HB 1514-FN-A – AS INTRODUCED
2008 SESSION
01/04
HOUSE BILL 1514-FN-A
AN ACT establishing the New Hampshire state health investment program corporation and continually appropriating a special fund.
SPONSORS: Rep. J. Hammond, Hills 3; Rep. McEachern, Rock 16; Rep. Wall, Straf 7; Rep. Beck, Hills 2; Rep. Beauchesne, Merr 8
COMMITTEE: Health, Human Services and Elderly Affairs
This bill establishes the New Hampshire state health investment program corporation and fund modeled on the healthy kids corporation to provide access to health care to low and moderate income persons.
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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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
08-2451
01/04
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Eight
AN ACT establishing the New Hampshire state health investment program corporation and continually appropriating a special fund.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 Statement of Purpose. The general court recognizes that many New Hampshire citizens lack adequate access to health care services and experience diminished health outcomes because they cannot obtain affordable health insurance coverage. The purpose of this act is to provide those low and moderate income persons access to the health care system by establishing premiums based on a percentage of income to purchase primary health care thereby allowing participants to have a medical home.
2 New Chapter; New Hampshire State Health Investment Program Corporation. Amend RSA by inserting after chapter 126-Q the following new chapter:
CHAPTER 126-R
NEW HAMPSHIRE STATE HEALTH INVESTMENT PROGRAM CORPORATION
126-R:1 In this chapter:
I. “Board” means the New Hampshire state health investment program board established in RSA 126-R:3.
II. “Corporation” means the New Hampshire state health investment program (NHSHIP) corporation established in RSA 126-R:2.
III. “Health care provider” means an individual or facility licensed, certified, or otherwise authorized or permitted by law to administer health care, for profit or otherwise, in the ordinary course of business or professional practice.
IV. “Medical home” means providing continuity and integration of primary health care to a patient.
126-R:2 Corporation Established. There is hereby created a body politic and corporate having a distinct legal existence separate from the state and not constituting a department of state government, to be known as the New Hampshire state health investment program corporation to carry out the provisions of this chapter. The corporation is hereby deemed to be a public instrumentality and the exercise by the authority of the powers conferred by this chapter shall be deemed and held to be the performance of public and essential governmental functions of the state. The corporation shall be a private nonprofit corporation and shall have all the powers necessary to carry out the purposes of this chapter, including, but not limited to, the power to receive and accept grants, loans, or advances of funds from any public or private agency and to receive and accept from any source, contributions of money, property, labor, or any other thing of value, to be held, used, and applied for the purposes of this chapter. Notwithstanding any other provision of law, any payments made by the corporation for insurance coverage under this chapter, either directly or indirectly, shall be exempt from the premium tax under RSA 400-A:32.
126-R:3 New Hampshire State Health Investment Program Board Established.
I. The powers of the corporation shall be vested in 17 members who shall hold 3-year terms of office as follows:
(a) A public member, appointed by the governor.
(b) A member of the house of representatives, appointed by the speaker of the house of representatives.
(c) A member of the senate, appointed by the president of the senate.
(d) The commissioner of the insurance department, or designee.
(e) The commissioner of the department of health and human services, or designee.
(f) The commissioner of the department of labor, or designee.
(g) Two representatives of the business community, appointed by the governor.
(h) One member appointed by the New Hampshire Hospital Association.
(i) One member appointed by the New Hampshire Academy of Family Physicians.
(j) One member appointed by the New Hampshire Nurses’ Association.
(k) One member appointed by the Business and Industry Association of New Hampshire.
(l) One member appointed by the New Hampshire Medical Society.
(m) One member appointed by the Endowment for Health.
(n) One member appointed by the New Hampshire Citizens Health Initiative.
(o) One member from a community health center appointed by the Bi-State Primary Care Association.
(p) One member appointed by the New Hampshire Municipal Association.
II. The members of the board shall serve 3-year staggered terms, except that the members in subparagraphs I(b), (c), (d), (e), and (f) shall serve terms of office coterminous with the term of office in the position that qualifies that member to be a member of the board.
III. The members shall elect annually from among their number a chairperson and such officers as they may determine. A member shall hold office until a successor has been appointed and qualified. Members shall receive no salary for the performance of their duties under this chapter, but each member shall be reimbursed for reasonable expenses incurred in carrying out duties under this chapter. Any such expenses by board members shall have prior approval by 7 members of the board of directors before reimbursement. A member of the board of directors may be removed for cause by the official who appointed that member.
