Maryland 2022 Regular Session

Maryland Senate Bill SB632 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	LAWRENCE J. HOGAN, JR., Governor Ch. 483
2		-
3		-	– 1 –
4		-	Chapter 483
5		-	(Senate Bill 632)
6		-
7		-	AN ACT concerning
8		-
9		-	Maryland Health Benefit Exchange – Small Business and Nonprofit Health
10		-	Insurance Subsidies Program – Workgroup
11		-
12		-	FOR the purpose of establishing a Small Business and Nonprofit Health Insurance
13		-	Subsidies Program in the State to provide subsidies to small business and nonprofit
14		-	employers and their employees for the purchase of qualified health benefit plans on
15		-	the Maryland Health Benefit Exchange requiring the Maryland Health Benefit
16		-	Exchange to convene a workgroup to study and make recommendations relating to
17		-	the establishment of a Small Business and Nonprofit Health Insurance Subsidies
18		-	Program to provide subsidies to small businesses and nonprofit employers and their
19		-	employees for the purchase of health benefit plans; and generally relating to the
20		-	Maryland Health Benefit Exchange and subsidies for small businesses and
21		-	nonprofits.
22		-
23		-	BY repealing and reenacting, with amendments,
24		-	Article – Insurance
25		-	Section 31–107
26		-	Annotated Code of Maryland
27		-	(2017 Replacement Volume and 2021 Supplement)
28		-
29		-	BY adding to
30		-	Article – Insurance
31		-	Section 31–123
32		-	Annotated Code of Maryland
33		-	(2017 Replacement Volume and 2021 Supplement)
34		-
35		-	SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND,
36		-	That the Laws of Maryland read as follows:
37		-
38		-	(a) The Maryland Health Benefit Exchange shall convene a workgroup to study
39		-	and make recommendations relating to the establishment of a Small Busines s and
40		-	Nonprofit Health Insurance Subsidies Program to provide subsidies to small businesses
41		-	and nonprofit employers and their employees for the purchase of health benefit plans.
42		-
43		-	(b) The Exchange shall invite the following persons to participate in the
44		-	workgroup convened under subsection (a) of this section:
45		-
46		-	(1) individuals from the small business and nonprofit community,
47		-	including owners, employers, and employees;
48		-
49		-	(2) health insurance carrier representatives; Ch. 483 2022 LAWS OF MARYLAND
50		-
51		-	– 2 –
52		-
53		-	(3) licensed health insurance producers;
54		-
55		-	(4) representatives of business, nonprofit, consumer advocacy, and other
56		-	organizations; and
57		-
58		-	(5) any other person who expresses interest in participating in the
59		-	workgroup.
60		-
61		-	(c) The workgroup convened under subsection (a) of this section shall study and
62		-	make findings and recommendations regarding:
63		-
64		-	(1) the health insurance coverage needs of small employers, nonprofit
65		-	employers, and their employees;
66		-
67		-	(2) objectives and target metrics for the Program;
68		-
69		-	(3) the optimal scope and design features of a Small Business and
70		-	Nonprofit Health Insurance Subsidies Program, including:
71		-
72		-	(i) whether subsidies under the Program should be available for the
73		-	purchase of qualified health plans offered to small employers on the Exchange and the
74		-	purchase of health benefit plans offered to small employers outside the Exchange;
75		-
76		-	(ii) subsidy eligibility and payment parameters for the Program;
77		-
78		-	(iii) the administrative structure and infrastructure investments
79		-	required for implementation of the Program, including any requirements for the Exchange,
80		-	health insurance carriers, and any other entities involved in the implementation of the
81		-	Program; and
82		-
83		-	(iv) the duration of the Program;
84		-
85		-	(4) the cost to administer the Program, including the cost to provide
86		-	subsidies and operational costs; and
87		-
88		-	(5) the sources and levels of funding needed to support the Program.
89		-
90		-	(d) On or before October 1, 2022, the Exchange shall submit a report to the
91		-	Governor and, in accordance with § 2–1257 of the State Government Article, the Senate
92		-	Finance Committee and the House Health and Government Operations Committee that
93		-	includes the findings and recommendations of the workgroup required under this section.
94		-
95		-	SECTION 2. AND BE IT FURTHER ENACTED, That it is the intent of the General
96		-	Assembly that, beginning in fiscal year 2024 and in each fiscal year thereafter, the
97		-	Governor shall include in the annual budget bill an appropriation of funding to establish LAWRENCE J. HOGAN, JR., Governor Ch. 483
98		-
99		-	– 3 –
100		-	and operate a Small Business and Nonprofit Health Insurance Subsidies Program with a
101		-	design as recommended by the workgroup under Section 1 of this Act.
102		-
103		-	Article – Insurance
104		-
105		-	31–107.
106		-
107		-	(a) There is a Maryland Health Benefit Exchange Fund.
