Maryland 2023 Regular Session

Maryland House Bill HB588 Compare Versions

Version 1 (Old)

Version 2 (New)

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		-	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	5		hb0588
9	6
10	7		HOUSE BILL 588
11	8		J5 3lr1153
12	9		HB 1035/22 – HGO CF SB 365
13	10		By: Delegates Cullison, Taveras, Acevero, Alston, Bagnall, Boafo, Charkoudian,
14	11		Charles, Embry, Fair, Foley, Fraser–Hidalgo, Harris, Ivey, Kelly, Kerr,
15	12		R. Lewis, Lopez, Mireku–North, Palakovich Carr, Pena–Melnyk, Phillips,
16	13		Qi, Queen, Ruth, Simpson, Stewart, Terrasa, Turner, Vogel, White, Woods,
17		-	and Ziegler Ziegler, Bhandari, Guzzone, Hill, S. Johnson, Kaiser, Martinez,
18		-	and Rosenberg
	14	+	and Ziegler
19	15		Introduced and read first time: February 3, 2023
20	16		Assigned to: Health and Government Operations
21		-	Committee Report: Favorable with amendments
22		-	House action: Adopted
23		-	Read second time: March 5, 2023
24	17
25		-	~~CHAPTER ______~~
	18	+	A BILL ENTITLED
26	19
27	20		AN ACT concerning 1
28	21
29	22		Health Insurance – Qualified Resident Enrollment Program 2
30	23		(Access to Care Act) 3
31	24
32	25		FOR the purpose of altering the purpose for the Maryland Health Benefit Exchange Fund 4
33	26		to include the provision of funding for the establishment and operation of the 5
34		-	Qualified Resident Enrollment Program; authorizing the use of federal pass–through 6
35		-	funds for certain programs as approved under a certain waiver; requiring the 7
36		-	Maryland Health Benefit Exchange to make qualified plans available to qualified 8
37		-	residents; requiring the Maryland Health Benefit Exchange to establish and 9
38		-	implement the Qualified Resident Enrollment Program to allow qualified residents 10
39		-	to obtain coverage, facilitate the enrollment of qualified residents in qualified health 11
40		-	plans, and, based on the availability of funds, provide premium assistance and 12
41		-	cost–sharing reductions to qualified residents; providing that the implementation of 13
42		-	subsidies under the Program is contingent on approval of a certain waiver 14
43		-	application amendment; requiring the Exchange to submit a certain report to the 15
44		-	General Assembly within a certain period of time before implementing certain 16
45		-	subsidies; and generally relating to the Qualified Resident Enrollment Program. 17
	27	+	Qualified Resident Enrollment Program; requiring the Maryland Health Benefit 6
	28	+	Exchange to make qualified plans available to qualified residents; requiring the 7
	29	+	Maryland Health Benefit Exchange to establish and implement the Qualified 8
	30	+	Resident Enrollment Program to allow qualified residents to obtain coverage, 9
	31	+	facilitate the enrollment of qualified residents in qualified health plans, and, based 10
	32	+	on the availability of funds, provide premium assistance and cost–sharing reductions 11
	33	+	to qualified residents; providing that the implementation of the Program is 12
	34	+	contingent on approval of a certain waiver application amendment; and generally 13
	35	+	relating to the Qualified Resident Enrollment Program. 14
46	36
47		-	BY repealing and reenacting, without amendments, 18
48		-	Article – Insurance 19 2 HOUSE BILL 588
	37	+	BY repealing and reenacting, without amendments, 15
	38	+	Article – Insurance 16
	39	+	Section 31–101(a) and 31–108(a) 17
	40	+	Annotated Code of Maryland 18
	41	+	(2017 Replacement Volume and 2022 Supplement) 19
	42	+
	43	+	BY adding to 20
	44	+	Article – Insurance 21
	45	+	Section 31–101(u–1), 31–123, and 31–124 22