IV. There shall be no liability on the part of, and no cause of action shall arise against, any member of the board of directors, or its employees or agents, for any action they take in the performance of their powers and duties under this chapter.
V. The corporation shall not be deemed an insurer. The officers, directors, and employees of the corporation shall not be deemed to be the agents of an insurer. Neither the corporation nor any officer, director, or employee of the corporation shall be subject to the licensing requirements of the insurance code or the rules of the department of insurance. However, the department of insurance may require that any marketing representative utilized and compensated by the corporation be appointed as a representative of the health insurers with which the corporation contracts.
VI. The board shall have complete fiscal control over the corporation and shall be responsible for all corporate operations.
126-R:4 Meetings of Board. Meetings shall be held at the call of the chairperson or when 5 members so request. Seven members of the board shall constitute a quorum and the affirmative vote of 7 members shall be necessary for any action taken by the authority. No vacancy in the membership of the board shall impair the right of a quorum to exercise all the rights and perform all the duties of the corporation.
126-R:5 Powers and Duties.
I. The corporation shall:
(a) Establish participation criteria and eligibility for low and moderate individuals for enrollment in NHSHIP.
(b) Arrange for the collection of any premium, in an amount to be determined by the board of directors, based on a percentage of personal income, or on a sliding fee scale correlating to such a percentage, from all qualifying participants to provide for payment for preventive health care services and/or premiums for comprehensive health insurance coverage and for the actual or estimated administrative expenses incurred during the period for which payments are made.
(c) Consult appropriate professional organizations and primary care providers, and establish standards for comprehensive preventive health care services and chronic disease management, and negotiate appropriate compensation rates for defined health care services, and contract with primary care providers for same, on behalf of each participant, and establish a medical home with or for each participant.
(d) If appropriate, contract with an appropriate business services entity to provide administrative services to the corporation.
(e) Contract with any provider of health care services or authorized insurer, in accordance with standards established by the corporation and to the extent that funding is available, to provide comprehensive health care or insurance for extraordinary or catastrophic health care needs beyond the corporation’s primary-care mission.
(f) Require of health care providers holding NHSHIP contracts to report exact costs of participants on a quarterly basis, so that the corporation can assess the efficacy of its program and direct appropriate funding as needed, and keep a census of its covered individuals and their health needs.
(g) Develop and implement a plan to publicize the NHSHIP corporation, the eligibility requirements of the program, and the procedures for enrollment in the program and to maintain public awareness of the corporation and the program.
(h) Secure staff necessary to properly administer the corporation. Staff costs shall be funded from state funds appropriated by the general court and such other private or public funds as become available. The board of directors shall determine the number of staff members necessary to administer the corporation.
(i) Enter into contracts or agreements with local businesses, civic groups, or other agencies which choose to provide on-site information, enrollment, and other services necessary to the operation of the corporation.
(j) Provide an annual interim report, the first on or before January 1, 2009, to the governor, insurance commissioner, commissioner of health and human services, senate president, and speaker of the house of representatives on the development of the program.
II. The corporation may establish procedures for coordinating benefits under this program with benefits under other public and private coverage.
126-R:6 Rulemaking Authority. The corporation may adopt rules, pursuant to its own procedures, relative to:
I. The conduct of its business, including the administrative and accounting procedures for operation of the corporation.
II. The eligibility criteria which individuals must meet in order to participate in the program.
III. The procedures under which applicants to and participants in the program may have grievances reviewed by an impartial body and reported to the board of directors of the corporation.
IV. Application procedures.
V. Schedules of fees and other charges to be made by the corporation in renewing, acting upon, or accepting applications under this chapter and any other matters related to such applications as the corporation may deem necessary.
VI. Confidentiality of medical records obtained under this chapter.
VII. Such other matters as are necessary to carry out the powers and duties of the corporation.
126-R:7 Subcommittee Established.
I. The department of health and human services shall work with a subcommittee that is comprised of appropriate members of the board and that includes other members as follows:
(a) One member appointed by the Home Care Association of New Hampshire.
(b) One member appointed by the college of health and human services, university of New Hampshire.
(c) Two consumers appointed by the governor and council.
II. The members appointed pursuant to subparagraph I(c) shall be appointed to a 2-year term.
III. The subcommittee shall:
(a) Review information on the characteristics of New Hampshire’s uninsured population.
