ACT 1498 of 2013
State of Arkansas As Engrossed: H4/3/13 H4/6/13 H4/10/13 S4/17/13
89th General Assembly A Bill
Regular Session, 2013 HOUSE BILL 1143
By: Representatives J. Burris, Carter, Biviano
By: Senators J. Dismang, Bookout, D. Sanders, Irvin
For An Act To Be Entitled
AN ACT CONCERNING HEALTH INSURANCE FOR CITIZENS OF THE STATE OF ARKANSAS; TO CREATE THE HEALTH CARE INDEPENDENCE ACT OF 2013; TO DECLARE AN EMERGENCY; AND FOR OTHER PURPOSES.
TO CREATE THE HEALTH CARE INDEPENDENCE ACT OF 2013; AND TO DECLARE AN EMERGENCY.
WHEREAS, Arkansas has historically addressed state-specific needs to achieve personal responsibility and affordable health care for its citizens such as the ARHealthNetworks partnership between the state and small businesses; and
WHEREAS, Arkansas has initiated nationally recognized and transformative changes in the healthcare delivery system through alignment of payment incentives, health care delivery system improvements, enhanced rural health care access, initiatives to reduce waste, fraud and abuse, policies and plan structures to encourage the proper utilization of the healthcare system, and policies to advance disease prevention and health promotion; and
WHEREAS, Arkansas is uniquely situated to serve as a laboratory of comprehensive and innovative healthcare reform that can reduce the state and federal obligations to entitlement spending; and
WHEREAS, faced with the disruptive challenges from federal legislation and regulations, the General Assembly asserts its responsibility for local control and innovation to achieve health care access, improved health care quality, reduce traditional Medicaid enrollment, remove disincentives for work and social mobility, and required cost-containment; and
WHEREAS, the General Assembly hereby creates the Health Care Independence Act of 2013;
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS:
SECTION 1. Arkansas Code Title 20, Chapter 77, is amended to create a new subchapter to read as follows:
Subchapter 21 — Health Care Independence Act of 2013
This act shall be known and may be cited as the “Health Care Independence Act of 2013”.
20-77-2102. Legislative intent.
(a) Notwithstanding any general or specific laws to the contrary, the Department of Human Services is to explore design options that reform the Medicaid Program utilizing the Health Care Independence Act of 2013 so that it is a fiscally sustainable, cost-effective, personally responsible, and opportunity-driven program utilizing competitive and value-based purchasing to:
(1) Maximize the available service options;
(2) Promote accountability, personal responsibility, and transparency;
(3) Encourage and reward healthy outcomes and responsible choices; and
(4) Promote efficiencies that will deliver value to the taxpayers.
(b)(1) It is the intent of the General Assembly that the State of Arkansas through the Department of Human Services shall utilize a private insurance option for “low-risk” adults.
(2) The Health Care Independence Act of 2013 shall ensure that:
(A) Private health care options increase and government-3
operated programs such as Medicaid decrease; and
(B) Decisions about the design, operation and implementation of this option, including cost, remain within the purview of the State of Arkansas and not with Washington, D.C.
(a) The purpose of this subchapter is to:
(1) Improve access to quality health care;
(2) Attract insurance carriers and enhance competition in the Arkansas insurance marketplace;
(3) Promote individually-owned health insurance;
(4) Strengthen personal responsibility through cost-sharing;
(5) Improve continuity of coverage;
(6) Reduce the size of the state-administered Medicaid program;
(7) Encourage appropriate care, including early intervention, prevention, and wellness;
(8) Increase quality and delivery system efficiencies;
(9) Facilitate Arkansas’s continued payment innovation, delivery system reform, and market-driven improvements;
(10) Discourage over-utilization; and
(11) Reduce waste, fraud, and abuse.
(b) The State of Arkansas shall take an integrated and market-based approach to covering low-income Arkansans through offering new coverage opportunities, stimulating market competition, and offering alternatives to the existing Medicaid program.
