1 Department of Health and Human Services; Premium Assistance Program. Amend RSA 126-A:5, XXV (a) and (b) to read as follows:

XXV.(a) Consistent with the time frames in this paragraph, there is hereby established the marketplace premium assistance program. This will be a premium assistance program for newly eligible adults and their eligible spouse and dependents, if applicable, until December 31, 2018 and shall be administered by the department of health and human services. In order to receive medical assistance from the program, newly eligible adults who are ineligible for the HIPP program shall choose from any qualified health plans (QHPs) offered on the federally-facilitated exchange if cost effective; provided, however, that any newly eligible adult who had coverage under an alternative benefit plan (ABP) offered by a managed care organization (MCO) under paragraph XIX during the voluntary bridge to marketplace premium assistance program established under RSA 126-A:5, XXIV shall be automatically enrolled at the beginning of open enrollment in a comparable QHP by that same MCO if one is available, unless such newly eligible adult subsequently chooses a different QHP during the enrollment period. If a comparable QHP is not offered by the newly eligible adult's MCO then the newly eligible adult may choose from any QHPs, if cost effective. Provider payments shall be in an amount which shall be no less than before the effective date of this paragraph.

(b) On or before December 1, 2014, the commissioner shall submit to CMS any necessary waiver application to implement the provisions of this paragraph, including provisions to address individuals determined to be medically frail complex after completion of a health questionnaire screening process. To the greatest extent practicable the waiver shall incorporate measures to promote continuity of health insurance coverage and personal responsibility, including but not limited to: co-pays, deductibles, disincentives for inappropriate emergency room use, and mandatory wellness programs. Prior to submitting the waiver to CMS the commissioner shall present the waiver to the fiscal committee of the general court for approval. The program shall not begin until such waivers have been approved by CMS.

2 New Hampshire Health Protection Program. Amend RSA 126-A:5, XXIV(b) to read as follows:

(b) The commissioner shall seek any necessary waivers or state plan amendments to implement the provisions of this paragraph, including provisions to address individuals determined to be medically frail complex after completion of a health questionnaire screening process. To the greatest extent practicable the waiver or state plan amendments shall incorporate measures to promote continuity of health insurance coverage and personal responsibility, including but not limited to: co-pays, deductibles, disincentives for inappropriate emergency room use, and mandatory wellness programs. Prior to submitting the waiver or state plan amendments to CMS, the commissioner shall present the waiver or state plan amendments to the fiscal committee of the general court for approval. The program shall not begin until such waivers or state plan amendments have been approved by CMS.

3 Department of Health and Human Services; Premium Assistance Program. Amend RSA 126-A:5, XXX(c) to read as follows:

(c) If the waiver to implement the marketplace premium assistance program is approved on or before March 31, 2015 then, coverage under the voluntary bridge to marketplace premium assistance program established in RSA 126-A:5, XXIV shall terminate on December 31, 2015. Enrollment in the marketplace premium assistance program shall begin on October 15, 2015 and coverage shall begin on January 1, 2016. Coverage shall end on December 31, 2018. The cost of the medical assistance provided under the marketplace premium assistance program shall be paid solely from non-general fund sources, including federal funds as provided under 42 U.S.C. section 1396d(y).

4 Department of Health and Human Services; New Hampshire Health Protection Program. Amend RSA 126-A:5, XXX(a)(5) to read as follows:

(5) * Any waivers or amendments pursuant to this subparagraph shall be in place by April 30, 2018. The commissioner shall include in a waiver submitted pursuant to this subparagraph a requirement that any work requirement under subparagraph (a) which requires a waiver shall be equivalent to TANF, 42 U.S.C. section 607(d). Prior to submitting the waiver or state plan amendments to the CMS, the commissioner shall present the waiver or state plan amendments to the governor and the fiscal committee of the general court for approval. The program shall not be reauthorized until such waivers or state plan amendments have been approved by CMS. If the waiver or state plan is not approved, the commissioner shall immediately, no later than April 30, 2018, notify all program participants that the program has not been reauthorized beyond December 31, 2018.*