108		-
109		-	(b) (1) The purpose of the Fund is to:
110		-
111		-	(i) provide funding for the operation and administration of the
112		-	Exchange in carrying out the purposes of the Exchange under this subtitle;
113		-
114		-	(ii) provide funding for the establishment and operation of the State
115		-	Reinsurance Program authorized under this subtitle;
116		-
117		-	(iii) provide funding for the Medical Assistance Program and the
118		-	Senior Prescription Drug Assistance Program;
119		-
120		-	(iv) provide funding for the establishment and operation of Health
121		-	Equity Resource Communities under Title 20, Subtitle 14 of the Health – General Article;
122		-	[and]
123		-
124		-	(v) provide funding for the establishment and operation of the
125		-	State–Based Young Adult Health Insurance Subsidies Pilot Program authorized under this
126		-	subtitle; AND
127		-
128		-	(VI) PROVIDE FUNDING FOR THE ESTABLISHMENT AN D
129		-	OPERATION OF THE SMALL BUSINESS AND NONPROFIT HEALTH INSURANCE
130		-	SUBSIDIES PROGRAM AUTHORIZED UN DER THIS SUBTITLE .
131		-
132		-	(2) The operation and administration of the Exchange, the State
133		-	Reinsurance Program, [and] the State–Based Young Adult Health Insurance Subsidies
134		-	Pilot Program, AND THE SMALL BUSINESS AND NONPROFIT HEALTH INSURANCE
135		-	SUBSIDIES PROGRAM may include functions delegated by the Exchange to a third party
136		-	under law or by contract.
137		-
138		-	(c) The Exchange shall administer the Fund.
139		-
140		-	(d) (1) The Fund is a special, nonlapsing fund that is not subject to § 7–302 of
141		-	the State Finance and Procurement Article.
142		-
143		-	(2) The State Treasurer shall hold the Fund separately, and the
144		-	Comptroller shall account for the Fund.
145		-	Ch. 483 2022 LAWS OF MARYLAND
146		-
147		-	– 4 –
148		-	(e) The Fund consists of:
149		-
150		-	(1) any user fees or other assessments collected by the Exchange;
151		-
152		-	(2) all revenue deposited into the Fund that is received from the
153		-	distribution of the premium tax under § 6–103.2 of this article;
154		-
155		-	(3) income from investments made on behalf of the Fund;
156		-
157		-	(4) interest on deposits or investments of money in the Fund;
158		-
159		-	(5) money collected by the Board as a result of legal or other actions taken
160		-	by the Board on behalf of the Exchange or the Fund;
161		-
162		-	(6) money donated to the Fund;
163		-
164		-	(7) money awarded to the Fund through grants;
165		-
166		-	(8) any pass–through funds received from the federal government under a
167		-	waiver approved under § 1332 of the Affordable Care Act;
168		-
169		-	(9) any funds designated by the federal government to provide reinsurance
170		-	to carriers that offer individual health benefit plans in the State;
171		-
172		-	(10) any funds designated by the State to provide reinsurance to carriers
173		-	that offer individual health benefit plans in the State;
174		-
175		-	(11) any funds designated by the State to provide State–based health
176		-	insurance subsidies to young adults in the State;
177		-
178		-	(12) ANY FEDERAL FUNDS AV AILABLE TO PROVIDE H EALTH
179		-	INSURANCE SUBSIDIES TO QUALIFIED SMALL B USINESS AND NONPROFI T
180		-	EMPLOYERS AND THEIR EMPLOYEES IN THE STATE, INCLUDING FUNDS FROM THE
181		-	FEDERAL AMERICAN RESCUE PLAN OF 2021;
182		-
183		-	[(12)] (13) any federal funds received in accordance with § 31–121 of this
184		-	subtitle for the administration of small business tax credits; and
185		-
186		-	[(13)] (14) any other money from any other source accepted for the benefit
187		-	of the Fund.
188		-
189		-	(f) (1) The Fund may be used only:
190		-
191		-	(i) 1. for the operation and administration of the Exchange in
192		-	carrying out the purposes authorized under this subtitle;
193		-	LAWRENCE J. HOGAN, JR., Governor Ch. 483
194		-
195		-	– 5 –
196		-	2. for the establishment and operation of the State
197		-	Reinsurance Program; and
198		-
199		-	3. for appropriations to the Health Equity Resource
200		-	Community Reserve Fund under § 20–1407 of the Health – General Article;
201		-
202		-	(ii) in fiscal years 2021 and 2022, for the Medical Assistance
203		-	Program within the Medical Care Programs Administration of the Maryland Department
204		-	of Health;
205		-
206		-	(iii) in fiscal year 2022, for the Senior Prescription Drug Assistance
207		-	Program established under Title 15, Subtitle 10 of the Health – General Article; [and]
208		-
209		-	(iv) for the establishment and operation of the State–Based Young
210		-	Adult Health Insurance Subsidies Pilot Program; AND
211		-
212		-	(V) FOR THE ESTABLISHMEN T AND OPERATION OF T HE SMALL
213		-	BUSINESS AND NONPROFIT HEALTH INSURANCE SUBSIDIES PROGRAM.