	46	+	Annotated Code of Maryland 23
	47	+	(2017 Replacement Volume and 2022 Supplement) 24
	48	+	2 HOUSE BILL 588
49	49
50	50
51		-	Section 31–101(a) and 31–108(a) 1
52		-	Annotated Code of Maryland 2
53		-	(2017 Replacement Volume and 2022 Supplement) 3
	51	+	BY repealing and reenacting, with amendments, 1
	52	+	Article – Insurance 2
	53	+	Section 31–107, 31–108(b)(1), and 31–115(b)(7) 3
	54	+	Annotated Code of Maryland 4
	55	+	(2017 Replacement Volume and 2022 Supplement) 5
54	56
55		-	BY adding to 4
56		-	Article – Insurance 5
57		-	Section 31–101(u–1), 31–123, and 31–124 6
58		-	Annotated Code of Maryland 7
59		-	(2017 Replacement Volume and 2022 Supplement) 8
	57	+	SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 6
	58	+	That the Laws of Maryland read as follows: 7
60	59
61		-	BY repealing and reenacting, with amendments, 9
62		-	Article – Insurance 10
63		-	Section 31–107, 31–108(b)(1), and 31–115(b)(7) 11
64		-	Annotated Code of Maryland 12
65		-	(2017 Replacement Volume and 2022 Supplement) 13
	60	+	Article – Insurance 8
66	61
67		-	SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 14
68		-	That the Laws of Maryland read as follows: 15
	62	+	31–101. 9
69	63
70		-	~~Article – Insurance 16~~
	64	+	(a) In this subtitle the following words have the meanings indicated. 10
71	65
72		-	31–101. 17
	66	+	(U–1) “QUALIFIED RESIDENT ” MEANS AN INDIVIDUAL , INCLUDING A MINOR , 11
	67	+	REGARDLESS OF IMMIGR ATION STATUS, WHO AT THE TIME OF E NROLLMENT : 12
73	68
74		-	(a) In this subtitle the following words have the meanings indicated. 18
	69	+	(1) IS SEEKING TO ENROLL IN A QUALIFIED HEALT H PLAN OFFERED 13
	70	+	TO INDIVIDUALS THROU GH THE EXCHANGE; 14
75	71
76		-	(U–1) “QUALIFIED RESIDENT ” MEANS AN INDIVIDUAL , INCLUDING A MINOR , 19
77		-	REGARDLESS OF IMMIGR ATION STATUS, WHO AT THE TIME OF E NROLLMENT : 20
	72	+	(2) RESIDES IN THE STATE; 15
78	73
79		-	(1) IS ~~SEEKING TO ENROLL IN A QUALIFIED HEALTH PLAN OFFERED 21~~
80		-	~~TO INDIVIDUALS THROU GH THE EXCHANGE~~; 22
	74	+	(3) IS NOT INCARCERATED , OTHER THAN INCARCERA TION PENDING 16
	75	+	DISPOSITION OF CHARG ES; AND 17
81	76
82		-	(2) RESIDES IN THE STATE; 23
	77	+	(4) IS NOT ELIGIBLE FOR THE FEDERAL PREMIUM TAX CREDIT, THE 18
	78	+	MARYLAND MEDICAL ASSISTANCE PROGRAM, MEDICARE, THE MARYLAND 19
	79	+	CHILDREN’S HEALTH PLAN, OR EMPLOYER –SPONSORED MINIMUM ESSENTI AL 20
	80	+	COVERAGE. 21
83	81
84		-	(3) IS NOT INCARCERATED , OTHER THAN INCARCERA TION PENDING 24
85		-	DISPOSITION OF CHARG ES; AND 25
	82	+	31–107. 22
86	83
87		-	(4) IS NOT ELIGIBLE FOR THE FEDERAL PREMIUM TAX CREDIT, THE 26
88		-	MARYLAND MEDICAL ASSISTANCE PROGRAM, MEDICARE, THE MARYLAND 27
89		-	CHILDREN’S HEALTH PLAN, OR EMPLOYER –SPONSORED MINIMUM ES SENTIAL 28
90		-	COVERAGE. 29
	84	+	(a) There is a Maryland Health Benefit Exchange Fund. 23
91	85
92		-	~~31–107. 30~~
	86	+	(b) (1) The purpose of the Fund is to: 24
93	87
94		-	(a) There is a Maryland Health Benefit Exchange Fund. 31
	88	+	(i) provide funding for the operation and administration of the 25
	89	+	Exchange in carrying out the purposes of the Exchange under this subtitle; 26
95	90
96		-	(b) (1) The purpose of the Fund is to: 32 HOUSE BILL 588 3
	91	+	(ii) provide funding for the establishment and operation of the State 27
	92	+	Reinsurance Program authorized under this subtitle; 28
	93	+
	94	+	(iii) provide funding for the Medical Assistance Program and the 29
	95	+	Senior Prescription Drug Assistance Program; 30
	96	+	HOUSE BILL 588 3
	97	+
	98	+
	99	+	(iv) provide funding for the establishment and operation of Health 1
	100	+	Equity Resource Communities under Title 20, Subtitle 14 of the Health – General Article; 2
