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Second Regular Session
Seventy-second General Assembly
STATE OF COLORADO
DRAFT
LLS NO. 20-1144.01 Christy Chase x2008 SENATE BILL
SENATE SPONSORSHIP Moreno,
HOUSE SPONSORSHIP (None),
BILL TOPIC: "Health Insurance Affordability Enterprise Fee"
A BILL FOR AN ACT
101 CONCERNING MEASURES TO ADDRESS THE AFFORDABILITY OF HEALTH
102 INSURANCE FOR COLORADANS PURCHASING COVERAGE ON THE
103
104 ESTABLISHING AN ENTERPRISE TO ADMINISTER A HEALTH
105 INSURANCE AFFORDABILITY FEE ASSESSED ON CERTAIN HEALTH
106 INSURERS TO FUND MEASURES TO REDUCE PREMIUMS FOR
107 INDIVIDUAL HEALTH BENEFIT PLANS OFFERED ON THE
108 COLORADO HEALTH BENEFIT EXCHANGE. <{first stab at title -
109 needs work}>
Bill Summary
(Note: This summary applies to this bill as introduced and does not reflect any amendments that may be subsequently adopted. If this bill passes third reading in the house of introduction, a bill summary that
Capital letters or bold & italic numbers indicate new material to be added to existing statute.
Dashes through the words indicate deletions from existing statute.
INDIVIDUAL MARKET, AND, IN CONNECTION THEREWITH,
DRAFT
4.28.20
-2- DRAFT
The bill summary for this measure has been intentionally omitted and will appear on future redrafts of this measure.
applies to the reengrossed version of this bill will be available at http://leg.colorado.gov.)
1 Be it enacted by the General Assembly of the State of Colorado:
2 SECTION 1. In Colorado Revised Statutes, add part 12 to article
3 16 of title 10 as follows:
4 PART 12
5 HEALTH INSURANCE AFFORDABILITY ACT
6 10-16-1201. Short title. THE SHORT TITLE OF THIS PART 12 IS THE
7 "HEALTH INSURANCE AFFORDABILITY ACT".
8 10-16-1202. Definitions. AS USED IN THIS PART 12, UNLESS THE
9 CONTEXT OTHERWISE REQUIRES:
10 (1) "ADVANCE PREMIUM TAX CREDIT" MEANS THE REFUNDABLE
11 TAX CREDIT AVAILABLE PURSUANT TO THE FEDERAL ACT TO ASSIST
12 CERTAIN INDIVIDUALS IN PURCHASING A HEALTH BENEFIT PLAN ON THE
13 EXCHANGE.
14 (2) "BOARD" MEANS THE HEALTH INSURANCE AFFORDABILITY
15 BOARD CREATED IN SECTION 10-16-1203.
16 (3) "ENTERPRISE" MEANS THE COLORADO HEALTH INSURANCE
17 AFFORDABILITY ENTERPRISE CREATED IN SECTION 10-16-1204.
18 (4) "FEDERAL POVERTY LINE" HAS THE SAME MEANING AS
19 "POVERTY LINE", AS DEFINED IN 42 U.S.C. SEC. 9902 (2).
20 (5) "FEE" MEANS THE HEALTH INSURANCE AFFORDABILITY FEE
21 ESTABLISHED AND ASSESSED PURSUANT TO SECTION 10-16-1204.
22 (6) "FUND" MEANS THE HEALTH INSURANCE AFFORDABILITY CASH
DRAFT
4.28.20
-3- DRAFT
1 FUND CREATED IN SECTION 10-16-1205.
2 (7) "HOUSEHOLD INCOME" HAS THE SAME MEANING AS SET FORTH
3 IN 26 U.S.C. SEC. 36B (d)(2) OF THE FEDERAL "INTERNAL REVENUE CODE
4 OF 1986", AS AMENDED.
5 (8) "MEDICAID" MEANS FEDERAL INSURANCE OR ASSISTANCE AS
6 PROVIDED BY TITLE XIX OF THE FEDERAL "SOCIAL SECURITY ACT", AS
7 AMENDED, AND THE "COLORADO MEDICAL ASSISTANCE ACT", ARTICLES
8 4, 5, AND 6 OF TITLE 25.5.
9 (9) "MEDICARE" MEANS FEDERAL INSURANCE OR ASSISTANCE
10 PROVIDED BY THE "HEALTH INSURANCE FOR THE AGED ACT", TITLE XVIII
11 OF THE FEDERAL "SOCIAL SECURITY ACT", AS AMENDED, 42 U.S.C. SEC.
12 1395 ET SEQ.