214		-
215		-	(2) In each of fiscal years 2023 through 2025, the Governor shall:
216		-
217		-	(i) transfer $15,000,000 to the Health Equity Resource Community
218		-	Reserve Fund; and
219		-
220		-	(ii) include the funds transferred in accordance with item (i) of this
221		-	paragraph in the annual budget bill as an appropriation to the Health Equity Resource
222		-	Community Reserve Fund under § 20–1407 of the Health – General Article.
223		-
224		-	(g) (1) The Board shall maintain separate accounts within the Fund for
225		-	Exchange operations, for the State Reinsurance Program, [and] for the State–Based Young
226		-	Adult Health Insurance Subsidies Pilot Program, AND FOR THE SMALL BUSINESS AND
227		-	NONPROFIT HEALTH INSURANCE SUBSIDIES PROGRAM.
228		-
229		-	(2) Accounts within the Fund shall contain the money that is intended to
230		-	support the purpose for which each account is designated.
231		-
232		-	(3) Funds received from the distribution of the premium tax under §
233		-	6–103.2 of this article shall be placed in the account for Exchange operations and may be
234		-	used only for the purpose of funding the operation and administration of the Exchange.
235		-
236		-	(4) The following funds may be used only for the purposes of funding the
237		-	State Reinsurance Program:
238		-
239		-	(i) any pass–through funds received from the federal government
240		-	under a waiver approved under § 1332 of the Affordable Care Act to provide reinsurance to
241		-	carriers that offer individual health benefit plans in the State; Ch. 483 2022 LAWS OF MARYLAND
242		-
243		-	– 6 –
244		-
245		-	(ii) any funds designated by the federal government to provide
246		-	reinsurance to carriers that offer individual health benefit plans in the State; and
247		-
248		-	(iii) any funds designated by the State to provide reinsurance to
249		-	carriers that offer individual health benefit plans in the State.
250		-
251		-	(h) (1) Expenditures from the Fund for the purposes authorized by this
252		-	subtitle may be made only:
253		-
254		-	(i) with an appropriation from the Fund approved by the General
255		-	Assembly in the State budget; or
256		-
257		-	(ii) by the budget amendment procedure provided for in Title 7,
258		-	Subtitle 2 of the State Finance and Procurement Article.
259		-
260		-	(2) Notwithstanding § 7–304 of the State Finance and Procurement Article,
261		-	if the amount of the distribution from the premium tax under § 6–103.2 of this article
262		-	exceeds in any State fiscal year the actual expenditures incurred for the operation and
263		-	administration of the Exchange, funds in the Exchange operations account from the
264		-	premium tax that remain unspent at the end of the State fiscal year shall revert to the
265		-	General Fund of the State.
266		-
267		-	(3) If operating expenses of the Exchange may be charged to either State
268		-	or non–State fund sources, the non–State funds shall be charged before State funds are
269		-	charged.
270		-
271		-	(i) (1) The State Treasurer shall invest the money of the Fund in the same
272		-	manner as other State money may be invested.
273		-
274		-	(2) Any investment earnings of the Fund shall be credited to the Fund.
275		-
276		-	(3) Except as provided in subsection (h)(2) of this section, no part of the
277		-	Fund may revert or be credited to the General Fund or any special fund of the State.
278		-
279		-	(j) A debt or an obligation of the Fund is not a debt of the State or a pledge of
280		-	credit of the State.
281		-
282		-	31–123.
283		-
284		-	(A) (1) IN THIS SECTION THE F OLLOWING WORDS HAVE THE MEANINGS
285		-	INDICATED.
286		-
287		-	(2) “PROGRAM” MEANS THE SMALL BUSINESS AND NONPROFIT
288		-	HEALTH INSURANCE SUBSIDIES PROGRAM.
289		-	LAWRENCE J. HOGAN, JR., Governor Ch. 483
290		-
291		-	– 7 –
292		-	(3) (I) “QUALIFIED EMPLOYER ” MEANS AN EMPLOYER WI TH
293		-	FEWER THAN 25 FULL–TIME EQUIVALENT EMPL OYEES.
294		-
295		-	(II) “QUALIFIED EMPLOYER ” INCLUDES A NONPROFIT
296		-	ORGANIZATION EMPLOYER WITH FEWER THAN 25 FULL–TIME EQUIVALENT
297		-	EMPLOYEES.
298		-
299		-	(B) THE EXCHANGE, IN CONSULTATION WITH THE COMMISSIONER AND AS
300		-	APPROVED BY THE BOARD, SHALL ESTABLISH AND IMPLEMENT A SMALL BUSINESS
301		-	AND NONPROFIT HEALTH INSURANCE SUBSIDIES PROGRAM TO PROVIDE
302		-	SUBSIDIES TO QUALIFIE D EMPLOYERS AND THEI R EMPLOYEES FOR THE PURCHASE
303		-	OF QUALIFIED HEALTH BENEFIT PLANS ON THE EXCHANGE.
304		-
305		-	(C) THE PROGRAM REQUIRED UNDE R THIS SECTION SHALL BE DESIGNED
306		-	TO REDUCE THE AMOUNT THAT QUALIFIED EMPLO YERS AND THEIR EMPLO YEES PAY
307		-	FOR QUALIFIED HEALTH B ENEFIT PLANS ON THE EXCHANGE.