	101	+	[and] 3
	102	+
	103	+	(v) provide funding for the establishment and operation of the 4
	104	+	State–Based Young Adult Health Insurance Subsidies Pilot Program authorized under this 5
	105	+	subtitle; AND 6
	106	+
	107	+	(VI) PROVIDE FUNDING FOR THE ESTABLISHMENT AN D 7
	108	+	OPERATION OF THE QUALIFIED RESIDENT ENROLLMENT PROGRAM. 8
	109	+
	110	+	(2) The operation and administration of the Exchange, the State 9
	111	+	Reinsurance Program, [and] the State–Based Young Adult Health Insurance Subsidies 10
	112	+	Pilot Program, AND THE QUALIFIED RESIDENT ENROLLMENT PROGRAM may include 11
	113	+	functions delegated by the Exchange to a third party under law or by contract. 12
	114	+
	115	+	(c) The Exchange shall administer the Fund. 13
	116	+
	117	+	(d) (1) The Fund is a special, nonlapsing fund that is not subject to § 7–302 of 14
	118	+	the State Finance and Procurement Article. 15
	119	+
	120	+	(2) The State Treasurer shall hold the Fund separately, and the 16
	121	+	Comptroller shall account for the Fund. 17
	122	+
	123	+	(e) The Fund consists of: 18
	124	+
	125	+	(1) any user fees or other assessments collected by the Exchange; 19
	126	+
	127	+	(2) all revenue deposited into the Fund that is received from the 20
	128	+	distribution of the premium tax under § 6–103.2 of this article; 21
	129	+
	130	+	(3) income from investments made on behalf of the Fund; 22
	131	+
	132	+	(4) interest on deposits or investments of money in the Fund; 23
	133	+
	134	+	(5) money collected by the Board as a result of legal or other actions taken 24
	135	+	by the Board on behalf of the Exchange or the Fund; 25
	136	+
	137	+	(6) money donated to the Fund; 26
	138	+
	139	+	(7) money awarded to the Fund through grants; 27
	140	+
	141	+	(8) any pass–through funds received from the federal government under a 28
	142	+	waiver approved under § 1332 of the Affordable Care Act; 29
	143	+
	144	+	(9) any funds designated by the federal government to provide reinsurance 30 4 HOUSE BILL 588
	145	+
	146	+
	147	+	to carriers that offer individual health benefit plans in the State; 1
	148	+
	149	+	(10) any funds designated by the State to provide reinsurance to carriers 2
	150	+	that offer individual health benefit plans in the State; 3
	151	+
	152	+	(11) any funds designated by the State to provide State–based health 4
	153	+	insurance subsidies to young adults in the State; 5
	154	+
	155	+	(12) any federal funds received in accordance with § 31–121 of this subtitle 6
	156	+	for the administration of small business tax credits; [and] 7
	157	+
	158	+	(13) ANY FUNDS DESIGNATED BY THE STATE TO PROVIDE 8
	159	+	STATE–BASED HEALTH INSURAN CE SUBSIDIES TO QUAL IFIED RESIDENTS IN T HE 9
	160	+	STATE; AND 10
	161	+
	162	+	(14) any other money from any other source accepted for the benefit of the 11
	163	+	Fund. 12
	164	+
	165	+	(f) (1) The Fund may be used only: 13
	166	+
	167	+	(i) 1. for the operation and administration of the Exchange in 14
	168	+	carrying out the purposes authorized under this subtitle; 15
	169	+
	170	+	2. for the establishment and operation of the State 16
	171	+	Reinsurance Program; and 17
	172	+
	173	+	3. for appropriations to the Health Equity Resource 18
	174	+	Community Reserve Fund under § 20–1407 of the Health – General Article; 19
	175	+
	176	+	(ii) in fiscal years 2021 and 2022, for the Medical Assistance 20
	177	+	Program within the Medical Care Programs Administration of the Maryland Department 21
	178	+	of Health; 22
	179	+
	180	+	(iii) in fiscal year 2022, for the Senior Prescription Drug Assistance 23
