CHAPTER 243
SB 455-FN – FINAL VERSION
13May2010… 1808h
2010 SESSION
01/05
SENATE BILL 455-FN
AN ACT relative to federal health care reform.
SPONSORS: Sen. Sgambati, Dist 4; Sen. Cilley, Dist 6; Sen. D'Allesandro, Dist 20; Sen. DeVries, Dist 18; Sen. Fuller Clark, Dist 24; Sen. Gallus, Dist 1; Sen. Gilmour, Dist 12; Sen. Hassan, Dist 23; Sen. Houde, Dist 5; Sen. Janeway, Dist 7; Sen. Kelly, Dist 10; Sen. Lasky, Dist 13; Sen. Merrill, Dist 21; Sen. Odell, Dist 8; Sen. Reynolds, Dist 2; Rep. Schlachman, Rock 13
COMMITTEE: Commerce, Labor and Consumer Protection
This bill authorizes the insurance commissioner to implement the insurance reforms required under federal law. The bill also revises the laws regarding dependent coverage to conform to federal law.
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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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
13May2010… 1808h
10-2823
01/05
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Ten
AN ACT relative to federal health care reform.
Be it Enacted by the Senate and House of Representatives in General Court convened:
243:1 New Chapter; Federal Health Care Reform 2010. Amend RSA by inserting after chapter 420-K the following new chapter:
CHAPTER 420-L
FEDERAL HEALTH CARE REFORM 2010
420-L:1 Purpose and Scope.
I. The intent of this chapter is to preserve the insurance regulatory authority of the state by authorizing the commissioner to implement the insurance reforms required under the Patient Protection and Affordable Care Act of 2009, as amended by the Health Care and Education Reconciliation Act of 2010 that take effect on or before July 1, 2011, (hereinafter “Act”).
II. The provisions of this chapter shall ensure that New Hampshire residents obtain the full protections and benefits provided by the Act prior to any legislative action in the 2011 legislative session that may be necessary.
420-L:2 Definitions. In this chapter:
I. “Act” means 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).
II. “Commissioner” means the insurance commissioner.
III. “Department” means the insurance department.
IV. “Health Care and Education Reconciliation Act of 2010” means the law enacted by the 111th United States Congress, HR 4872, (Public Law 111-152) signed into law on March 30, 2010.
V. “Patient Protection and Affordable Care Act of 2009” means the law enacted by the 111th United States Congress, HR 3590, (Public Law 111-148) signed into law on March 30, 2010.
420-L:3 Authority of the Commissioner. The commissioner shall enforce the consumer protections and market reforms as set forth in the Act that relate to insurance. This shall not include the medical assistance program under RSA 167. The commissioner shall have full power and authority in accordance with the time frames set forth in the Act to:
I. Make, adopt, and amend rules and regulations pursuant to RSA 541-A for, or as an aid to, the administration of any provision of the Act relating to insurance;
II. Apply for any grant funds available under the Act; and
III. Adopt and apply standards consistent with the Act for form and rate review of insurance products and any other regulatory oversight functions performed by the department.
420-L:4 Interpretation. All provisions in this chapter shall be interpreted consistently with the Act, and in executing the authority granted under this chapter, the commissioner shall be guided by applicable provisions of the Act, by federal regulations and any federal interpretations, standards, or guidance issued pursuant to the Act.
420-L:5 Application of Law. Any provision within Title XXXVII that prevents the application of the Act without providing greater consumer protections or increased access to health insurance coverage shall be preempted.
420-L:6 Health Insurance Reform Oversight Committee. There is established a health insurance reform oversight committee consisting of 2 members of the senate, appointed by the president of the senate, one of whom shall be from the senate commerce, labor and consumer protection committee, and 3 members of the house of representatives, appointed by the speaker of the house, 2 of whom shall be from the house commerce and consumer affairs committee. The committee shall meet at the request of the commissioner, but no more frequently than monthly. The commissioner shall make such periodic reports to the oversight committee relative to the department’s federal insurance reform implementation plans and initiatives as may be required by the oversight committee. The oversight committee shall make a summary report on federal insurance reform implementation, together with any recommendations for legislation, to the house commerce and consumer affairs committee and the senate commerce, labor and consumer protection committee by the first day of the 2011 legislative session.
243:2 New Paragraph; Individual Health Insurance; Purpose. Amend RSA 404-G:1 by inserting after paragraph III the following new paragraph:
IV. Authorize the association to establish a federally qualified high risk pool pursuant to section 1101 of the Patient Protection and Affordable Care Act of 2009 (PL 111-148), as amended by the Health Care and Education Reconciliation Act of 2010 (PL 111-152).
243:3 New Paragraph; Individual Health Insurance; Definition Added. Amend RSA 404-G:2 by inserting after paragraph I the following new paragraph:
I-a. “Act” means the Patient Protection and Affordable Care Act of 2009 (PL 111-148), as amended by the Health Care and Education Reconciliation Act of 2010 (PL 111-152).