308		-
309		-	(D) FOR CALENDAR YEARS 2024 THROUGH 2028, THE EXCHANGE, IN
310		-	CONSULTATION WITH TH E COMMISSIONER AND AS A PPROVED BY THE BOARD,
311		-	SHALL ESTABLISH SUBS IDY ELIGIBILITY AND PAYMENT PARAMETERS F OR THE
312		-	PROGRAM.
313		-
314		-	(E) SUBJECT TO AVAILABLE FUNDS, IN EACH OF FISCAL YE ARS 2023
315		-	THROUGH 2029, THE EXCHANGE MAY DESIGNAT E FUNDS FROM THE FUND TO BE
316		-	USED FOR THE PROGRAM SO THAT FOR C ALENDAR YEARS 2024 THROUGH 2028 NOT
317		-	MORE THAN:
318		-
319		-	(1) $45,000,000 IN ANNUAL SUBSIDIES MAY BE PROVIDED TO
320		-	QUALIFIED EMPLOYERS AND THEIR EMPLOYEES WHO MEET THE SUBSIDY
321		-	ELIGIBILITY AND PAYM ENT PARAMETERS ESTAB LISHED UNDER SUBSECT ION (D) OF
322		-	THIS SECTION; AND
323		-
324		-	(2) $3,000,000 MAY BE SPENT IN SMAL L BUSINESS OUTREACH
325		-	ACTIVITIES FOR THE P URPOSE OF EDUCAT ING QUALIFIED EMPLOY ERS ABOUT THE
326		-	PROGRAM.
327		-
328		-	(F) ON OR BEFORE JANUARY 1, 2023, THE EXCHANGE SHALL ADOPT
329		-	REGULATIONS CARRYING OUT THIS SECTION .
330		-
331		-	(G) (1) THE EXCHANGE SHALL TRACK ON A MONTHLY BASIS
332		-	EXPENDITURES ON SUBS IDIES PROVIDED UNDER THE PROGRAM, INCLUDING:
333		-
334		-	(I) THE AVERAGE NUMBER O F QUALIFIED EMPLOYER S AND
335		-	THEIR EMPLOYEES RECE IVING SUBSIDIES UNDE R THE PROGRAM; AND Ch. 483 2022 LAWS OF MARYLAND
336		-
337		-	– 8 –
338		-
339		-	(II) THE AVERAGE SUBSIDY AMOUNT RECEIVED BY Q UALIFIED
340		-	EMPLOYERS AND THEIR EMPLOYEES UNDER THE PROGRAM.
341		-
342		-	(2) THE INFORMATION TRACKED BY THE EXCHANGE UNDER
343		-	PARAGRAPH (1) OF THIS SUBSECTION S HALL BE:
344		-
345		-	(I) POSTED ON THE WEBSIT E OF THE EXCHANGE;
346		-
347		-	(II) INCLUDED IN THE ANNU AL REPORT REQUIRED U NDER §
348		-	31–119(D) OF THIS SUBTITLE; AND
349		-
350		-	(III) ON OR BEFORE DECEMBER 1, 2028, REPORTED TO THE
351		-	SENATE FINANCE COMMITTEE AND THE HOUSE HEALTH AND GOVERNMENT
352		-	OPERATIONS COMMITTEE, IN ACCORDANCE WITH § 2–1257 OF THE STATE
353		-	GOVERNMENT ARTICLE.
354		-
355		-	SECTION 2. 3. AND BE IT FURTHER ENACTED, That this Act shall take effect
356		-	October June 1, 2022. It Section 1 of this Act shall remain effective for a period of 7 years
357		-	1 year and 1 month and, at the end of September 30, 2029, June 30, 2023, Section 1 of this
358		-	Act, with no further action required by the General Assembly, shall be abrogated and of no
359		-	further force and effect.
360	1
361	2
362		-	Approved by the Governor, May 16, 2022.
	3	+	EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
	4	+	[Brackets] indicate matter deleted from existing law.
	5	+	Underlining indicates amendments to bill.
	6	+	Strike out indicates matter stricken from the bill by amendment or deleted from the law by
	7	+	amendment.