13 (10) "REINSURANCE PROGRAM" MEANS THE COLORADO
14 REINSURANCE PROGRAM CREATED IN PART 11 OF THIS ARTICLE 16.
15 10-16-1203. Health insurance affordability board - creation -
16 membership - powers and duties - subject to open meetings and
17 public records laws. (1) (a) THERE IS HEREBY CREATED THE HEALTH
18 INSURANCE AFFORDABILITY BOARD, WHICH BOARD IS RESPONSIBLE FOR
19 GOVERNANCE OF THE ENTERPRISE ESTABLISHED IN THIS PART 12. THE
20 BOARD CONSISTS OF NINE VOTING MEMBERS APPOINTED BY THE
21 GOVERNOR, WITH THE CONSENT OF THE SENATE, AS FOLLOWS:
22 (I) THE EXECUTIVE DIRECTOR OF THE EXCHANGE OR THE
23 EXECUTIVE DIRECTOR'S DESIGNEE;
24 (II) ONE MEMBER WHO IS EMPLOYED BY A CARRIER;
25 (III) ONE MEMBER WHO IS A REPRESENTATIVE OF A STATEWIDE
26 ASSOCIATION OF HEALTH BENEFIT PLANS;
27 (IV) ONE MEMBER OF THE HEALTH CARE INDUSTRY WHO DOES NOT
DRAFT
4.28.20
-4- DRAFT
1 REPRESENT A CARRIER;
2 (V) TWO MEMBERS WHO ARE CONSUMERS OF HEALTH CARE WHO
3 ARE NOT REPRESENTATIVES OR EMPLOYEES OF A HOSPITAL, CARRIER, OR
4 OTHER HEALTH CARE INDUSTRY ENTITY. TO THE EXTENT POSSIBLE, THE
5 GOVERNOR SHALL ENSURE THAT THE CONSUMER MEMBERS OF THE BOARD
6 APPOINTED ARE INDIVIDUALS WITH AN ANNUAL HOUSEHOLD INCOME OF
7 LESS THAN FOUR HUNDRED PERCENT OF THE FEDERAL POVERTY LINE, WHO
8 LACK AFFORDABLE OFFERS OF COVERAGE FROM THEIR EMPLOYERS, AND
9 WHO DO NOT QUALIFY FOR ADVANCE PREMIUM TAX CREDITS UNDER THE
10 FEDERAL ACT.
11 (VI) ONE MEMBER WHO REPRESENTS A HEALTH CARE ADVOCACY
12 ORGANIZATION;
13 (VII) ONE MEMBER WHO IS A REPRESENTATIVE OF A BUSINESS
14 THAT PURCHASES OR OTHERWISE PROVIDES HEALTH INSURANCE FOR ITS
15 EMPLOYEES; AND
16 (VIII) THE COMMISSIONER OR THE COMMISSIONER'S DESIGNEE.
17 (b) NO MORE THAN SEVEN FIVE <{This would possibly allow a super
18 majority affiliated with the same political party. You might want to
19 lower this to 5 or 6.}> MEMBERS OF THE BOARD MAY BE AFFILIATED WITH
20 THE SAME POLITICAL PARTY, AND THE MEMBERSHIP MUST REFLECT THE
21 DIVERSITY OF THE STATE WITH REGARD TO RACE, ETHNICITY,
22 IMMIGRATION STATUS, INCOME, WEALTH, ABILITY AND GEOGRAPHY. <{and
23 disability?}>
24 (2) (a) (I) EXCEPT AS PROVIDED IN SUBSECTION (2)(a)(II) OF THIS
25 SECTION, THE TERM OF OFFICE OF THE MEMBERS OF THE BOARD IS FOUR
26 YEARS. <{any limit on number of terms?}>
27 (II) IN ORDER TO ENSURE STAGGERED TERMS OF OFFICE, THE
DRAFT
4.28.20
Comment [EM1]: Recommend a limit of 2
terms.