243:4 Individual Health Insurance; Definitions. Amend RSA 404-G:2, X-a to read as follows:
X-a. “Plan of operation” means the plan of operation of the risk sharing mechanism [and], the high risk pool, and the federally qualified high risk pool, including articles, bylaws and operating rules, procedures and policies adopted by the association.
243:5 New Subparagraph; Individual Health Insurance; Powers of Association. Amend RSA 404-G:3, II by inserting after subparagraph (h) the following new subparagraph:
(i) Perform additional powers as set forth in RSA 404-G:5-g.
243:6 New Paragraph; High Risk Pool Administrator. Amend RSA 404-G:5-c by inserting after paragraph VIII the following new paragraph:
IX. The association may use the same administrator for both the high risk pool and the federally qualified high risk pool. Notwithstanding the provisions of subparagraph II(b), the association may extend the term of the current contract with the existing high risk pool administrator without a competitive bidding process until January 1, 2014.
243:7 New Section; Federally Qualified High Risk Pool. Amend RSA 404-G by inserting after section 5-f the following new section:
404-G:5-g Federally Qualified High Risk Pool.
I. The association shall negotiate and submit to the commissioner for approval a contract with the United States Department of Health and Human Services to create a federally qualified high risk pool pursuant to the Act. This pool shall be known as the “federally qualified high risk pool” and the contract shall be known as the “federally qualified high risk pool contract.” The eligibility requirements, premiums, benefits, and all other elements of the federally qualified high risk pool and its operations shall be governed solely by federal law and regulation and the federally qualified high risk pool contract. Individuals covered by insurance under the federally qualified high risk pool shall not be covered lives for the purposes of this chapter. The federally qualified high risk pool shall be funded solely by federal moneys and premiums charged for coverage under it, and shall not be funded with state general fund revenue or any assessments under this chapter. All federal moneys received by the association for the federally qualified high risk pool shall be used solely for the federally qualified high risk pool.
II. In addition to the powers and duties enumerated elsewhere in this chapter, the board of directors of the association shall have the following powers and duties with respect to the federally qualified high risk pool:
(a) Make application, subject to review and approval of the commissioner, to establish and operate a federally qualified high risk pool; and
(b) Enter into contract with the Secretary of the United States Department of Health and Human Services, subject to review and approval of the commissioner, to establish and operate a federally qualified high risk pool under section 1101 of the Act.
III. The board of directors of the association shall adopt a plan of operation for the federally qualified high risk pool. This plan of operation shall include the federally qualified high risk pool contract, all federal rules and guidance issued with respect to federally qualified high risk pools, and any other provisions deemed necessary by the board to operate the federally qualified high risk pool.
243:8 Accident and Health Insurance; Dependent Coverage. Amend RSA 415:5, I(3)(a) to read as follows:
(3)(a) It purports to insure only one person, except that a policy may, at the election of the carrier, insure, originally or by subsequent amendment, upon the application of an adult member of a family who shall be deemed the policyholder, any 2 or more eligible members of that family, including husband, wife, dependent children, or any other person dependent on the policyholder. In the event a carrier elects to provide coverage for dependent children, the term “dependent child” shall include a subscriber’s child by blood or by law, who is [unmarried and one of the following:
(1) Under age 19.
(2) Under age 25 if the child is a full-time enrolled student at an educational institution.
(3) Under age 26, a resident of New Hampshire, and is not provided coverage as a named subscriber, insured, enrollee, or covered person under any other group or individual health benefits plan, group health plan, church plan, or health benefits plan, or entitled to benefits under Title XVIII of the Social Security Act, Public Law 89-97, 42 U.S.C. section 1395 et seq] under age 26.
243:9 Health Services Corporations; Dependent Coverage. Amend RSA 420-A:10-a, I to read as follows:
I. A policy may, at the election of the carrier, insure, originally or by subsequent amendment, upon application of an adult member of a family who shall be deemed the policyholder, any 2 or more eligible members of that family, including husband, wife, dependent children, or any other person dependent upon the policyholder. In the event a carrier elects to provide coverage for dependent children, the term “dependent child” shall include a subscriber’s child by blood or by law, who is [unmarried and one of the following:
(a) Under age 19.
(b) Under age 25 if the child is a full-time enrolled student at an educational institution.
(c) Under age 26, a resident of New Hampshire, and is not provided coverage as a named subscriber, insured, enrollee, or covered person under any other group or individual health benefits plan, group health plan, church plan, or health benefits plan, or entitled to benefits under Title XVIII of the Social Security Act, Public Law 89-97, 42 U.S.C. section 1395 et seq] under age 26. 243:10 Health Maintenance Organizations; Dependent Coverage. Amend RSA 420-B:8-aa, I to read as follows:
I. A policy may, at the election of the carrier, insure, originally or by subsequent amendment, upon application of an adult member of a family who shall be deemed the policyholder, any 2 or more eligible members of that family, including husband, wife, dependent children, or any other person dependent upon the policyholder. In the event a carrier elects to provide coverage for dependent children, the term “dependent child” shall include a subscriber’s child by blood or by law, who is [unmarried and one of the following:
(a) Under age 19.