	8	+	sb0632
	9	+
	10	+	SENATE BILL 632
	11	+	J5, C3 2lr1676
	12	+	CF HB 709
	13	+	By: Senators Hester, Feldman, and Benson
	14	+	Introduced and read first time: February 3, 2022
	15	+	Assigned to: Finance
	16	+	Committee Report: Favorable with amendments
	17	+	Senate action: Adopted
	18	+	Read second time: March 7, 2022
	19	+
	20	+	CHAPTER ______
	21	+
	22	+	AN ACT concerning 1
	23	+
	24	+	Maryland Health Benefit Exchange – Small Business and Nonprofit Health 2
	25	+	Insurance Subsidies Program – Workgroup 3
	26	+
	27	+	FOR the purpose of establishing a Small Business and Nonprofit Health Insurance 4
	28	+	Subsidies Program in the State to provide subsidies to small business and nonprofit 5
	29	+	employers and their employees for the purchase of qualified health benefit plans on 6
	30	+	the Maryland Health Benefit Exchange requiring the Maryland Health Benefit 7
	31	+	Exchange to convene a workgroup to study and make recommendations relating to 8
	32	+	the establishment of a Small Business and Nonprofit Health Insurance Subsidies 9
	33	+	Program to provide subsidies to small businesses and nonprofit employers and their 10
	34	+	employees for the purchase of health benefit plans; and generally relating to the 11
	35	+	Maryland Health Benefit Exchange and subsidies for small businesses and 12
	36	+	nonprofits. 13
	37	+
	38	+	BY repealing and reenacting, with amendments, 14
	39	+	Article – Insurance 15
	40	+	Section 31–107 16
	41	+	Annotated Code of Maryland 17
	42	+	(2017 Replacement Volume and 2021 Supplement) 18
	43	+
	44	+	BY adding to 19
	45	+	Article – Insurance 20
	46	+	Section 31–123 21
	47	+	Annotated Code of Maryland 22
	48	+	(2017 Replacement Volume and 2021 Supplement) 23 2 SENATE BILL 632
	49	+
	50	+
	51	+
	52	+	SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 1
	53	+	That the Laws of Maryland read as follows: 2
	54	+
	55	+	(a) The Maryland Health Benefit Exchange shall convene a workgroup to study 3
	56	+	and make recommendations relating to the establishment of a Small Busines s and 4
	57	+	Nonprofit Health Insurance Subsidies Program to provide subsidies to small businesses 5
	58	+	and nonprofit employers and their employees for the purchase of health benefit plans. 6
	59	+
	60	+	(b) The Exchange shall invite the following persons to participate in the 7
	61	+	workgroup convened under subsection (a) of this section: 8
	62	+
	63	+	(1) individuals from the small business and nonprofit community, 9
	64	+	including owners, employers, and employees; 10
	65	+
	66	+	(2) health insurance carrier representatives; 11
	67	+
	68	+	(3) licensed health insurance producers; 12
	69	+
	70	+	(4) representatives of business, nonprofit, consumer advocacy, and other 13
	71	+	organizations; and 14
	72	+
	73	+	(5) any other person who expresses interest in participating in the 15
	74	+	workgroup. 16
	75	+
	76	+	(c) The workgroup convened under subsection (a) of this section shall study and 17
	77	+	make findings and recommendations regarding: 18
	78	+
	79	+	(1) the health insurance coverage needs of small employers, nonprofit 19
	80	+	employers, and their employees; 20
	81	+
	82	+	(2) objectives and target metrics for the Program; 21
	83	+
	84	+	(3) the optimal scope and design features of a Small Business and 22
	85	+	Nonprofit Health Insurance Subsidies Program, including: 23
	86	+
	87	+	(i) whether subsidies under the Program should be available for the 24
	88	+	purchase of qualified health plans offered to small employers on the Exchange and the 25
	89	+	purchase of health benefit plans offered to small employers outside the Exchange; 26
	90	+
	91	+	(ii) subsidy eligibility and payment parameters for the Program; 27
	92	+
	93	+	(iii) the administrative structure and infrastructure investments 28
	94	+	required for implementation of the Program, including any requirements for the Exchange, 29
	95	+	health insurance carriers, and any other entities involved in the implementation of the 30
	96	+	Program; and 31
	97	+	SENATE BILL 632 3
	98	+
	99	+
	100	+	(iv) the duration of the Program; 1
	101	+
	102	+	(4) the cost to administer the Program, including the cost to provide 2
	103	+	subsidies and operational costs; and 3
	104	+
	105	+	(5) the sources and levels of funding needed to support the Program. 4
	106	+
	107	+	(d) On or before October 1, 2022, the Exchange shall submit a report to the 5