	181	+	Program established under Title 15, Subtitle 10 of the Health – General Article; [and] 24
	182	+
	183	+	(iv) for the establishment and operation of the State–Based Young 25
	184	+	Adult Health Insurance Subsidies Pilot Program; AND 26
	185	+
	186	+	(V) FOR THE ESTABLISHMEN T AND OPERATION OF T HE 27
	187	+	QUALIFIED RESIDENT ENROLLMENT PROGRAM. 28
	188	+
	189	+	(2) In each of fiscal years 2023 through 2025, the Governor shall: 29
	190	+
	191	+	(i) transfer $15,000,000 to the Health Equity Resource Community 30
	192	+	Reserve Fund; and 31 HOUSE BILL 588 5
97	193
98	194
99	195
100		-	(i) provide funding for the operation and administration of the 1
101		-	Exchange in carrying out the purposes of the Exchange under this subtitle; 2
	196	+	(ii) include the funds transferred in accordance with item (i) of this 1
	197	+	paragraph in the annual budget bill as an appropriation to the Health Equity Resource 2
	198	+	Community Reserve Fund under § 20–1407 of the Health – General Article. 3
102	199
103		-	(ii) provide funding for the establishment and operation of the State 3
104		-	Reinsurance Program authorized under this subtitle; 4
	200	+	(g) (1) The Board shall maintain separate accounts within the Fund for 4
	201	+	Exchange operations, for the State Reinsurance Program, [and] for the State–Based Young 5
	202	+	Adult Health Insurance Subsidies Pilot Program, AND FOR THE ESTABLIS HMENT AND 6
	203	+	OPERATION OF THE QUALIFIED RESIDENT ENROLLMENT PROGRAM. 7
105	204
106		-	(~~iii~~) ~~provide funding for~~ the ~~Medical Assistance Program and~~ the 5
107		-	~~Senior Prescription Drug Assistance Program;~~ 6
	205	+	(2) Accounts within the Fund shall contain the money that is intended to 8
	206	+	support the purpose for which each account is designated. 9
108	207
109		-	(iv) ~~provide funding for~~ the ~~establishment and operation~~ of ~~Health 7~~
110		-	~~Equity Resource Communities under Title 20, Subtitle 14~~ of the ~~Health – General Article;~~ 8
111		-	[and~~] 9~~
	208	+	(3) Funds received from the distribution of the premium tax under § 10
	209	+	6–103.2 of this article shall be placed in the account for Exchange operations and may be 11
	210	+	used only for the purpose of funding the operation and administration of the Exchange. 12
112	211
113		-	(v) provide funding for the establishment and operation of the 10
114		-	State–Based Young Adult Health Insurance Subsidies Pilot Program authorized under this 11
115		-	subtitle; AND 12
	212	+	(4) The following funds may be used only for the purposes of funding the 13
	213	+	State Reinsurance Program: 14
116	214
117		-	(VI) PROVIDE FUNDING FOR TH E ESTABLISHMENT AND 13
118		-	OPERATION OF THE QUALIFIED RESIDENT ENROLLMENT PROGRAM. 14
	215	+	(i) any pass–through funds received from the federal government 15
	216	+	under a waiver approved under § 1332 of the Affordable Care Act to provide reinsurance to 16
	217	+	carriers that offer individual health benefit plans in the State; 17
119	218
120		-	(2) The operation and administration of the Exchange, the State 15
121		-	Reinsurance Program, [and] the State–Based Young Adult Health Insurance Subsidies 16
122		-	Pilot Program, AND THE QUALIFIED RESIDENT ENROLLMENT PROGRAM may include 17
123		-	functions delegated by the Exchange to a third party under law or by contract. 18
	219	+	(ii) any funds designated by the federal government to provide 18
	220	+	reinsurance to carriers that offer individual health benefit plans in the State; 19
124	221
125		-	(c) The Exchange shall administer the Fund. 19
	222	+	(iii) any funds designated by the State to provide reinsurance to 20