As used in this subchapter:
(1) “Carrier” means a private entity certified by the State Insurance Department and offering plans through the Health Insurance Marketplace;
(2) “Cost sharing” means the portion of the cost of a covered medical service that must be paid by or on behalf of eligible individuals, consisting of copayments or coinsurance but not deductibles;
(3) “Eligible individuals” means individuals who:
(A) Are adults between nineteen (19) years of age and sixty-five (65) years of age with an income that is equal to or less than one hundred thirty-eight percent (138%) of the federal poverty level, including without limitation individuals who would not be eligible for Medicaid under laws and rules in effect on January 1, 2013;
(B) Have been authenticated to be a United States citizen or documented qualified alien according to the federal Personal Responsibility and Work Opportunity Reconciliation Act of 1996, Pub. L. No. 104-193, as existing on January 1, 2013; and
(C) Are not determined to be more effectively covered through the standard Medicaid program, such as an individual who is medically frail or other individuals with exceptional medical needs for whom coverage through the Health Insurance Marketplace is determined to be impractical, overly complex, or would undermine continuity or effectiveness of care;
(4) “Healthcare coverage” means healthcare benefits as defined by certification or rules, or both, promulgated by the State Insurance Department for the Qualified Health Plans or available on the marketplace;
(5) “Health Insurance Marketplace” means the vehicle created to help individuals, families, and small businesses in Arkansas shop for and select health insurance coverage in a way that permits comparison of available Qualified Health Plan based upon price, benefits, services, and quality, regardless of the governance structure of the marketplace;
(6) “Premium” means a charge that must be paid as a condition of enrolling in health care coverage;
(7) “Program” means the Health Care Independence Program established by this subchapter;
(8) “Qualified Health Plan” means a State Insurance Department certified individual health insurance plan offered by a carrier through the Health Insurance Marketplace; and
(9) “Independence account” mean individual financing structures that operate similar to a health savings account or a medical savings account.
20-77-2105. Administration of the Health Care Independence Program.
(a) The Department of Human Services shall:
(1) Create and administer the Health Care Independence Program; and
(2)(A) Submit and apply for any:
(i) Federal waivers necessary to implement the program in a manner consistent with this subchapter, including without limitation approval for a comprehensive waiver under Section 1115 of the Social Security Act, 42 U.S.C. § 1315; and
(ii)(a) Medicaid State Plan Amendments necessary to implement the program in a manner consistent with this subchapter.
(b) The Department of Human Services shall submit only those Medicaid State Plan Amendments under subdivision (a)(2)(A)(ii)(a) of this section that are optional and therefore may be revoked by the state at its discretion.
(B)(i) As part of its actions under subdivision (a)(2)(A) of this section, the Department of Human Services shall confirm that 17
employers shall not be subject to the penalties, including without limitation an assessable payment, under Section 1513 of Pub. L. No. 111-148, as existing on January 1, 2013, concerning shared responsibility, for employees who are eligible individuals if the employees:
(a) Are enrolled in the program; and
(b) Enroll in a Qualified Health Plan through the Health Insurance Marketplace.
(ii) If the Department of Human Services is unable to confirm provisions under subdivision (a)(2)(B)(i) of this section, the program shall not be implemented.
(b)(1) Implementation of the program is conditioned upon the receipt of necessary federal approvals.
(2) If the Department of Human Services does not receive the necessary federal approvals, the program shall not be implemented.
(c) The program shall include premium assistance for eligible individuals to enable their enrollment in a Qualified Health Plan through the Health Insurance Marketplace.
(d)(1) The Department of Human Services is specifically authorized to pay premiums and supplemental cost-sharing subsidies directly to the Qualified Health Plans for enrolled eligible individuals.
(2) The intent of the payments under subdivision (d)(1) of this section is to increase participation and competition in the health insurance market, intensify price pressures, and reduce costs for both publicly and privately funded health care.