	108	+	Governor and, in accordance with § 2–1257 of the State Government Article, the Senate 6
	109	+	Finance Committee and the House Health and Government Operations Committee that 7
	110	+	includes the findings and recommendations of the workgroup required under this section. 8
	111	+
	112	+	SECTION 2. AND BE IT FURTHER ENACTED, That it is the intent of the General 9
	113	+	Assembly that, beginning in fiscal year 2024 and in each fiscal year thereafter, the 10
	114	+	Governor shall include in the annual budget bill an appropriation of funding to establish 11
	115	+	and operate a Small Business and Nonprofit Health Insurance Subsidies Program with a 12
	116	+	design as recommended by the workgroup under Section 1 of this Act. 13
	117	+
	118	+	Article – Insurance 14
	119	+
	120	+	31–107. 15
	121	+
	122	+	(a) There is a Maryland Health Benefit Exchange Fund. 16
	123	+
	124	+	(b) (1) The purpose of the Fund is to: 17
	125	+
	126	+	(i) provide funding for the operation and administration of the 18
	127	+	Exchange in carrying out the purposes of the Exchange under this subtitle; 19
	128	+
	129	+	(ii) provide funding for the establishment and operation of the State 20
	130	+	Reinsurance Program authorized under this subtitle; 21
	131	+
	132	+	(iii) provide funding for the Medical Assistance Program and the 22
	133	+	Senior Prescription Drug Assistance Program; 23
	134	+
	135	+	(iv) provide funding for the establishment and operation of Health 24
	136	+	Equity Resource Communities under Title 20, Subtitle 14 of the Health – General Article; 25
	137	+	[and] 26
	138	+
	139	+	(v) provide funding for the establishment and operation of the 27
	140	+	State–Based Young Adult Health Insurance Subsidies Pilot Program authorized under this 28
	141	+	subtitle; AND 29
	142	+
	143	+	(VI) PROVIDE FUNDING FOR THE ESTABLISHMENT AN D 30
	144	+	OPERATION OF THE SMALL BUSINESS AND NONPROFIT HEALTH INSURANCE 31
	145	+	SUBSIDIES PROGRAM AUTHORIZED UN DER THIS SUBTITLE . 32
	146	+	4 SENATE BILL 632
	147	+
	148	+
	149	+	(2) The operation and administration of the Exchange, the State 1
	150	+	Reinsurance Program, [and] the State–Based Young Adult Health Insurance Subsidies 2
	151	+	Pilot Program, AND THE SMALL BUSINESS AND NONPROFIT HEALTH INSURANCE 3
	152	+	SUBSIDIES PROGRAM may include functions delegated by the Exchange to a third party 4
	153	+	under law or by contract. 5
	154	+
	155	+	(c) The Exchange shall administer the Fund. 6
	156	+
	157	+	(d) (1) The Fund is a special, nonlapsing fund that is not subject to § 7–302 of 7
	158	+	the State Finance and Procurement Article. 8
	159	+
	160	+	(2) The State Treasurer shall hold the Fund separately, and the 9
	161	+	Comptroller shall account for the Fund. 10
	162	+
	163	+	(e) The Fund consists of: 11
	164	+
	165	+	(1) any user fees or other assessments collected by the Exchange; 12
	166	+
	167	+	(2) all revenue deposited into the Fund that is received from the 13
	168	+	distribution of the premium tax under § 6–103.2 of this article; 14
	169	+
	170	+	(3) income from investments made on behalf of the Fund; 15
	171	+
	172	+	(4) interest on deposits or investments of money in the Fund; 16
	173	+
	174	+	(5) money collected by the Board as a result of legal or other actions taken 17
	175	+	by the Board on behalf of the Exchange or the Fund; 18
	176	+
	177	+	(6) money donated to the Fund; 19
	178	+
	179	+	(7) money awarded to the Fund through grants; 20
	180	+
	181	+	(8) any pass–through funds received from the federal government under a 21
	182	+	waiver approved under § 1332 of the Affordable Care Act; 22
	183	+
	184	+	(9) any funds designated by the federal government to provide reinsurance 23
	185	+	to carriers that offer individual health benefit plans in the State; 24
	186	+
	187	+	(10) any funds designated by the State to provide reinsurance to carriers 25
	188	+	that offer individual health benefit plans in the State; 26
	189	+
	190	+	(11) any funds designated by the State to provide State–based health 27
	191	+	insurance subsidies to young adults in the State; 28
	192	+
	193	+	(12) ANY FEDERAL FUNDS AV AILABLE TO PROVIDE H EALTH 29
	194	+	INSURANCE SUBSIDIES TO QUALIFIED SMALL B USINESS AND NONPROFI T 30 SENATE BILL 632 5
	195	+
	196	+
	197	+	EMPLOYERS AND THEIR EMPLOYEES IN THE STATE, INCLUDING FUNDS FROM THE 1
