 for future codification purposes. Diverts the funding stream currently supporting the North Carolina Health Insurance Risk Pool to support the Exchange, beginning in 2014. Requires the Exchange to publish on the internet the average costs of licensing and regulatory fees, administrative costs, monies lost to fraud and waste, and any other payments. States that nothing in the act will be construed to conflict with, preempt, or supersede the Commissioner's authority to regulate the business of insurance. Requires all health carriers offering qualified health plans to comply fully with all applicable laws, unless specifically excepted. Includes a severability clause.