	223	+	carriers that offer individual health benefit plans in the State; and 21
126	224
127		-	(d) (1) ~~The Fund is a special, nonlapsing fund that is not subject to § 7–302~~ of 20
128		-	the ~~State Finance and Procurement~~ Article. 21
	225	+	(iv) except as provided in subsection (f) of this section, funds received 22
	226	+	from the distribution of the assessment under § 6–102.1 of this article. 23
129	227
130		-	(2) ~~The State Treasurer shall hold~~ the Fund ~~separately, and~~ the 22
131		-	~~Comptroller shall account for the Fund.~~ 23
	228	+	(h) (1) Expenditures from the Fund for the purposes authorized by this 24
	229	+	subtitle may be made only: 25
132	230
133		-	(e) The Fund consists of: 24
	231	+	(i) with an appropriation from the Fund approved by the General 26
	232	+	Assembly in the State budget; or 27
134	233
135		-	(1) any user fees or other assessments collected by the Exchange; 25
	234	+	(ii) by the budget amendment procedure provided for in Title 7, 28
	235	+	Subtitle 2 of the State Finance and Procurement Article. 29
136	236
137		-	(2) all revenue deposited into the Fund that is received from the 26
138		-	distribution of the premium tax under § 6–103.2 of this article; 27
139		-
140		-	(3) income from investments made on behalf of the Fund; 28
141		-
142		-	(4) interest on deposits or investments of money in the Fund; 29
143		-	4 HOUSE BILL 588
	237	+	(2) Notwithstanding § 7–304 of the State Finance and Procurement Article, 30
	238	+	if the amount of the distribution from the premium tax under § 6–103.2 of this article 31
	239	+	exceeds in any State fiscal year the actual expenditures incurred for the operation and 32
	240	+	administration of the Exchange, funds in the Exchange operations account from the 33
	241	+	premium tax that remain unspent at the end of the State fiscal year shall revert to the 34 6 HOUSE BILL 588
144	242
145	243
146		-	(5) money collected by the Board as a result of legal or other actions taken 1
147		-	by the Board on behalf of the Exchange or the Fund; 2
	244	+	General Fund of the State. 1
148	245
149		-	(6) money donated to the Fund; 3
	246	+	(3) If operating expenses of the Exchange may be charged to either State 2
	247	+	or non–State fund sources, the non–State funds shall be charged before State funds are 3
	248	+	charged. 4
150	249
151		-	(7) money awarded to the Fund through grants; 4
	250	+	(i) (1) The State Treasurer shall invest the money of the Fund in the same 5
	251	+	manner as other State money may be invested. 6
152	252
153		-	(8) any pass–through funds received from the federal government under a 5
154		-	waiver approved under § 1332 of the Affordable Care Act; 6
	253	+	(2) Any investment earnings of the Fund shall be credited to the Fund. 7
155	254
156		-	(9) ~~any funds designated by~~ the ~~federal government to provide reinsurance 7~~
157		-	to ~~carriers that offer individual health benefit plans in~~ the State~~; 8~~
	255	+	(3) Except as provided in subsection (h)(2) of this section, no part of the 8
	256	+	Fund may revert or be credited to the General Fund or any special fund of the State. 9
158	257
159		-	(10) ~~any funds designated by~~ the State ~~to provide reinsurance to carriers 9~~
160		-	~~that offer individual health benefit plans in~~ the State~~; 10~~
	258	+	(j) A debt or an obligation of the Fund is not a debt of the State or a pledge of 10
	259	+	credit of the State. 11
161	260
162		-	(11) any funds designated by the State to provide State–based health 11
163		-	insurance subsidies to young adults in the State; 12
	261	+	31–108. 12
164	262
165		-	(12) any federal funds received in accordance with § 31–121 of this subtitle 13