(e) To the extent allowable by law:
(1) The Department of Human Services shall pursue strategies that promote insurance coverage of children in their parents’ or caregivers’ plan, including children eligible for the ARKids First Program Act, § 20-77-9
1101 et seq., commonly known as the “ARKids B program”; and
(2) Upon the receipt of necessary federal approval, during calendar year 2015 the Department of Human Services shall include and transition to the Health Insurance Marketplace:
(A) Children eligible for the ARKids First Program Act, § 20-77-1101 et seq.; and
(B) Populations under Medicaid from zero percent (0%) of the federal poverty level to seventeen percent (17%) of the federal poverty level.
(3) The Department of Human Services shall develop and implement a strategy to inform Medicaid recipient populations whose needs would be reduced or better served through participation in the Health Insurance Marketplace.
(f) The program shall include allowable cost sharing for eligible individuals that is comparable to that for individuals in the same income range in the private insurance market and is structured to enhance eligible individuals’ investment in their health care purchasing decisions.
(g)(1) The State Insurance Department and Department of Human Services shall administer and promulgate rules to administer the program authorized under this subchapter.
(2) No less than thirty (30) days before the State Insurance Department and Department of Human Services begin promulgating a rule under this subchapter, the proposed rule shall be presented to the Legislative Council.
(h) The program authorized under this subchapter shall terminate within one hundred twenty (120) days after a reduction in any of the following federal medical assistance percentages:
(1) One hundred percent (100%) in 2014, 2015,
(2) Ninety-five percent (95%) in 2017;
(3) Ninety-four percent (94%) in 2018;
(4) Ninety-three percent (93%) in 2019; and
(5) Ninety percent (90%) in 2020 or any year after 2020.
(i) An eligible individual enrolled in the program shall affirmatively acknowledge that:
(1) The program is not a perpetual federal or state right or a guaranteed entitlement;
(2) The program is subject to cancellation upon appropriate
(3) The program is not an entitlement program.
(j)(1) The Department of Human Services shall develop a model and seek from the Center for Medicare and Medicaid Services all necessary waivers and approvals to allow non-aged, non-disabled program-eligible participants to enroll in a program that will create and utilize Independence Accounts that operate similar to a Health Savings Account or Medical Savings Account during the calendar year 2015.
(2) The Independence Accounts shall:
(A) Allow a participant to purchase cost-effective high-21
deductible health insurance; and
(B) Promote independence and self-sufficiency.
(3) The state shall implement cost sharing and co-pays and, as a condition of participation, earnings shall exceed fifty percent (50%) of the federal poverty level.
(4) Participants may receive rewards based on healthy living and self-sufficiency.
(5)(A) At the end of each fiscal year, if there are funds remaining in the account, a majority of the state’s contribution will remain in the participant’s control as a positive incentive for the responsible use of the health care system and personal responsibility of health maintenance.
(B) Uses of the funds may include without limitation rolling the funds into a private sector health savings account for the participant according to rules promulgated by the Department of Human Services.
(6) The Department of Human Services shall promulgate rules to implement this subsection (j).
(k)(1) State obligations for uncompensated care shall be projected, tracked, and reported to identify potential incremental future decreases.
(2) The Department of Human Services shall recommend appropriate adjustments to the General Assembly.
(3) Adjustments shall be made by the General Assembly as appropriate.
(l) The Department of Human Services shall track the Hospital Assessment Fee as defined in § 20-77-1902 and report to the General Assembly subsequent decreases based upon reduced uncompensated care.
(m) On a quarterly basis, the Department of Human Services and the State Insurance Department shall report to the Legislative Council or to the 13
Joint Budget Committee if the General Assembly is in session, available information regarding:
(1) Program enrollment;
(2) Patient experience;
(3) Economic impact including enrollment distribution;
(4) Carrier competition; and
(5) Avoided uncompensated care.
20-77-2106. Standards of healthcare coverage through the Health Insurance Marketplace.