-5- DRAFT
1 INITIAL TERM OF OFFICE OF FIVE OF THE MEMBERS OF THE BOARD IS TWO
2 YEARS AND THE INITIAL TERM OF OFFICE OF THE REMAINDER OF THE
3 MEMBERS OF THE BOARD IS FOUR YEARS. <{Do you want to specify which
4 5 members have initial 2-year terms or leave it to the governor to
5 determine?}>
6 (b) MEMBERS OF THE BOARD SERVE AT THE PLEASURE OF THE
7 GOVERNOR AND MAY BE REMOVED BY THE GOVERNOR OR FOR CAUSE BY
8 A MAJORITY VOTE OF THE BOARD MEMBERS.
9 (c) A MEMBER WHO IS APPOINTED TO FILL A VACANCY SHALL
10 SERVE THE REMAINDER OF THE UNEXPIRED TERM OF THE MEMBER WHOSE
11 VACANCY IS BEING FILLED.
12 (d) MEMBERS OF THE BOARD WHO RESIDE MORE THAN FIFTY MILES
13 FROM THE LOCATION OF A BOARD MEETING ARE ENTITLED TO RECEIVE THE
14 SAME PER DIEM COMPENSATION AND REIMBURSEMENT OF EXPENSES AS
15 PROVIDED FOR MEMBERS OF BOARDS AND COMMISSIONS PURSUANT TO
16 SECTION 12-20-103 (6). ALL MEMBERS MAY BE REIMBURSED FOR ACTUAL
17 AND NECESSARY EXPENSES, INCLUDING ANY REQUIRED DEPENDENT CARE
18 AND DEPENDENT OR ATTENDANT TRAVEL, FOOD, AND LODGING, WHILE
19 ENGAGED IN THE PERFORMANCE OF OFFICIAL DUTIES OF THE BOARD.
20 <{Any change to this given current fiscal climate?}>
21 (3) THE BOARD SHALL MEET AS OFTEN AS NECESSARY TO CARRY
22 OUT ITS DUTIES PURSUANT TO THIS PART 12.
23 (4) THE BOARD IS AUTHORIZED TO:
24 (a) IMPLEMENT AND ADMINISTER THE ENTERPRISE; <{Added this
25 - OK?}>
26 (b) ESTABLISH ADMINISTRATIVE AND ACCOUNTING PROCEDURES
27 FOR THE OPERATION OF THE ENTERPRISE; <{Added this - OK?}>
DRAFT
4.28.20
Comment [EM2]: Recommend leave to Gov.
Comment [EM3]: I think this reimbursement
is critical for equity in the Board and hopefully
these funds can be taken out of the fee.
Comment [EM4]: OK.
Comment [EM5]: OK.
-6- DRAFT
1 (c) DETERMINE THE TIMING AND METHODOLOGY FOR ASSESSING
2 AND COLLECTING THE FEE;
3 (d) DETERMINE AN APPROACH TO IMPLEMENTING SECTION
4 10-16-1204 (4)(c), INCLUDING:
5 (I) PROCEDURES FOR DETERMINING ELIGIBILITY FOR
6 REDUCED-COST COVERAGE OPTIONS AVAILABLE PURSUANT TO SECTION
7 10-16-1204 (4)(c);
8 (II) PROCEDURES FOR ENROLLMENT IN REDUCED-COST COVERAGE
9 OPTIONS AVAILABLE PURSUANT TO SECTION 10-16-1204 (4)(c); AND
10 <{Aren't these procedures already established by the exchange? What
11 is the point of this provision?}>
12 (III) AFFORDABILITY REQUIREMENTS FOR REDUCED-COST OPTIONS
13 AVAILABLE PURSUANT TO SECTION 10-16-1204 (4)(c) THAT ARE BASED ON
14 INCOME; <{What is the meaning of this provision? Would the board be
15 setting an amount by which carriers would have to reduce premiums
16 for individuals receiving the APTC and those whose income is below
17 400% FPL who don't qualify for the APTC?}>
18 (e) DETERMINE THE PAYMENTS TO BE MADE TO HEALTH BENEFIT
19 PLANS/CARRIERS/INSURERS PURSUANT TO SECTION 10-16-1204 (4)(c); AND
20 <{Need to determine who is the recipient of the payments - confer with
21 DOI. Probably should be carriers that offer/issue health benefit plans
22 on the individual market, right?}>
23 (f) ESTABLISH BYLAWS, AS APPROPRIATE, AND CONSISTENT WITH
24 THIS PART 12, FOR ITS EFFECTIVE OPERATION.
25 (5) MEETINGS OF THE BOARD ARE SUBJECT TO THE OPEN MEETINGS
26 PROVISIONS OF THE "COLORADO SUNSHINE ACT OF 1972", CONTAINED IN
27 PART 4 OF ARTICLE 6 OF TITLE 24. EXCEPT AS OTHERWISE PROVIDED IN THE
DRAFT
4.28.20
Comment [EM6]: They are established for
the exchange, but the exchange bars
participation by people without proper
documentation and doesn’t allow the provision
of financial assistance to families in the family
glitch. Therefore, we are standing up
“exchange look-alike coverage” through this
enterprise.
Comment [EM7]: That’s right – they have to
figure out how to give out the state-level
subsidies. We have limited their discretion
though to focus the benefit on those most in
need.
Comment [EM8]: DOI: please inform.