	198	+	FEDERAL AMERICAN RESCUE PLAN OF 2021; 2
	199	+
	200	+	[(12)] (13) any federal funds received in accordance with § 31–121 of this 3
	201	+	subtitle for the administration of small business tax credits; and 4
	202	+
	203	+	[(13)] (14) any other money from any other source accepted for the benefit 5
	204	+	of the Fund. 6
	205	+
	206	+	(f) (1) The Fund may be used only: 7
	207	+
	208	+	(i) 1. for the operation and administration of the Exchange in 8
	209	+	carrying out the purposes authorized under this subtitle; 9
	210	+
	211	+	2. for the establishment and operation of the State 10
	212	+	Reinsurance Program; and 11
	213	+
	214	+	3. for appropriations to the Health Equity Resource 12
	215	+	Community Reserve Fund under § 20–1407 of the Health – General Article; 13
	216	+
	217	+	(ii) in fiscal years 2021 and 2022, for the Medical Assistance 14
	218	+	Program within the Medical Care Programs Administration of the Maryland Department 15
	219	+	of Health; 16
	220	+
	221	+	(iii) in fiscal year 2022, for the Senior Prescription Drug Assistance 17
	222	+	Program established under Title 15, Subtitle 10 of the Health – General Article; [and] 18
	223	+
	224	+	(iv) for the establishment and operation of the State–Based Young 19
	225	+	Adult Health Insurance Subsidies Pilot Program; AND 20
	226	+
	227	+	(V) FOR THE ESTABLISHMEN T AND OPERATION OF T HE SMALL 21
	228	+	BUSINESS AND NONPROFIT HEALTH INSURANCE SUBSIDIES PROGRAM. 22
	229	+
	230	+	(2) In each of fiscal years 2023 through 2025, the Governor shall: 23
	231	+
	232	+	(i) transfer $15,000,000 to the Health Equity Resource Community 24
	233	+	Reserve Fund; and 25
	234	+
	235	+	(ii) include the funds transferred in accordance with item (i) of this 26
	236	+	paragraph in the annual budget bill as an appropriation to the Health Equity Resource 27
	237	+	Community Reserve Fund under § 20–1407 of the Health – General Article. 28
	238	+
	239	+	(g) (1) The Board shall maintain separate accounts within the Fund for 29
	240	+	Exchange operations, for the State Reinsurance Program, [and] for the State–Based Young 30
	241	+	Adult Health Insurance Subsidies Pilot Program, AND FOR THE SMALL BUSINESS AND 31
	242	+	NONPROFIT HEALTH INSURANCE SUBSIDIES PROGRAM. 32 6 SENATE BILL 632
	243	+
	244	+
	245	+
	246	+	(2) Accounts within the Fund shall contain the money that is intended to 1
	247	+	support the purpose for which each account is designated. 2
	248	+
	249	+	(3) Funds received from the distribution of the premium tax under § 3
	250	+	6–103.2 of this article shall be placed in the account for Exchange operations and may be 4
	251	+	used only for the purpose of funding the operation and administration of the Exchange. 5
	252	+
	253	+	(4) The following funds may be used only for the purposes of funding the 6
	254	+	State Reinsurance Program: 7
	255	+
	256	+	(i) any pass–through funds received from the federal government 8
	257	+	under a waiver approved under § 1332 of the Affordable Care Act to provide reinsurance to 9
	258	+	carriers that offer individual health benefit plans in the State; 10
	259	+
	260	+	(ii) any funds designated by the federal government to provide 11
	261	+	reinsurance to carriers that offer individual health benefit plans in the State; and 12
	262	+
	263	+	(iii) any funds designated by the State to provide reinsurance to 13
	264	+	carriers that offer individual health benefit plans in the State. 14
	265	+
	266	+	(h) (1) Expenditures from the Fund for the purposes authorized by this 15
	267	+	subtitle may be made only: 16
	268	+
	269	+	(i) with an appropriation from the Fund approved by the General 17
	270	+	Assembly in the State budget; or 18
	271	+
	272	+	(ii) by the budget amendment procedure provided for in Title 7, 19
	273	+	Subtitle 2 of the State Finance and Procurement Article. 20
	274	+
	275	+	(2) Notwithstanding § 7–304 of the State Finance and Procurement Article, 21
	276	+	if the amount of the distribution from the premium tax under § 6–103.2 of this article 22
	277	+	exceeds in any State fiscal year the actual expenditures incurred for the operation and 23
	278	+	administration of the Exchange, funds in the Exchange operations account from the 24
	279	+	premium tax that remain unspent at the end of the State fiscal year shall revert to the 25
	280	+	General Fund of the State. 26
	281	+
	282	+	(3) If operating expenses of the Exchange may be charged to either State 27