5 Department of Health and Human Services; New Hampshire Health Protection Program. Amend RSA 126-A:5, XXX(f) to read as follows:

(f) The commissioner shall seek any new waiver or state plan amendments to implement the provisions of this paragraph. Any such waivers or amendments necessary shall be in place by November 1, 2016. Prior to submitting the waiver or state plan amendments to the CMS, the commissioner shall present the waiver or state plan amendments to the fiscal committee of the general court for approval. The program shall not be reauthorized until such waivers or state plan amendments have been approved by CMS. If the waiver or state plan is not approved, the commissioner shall immediately, no later than November 1, 2016, notify all program participants that the program has not been reauthorized beyond December 31, 2016.

6 New Hampshire Health Protection Trust Fund. Amend the introductory paragraph of RSA 126-A:5-b, I to read as follows:

I. There is hereby established the New Hampshire health protection trust fund which shall be accounted for distinctly and separately from all other funds and shall be non-interest bearing. The trust fund shall be administered by the commissioner of the department of health and human services and shall be used solely to provide coverage for the newly eligible Medicaid population as provided for under RSA 126-A:5, XXIV-XXVI and RSA 126-A:67 in qualified health plans on the federal marketplace and pay for the administrative costs for the program. The commissioner may accept any gifts, grants, donations, or other funding from any source and shall deposit all such revenue received into the fund. No state general fund appropriations shall be deposited into the fund. All moneys in the trust fund shall be nonlapsing and shall be continually appropriated to the commissioner of the department of health and human services for the purposes of the trust fund. The trust fund shall be authorized to pay and/or reimburse:

7 Funding the State Share of the New Hampshire Health Protection Program. Amend RSA 126-A:5-c, I-II to read as follows:

I. In this section:

(a) "Program'' means the New Hampshire health protection program under RSA 126-A:5, XXIV-XXV, and XXX.

(b) "Remainder amount'' means the cost of the program for coverage effective between January 1, 2017 and June 30, 2017 plus administrative costs attributable to the program, less all federal reimbursement for the program and federal reimbursement for the related administrative costs; and the cost of the program for coverage effective between July 1, 2017 and December 31, 2018, plus administrative costs attributable to the program, less all federal reimbursement for the program and federal reimbursement for administrative costs attributable to the program, and taxes attributable to premiums written for medical and other medical related services for the newly eligible Medicaid population as provided for under RSA 126-A:5, XXIV-XXVI, and XXX, consistent with RSA 400-A:32, III(b).

II. Funding for the program from January 1, 2017 until December 31, 2018 shall not be funded from general funds.

(a) After December 31, 2018, the program shall be funded as follows:

(a) (1) Federal funds as made available by 42 U.S.C. section 1396d(y)(1).

(b) (2) Revenue generated under RSA 400-A:32, III(b).

(c) (3) Other non-general and general fund revenues.

(b) The governor is authorized to draw a warrant sufficient to cover the remaining state share of program costs out of any money in the treasury not otherwise appropriated.

8 New Paragraph; Department of Health and Human Services; New Hampshire Health Protection Program. Amend RSA 126-A:5 by inserting after paragraph XXVI the following new paragraph:

XXVI-a. The commissioner shall seek a waiver or state plan amendment relative to developing a screening process to screen enrollees in the New Hampshire health protection program established under paragraphs XXIV, XXV, and XXX who are medically complex. Such enrollees shall participate in the program through the managed care program. The waiver shall seek to allow the commissioner to amend or re-procure managed care contracts if necessary. Prior to submitting the waiver or state plan amendments to the CMS, the commissioner shall present the waiver or state plan amendments to the fiscal committee of the general court for approval.

9 New Hampshire Health Protection Program; Federal Match. Amend 2014, 3:10, I as amended by 2016:13:13 to read as follows:

I. If at any time the federal match rate applied to medical assistance for newly eligible adults under RSA 126-A:5, XXIV-XXV, and XXX between July 1, 2014 - December 31, 2016 is less than 100 90 percent, less than 95 percent in 2017 and less than 94 percent in 2018, of the amount as set forth in 42 U.S.C. section 1396d(y)(1), then RSA 126-A:5, XXIV [and] XXV, and XXX shall be repealed 180 days after the event under this subparagraph occurs upon notification by the commissioner of the department of health and human services to the secretary of state and the director of legislative services. The commissioner shall immediately issue notice to program participants of the program's pending repeal.