-7- DRAFT
1 "COLORADO OPEN RECORDS ACT", PART 2 OF ARTICLE 72 OF TITLE 24, OR
2 OTHER APPLICABLE STATE OR FEDERAL LAW, RECORDS OF THE BOARD AND
3 THE PROGRAM ARE SUBJECT TO THE "COLORADO OPEN RECORDS ACT".
4 10-16-1204. Health insurance affordability enterprise -
5 creation - powers and duties - assess and allocate health insurance
6 affordability fee. (1) (a) THERE IS HEREBY CREATED IN THE DIVISION THE
7 COLORADO HEALTH INSURANCE AFFORDABILITY ENTERPRISE. THE
8 ENTERPRISE IS AND OPERATES AS A GOVERNMENT-OWNED BUSINESS
9 WITHIN THE DIVISION FOR THE PURPOSE OF CHARGING AND COLLECTING
10 THE HEALTH INSURANCE AFFORDABILITY FEE FROM HEALTH BENEFIT
11 PLANS AND USING THE FEE FOR THE PURPOSES SPECIFIED IN THIS SECTION.
12 <{Draft provided to me used "health benefits plans" as the entity from
13 whom the fee is collected. I assume this should actually refer to
14 "carriers" or a specially-defined group of insurers, depending on which
15 insurers will be subject to the fee. The fact sheet refers to individual,
16 small group, large group, and Medicaid managed care organizations -
17 so, I assume carriers/insurers offering health benefit plans to
18 individuals and groups and then the Medicaid managed care
19 organizations. Is that correct? But note my comment, below, where
20 there is language exempting medicaid from the fee. Will need to make
21 that provision consistent with this provision and the definition of
22 insurers subject to the fee.}>
23 (b) (I) THE ENTERPRISE CONSTITUTES AN ENTERPRISE FOR
24 PURPOSES OF SECTION 20 OF ARTICLE X OF THE STATE CONSTITUTION SO
25 LONG AS IT RETAINS THE AUTHORITY TO ISSUE REVENUE BONDS AND
26 RECEIVES LESS THAN TEN PERCENT OF ITS TOTAL REVENUES IN GRANTS, AS
27 DEFINED IN SECTION 24-77-102 (7), FROM ALL COLORADO STATE AND
DRAFT
4.28.20
Comment [EM9]: We want to include
“carriers/insurers offering health benefit
plans to individuals and groups.” We do not
intend to include Medicaid MCOs.
-8- DRAFT
1 LOCAL GOVERNMENTS COMBINED. SO LONG AS IT CONSTITUTES AN
2 ENTERPRISE PURSUANT TO THIS SECTION, THE ENTERPRISE IS NOT A
3 DISTRICT FOR PURPOSES OF SECTION 20 OF ARTICLE X OF THE STATE
4 CONSTITUTION.
5 (II) SUBJECT TO APPROVAL BY THE GENERAL ASSEMBLY, EITHER
6 BY BILL OR JOINT RESOLUTION, AND AFTER APPROVAL BY THE GOVERNOR
7 PURSUANT TO SECTION 39 OF ARTICLE V OF THE STATE CONSTITUTION, THE
8 ENTERPRISE IS HEREBY AUTHORIZED TO ISSUE REVENUE BONDS FOR THE
9 EXPENSES OF THE ENTERPRISE, SECURED BY REVENUES OF THE
10 ENTERPRISE.
11 (2) THE ENTERPRISE'S PRIMARY POWERS AND DUTIES ARE:
12 (a) TO ASSESS AND COLLECT THE FEE SPECIFIED IN SUBSECTION (3)
13 OF THIS SECTION;
14 (b) TO ALLOCATE MONEY IN THE FUND IN ACCORDANCE THE
15 SUBSECTION (4) OF THIS SECTION;
16 (c) TO ENTER INTO AGREEMENTS WITH THE DIVISION TO THE
17 EXTENT NECESSARY TO COLLECT AND ALLOCATE THE FEE; AND
18 (d) TO ADOPT AND AMEND OR REPEAL POLICIES FOR THE
19 REGULATION OF ITS AFFAIRS AND THE CONDUCT OF ITS BUSINESS
20 CONSISTENT WITH THIS PART 12.
21 (3) (a) THE ENTERPRISE SHALL CHARGE AND COLLECT FROM
22 HEALTH BENEFIT PLANS/CARRIERS/INSURERS A FEE OF THREE PERCENT OF
23 PREMIUMS COLLECTED BY HEALTH BENEFIT PLANS/CARRIERS/INSURERS
24 FOR HEALTH BENEFIT PLANS ISSUED IN THIS STATE. THE ENTERPRISE SHALL
25 USE THE FEE AS FOLLOWS:
26 (I) TO PROVIDE SUSTAINING FUNDS TO THE REINSURANCE
27 PROGRAM;
DRAFT
4.28.20
Comment [EM10]: We need to include
details on timing in this section
-9- DRAFT
1 (II) TO INCREASE THE AFFORDABILITY OF HEALTH INSURANCE ON
2 THE INDIVIDUAL MARKET FOR COLORADANS WHO EITHER RECEIVE THE
3 ADVANCE PREMIUM TAX CREDITS
3 (III) TO MAKE AVAILABLE AFFORDABLE HEALTH CARE COVERAGE OPTIONS
FOR INDIVIDUALS WHO DO NOT QUALIFY FOR MEDICAID, CHIP OR
ADVANCED PREMIUM TAX CREDITS AND WHO HAVE A HOUSEHOLD
