Revision: April 5, 2023, 3:42 p.m.
Health and Human Services
April 5, 2023
Amendment to HB 613-FN
Amend the bill by replacing section 1 with the following:
1 Individual Health Insurance Market; Purpose. Amend RSA 404-G:1 to read as follows:
404-G:1 Purpose of Provisions. The [purpose] purposes of this chapter [is] are to:
I. Protect the citizens of this state who participate in the individual health insurance market by providing a mechanism to equitably distribute the excessive risk sometimes associated with this market and to [enable insurers to better protect against the costs of covering high risk individuals] promote market stability.
II. [Create a nonprofit, voluntary organization to facilitate the availability of affordable individual nongroup health insurance by establishing an assessment mechanism and an individual health insurance market mandatory risk sharing plan as a mechanism to distribute the risks associated within the individual nongroup market and to support the New Hampshire granite advantage health care program established in RSA 126-AA.] Authorize the creation of a nonprofit, voluntary organization which shall be known as the New Hampshire individual health plan benefit association, "the association" or "the New Hampshire health plan", to promote the purposes and carry out the requirements of this chapter under the oversight by the commissioner.
III. [Establish a high risk pool that will provide access to health insurance to all residents of the state who are denied health insurance for medical or health reasons. The premiums charged for coverage in the high risk pool shall be affordable and the coverage provided shall be reasonably comprehensive and comparable to coverage available outside of the high risk pool. It is the intent of the legislature that the high risk pool shall be adequately funded through an annual, and if necessary, a special assessment mechanism, that the high risk pool shall utilize cost containment measures, including, but not limited to, providing network based coverage, and that measures shall be taken to avoid inappropriate shifting of costs and risk to the high risk pool.] Support the affordability and accessibility of health insurance in the state's individual market.
IV. [Authorize the association to establish a federally qualified high risk pool pursuant to section 1101 of the Patient Protection and Affordable Care Act of 2009 (PL 111-148), as amended by the Health Care and Education Reconciliation Act of 2010 (PL 111-152).] Establish one or more individual health insurance market mandatory risk sharing plans as a mechanism to distribute the risks associated within the nongroup, individual market.
V. Support the New Hampshire granite advantage health care program established in RSA 126-AA or any successor program.
VI. Establish an assessment mechanism to fund the association’s programs as defined in RSA 404-G:2, IX and the association’s support of the New Hampshire granite advantage health care program established in RSA 126-AA or any successor program.
Amend RSA 404-G:2, IX as inserted by section 2 of the bill by replacing it with the following:
IX. ["Insurer" means any entity licensed pursuant to RSA 402, RSA 420-A, or RSA 420-B.] “Program” means any initiative undertaken by the association with the approval of the commissioner to fulfill any stated purpose of this chapter or any other statutory requirement, including but not limited to the reinsurance program authorized under RSA 420-N:6-a and supporting the New Hampshire granite advantage health care program under RSA 126-AA.
Amend the bill by replacing section 3 with the following:
404-G:5 Plan of Operation. The board of directors of the association shall adopt a plan of operation which shall provide for the implementation of each program authorized or required under this chapter or under other statutory provisions referring to this chapter. The plan of operation shall be approved by the commissioner prior to implementation and may be amended from time to time with the approval of the commissioner. The plan of operation shall provide substantially the following:
I. Description of each program’s objectives including a description of how the association anticipates fulfilling those objectives.
II. Description of how the program will be funded including a description regarding how assessments will be calculated, collected, and distributed, how any excess assessment revenue will be addressed, and the establishment of any reserve funds.
III. Administrative matters. The plan of operation shall further provide for all of the following:
(a) Responsibility for the handling and accounting of funds and other assets of the association.
(b) The financial and other records required to be kept, including the annual report to be submitted to the commissioner.
(c) Compliance with this chapter and any other applicable laws and regulations, including without limitation the terms of any federal waiver or other grant that may fund, in whole or in party, any of the association’s programs.
(d) Such other administrative provisions as are necessary or proper for the execution of the powers and duties of the association.
404-G:5-a Assessments. The association shall establish and collect assessments for each program in accordance with the plan of operation approved by the commissioner.
I. Method of Determining Assessments.
(a) Assessments shall be calculated based on the number of lives covered by assessable entities. The number of covered lives shall be determined each month during the calendar year. Any assessment shall be calculated as the number of covered lives multiplied by a specified assessment rate. The assessment amount shall be subject to approval by the commissioner. The association shall provide a basis for recommending the specified assessment rate, including a projection of the calculated assessment amount and consideration of any prior year shortfalls or overages.
(b) Each covered life should be included in the assessment only once. The association shall adopt procedures by which affiliated assessable entities calculate their assessment on an aggregate basis and procedures to ensure that no covered life is counted more than once.
II. Unless otherwise determined by the association, the assessable entity responsible for the payment of the associated claims for the covered lives shall be the entity responsible for reporting assessable lives and payment of the corresponding assessment.
III. The association may establish a special assessment in addition to the regular assessment with the approval of the commissioner.
(a) The association shall only establish a special assessment if the association determines that its funds are or will become insufficient to fulfill the program’s purpose.
(b) The association shall only assess, through the special assessment, at a rate necessary to fund the deficiency ascertained in subparagraph (a).
IV. The regular assessment rate established by the association shall be:
(a) Calculated on a calendar year basis and fixed throughout the calendar year;
(b) Established no later than the first day of November preceding the calendar year for which the rate is to be applied;
(c) Calculated to be sufficient to meet the funding needs for the implementation of the programs administered by the association, including the reinsurance mechanism provided for under RSA 420-N:6-a and the association’s share of the costs of the New Hampshire granite advantage health care program established under RSA 126-AA in the amount described in subparagraph (d); and
(d) An amount not to exceed the lesser of the remainder amount, as defined in RSA 126- AA:1, V, or the amount specified in RSA 126-AA:1, V(a) plus taxes attributable to premiums written for medical and other medical-related services for the newly eligible Medicaid population. The association shall transfer all amounts collected pursuant to this subparagraph to the New Hampshire granite advantage health care trust fund established pursuant to RSA 126- AA:3.
V. The commissioner shall approve the regular assessment rate, and any special assessment rate, if he or she finds that the amount petitioned by the board is no greater than is necessary to fulfill the purposes of this chapter. For the purpose of making this determination, the commissioner may, at the expense of the association, seek independent actuarial certification of the need for the proposed assessment or special assessment amount.