10 Repeal. The following are repealed:

I. RSA 126-A:5-d, relative to voluntary hospital donations.

II. 2014, 3:12, II, III, IV, V, VI, VII, relative to repeals of the New Hampshire health protection program.

11 Effective Date. This act shall take effect upon its passage.

1 Department of Health and Human Services; Premium Assistance Program. Amend RSA 126-A:5, XXV (a) and (b) to read as follows:

XXV.(a) Consistent with the time frames in this paragraph, there is hereby established the marketplace premium assistance program. This will be a premium assistance program for newly eligible adults and their eligible spouse and dependents, if applicable, and shall be administered by the department of health and human services. In order to receive medical assistance from the program, newly eligible adults who are ineligible for the HIPP program shall choose from any qualified health plans (QHPs) offered on the federally-facilitated exchange if cost effective; provided, however, that any newly eligible adult who had coverage under an alternative benefit plan (ABP) offered by a managed care organization (MCO) under paragraph XIX during the voluntary bridge to marketplace premium assistance program established under RSA 126-A:5, XXIV shall be automatically enrolled at the beginning of open enrollment in a comparable QHP by that same MCO if one is available, unless such newly eligible adult subsequently chooses a different QHP during the enrollment period. If a comparable QHP is not offered by the newly eligible adult's MCO then the newly eligible adult may choose from any QHPs, if cost effective. Provider payments shall be in an amount which shall be no less than before the effective date of this paragraph.

(b) On or before December 1, 2014, the commissioner shall submit to CMS any necessary waiver application to implement the provisions of this paragraph, including provisions to address individuals determined to be medically complex after completion of a health questionnaire screening process. To the greatest extent practicable the waiver shall incorporate measures to promote continuity of health insurance coverage and personal responsibility, including but not limited to: co-pays, deductibles, disincentives for inappropriate emergency room use, and mandatory wellness programs. Prior to submitting the waiver to CMS the commissioner shall present the waiver to the fiscal committee of the general court for approval. The program shall not begin until such waivers have been approved by CMS.

2 New Hampshire Health Protection Program. Amend RSA 126-A:5, XXIV(b) to read as follows:

(b) The commissioner shall seek any necessary waivers or state plan amendments to implement the provisions of this paragraph, including provisions to address individuals determined to be medically complex after completion of a health questionnaire screening process. To the greatest extent practicable the waiver or state plan amendments shall incorporate measures to promote continuity of health insurance coverage and personal responsibility, including but not limited to: co-pays, deductibles, disincentives for inappropriate emergency room use, and mandatory wellness programs. Prior to submitting the waiver or state plan amendments to CMS, the commissioner shall present the waiver or state plan amendments to the fiscal committee of the general court for approval. The program shall not begin until such waivers or state plan amendments have been approved by CMS.

3 Department of Health and Human Services; Premium Assistance Program. Amend RSA 126-A:5, XXX(c) to read as follows:

(c) If the waiver to implement the marketplace premium assistance program is approved on or before March 31, 2015 then, coverage under the voluntary bridge to marketplace premium assistance program established in RSA 126-A:5, XXIV shall terminate on December 31, 2015. Enrollment in the marketplace premium assistance program shall begin on October 15, 2015 and coverage shall begin on January 1, 2016.

4 Department of Health and Human Services; New Hampshire Health Protection Program. Amend RSA 126-A:5, XXX(a)(5) to read as follows:

(5) The commissioner shall include in a waiver submitted pursuant to this subparagraph a requirement that any work requirement under subparagraph (a) which requires a waiver shall be equivalent to TANF, 42 U.S.C. section 607(d). Prior to submitting the waiver or state plan amendments to the CMS, the commissioner shall present the waiver or state plan amendments to the governor and the fiscal committee of the general court for approval.