	283	+	or non–State fund sources, the non–State funds shall be charged before State funds are 28
	284	+	charged. 29
	285	+
	286	+	(i) (1) The State Treasurer shall invest the money of the Fund in the same 30
	287	+	manner as other State money may be invested. 31
	288	+
	289	+	(2) Any investment earnings of the Fund shall be credited to the Fund. 32
	290	+	SENATE BILL 632 7
	291	+
	292	+
	293	+	(3) Except as provided in subsection (h)(2) of this section, no part of the 1
	294	+	Fund may revert or be credited to the General Fund or any special fund of the State. 2
	295	+
	296	+	(j) A debt or an obligation of the Fund is not a debt of the State or a pledge of 3
	297	+	credit of the State. 4
	298	+
	299	+	31–123. 5
	300	+
	301	+	(A) (1) IN THIS SECTION THE F OLLOWING WORDS HAVE THE MEANINGS 6
	302	+	INDICATED. 7
	303	+
	304	+	(2) “PROGRAM” MEANS THE SMALL BUSINESS AND NONPROFIT 8
	305	+	HEALTH INSURANCE SUBSIDIES PROGRAM. 9
	306	+
	307	+	(3) (I) “QUALIFIED EMPLOYER ” MEANS AN EMPLOYER WI TH 10
	308	+	FEWER THAN 25 FULL–TIME EQUIVALENT EMPL OYEES. 11
	309	+
	310	+	(II) “QUALIFIED EMPLOYER ” INCLUDES A NONPROFIT 12
	311	+	ORGANIZATION EMPLOYE R WITH FEWER THAN 25 FULL–TIME EQUIVALENT 13
	312	+	EMPLOYEES. 14
	313	+
	314	+	(B) THE EXCHANGE, IN CONSULTATION WITH THE COMMISSIONER AND AS 15
	315	+	APPROVED BY THE BOARD, SHALL ESTABLISH AND IMPLEMENT A SMALL BUSINESS 16
	316	+	AND NONPROFIT HEALTH INSURANCE SUBSIDIES PROGRAM TO PROVIDE 17
	317	+	SUBSIDIES TO QU ALIFIED EMPLOYERS AN D THEIR EMPLOYEES FO R THE PURCHASE 18
	318	+	OF QUALIFIED HEALTH BENEFIT PLANS ON THE EXCHANGE. 19
	319	+
	320	+	(C) THE PROGRAM REQUIRED UNDE R THIS SECTION SHALL BE DESIGNED 20
	321	+	TO REDUCE THE AMOUNT THAT QUALIFIED EMPLO YERS AND THEIR EMPLO YEES PAY 21
	322	+	FOR QUALIFIED HE ALTH BENEFIT PLANS O N THE EXCHANGE. 22
	323	+
	324	+	(D) FOR CALENDAR YEARS 2024 THROUGH 2028, THE EXCHANGE, IN 23
	325	+	CONSULTATION WITH TH E COMMISSIONER AND AS A PPROVED BY THE BOARD, 24
	326	+	SHALL ESTABLISH SUBS IDY ELIGIBILITY AND PAYMENT PARAMETERS F OR THE 25
	327	+	PROGRAM. 26
	328	+
	329	+	(E) SUBJECT TO AVAILABLE FUNDS , IN EACH OF FISCAL YE ARS 2023 27
	330	+	THROUGH 2029, THE EXCHANGE MAY DESIGNAT E FUNDS FROM THE FUND TO BE 28
	331	+	USED FOR THE PROGRAM SO THAT FOR C ALENDAR YEARS 2024 THROUGH 2028 NOT 29
	332	+	MORE THAN: 30
	333	+
	334	+	(1) $45,000,000 IN ANNUAL SUBSIDIES MAY BE PROVIDED TO 31
	335	+	QUALIFIED EMPLOYERS AND THEIR EMPLOYEES WHO MEET THE SUBSIDY 32 8 SENATE BILL 632
	336	+
	337	+
	338	+	ELIGIBILITY AND PAYM ENT PARAMETERS ESTAB LISHED UNDER SUBSECT ION (D) OF 1
	339	+	THIS SECTION; AND 2
	340	+
	341	+	(2) $3,000,000 MAY BE SPENT IN SMAL L BUSINESS OUTREACH 3
	342	+	ACTIVITIES FOR THE P URPOSE OF EDUCATING QUALIFIED EM PLOYERS ABOUT THE 4
	343	+	PROGRAM. 5
	344	+
	345	+	(F) ON OR BEFORE JANUARY 1, 2023, THE EXCHANGE SHALL ADOPT 6
	346	+	REGULATIONS CARRYING OUT THIS SECTION . 7
	347	+
	348	+	(G) (1) THE EXCHANGE SHALL TRACK ON A MONTHLY BASIS 8
	349	+	EXPENDITURES ON SUBS IDIES PROVIDED UNDER THE PROGRAM, INCLUDING: 9
	350	+
	351	+	(I) THE AVERAGE NUMBER OF QUALIFIED EMPLOYERS AND 10
	352	+	THEIR EMPLOYEES RECE IVING SUBSIDIES UNDE R THE PROGRAM; AND 11
	353	+
	354	+	(II) THE AVERAGE SUBSIDY AMOUNT RECEIVED BY Q UALIFIED 12
	355	+	EMPLOYERS AND THEIR EMPLOYEES UNDER THE PROGRAM. 13
	356	+
	357	+	(2) THE INFORMATION TRACK ED BY THE EXCHANGE UNDER 14
	358	+	PARAGRAPH (1) OF THIS SUBSECTION S HALL BE: 15
	359	+
	360	+	(I) POSTED ON THE WEBSIT E OF THE EXCHANGE; 16
	361	+
	362	+	(II) INCLUDED IN THE ANNU AL REPORT REQUIRED U NDER § 17
	363	+	31–119(D) OF THIS SUBTITLE; AND 18
	364	+
	365	+	(III) ON OR BEFORE DECEMBER 1, 2028, REPORTED TO THE 19
	366	+	SENATE FINANCE COMMITTEE AND THE HOUSE HEALTH AND GOVERNMENT 20
	367	+	OPERATIONS COMMITTEE, IN ACCORDANCE WITH § 2–1257 OF THE STATE 21
	368	+	GOVERNMENT ARTICLE. 22
	369	+
	370	+	SECTION 2. 3. AND BE IT FURTHER ENACTED, That this Act shall take effect 23
	371	+	October June 1, 2022. It Section 1 of this Act shall remain effective for a period of 7 years 24
	372	+	1 year and 1 month and, at the end of September 30, 2029, June 30, 2023, Section 1 of this 25
	373	+	Act, with no further action required by the General Assembly, shall be abrogated and of no 26
	374	+	further force and effect. 27
	375	+
	376	+
	377	+