Maryland 2022 Regular Session

Maryland Senate Bill SB728 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1
2	2
3	3	EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
4	4	[Brackets] indicate matter deleted from existing law.
5	5	sb0728
6	6
7	7	SENATE BILL 728
8	8	J5 2lr1762
9	9	CF 2lr1466
10	10	By: Senator Lam
11	11	Introduced and read first time: February 7, 2022
12	12	Assigned to: Finance
13	13
14	14	A BILL ENTITLED
15	15
16	16	AN ACT concerning 1
17	17
18	18	Health Insurance – Qualified Resident State Subsidy Program 2
19	19	(Access to Care Act) 3
20	20
21	21	FOR the purpose of altering the purpose of the Maryland Health Benefit Exchange Fund 4
22	22	to include the provision of funding for the establishment and operation of the 5
23	23	Qualified Resident State Subsidy Program; requiring the Maryland Health Benefit 6
24	24	Exchange to establish and implement the Program to provide State premium 7
25	25	assistance and cost–sharing reductions to qualified residents; providing that the 8
26	26	implementation of the Program is contingent on approval of a certain waiver 9
27	27	application; and generally relating to the Qualified Resident State Subsidy Program. 10
28	28
29	29	BY repealing and reenacting, without amendments, 11
30	30	Article – Insurance 12
31	31	Section 31–101(a) and 31–108(a) 13
32	32	Annotated Code of Maryland 14
33	33	(2017 Replacement Volume and 2021 Supplement) 15
34	34
35	35	BY adding to 16
36	36	Article – Insurance 17
37	37	Section 31–101(u–1), 31–123, and 31–124 18
38	38	Annotated Code of Maryland 19
39	39	(2017 Replacement Volume and 2021 Supplement) 20
40	40
41	41	BY repealing and reenacting, with amendments, 21
42	42	Article – Insurance 22
43	43	Section 31–107, 31–108(b)(1), and 31–115(b)(7) 23
44	44	Annotated Code of Maryland 24
45	45	(2017 Replacement Volume and 2021 Supplement) 25
46	46
47	47	SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 26
48	48	That the Laws of Maryland read as follows: 27 2 SENATE BILL 728
49	49
50	50
51	51
52	52	Article – Insurance 1
53	53
54	54	31–101. 2
55	55
56	56	(a) In this subtitle the following words have the meanings indicated. 3
57	57
58	58	(U–1) “QUALIFIED RESIDENT ” MEANS AN INDIVIDUAL , INCLUDING A MINOR , 4
59	59	REGARDLESS OF IMMIGR ATION STATUS, WHO AT THE TIME OF E NROLLMENT : 5
60	60
61	61	(1) IS SEEKING TO ENROLL IN A QUALIFIED HEALT H PLAN OFFERED 6
62	62	TO INDIVIDUALS THROU GH THE EXCHANGE; 7
63	63
64	64	(2) RESIDES IN THE STATE; 8
65	65
66	66	(3) IS NOT INCARCERATED , OTHER THAN INCARCERA TION PENDING 9
67	67	DISPOSITION OF CHARG ES; AND 10
68	68
69	69	(4) IS NOT ELIGIBLE FOR THE FEDERAL PRE MIUM TAX CREDIT , THE 11
70	70	MARYLAND MEDICAL ASSISTANCE PROGRAM, MEDICARE, THE MARYLAND 12
71	71	CHILDREN’S HEALTH PLAN, OR EMPLOYER –SPONSORED MINIMUM ES SENTIAL 13
72	72	COVERAGE. 14
73	73
74	74	31–107. 15
75	75
76	76	(a) There is a Maryland Health Benefit Exchange Fund. 16
77	77
78	78	(b) (1) The purpose of the Fund is to: 17
79	79
80	80	(i) provide funding for the operation and administration of the 18
81	81	Exchange in carrying out the purposes of the Exchange under this subtitle; 19
82	82
83	83	(ii) provide funding for the establishment and operation of the State 20
84	84	Reinsurance Program authorized under this subtitle; 21
85	85
86	86	(iii) provide funding for the Medical Assistance Program and the 22
87	87	Senior Prescription Drug Assistance Program; 23
88	88
89	89	(iv) provide funding for the establishment and operation of Health 24
90	90	Equity Resource Communities under Title 20, Subtitle 14 of the Health – General Article; 25
91	91	[and] 26
92	92
93	93	(v) provide funding for the establishment and operation of the 27
94	94	State–Based Young Adult Health Insurance Subsidies Pilot Program authorized under this 28
95	95	subtitle; AND 29 SENATE BILL 728 3
96	96
97	97
98	98