INCOME OF LESS THAN TWO HUNDRED AND SIXTY PERCENT OF THE
FEDERAL POVERTY LINE. OR ARE INELIGIBLE FOR THE ADVANCE
4 PREMIUM TAX CREDIT AND MEDICAID? BUT HAVE A HOUSEHOLD INCOME
54 OF LESS THAN FOUR HUNDRED PERCENT OF THE FEDERAL POVERTY LINE;
65 AND <{Should "and medicaid" be added to make it clear this program
76 is not available for individuals who are eligible for medicaid?}>
87 (III) TO PAY THE ENTERPRISE'S ACTUAL ADMINISTRATIVE COSTS,
98 LIMITED TO THREE PERCENT OF THE ENTERPRISE'S EXPENDITURES BASED
109 ON A METHODOLOGY APPROVED BY THE OFFICE OF STATE PLANNING AND
1110 BUDGETING, INCLUDING THE FOLLOWING COSTS: <{Typically, admin cost
1211 limits are tied to a percent of revenues, NOT expenditures. It looks like
1312 this language comes from the healthcare affordability and
1413 sustainability fee, which is unique. I recommend that if you want to cap
1514 admin costs, tie the percentage to revenues, not expenditures. I also
1615 don't think you need the OSPB methodology language.}>
1716 (A) THE ADMINISTRATIVE EXPENSES OF THE ENTERPRISE;
1817 (B) THE ENTERPRISE'S ACTUAL COSTS RELATED TO IMPLEMENTING
1918 AND MAINTAINING THE FEE, INCLUDING PERSONAL SERVICES AND
2019 OPERATING EXPENSES; AND
2120 (C) THE COSTS FOR CONDUCTING ANALYSES NECESSARY TO
2221 ESTABLISH THE FEE AND TO DETERMINE THE PAYMENTS TO BE MADE TO
2322 HEALTH BENEFIT PLANS/CARRIERS/INSURERS PURSUANT TO SUBSECTION
2423 (4) OF THIS SECTION AND THE REQUIREMENTS FOR REDUCED-COST
2524 COVERAGE OFFERED BY HEALTH BENEFIT PLANS/CARRIERS/INSURERS
DRAFT
4.28.20
Formatted: Not Expanded by / Condensed
by
Comment [EM11]: I think we need to break
out these two uses.
Formatted: Indent: Left: 0", Right: 1.37"
Comment [EM12]: Good catch.
Comment [EM13]: I think OK to tie to 3
percent of revenue and eliminate the OSBP
methodology.
-10-
DRAFT
2625 PURSUANT TO SUBSECTION (4) OF THIS SECTION.
2726 (b) (I) EXCEPT AS PROVIDED IN SUBSECTION (3)(b)(II) OF THIS
-10- DRAFT
1 SECTION, THE ENTERPRISE SHALL CHARGE AND COLLECT THE FEE FOR ANY
2 BENEFIT YEAR STARTING ON OR AFTER JANUARY 1, 2021. <{If the fee is
3 collected starting in 2021, what is the timing of when the fees are
4 actually received by the enterprise and then when would the revenues
5 be available to allocate to reinsurance and to the carriers?}>
6 (II) IF A FEDERAL WAIVER IS REQUIRED FOR THE ENTERPRISE TO
7 COLLECT THE FEE, IMPLEMENTATION OF THE FEE IS CONTINGENT UPON
8 APPROVAL OF THE FEDERAL WAIVER PURSUANT TO SECTION 10-16-1207.
9 IF THE FEDERAL WAIVER IS APPROVED, THE ENTERPRISE SHALL BEGIN
10 COLLECTING THE FEE FOR ANY BENEFIT YEAR STARTING AFTER THE
11 APPROVAL.
126 (c) THIS SUBSECTION (3) DOES NOT APPLY TO PLANS OR BENEFITS
137 PROVIDED UNDER MEDICARE, MEDICAID, OR THE "CHILDREN'S BASIC
148 HEALTH PLAN" ESTABLISHED UNDER ARTICLE 8 OF TITLE 25.5. <{I know
159 this comes from the special assessments provision in the reinsurance
1610 program. This language appears to preclude the program from
1711 assessing fees on medicaid MPOs - is that the intent? The fact sheet
1812 says that medicaid MPOs would be subject to the fee. If that is the case,
1913 the above language needs to be modified.}>
2014 (4) THE ENTERPRISE SHALL TRANSMIT THE FEES COLLECTED
2115 PURSUANT TO THIS SECTION TO THE STATE TREASURER FOR DEPOSIT IN THE
2216 HEALTH INSURANCE AFFORDABILITY CASH FUND. THE ENTERPRISE SHALL
2317 ALLOCATE THE MONEY IN THE FUND ANNUALLY AS FOLLOWS:
2418 (a) NINETY MILLION DOLLARS EACH YEAR TO THE REINSURANCE
2519 PROGRAM CASH FUND CREATED IN SECTION 10-16-1107; <{Considering
2620 whether this allocation to another enterprise is problematic.}>
2721 (b) OF THE REMAINING BALANCE IN THE FUND AFTER DEDUCTING
DRAFT
4.28.20
Comment [EM14]: Need to continue to
address timing and allowed for reconciled
payments with DOI.