(a) Healthcare coverage shall be achieved through a qualified health plan at the silver level as provided in 42 U.S.C. §§ 18022 and 18071, as existing on January 1, 2013, that restricts cost sharing to amounts that do not exceed Medicaid cost-sharing limitations.
(b)(1) All participating carriers in the Health Insurance Marketplace shall offer healthcare coverage conforming to the requirements of this subchapter.
(2) A participating carrier in the Health Insurance Marketplace shall maintain a medical loss ratio of at least eighty percent (80%) for an individual and small group market policy and at least eighty-five percent (85%) for a large group market policy as required under Pub. L. No. 111-148, as existing on January 1, 2013.
(c) To assure price competitive choice among healthcare coverage
options, the State Insurance Department shall assure that at least two (2) qualified health plans are offered in each county in the state.
(d) Health insurance carriers offering health care coverage for program eligible individuals shall participate in Arkansas Payment Improvement Initiatives including:
(1) Assignment of primary care clinician;
(2) Support for patient-centered medical home; and
(3) Access of clinical performance data for providers.
(e) On or before July 1, 2013, the State Insurance Department shall implement through certification requirements, rule, or both the applicable provisions of this subchapter.
(a) The General Assembly shall assure that a mechanism within the Health Insurance Marketplace is established and operated to facilitate enrollment of eligible individuals.
(b) The enrollment mechanism shall include an automatic verification system to guard against waste, fraud, and abuse in the program.
20-77-2108. Effective date.
This subchapter shall be in effect until June 30, 2017, unless amended or extended by the General Assembly.
SECTION 2. Arkansas Code Title 19, Chapter 5, Subchapter 11, is amended to add an additional section to read as follows:
19-5-1140. Health Care Independence Program Trust Fund.
(a) There is created on the books of the Treasurer of State, the Auditor of State, and the Chief Fiscal Officer of the State a trust fund to be known as the “Health Care Independence Program Trust Fund”.
(b)(1) The Health Care Independence Program Trust Fund may consist of moneys saved and accrued under the Health Care Independence Act of 2013, § 20-77-2101 et seq., including without limitation:
(A) Increases in premium tax collections;
(B) Reductions in uncompensated care; and
(C) Other spending reductions resulting from the Health Care Independence Act of 2013, 20-77-2101 et seq.
(2) The fund shall also consist of other revenues and funds authorized by law.
(c) The fund may be used by the Department of Human Services to pay for future obligations under the Health Care Independence Program created by the Health Care Independence Act of 2013, § 20-77-2101 et seq.
SECTION 3. NOT TO BE CODIFIED. (a) The implementation of this act is suspended until an appropriation for the implementation of this act is passed by a three-fourths vote of both houses of the Eighty-Ninth General Assembly.
(b) If an appropriation for the implementation of this act is
not passed by the Eighty-Ninth General Assembly, this act is void.
SECTION 4. NOT TO BE CODIFIED. The enactment and adoption of this act shall supersede Section 21 of HB1219 of the Eighty-Ninth General Assembly, if Section 21 of HB1219 of the Eighty-Ninth General Assembly is enacted and adopted.
SECTION 5. EMERGENCY CLAUSE. It is found and determined by the General Assembly of the State of Arkansas that the Health Care Independence Program requires private insurance companies to create, present to the Department of Human Services for approval, implement, and market a new kind of insurance policy; and that the private insurance companies need certainty about the law creating the Health Care Independence Program before fully investing time, funds, personnel, and other resources to the development of the new insurance policies. Therefore, an emergency is declared to exist, and this act being immediately necessary for the preservation of the public peace, health, and safety shall become effective on:
(1) The date of its approval by the Governor;
(2) If the bill is neither approved nor vetoed by the Governor, the expiration of the period of time during which the Governor may veto the bill; or
(3) If the bill is vetoed by the Governor and the veto is overridden, the date the last house overrides the veto.