99	99	(VI) PROVIDE FUNDING FOR THE ESTABLISHMENT AND 1
100	100	OPERATION OF THE QUALIFIED RESIDENT STATE SUBSIDY PROGRAM. 2
101	101
102	102	(2) The operation and administration of the Exchange, the State 3
103	103	Reinsurance Program, [and] the State–Based Young Adult Health Insurance Subsidies 4
104	104	Pilot Program, AND THE QUALIFIED RESIDENT STATE SUBSIDY PROGRAM may 5
105	105	include functions delegated by the Exchange to a third party under law or by contract. 6
106	106
107	107	(c) The Exchange shall administer the Fund. 7
108	108
109	109	(d) (1) The Fund is a special, nonlapsing fund that is not subject to § 7–302 of 8
110	110	the State Finance and Procurement Article. 9
111	111
112	112	(2) The State Treasurer shall hold the Fund separately, and the 10
113	113	Comptroller shall account for the Fund. 11
114	114
115	115	(e) The Fund consists of: 12
116	116
117	117	(1) any user fees or other assessments collected by the Exchange; 13
118	118
119	119	(2) all revenue deposited into the Fund that is received from the 14
120	120	distribution of the premium tax under § 6–103.2 of this article; 15
121	121
122	122	(3) income from investments made on behalf of the Fund; 16
123	123
124	124	(4) interest on deposits or investments of money in the Fund; 17
125	125
126	126	(5) money collected by the Board as a result of legal or other actions taken 18
127	127	by the Board on behalf of the Exchange or the Fund; 19
128	128
129	129	(6) money donated to the Fund; 20
130	130
131	131	(7) money awarded to the Fund through grants; 21
132	132
133	133	(8) any pass–through funds received from the federal government under a 22
134	134	waiver approved under § 1332 of the Affordable Care Act; 23
135	135
136	136	(9) any funds designated by the federal government to provide reinsurance 24
137	137	to carriers that offer individual health benefit plans in the State; 25
138	138
139	139	(10) any funds designated by the State to provide reinsurance to carriers 26
140	140	that offer individual health benefit plans in the State; 27
141	141
142	142	(11) any funds designated by the State to provide State–based health 28
143	143	insurance subsidies to young adults in the State; 29
144	144	4 SENATE BILL 728
145	145
146	146
147	147	(12) any federal funds received in accordance with § 31–121 of this subtitle 1
148	148	for the administration of small business tax credits; [and] 2
149	149
150	150	(13) ANY FUNDS DESIGNATED BY THE STATE TO PROVIDE 3
151	151	STATE–BASED HEALTH INSURAN CE SUBSIDIES TO QUAL IFIED RESIDENTS IN T HE 4
152	152	STATE; AND 5
153	153
154	154	(14) any other money from any other source accepted for the benefit of the 6
155	155	Fund. 7
156	156
157	157	(f) (1) The Fund may be used only: 8
158	158
159	159	(i) 1. for the operation and administration of the Exchange in 9
160	160	carrying out the purposes authorized under this subtitle; 10
161	161
162	162	2. for the establishment and operation of the State 11
163	163	Reinsurance Program; and 12
164	164
165	165	3. for appropriations to the Health Equity Resource 13
166	166	Community Reserve Fund under § 20–1407 of the Health – General Article; 14
167	167
168	168	(ii) in fiscal years 2021 and 2022, for the Medical Assistance 15
169	169	Program within the Medical Care Programs Administration of the Maryland Department 16
170	170	of Health; 17
171	171
172	172	(iii) in fiscal year 2022, for the Senior Prescription Drug Assistance 18
173	173	Program established under Title 15, Subtitle 10 of the Health – General Article; [and] 19
174	174
175	175	(iv) for the establishment and operation of the State–Based Young 20
176	176	Adult Health Insurance Subsidies Pilot Program; AND 21
177	177
178	178	(V) FOR THE ESTABLISHMEN T AND OPERATION OF T HE 22
179	179	QUALIFIED RESIDENT STATE SUBSIDY PROGRAM. 23
180	180
181	181	(2) In each of fiscal years 2023 through 2025, the Governor shall: 24
182	182
