Revision: Dec. 27, 2018, 10:26 a.m.
HB 179-FN-A - AS INTRODUCED
HOUSE BILL 179-FN-A
SPONSORS: Rep. P. Schmidt, Straf. 19
COMMITTEE: Commerce and Consumer Affairs
This bill establishes a New Hampshire health access corporation and health access fund.
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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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Nineteen
Be it Enacted by the Senate and House of Representatives in General Court convened:
New Hampshire Health Access Corporation
126-BB:1 Purpose. 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 chapter is to address this problem by promoting the availability of affordable health insurance for persons who would otherwise be without coverage. Under this market-oriented approach, the New Hampshire health access corporation contracts with health insurers to provide the needed coverage. Eligibility is designed to include persons who can demonstrate that they are uninsured because they are without access to affordable coverage and to exclude persons who have access to other health insurance coverage that is within their means.
126-BB:2 Definitions. In this chapter:
I. “Board” means the health access board established in RSA 126-BB:4.
II. “Corporation” means the New Hampshire health access corporation established in this chapter.
III. “Health insurer” means any entity licensed to provide health insurance pursuant to title 37 or any other provider of health care services approved by the commissioner of the insurance department.
IV. “Medicaid waiver” means a section 1115 research and demonstration waiver application or a section 1915(b) freedom of choice waiver application approved by the Health Care Financing Administration.
126-BB:3 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 health access 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.
126-BB:4 Health Access Board.
I. The powers of the corporation shall be vested in 16 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) Two representatives of the business community, appointed by the governor.
(g) One member appointed by the New Hampshire Hospital Association.
(h) One member appointed by the New Hampshire Academy of Family Practice.
(i) One member appointed by the New Hampshire Nurses Association.
(j) One member appointed by the Business and Industry Association of New Hampshire.
(k) One member appointed by the New Hampshire Medical Society.
(l) Four members-at-large, appointed by the health access board of directors.
II. The initial terms of office shall be as follows: the members in subparagraphs I(a) and (g) and one member in subparagraph (f) shall serve for 1 year; one member in subparagraph (f) and the members in subparagraphs I(h) and (k) shall serve for 2 years; and the members in subparagraphs I(i), (j) shall serve for 3 years. The other members in subparagraphs I(b), (c), (d) and (e) shall serve terms which are coterminous with their terms in office. Two of the 4 members in subparagraph I(l) shall serve for 1 year, one shall serve for 2 years, and one shall serve for 3 years.
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. Except as provided in RSA 126-BB:6, I, the board shall have complete fiscal control over the corporation and shall be responsible for all corporate operations.
126-BB:5 Meetings of Board. Meetings shall be held at the call of the chairperson or when 5 members so request. Nine members of the board shall constitute a quorum and the affirmative vote of 9 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-BB:6 Powers and Duties.
I. The corporation shall develop eligibility criteria and provider selection criteria which shall be approved by the legislative fiscal committee prior to their implementation by the corporation. Any subsequent modification of these criteria shall be approved by the legislative fiscal committee prior to their implementation. In this paragraph “eligibility criteria” means those criteria which adults must meet in order to participate in the program and “provider selection criteria” means those criteria that health insurers must meet in order to offer benefits under the program.
II. Following receipt of the approval required in paragraph I, the corporation shall take all actions necessary to implement the program, including but not limited to:
(a) Organizing purchasing groups to facilitate the provision of preventive health care services and comprehensive health insurance coverage to adults.
(b) Arranging for the collection of any premium, in an amount to be determined by the board of directors, from all participants to provide for payment for preventive health care services 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) Consulting appropriate professional organizations and establishing standards for preventive health care services and providers and comprehensive insurance benefits appropriate to adults.
(d) Establishing participation criteria and, if appropriate, contracting with a health insurer or licensed insurance administrator to provide administrative services to the corporation.
(e) Contracting with health insurers, in accordance with standards established by the corporation, to provide comprehensive insurance coverage and preventive health care services to participants.
(f) Developing and implementing a plan to publicize the New Hampshire health access 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.
(g) Securing staff necessary to properly administer the corporation. Staff costs shall be funded from such private or public funds as become available. The board of directors shall determine the number of staff members necessary to administer the corporation.
III. Coverage under the corporation's program shall be secondary to any other available private coverage held by the participant. The corporation may establish procedures for coordinating benefits under this program with benefits under other public and private coverage.
126-BB:7 Adoption of Policy. The corporation may adopt policies, 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 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.
III. Application procedures.
IV. Schedules of fees and other charges to be made by the corporation and the health insurers in renewing, acting upon, or accepting applications under this chapter and any other matters related to such applications as the corporation may deem necessary.
V. Confidentiality of medical records obtained under this chapter.
VI. Such other matters as are necessary to carry out the powers and duties of the corporation.
126-BB:8 New Hampshire Health Access Fund. There shall be a fund to be known as the New Hampshire health access fund. The New Hampshire health access corporation established in RSA 126-BB:3 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 New Hampshire health access fund and may be expended by the New Hampshire health access corporation to accomplish the purposes of RSA 126-BB. 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 New Hampshire health access board of directors.
2 Applicability. The commissioner of health and human services shall call the first meeting of the health access board, established in RSA 126-BB:4 inserted by section 1 of this act, within one year of the effective date of section 1 of this act or federal approval of the Medicaid waiver, whichever first occurs.
HB 179-FN-A- FISCAL NOTE
FISCAL IMPACT: [ X ] State [ ] County [ ] Local [ ] None
Estimated Increase / (Decrease)
[ X ] General [ ] Education [ ] Highway [ X ] Other - New Hampshire Health Access Fund
This bill establishes a New Hampshire Health Access Corporation (Corporation), which would have a distinct legal existence separate from the State for the purpose of promoting the availability of affordable health insurance for those without access to such insurance. The Corporation would be a private, nonprofit entity with the power to receive and accept grants, loans and advances of funds from public and private sources, as well as to accept money and other things of value from any source. Revenue is to be deposited into a newly created New Hampshire Health Access Fund, which may be expended by the Corporation to advance the purposes of the bill. In addition, the bill defines and makes reference to a "Medicaid waiver," but does not specify the nature or purpose of such a waiver, nor does it address whether the Corporation is obligated to request that the Department of Health and Human Services seek such a waiver from the federal Centers for Medicare and Medicaid Services.
The Insurance Department notes that among the Corporation's powers are the powers to collect premiums and contract with insurance carriers to provide comprehensive insurance coverage. As the bill explicitly states that the Corporation itself is not to be considered an insurer, it is unclear whether the premiums collected by the Corporation would be subject to the insurance premium tax, and if not, whether the funds paid to contracted health insurers would be subject to the premium tax. Depending on how these uncertainties are resolved, the bill may have an indeterminable impact on State General Fund revenue.
Department of Health and Human Services and Insurance Department