Comment [EM15]: A federal waiver should
not be required here, but is required for
reinsurance.
Comment [EM16]: We do want to
EXCLUDE Medicaid MCOs.
Comment [EM17]: We need to allow for the
possibility that a federal reinsurance program
is established and these resources are not
needed.
-11- DRAFT
1 THE ALLOCATION SPECIFIED IN SUBSECTION (4)(a) OF THIS SECTION, UP TO
2 THREE PERCENT FOR THE ENTERPRISE'S ADMINISTRATIVE COSTS; AND
3 (c) OF THE REMAINING BALANCE AFTER DEDUCTING THE AMOUNTS
4 REQUIRED PURSUANT TO SUBSECTIONS (4)(a) AND (4)(b) OF THIS SECTION:
5 ( I) TW E N T Y P E R C E N T T O H E A L T H B E N E F I T
6 PLANS/CARRIERS/INSURERS TO REDUCE THE COSTS OF INDIVIDUAL HEALTH
7 PLANS FOR INDIVIDUALS WHO PURCHASE AN INDIVIDUAL HEALTH BENEFIT
8 PLAN ON THE EXCHANGE AND RECEIVE THE ADVANCE PREMIUM TAX
9 CREDIT; AND
10 ( I I ) EI G H T Y P E R C E N T T O H E A L T H B E N E F I T
11 PLANS/CARRIERS/INSURERS TO REDUCE THE COSTS OF INDIVIDUAL HEALTH
12 PLANS FOR INDIVIDUALS, REGARDLESS OF THE IMMIGRATION STATUS, WHO:
13 (A) PURCHASE AN INDIVIDUAL HEALTH BENEFIT PLAN ON THE
14 EXCHANGE;
15 (B) HAVE A HOUSEHOLD INCOME OF LESS THAN FOUR TWO HUNDRED AND SIXTY
HUNDRED
16 PERCENT OF THE FEDERAL POVERTY LINE; AND
17 (C) ARE NOT ELIGIBLE FOR THE ADVANCE PREMIUM TAX CREDIT, MEDICAID OR
CHIP=.
1718 (D) Coverage with an actuarial value of at least 90 percent must be available for
a zero-dollar premium for the lowest-income customers.
1819 (5) THE ENTERPRISE SHALL MAKE THE ALLOCATIONS SPECIFIED IN
1920 SUBSECTION (4)(c) OF THIS SECTION IN ACCORDANCE WITH THE
2021 REQUIREMENTS DETERMINED BY THE BOARD PURSUANT TO SECTION
21 10-16-1203 (4)(d) AND (4)(e).
22 10-16-1205. Health insurance affordability cash fund -
23 creation. (1) THERE IS HEREBY CREATED IN THE STATE TREASURY THE
24 HEALTH INSURANCE AFFORDABILITY CASH FUND. THE FUND CONSISTS OF
25 THE FEE COLLECTED PURSUANT TO SECTION 10-16-1204 AND ALL
DRAFT
4.28.20
Comment [EM18]: We wanted to add in
allowable outreach activities in the early years
here. Need to fully explain waterfalling of
priories in first two year and in third year +.
Comment [EM19]: Is this language
problematic since we want to indicate the
PBC?
Formatted: Not Expanded by / Condensed
by
Comment [EM20]: We are continuing to
think through prioritization/waterfalling.