183	183	(i) transfer $15,000,000 to the Health Equity Resource Community 25
184	184	Reserve Fund; and 26
185	185
186	186	(ii) include the funds transferred in accordance with item (i) of this 27
187	187	paragraph in the annual budget bill as an appropriation to the Health Equity Resource 28
188	188	Community Reserve Fund under § 20–1407 of the Health – General Article. 29
189	189
190	190	(g) (1) The Board shall maintain separate accounts within the Fund for 30
191	191	Exchange operations, for the State Reinsurance Program, [and] for the State–Based Young 31
192	192	Adult Health Insurance Subsidies Pilot Program, AND FOR THE ESTABLIS HMENT AND 32 SENATE BILL 728 5
193	193
194	194
195	195	OPERATION OF THE QUALIFIED RESIDENT STATE SUBSIDY PROGRAM. 1
196	196
197	197	(2) Accounts within the Fund shall contain the money that is intended to 2
198	198	support the purpose for which each account is designated. 3
199	199
200	200	(3) Funds received from the distribution of the premium tax under § 4
201	201	6–103.2 of this article shall be placed in the account for Exchange operations and may be 5
202	202	used only for the purpose of funding the operation and administration of the Exchange. 6
203	203
204	204	(4) The following funds may be used only for the purposes of funding the 7
205	205	State Reinsurance Program: 8
206	206
207	207	(i) any pass–through funds received from the federal government 9
208	208	under a waiver approved under § 1332 of the Affordable Care Act to provide reinsurance to 10
209	209	carriers that offer individual health benefit plans in the State; 11
210	210
211	211	(ii) any funds designated by the federal government to provide 12
212	212	reinsurance to carriers that offer individual health benefit plans in the State; and 13
213	213
214	214	(iii) any funds designated by the State to provide reinsurance to 14
215	215	carriers that offer individual health benefit plans in the State. 15
216	216
217	217	(h) (1) Expenditures from the Fund for the purposes authorized by this 16
218	218	subtitle may be made only: 17
219	219
220	220	(i) with an appropriation from the Fund approved by the General 18
221	221	Assembly in the State budget; or 19
222	222
223	223	(ii) by the budget amendment procedure provided for in Title 7, 20
224	224	Subtitle 2 of the State Finance and Procurement Article. 21
225	225
226	226	(2) Notwithstanding § 7–304 of the State Finance and Procurement Article, 22
227	227	if the amount of the distribution from the premium tax under § 6–103.2 of this article 23
228	228	exceeds in any State fiscal year the actual expenditures incurred for the operation and 24
229	229	administration of the Exchange, funds in the Exchange operations account from the 25
230	230	premium tax that remain unspent at the end of the State fiscal year shall revert to the 26
231	231	General Fund of the State. 27
232	232
233	233	(3) If operating expenses of the Exchange may be charged to either State 28
234	234	or non–State fund sources, the non–State funds shall be charged before State funds are 29
235	235	charged. 30
236	236
237	237	(i) (1) The State Treasurer shall invest the money of the Fund in the same 31
238	238	manner as other State money may be invested. 32
239	239
240	240	(2) Any investment earnings of the Fund shall be credited to the Fund. 33
241	241	6 SENATE BILL 728
242	242
243	243
244	244	(3) Except as provided in subsection (h)(2) of this section, no part of the 1
245	245	Fund may revert or be credited to the General Fund or any special fund of the State. 2
246	246
247	247	(j) A debt or an obligation of the Fund is not a debt of the State or a pledge of 3
248	248	credit of the State. 4
249	249
250	250	31–108. 5
251	251
252	252	(a) On or before January 1, 2014, the functions and operations of the Exchange 6
253	253	shall include at a minimum all functions required by § 1311(d)(4) of the Affordable Care 7
