HB 609: The Shw Me Health Insurance Exchange Act Melissa Palmer and Amy Hyt Missuri Department f Insurance, Financial Institutins and Prfessinal Registratin (DIFP) April 14, 2011 1
HB 609: Backgrund Huse Bill 609 r the Shw-Me Health Insurance Exchange Act intrduced in Huse f Representatives (February 22) Spnsr: Rep. Chris Mlendrp Huse f Representatives perfected the bill n April 11; needs ne mre vte befre ging t the Senate 2
HB 609: Overview Quasi-public gvernmental agency under the directin f a bard f trustees (Sectin 376.1153) Bard Purpse: Cnduct the business necessary t implement the exchange and t carry ut the functins f the exchange in a fair and impartial manner in rder t execute a mre cmpetitive insurance marketplace. Unified individual and SHOP Exchange fr administrative purpses (Sectins 376.1150 and 376.1155) Des nt cmbine actuarial and underwriting functins Maintains separate and distinct risk pls Prvides fr ShwMe HIE cnfrmance with n wrng dr and Medicaid integratin requirements f ACA 3
HB 609: Gvernance Structure Bard f Trustees (17 trustees): The directrs f the fllwing departments as ex ffici members: Scial Services, Insurance, Financial Institutins and Prfessinal Registratin (vice chair), Mental Health, Health and Senir Services; Tw members f the huse f representatives, ne frm the majrity party and ne frm the minrity party, t be appinted by the speaker f the huse; Tw members f the senate, ne frm the majrity party and ne frm the minrity party, t be appinted by the president pr tem f the senate; Nine members t be appinted by the gvernr with the advice and cnsent f the senate: A representative fr licensed health insurance prducers A representative fr licensed health insurance issuers that is ranked as ne f the tp ten health insurance issuers A representative f a licensed health insurance issuer that is ranked between eleven and twenty health insurance issuers A public health cnsumer advcate A large emplyer representative A small emplyer representative An individual with expertise in administering and negtiating health plan cntracts n behalf f emplyees Tw at-large members 4
HB 609: Bard Requirements One member f the Bard will serve as Chair Elected annually by a majrity f members f the Bard Term limits vary based n member: General Assembly and Dept. Directr members serve fr entire duratin f time during which they hld their title/psitin All members appinted by the gvernr serve three-year terms, with the exceptin f initial terms fr which: At-large member serves a ne-year term Small emplyer and large emplyer representatives serve tw-year terms The representatives fr health insurance prducers and issuers, public health cnsumer advcate, and individual with health plan cntract expertise serve three-year terms Vacancies fr unexpired terms fr members f the General Assembly are filled by Speaker f the Huse and President Pr Tem f the Senate, and vacancies fr Gvernr appintees by the Gvernr All members are eligible fr reappintment Members serve withut cmpensatin May be reimbursed fr expenses incurred while attending meetings r perfrming duties authrized by Bard 5
HB 609: Cnflict f Interest Limitatins Financial interest in the exchange des nt prhibit an individual frm serving n Bard All appinted members must annually disclse all persnal and prfessinal financial interests related t peratin f the exchange Disclsures must be made available upn public request Annual disclsures may be supplemented thrughut the year as necessary Members must recuse themselves frm deliberatins r vting actins when a cnflict f interest has been disclsed Any Bard member r exchange emplyee accepting gratuity r cmpensatin fr the purpse f influencing vting actins, r that fails t disclse cnflicts f interest r recuse himself/herself, will frfeit membership r emplyment and be subject t penalties prescribed by law 6
HB 609: Exchange Persnnel Bard shall appint Executive Directr Executive Directr and the Bard will emply additinal essential fficers necessary t peratin f the exchange Executive Directr will emply ther emplyees t cnduct the business f the exchange, as authrized by the Bard Emplyees and fficers f the exchange will receive salaries and necessary expenses, as set by the Bard Bard must take int accunt salaries paid by health insurance issuers, health plans, and health care prviders when establishing pay schedules Exchange emplyees are nt cnsidered state emplyees, but are eligible t participate in the exchange 7
HB 609: Mechanisms fr Stakehlder Input Stakehlder grups may be frmed t prvide cnsultatin r guidance t the exchange r its bard. Members may include: Educated health care cnsumers wh are enrllees in QHPs r QDPs Individuals r entities with experience in facilitating enrllment in QHPs r QDPs Representatives f small emplyers and self-emplyed individuals Advcates fr enrlling hard-t-reach ppulatins Apprpriate eligible entities Health insurance issuers Health care prviders Others interested in access t affrdable quality health care services 8
HB 609: QHP Certificatin Standards The exchange shall develp criteria fr certificatin, recertificatin and decertificatin f QHPs cnsistent with Sectins 1301 and 1311 f the ACA and guidelines develped by the Secretary. (Sectin 376.1155) The exchange may cntract with DIFP fr the certificatin, recertificatin, and decertificatin f health plans and dental plans as QHPs. (Sectin 376.1160) The exchange shall certify a health plan as a qualified health plan r qualified dental plan if the plan has met necessary requirements (Sectin 376.1165) The exchange shall nt exclude a health plan n the basis that the health plan is ffered by an issuer nt cntracted with MO HealthNet. (Sectin 376.1165) 9
HB 609: QHP Certificatin Prcess The exchange shall nt exempt any health insurance issuer seeking certificatin f a QHP frm state licensure r slvency requirements. (Sectin 376.1165) The directr f DIFP shall determine whether a health plan seeking certificatin r recertificatin as a QHP meets all the requirements related t licensure and slvency. (Sectin 376.1165) The exchange shall establish an appeals prcess fr health insurance issuers t appeal a decertificatin decisin r the denial f certificatin as a QHP. (Sectin 376.1165) 10