(b) Identify, the population groups and geographic areas that are most appropriately targeted.
(c) Examine models for affordable health coverage, including models from other states.
(d) Identify options that would be most effective.
(e) Develop cost projections for those options.
(f) Research the level of premium contributions that eligible individuals would be willing to pay.
(g) Identify potential sources of funding.
IV. The subcommittee shall elect annually from among the members a chairperson. The first meeting of the subcommittee shall be called by the commissioner of the department of health and human services. The department of health and human services shall provide administrative staff support. The department of health and human services and the corporation shall jointly seek funding to support the subcommittee’s work.
V. The subcommittee shall make an annual report relative to its findings and any recommendations for proposed legislation to the speaker of the house of representatives, the senate president, the house clerk, the senate clerk, the governor, and the state library beginning November 1, 2009.
126-R:8 NHSHIP Fund. There is hereby established in the office of the state treasurer a fund to be known as the NHSHIP fund. The NHSHIP corporation established in RSA 126-R:2 is authorized to accept public sector and private sector grants, gifts, donations, and appropriations of any kind to further the goals of the corporation. Public sector appropriations shall be deposited in the NHSHIP fund and may be expended by the NHSHIP corporation to accomplish the purposes of RSA 126-R. The moneys in the fund shall be nonlapsing and shall be continually appropriated to the corporation. Other revenues of the corporation such as grants, gifts, donations, and participant premium payments shall not be considered revenue of the state, but rather shall be funds of the corporation to be deposited as determined by the NHSHIP board of directors.
126-R:9 Confidentiality. Notwithstanding any provision of law to the contrary, the corporation shall have access to the medical records of a participant. Such medical records may be maintained by state and local agencies. Any confidential information obtained by the corporation pursuant to this section shall remain confidential and shall not be subject to RSA 91-A.
3 New Subparagraph; Special Fund. Amend RSA 6:12, I by inserting after subparagraph (268) the following new subparagraph:
(269) Moneys received under RSA 126-R which shall be credited to the New Hampshire state health investment program fund, established in RSA 126-R:8.
4 Effective Date. This act shall take effect 60 days after its passage.
LBAO
08-2451
11/30/07
HB 1514-FN-A - FISCAL NOTE
AN ACT establishing the New Hampshire state health investment program corporation and continually appropriating a special fund.
FISCAL IMPACT:
The Department of Health and Human Services states this bill may increase state expenditures by an indeterminable amount, and have an indeterminable impact on state revenues in FY 2009 and each year thereafter. This bill will have no fiscal impact on county and local revenue or expenditures.
METHODOLOGY:
The Department of Health and Human Services states this bill establishes a non-profit corporation similar to the Healthy Kids Corporation, whose purpose is to provide access to health insurance to low-income uninsured and underinsured adults by establishing premiums based on a percentage of income to purchase primary health care thereby allowing participants to have a medical home. The corporation would not be a state agency, nor would it be housed or operated by a state agency. The Department would be required to participate with a subcommittee of the corporation in reviewing characteristics of the uninsured in New Hampshire; identifying groups and regions to be targeted; examining models of affordable health care in other jurisdictions, projecting costs; researching premiums; and identifying potential sources of funding. The Department assumes these responsibilities could be performed by a Bureau Chief at the Department with the assistance of a program specialist, depending on the duties. The Department assumes individuals served by the corporation are individuals who are not eligible for coverage by Medicaid or SCHIP, and therefore there will be no decrease in caseload as a result of this bill. The Department states it is unclear from the bill how insurance coverage will be provided to eligible individuals since the corporation is not an insurer according to the proposed statutory definition. The Department states it is also unclear where the funding for the corporation will come from, or if the intent is to leverage federal Medicaid dollars (in which case the development of a waiver and contracts would require additional staff resources). If the intent is for DHHS to have a more active role, system changes would be necessary for eligibility determination, enrollment, adjudication of claims, and processing of premium payments. This bill also establishes a non-lapsing continually appropriated fund which would consist of public and private sector grants, gifts and donations, and appropriations of any kind to further the goals of the corporation. The Department states any costs that may result from passage of this bill are indeterminable at this time.
This bill also provides that any payments made by the corporation for insurance coverage under this bill, either directly or indirectly, shall be exempt from the premium tax under RSA 400-A:32. This provision may decrease state revenue by an indeterminable amount.