254	254	Act. 8
255	255
256	256	(b) In compliance with § 1311(d)(4) of the Affordable Care Act, the Exchange 9
257	257	shall: 10
258	258
259	259	(1) make qualified plans available to qualified individuals, QUALIFIED 11
260	260	RESIDENTS, and qualified employers; 12
261	261
262	262	31–115. 13
263	263
264	264	(b) To be certified as a qualified health plan, a health benefit plan shall: 14
265	265
266	266	(7) be in the interest of qualified individuals, QUALIFIED RESIDENTS, and 15
267	267	qualified employers, as determined by the Exchange; 16
268	268
269	269	31–123. 17
270	270
271	271	(A) ON OR BEFORE JULY 1, 2023, THE EXCHANGE, IN CONSULTATION WITH 18
272	272	THE COMMISSIONER AND AS A PPROVED BY THE BOARD, SHALL SUBMIT A STATE 19
273	273	INNOVATION WAIVER APPLICATION UN DER § 1332 OF THE AFFORDABLE CARE ACT 20
274	274	TO ESTABLISH A QUALIFIED RESIDENT STATE SUBSIDY PROGRAM AND SEEK 21
275	275	FEDERAL PASS –THROUGH FUNDING TO A LLOW QUALIFIED RESID ENTS TO OBTAIN 22
276	276	COVERAGE THROUGH THE EXCHANGE. 23
277	277
278	278	(B) ON OR BEFORE DECEMBER 31, 2023, THE COMMISSIONER MAY WAIV E 24
279	279	ANY NOTIFICATION OR OTHER REQUIREMENTS T HAT APPLY TO A CARRI ER UNDER 25
280	280	THIS ARTICLE IN CALENDAR YEAR 2023 DUE TO THE IMPLEMENT ATION OF A WAIVER 26
281	281	APPROVED UNDER § 1332 OF THE AFFORDABLE CARE ACT. 27
282	282
283	283	31–124. 28
284	284
285	285	(A) THE EXCHANGE, IN CONSULTATION WITH THE COMMISSIONER AND AS 29
286	286	APPROVED BY THE BOARD, SHALL ESTABLISH AND IMPLEMENT A QUALIFIED 30
287	287	RESIDENT STATE SUBSIDY PROGRAM: 31
288	288	SENATE BILL 728 7
289	289
290	290
291	291	(1) TO PROVIDE STATE PREMIUM ASSISTA NCE AND COST –SHARING 1
292	292	REDUCTIONS TO QUALIF IED RESIDENTS; 2
293	293
294	294	(2) THAT MEETS THE REQUI REMENTS OF A WAIVER APPROVED 3
295	295	UNDER § 1332 OF THE AFFORDABLE CARE ACT; AND 4
296	296
297	297	(3) THAT IS CONSISTENT W ITH FEDERAL AND STATE LAW. 5
298	298
299	299	(B) THE QUALIFIED RESIDENT STATE SUBSIDY PROGRAM SHALL BE 6
300	300	DESIGNED TO MAKE IND IVIDUAL MARKET HEALT H INSURANCE COVERAGE OFFERED 7
301	301	THROUGH THE EXCHANGE AFFORDABLE T O QUALIFIED RESIDENT S. 8
302	302
303	303	(C) (1) BASED ON AVAILABLE FU NDS, THE EXCHANGE, IN CONSULTATION 9
304	304	WITH THE COMMISSIONER AND AS A PPROVED BY THE BOARD, SHALL ESTABLISH 10
305	305	SUBSIDY ELIGIBILITY AND PAYMENT PARAMETE RS FOR CALENDAR YEAR 2024 AND 11
306	306	EACH SUBSEQUENT CALE NDAR YEAR. 12
307	307
308	308	(2) THE SUBSIDY ELIGIBILITY AND PAYM ENT PARAMETERS 13
309	309	ESTABLISHED BY THE EXCHANGE SHALL, TO THE GREATEST EXTE NT POSSIBLE, 14
310	310	MIRROR THOSE APPLICA BLE TO QUALIFIED IND IVIDUALS. 15
311	311
312	312	(D) BEGINNING JANUARY 1, 2024, FUNDING FOR THE QUALIFIED 16
313	313	RESIDENT STATE SUBSIDY PROGRAM MAY BE MADE B Y USING: 17
314	314
315	315	(1) ANY PASS–THROUGH FUNDS RE CEIVED FROM THE FEDE RAL 18
316	316	GOVERNMENT UNDER A W AIVER APPROVED UNDER § 1332 OF THE AFFORDABLE 19
317	317	CARE ACT; 20
318	318
319	319	(2) ANY FUNDS DESIGNATED BY THE FEDERAL GOVER NMENT TO 21
320	320	PROVIDE HEALTH COVER AGE FOR QUALIFIED RE SIDENTS; AND 22
321	321
322	322	(3) ANY FUNDS DESIGNATED BY THE STATE TO PROVIDE HEAL TH 23
323	323	COVERAGE FOR QUALIFI ED RESIDENTS. 24
324	324
325	325	(E) THE IMPLEMENTATION OF THE QUALIFIED RESIDENT STATE SUBSIDY 25
326	326	PROGRAM SHALL BE CONT INGENT ON APPROVAL F ROM THE U.S. SECRETARY OF 26
327	327	HEALTH AND HUMAN SERVICES AND THE U.S. SECRETARY OF THE TREASURY OF A 27
328	328	STATE INNOVATION WAIVER APPLICATION UN DER § 1332 OF THE AFFORDABLE 28
329	329	CARE ACT. 29
330	330
331	331	(F) ON OR BEFORE JANUARY 1, 2024, THE EXCHANGE SHALL ADOPT 30
332	332	REGULATIONS TO CARRY OUT THIS SECTION . 31
333	333	8 SENATE BILL 728
334	334
335	335
336	336	SECTION 2. AND BE IT FURTHER ENACTED, Tha t this Act shall take effect 1
337	337	October 1, 2022. 2
338	338