5 Department of Health and Human Services; New Hampshire Health Protection Program. Amend RSA 126-A:5, XXX(f) to read as follows:

(f) The commissioner shall seek any new waiver or state plan amendments to implement the provisions of this paragraph. Prior to submitting the waiver or state plan amendments to the CMS, the commissioner shall present the waiver or state plan amendments to the fiscal committee of the general court for approval.

6 New Hampshire Health Protection Trust Fund. Amend the introductory paragraph of RSA 126-A:5-b, I to read as follows:

I. There is hereby established the New Hampshire health protection trust fund which shall be accounted for distinctly and separately from all other funds and shall be non-interest bearing. The trust fund shall be administered by the commissioner of the department of health and human services and shall be used solely to provide coverage for the newly eligible Medicaid population as provided for under RSA 126-A:5, XXIV-XXVI and RSA 126-A:67 in qualified health plans on the federal marketplace and pay for the administrative costs for the program. The commissioner may accept any gifts, grants, donations, or other funding from any source and shall deposit all such revenue received into the fund. All moneys in the trust fund shall be nonlapsing and shall be continually appropriated to the commissioner of the department of health and human services for the purposes of the trust fund. The trust fund shall be authorized to pay and/or reimburse:

7 Funding the State Share of the New Hampshire Health Protection Program. Amend RSA 126-A:5-c, I-II to read as follows:

I. In this section:

(a) "Program'' means the New Hampshire health protection program under RSA 126-A:5, XXIV-XXV, and XXX.

(b) "Remainder amount'' means the cost of the program for coverage effective between January 1, 2017 and June 30, 2017 plus administrative costs attributable to the program, less all federal reimbursement for the program and federal reimbursement for the related administrative costs; and the cost of the program for coverage effective between July 1, 2017 and December 31, 2018, plus administrative costs attributable to the program, less all federal reimbursement for the program and federal reimbursement for administrative costs attributable to the program, and taxes attributable to premiums written for medical and other medical related services for the newly eligible Medicaid population as provided for under RSA 126-A:5, XXIV-XXVI, and XXX, consistent with RSA 400-A:32, III(b).

II. Funding for the program from January 1, 2017 until December 31, 2018 shall not be funded from general funds.

(a) After December 31, 2018, the program shall be funded as follows:

(1) Federal funds as made available by 42 U.S.C. section 1396d(y)(1).

(2) Revenue generated under RSA 400-A:32, III(b).

(3) Other non-general and general fund revenues.

(b) The governor is authorized to draw a warrant sufficient to cover the remaining state share of program costs out of any money in the treasury not otherwise appropriated.

8 New Paragraph; Department of Health and Human Services; New Hampshire Health Protection Program. Amend RSA 126-A:5 by inserting after paragraph XXVI the following new paragraph:

XXVI-a. The commissioner shall seek a waiver or state plan amendment relative to developing a screening process to screen enrollees in the New Hampshire health protection program established under paragraphs XXIV, XXV, and XXX who are medically complex. Such enrollees shall participate in the program through the managed care program. The waiver shall seek to allow the commissioner to amend or re-procure managed care contracts if necessary. Prior to submitting the waiver or state plan amendments to the CMS, the commissioner shall present the waiver or state plan amendments to the fiscal committee of the general court for approval.

9 New Hampshire Health Protection Program; Federal Match. Amend 2014, 3:10, I as amended by 2016:13:13 to read as follows:

I. If at any time the federal match rate applied to medical assistance for newly eligible adults under RSA 126-A:5, XXIV-XXV, and XXX is less than 90 percent of the amount as set forth in 42 U.S.C. section 1396d(y)(1), then RSA 126-A:5, XXIV [and] XXV, and XXX shall be repealed 180 days after the event under this subparagraph occurs upon notification by the commissioner of the department of health and human services to the secretary of state and the director of legislative services. The commissioner shall immediately issue notice to program participants of the program's pending repeal.

10 Repeal. The following are repealed:

I. RSA 126-A:5-d, relative to voluntary hospital donations.

II. 2014, 3:12, II, III, IV, V, VI, VII, relative to repeals of the New Hampshire health protection program.

11 Effective Date. This act shall take effect upon its passage.