-12- DRAFT
26 INTEREST AND INCOME DERIVED FROM THE DEPOSIT AND INVESTMENT OF
27 MONEY IN THE FUND.
-13- DRAFT
1 (2) MONEY IN THE FUND SHALL NOT BE TRANSFERRED TO ANY
2 OTHER FUND, EXCEPT AS PROVIDED IN SECTION 10-16-1204 (4)(a), AND
3 SHALL NOT BE USED FOR ANY PURPOSE OTHER THAN THE PURPOSES
4 SPECIFIED IN THIS PART 12.
5 (3) ALL MONEY IN THE FUND IS CONTINUOUSLY AVAILABLE AND
6 APPROPRIATED TO THE ENTERPRISE TO USE IN ACCORDANCE WITH THIS
7 PART 12.
8 (4) THE FUND IS PART OF THE ENTERPRISE ESTABLISHED PURSUANT
9 TO SECTION 10-16-1204 (1).
10 10-16-1206. Rules. THE COMMISSIONER SHALL PROMULGATE
11 RULES NECESSARY FOR THE ADMINISTRATION AND IMPLEMENTATION OF
12 THIS PART 12, INCLUDING RULES TO PREVENT THE REINSURANCE PROGRAM
13 FROM CAUSING A DECLINE IN THE PURCHASING POWER OF EXCHANGE
14 CONSUMERS WHOSE HOUSEHOLD INCOME IS UP TO FOUR HUNDRED
15 PERCENT OF THE FEDERAL POVERTY LINE. IN PROMULGATING RULES FOR
16 THE ADMINISTRATION AND IMPLEMENTATION OF THIS PART 12, THE
17 COMMISSIONER MAY CONSIDER THE RESULTS OF THE EVALUATION AND
18 STUDY OF THE REINSURANCE PROGRAM CONDUCTED PURSUANT TO
19 SECTION 10-16-1104 (2). <{I changed the rulemaking authority to the
20 commissioner instead of the division as the commissioner has
21 rulemaking authority for the division. However, I'm not sure this
22 provision is necessary, or even appropriate in this part 12. Consider
23 whether this provision, if needed, should be included in the reinsurance
24 program statutes.}>
25 10-16-1207. Federal waiver - division to assist - fee contingent
26 on waiver approval - notice to general assembly. (1) (a) IF A FEDERAL
27 WAIVER IS REQUIRED FOR THE ENTERPRISE TO COLLECT THE FEE PURSUANT
DRAFT
4.28.20
Comment [EM21]: I think this should move
to reinsurance.
-14- DRAFT
1 TO THIS PART 12, THE ENTERPRISE, ACTING IN CONCERT WITH OR THROUGH
2 AN AGREEMENT WITH THE DIVISION, SHALL SEEK ANY FEDERAL WAIVER
3 NECESSARY TO ALLOW THE ENTERPRISE TO COLLECT THE FEE.
4 (b) AN APPLICATION FOR A FEDERAL WAIVER MUST CLEARLY
5 STATE THAT COLLECTION OF THE FEE IS CONTINGENT ON APPROVAL OF THE
6 WAIVER.
7 (c) THE ENTERPRISE SHALL ENSURE THAT A WAIVER APPLICATION
8 SUBMITTED PURSUANT TO THIS SECTION COMPLIES WITH THE
9 REQUIREMENTS SPECIFIED IN FEDERAL LAW.
10 (2) THE ENTERPRISE SHALL NOTIFY THE FOLLOWING IN WRITING OF
11 ANY FEDERAL ACTIONS REGARDING THE WAIVER REQUEST:
12 (a) THE JOINT BUDGET COMMITTEE OF THE GENERAL ASSEMBLY;
13 (b) THE SENATE COMMITTEE ON HEALTH AND HUMAN SERVICES OR
14 ANY SUCCESSOR COMMITTEE; AND
15 (c) THE HOUSE OF REPRESENTATIVES COMMITTEES ON HEALTH AND
16 INSURANCE AND PUBLIC HEALTH CARE AND HUMAN SERVICES OR ANY
17 SUCCESSOR COMMITTEES.
181 10-16-1208. Repeal of part - notice to revisor of statutes.
192 (1) THE ENTERPRISE SHALL NOTIFY THE REVISOR OF STATUTES IN
203 WRITING, BY E-MAIL SENT TO [email protected],
214 UPON RECEIPT FROM THE FEDERAL GOVERNMENT OF NOTICE OF APPROVAL
225 OR DENIAL OF A FEDERAL WAIVER REQUESTED PURSUANT TO SECTION
23 10-16-1207.
24 (2) (a) IF THE NOTICE FROM THE ENTERPRISE STATES THAT THE
25 WAIVER WAS DENIED, THIS PART 12 IS REPEALED, EFFECTIVE UPON THE
26 DATE IDENTIFIED IN THE NOTICE THAT THE WAIVER WAS DENIED OR, IF THE
DRAFT
4.28.20
Formatted: List Paragraph, Indent: Left:
0.16", Hanging: 0.53", Numbered + Level:
1 + Numbering Style: 1, 2, 3, … + Start at:
10 + Alignment: Left + Aligned at: 0.16" +
Indent at: 1.19", Tab stops: 0.69", Left +
0.69", Left
Comment [EM22]: A federal waiver should
not be required to collect this fee, though the
reinsurance portion will still require a waiver.