(b) Under age 25 if the child is a full-time enrolled student at an educational institution.
(c) Under age 26, a resident of New Hampshire, and is not provided coverage as a named subscriber, insured, enrollee, or covered person under any other group or individual health benefits plan, group health plan, church plan, or health benefits plan, or entitled to benefits under Title XVIII of the Social Security Act, Public Law 89-97, 42 U.S.C. section 1395 et seq] under age 26.
243:11 Preferred Provider Agreements; Dependent Coverage. Amend RSA 420-C:4-a, I to read as follows:
I. A policy may, at the election of the carrier, insure, originally or by subsequent amendment, upon application of an adult member of a family who shall be deemed the policyholder, any 2 or more eligible members of that family, including husband, wife, dependent children, or any other person dependent upon the policyholder. In the event a carrier elects to provide coverage for dependent children, the term “dependent child” shall include a subscriber’s child by blood or by law, who is [unmarried and one of the following:
(a) Under age 19.
(b) Under age 25 if the child is a full-time enrolled student at an educational institution.
(c) Under age 26, a resident of New Hampshire, and is not provided coverage as a named subscriber, insured, enrollee, or covered person under any other group or individual health benefits plan, group health plan, church plan, or health benefits plan, or entitled to benefits under Title XVIII of the Social Security Act, Public Law 89-97, 42 U.S.C. section 1395 et seq] under age 26. 243:12 Delta Dental; Dependent Coverage. Amend RSA 420-F:5-a, I to read as follows:
I. A policy may, at the election of the carrier, insure, originally or by subsequent amendment, upon application of an adult member of a family who shall be deemed the policyholder, any 2 or more eligible members of that family, including husband, wife, dependent children, or any other person dependent upon the policyholder. In the event a carrier elects to provide coverage for dependent children, the term “dependent child” shall include a subscriber’s child by blood or by law, who is [unmarried and one of the following:
(a) Under age 19.
(b) Under age 25 if the child is a full-time enrolled student at an educational institution.
(c) Under age 26, a resident of New Hampshire, and is not provided coverage as a named subscriber, insured, enrollee, or covered person under any other group or individual health benefits plan, group health plan, church plan, or health benefits plan, or entitled to benefits under Title XVIII of the Social Security Act, Public Law 89-97, 42 U.S.C. section 1395 et seq] under age 26. 243:13 Managed Care; Dependent Care. Amend RSA 420-J:8-d, I to read as follows:
I. A policy may, at the election of the carrier, insure, originally or by subsequent amendment, upon application of an adult member of a family who shall be deemed the policyholder, any 2 or more eligible members of that family, including husband, wife, dependent children, or any other person dependent upon the policyholder. In the event a carrier elects to provide coverage for dependent children, the term “dependent child” shall include a subscriber’s child by blood or by law, who is [unmarried and one of the following:
(a) Under age 19.
(b) Under age 25 if the child is a full-time enrolled student at an educational institution.
(c) Under age 26, a resident of New Hampshire, and is not provided coverage as a named subscriber, insured, enrollee, or covered person under any other group or individual health benefits plan, group health plan, church plan, or health benefits plan, or entitled to benefits under Title XVIII of the Social Security Act, Public Law 89-97, 42 U.S.C. section 1395 et seq] under age 26. 243:14 Health Reform Coordinator. Amend RSA 400-A:6, VII to read as follows:
VII. The commissioner shall appoint, as the commissioner’s assistants, a health care policy analyst, a health care statistician, a general counsel, an insurance fraud attorney, a senior insurance fraud investigator, an assistant property and casualty actuary, [and] a compliance and enforcement counsel, and a health reform coordinator, each of whom shall serve at the pleasure of the commissioner during good behavior. The health care policy analyst, health care statistician, general counsel, insurance fraud attorney, senior insurance fraud investigator, assistant property and casualty actuary, [and] compliance and enforcement counsel, and health reform coordinator, shall perform such duties and exercise such powers as the commissioner may authorize.
243:15 Repeal. RSA 420-L, relative to federal health care reform 2010, is repealed.
243:16 Rules. Any rules adopted solely pursuant to RSA 420-L shall expire July 1, 2012.
243:17 Effective Date.
I. Section 15 of this act shall take effect July 1, 2011.
II. Sections 1-7 and 14 of this act shall take effect upon its passage.
III. Section 16 of this act shall take effect July 1, 2012.
IV. The remainder of this act shall take effect September 23, 2010.
Approved: July 1, 2010
Effective Date: I. Section 15 shall take effect July 1, 2011.
II. Sections 1-7 and 14 shall take effect July 1, 2010.
III. Section 16 shall take effect July 1, 2012.
IV. Remainder shall take effect September 23, 2010.