-15- DRAFT
27 NOTICE DOES NOT SPECIFY THAT DATE, UPON THE DATE OF THE NOTICE OF
-16- DRAFT
1 DENIAL TO THE REVISOR OF STATUTES.
2 (b) IF THE NOTICE FROM THE ENTERPRISE STATES THAT THE
3 WAIVER WAS APPROVED, THIS SECTION IS REPEALED, EFFECTIVE UPON THE
4 DATE IDENTIFIED IN THE NOTICE THAT THE WAIVER WAS APPROVED OR, IF
5 THE NOTICE DOES NOT SPECIFY THAT DATE, UPON THE DATE OF THE NOTICE
6 OF APPROVAL TO THE REVISOR OF STATUTES.
7 SECTION 2. In Colorado Revised Statutes, 10-16-1104, amend
8 (1)(f) as follows:
9 10-16-1104. Commissioner powers and duties - rules - study
10 and report. (1) The commissioner has all powers necessary to
11 implement this part 11 and is specifically authorized to:
12 (f) Assess special fees against hospitals and, if applicable, carriers
13 for the continuous operation of the reinsurance program, as provided in
14 section 10-16-1108;
15 SECTION 3. In Colorado Revised Statutes, 10-16-1105, amend
16 (1)(e)(I) as follows:
17 10-16-1105. Reinsurance program - creation - enterprise
18 status - subject to waiver or funding approval - operation - payment
19 parameters - calculation of reinsurance payments - eligible carrier
20 requests - definition. (1) (e) (I) On a quarterly basis during the
21 applicable benefit year:
22 (A) Each eligible carrier shall report to the commissioner its
23 claims costs that exceed the attachment point for that benefit year; AND
24 (B) Each hospital that is subject to the special fees assessed
25 pursuant to section 10-16-1108 shall report to the commissioner the
26 amount the hospital is responsible for funding in the benefit year. and
27 (C) If special fees are assessed against carriers pursuant to section
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1 10-16-1108 (1)(b), each carrier that is subject to the special fees shall
2 report to the commissioner on its collected assessments in that benefit
3 year.
4 SECTION 4. In Colorado Revised Statutes, 10-16-1107, amend
5 (1)(a)(II), (1)(a)(IV), and (1)(a)(V); and add (1)(a)(VI) as follows:
6 10-16-1107. Funding for reinsurance program - sources -
7 permitted uses - reinsurance program cash fund - calculation of total
8 funding for program. (1) (a) There is hereby created in the state
9 treasury the reinsurance program cash fund, which consists of:
10 (II) Special fees assessed against hospitals and, if applicable,
11 carriers as provided in section 10-16-1108;
12 (IV) An amount of premium tax revenues deposited in the fund
13 pursuant to section 10-3-209 (4)(a)(III); and
14 (V) Any money the general assembly appropriates to the fund for
15 the program; AND
16 (VI) NINETY MILLION DOLLARS ALLOCATED TO THE FUND
17 PURSUANT TO SECTION 10-16-1204 (4)(a).
18 SECTION 5. In Colorado Revised Statutes, 10-16-1108, amend
19 (1)(a)(I) introductory portion, (1)(a)(I)(A), (4), and (5); and repeal (1)(b)
20 as follows:
21 10-16-1108. Special assessments against hospitals and carriers
22 - rules - enforcement. (1) (a) (I) For the 2020 and 2021 2022 benefit
23 years, as applicable YEAR, the commissioner may assess special fees
24 against hospitals, subject to the following:
25 (A) Fees assessed against hospitals must comply with and not
26 violate 42 CFR 433.68 and in any year, must not exceed the lesser of forty
27 EIGHTY million dollars or the maximum amount allowed under 42 CFR
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1 433.68; and <{If $80M is assessed in one year, 2022, will that exceed
2 the amount allowed under 42 CFR 433.68? I'm not sure the assessment
3 can be moved to a single year and then doubled. As I understand it, the
4 $40M cap is essentially the maximum amount allowed under the
5 federal regulation, so these changes may not work.}>
6 (b) (I) For any benefit year starting on or after January 1, 2020, if,
7 after carriers have filed and the commissioner has approved rates for the
8 benefit year, the federal government suspends the fee imposed pursuant
9 to section 9010 of the federal act for that benefit year, the commissioner
10 shall assess against carriers a special fee of two and two-tenths percent of
11 premiums collected by carriers, or a special fee in an amount equal to the
12 amount of the fee imposed by the federal government pursuant to section
13 9010 of the federal act if that fee amount is different than the amount
14 specified in this subsection (1)(b)(I), for the period that carriers collected
15 the fee imposed pursuant to section 9010 of the federal act.
16 (II) This subsection (1)(b) does not apply to plans or benefits
17 provided under medicare, medicaid, or the "Children's Basic Health Plan"
18 established under article 8 of title 25.5.
19 (4) If the federal centers for medicare and medicaid services in the
20 United States department of health and human services informs the state
21 that the state will not be in compliance with 42 CFR 433 as a result of the
22 special fees assessed on hospitals pursuant to this section, the
23 commissioner shall reduce the amount of the special fees as necessary to
24 avoid any reduction in the healthcare affordability and sustainability fee
25 collected pursuant to section 25.5-4-402.4. <{I understand this provision
26 may be getting modified so have included it as a placeholder.}>
27 (5) If a hospital or carrier, if applicable, fails to pay a special fee
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1 to the commissioner in accordance with the time periods established by
2 rule, the commissioner may use all powers conferred by the insurance
3 laws of this state to enforce payment of the special fees.
4 SECTION 6. Safety clause. The general assembly hereby finds,
5 determines, and declares that this act is necessary for the immediate
6 preservation of the public peace, health, or safety. <{Recommend safety
7 clause due to complications created by later session adjournment.
8 Sponsor OK?}>
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