166		-	for the administration of small business tax credits; [and] 14
	263	+	(a) On or before January 1, 2014, the functions and operations of the Exchange 13
	264	+	shall include at a minimum all functions required by § 1311(d)(4) of the Affordable Care 14
	265	+	Act. 15
167	266
168		-	(13) ANY FUNDS DESIGNATED BY THE STATE TO PROVIDE 15
169		-	STATE–BASED HEALTH INSURAN CE SUBSIDIES TO QUAL IFIED RESIDENTS IN T HE 16
170		-	STATE; AND 17
	267	+	(b) In compliance with § 1311(d)(4) of the Affordable Care Act, the Exchange 16
	268	+	shall: 17
171	269
172		-	(14) ~~any other money from any other source accepted for the benefit of the~~ 18
173		-	~~Fund.~~ 19
	270	+	(1) make qualified plans available to qualified individuals, QUALIFIED 18
	271	+	RESIDENTS, and qualified employers; 19
174	272
175		-	~~(f) (1) The Fund may be used only:~~ 20
	273	+	31–115. 20
176	274
177		-	(i) 1. for the operation and administration of the Exchange in 21
178		-	carrying out the purposes authorized under this subtitle; 22
	275	+	(b) To be certified as a qualified health plan, a health benefit plan shall: 21
179	276
180		-	~~2. for~~ the ~~establishment~~ and ~~operation of the State 23~~
181		-	~~Reinsurance Program~~; ~~and 24~~
	277	+	(7) be in the interest of qualified individuals, QUALIFIED RESIDENTS , and 22
	278	+	qualified employers, as determined by the Exchange; 23
182	279
183		-	3. for appropriations to the Health Equity Resource 25
184		-	Community Reserve Fund under § 20–1407 of the Health – General Article; 26
	280	+	31–123. 24
185	281
186		-	(ii) in fiscal years 2021 and 2022, for the Medical Assistance 27
187		-	Program within the Medical Care Programs Administration of the Maryland Department 28
188		-	of Health; 29
	282	+	(A) ON OR BEFORE JULY 1, 2024, THE EXCHANGE, IN CONSULTATION WITH 25
	283	+	THE COMMISSIONER AND AS A PPROVED BY THE BOARD, SHALL SUBMIT A STATE 26
	284	+	INNOVATION WAIVER APPLICATION AM ENDMENT UNDER § 1332 OF THE 27
	285	+	AFFORDABLE CARE ACT TO ESTABLISH A QUALIFIED RESIDENT ENROLLMENT 28
	286	+	PROGRAM AND SEEK FEDE RAL PASS–THROUGH FUNDING TO A LLOW QUALIFIED 29
	287	+	RESIDENTS TO OBTAIN COVERAGE THROUGH THE EXCHANGE. 30
189	288
190		-	(iii) in fiscal year 2022, for the Senior Prescription Drug Assistance 30
191		-	Program established under Title 15, Subtitle 10 of the Health – General Article; [and] 31 HOUSE BILL 588 5
	289	+	(B) ON OR BEFORE DECEMBER 31, 2024, THE COMMISSIONER MAY WAIV E 31 HOUSE BILL 588 7
	290	+
	291	+
	292	+	ANY NOTIFICATION OR OTHER REQUIREMENTS T HAT APPLY TO A CARRI ER UNDER 1
	293	+	THIS ARTICLE IN CALENDAR YE AR 2024 DUE TO THE IMPLEMENT ATION OF A WAIVER 2
	294	+	APPROVED UNDER § 1332 OF THE AFFORDABLE CARE ACT. 3
	295	+
	296	+	31–124. 4
	297	+
	298	+	(A) THE EXCHANGE, IN CONSULTATION WITH THE COMMISSIONER AND AS 5
	299	+	APPROVED BY THE BOARD, SHALL ESTABLISH AND IMPLEMENT A QUALIFIED 6
	300	+	RESIDENT ENROLLMENT PROGRAM: 7
	301	+
	302	+	(1) TO FACILITATE THE EN ROLLMENT OF QUALIFIE D RESIDENTS IN 8
	303	+	QUALIFIED HEALTH PLA NS; 9
	304	+
	305	+	(2) BASED ON THE AVAILAB ILITY OF FUNDS , TO PROVIDE STATE 10
	306	+	PREMIUM ASSISTANCE A ND COST–SHARING REDUCTIONS T O QUALIFIED RESIDENT S 11
	307	+	ENROLLED IN QUALIFIED HEALTH P LANS; 12
	308	+
	309	+	(3) THAT MEETS THE REQUI REMENTS OF A WAIVER APPROVED 13
	310	+	UNDER § 1332 OF THE AFFORDABLE CARE ACT; AND 14
	311	+
	312	+	(4) THAT IS CONSISTENT W ITH FEDERAL AND STATE LAW. 15
	313	+
	314	+	(B) THE QUALIFIED RESIDENT ENROLLMENT PROGRAM SHALL BE 16
	315	+	DESIGNED TO MAKE INDIVIDUAL MARKET HE ALTH INSURANCE COVER AGE OFFERED 17
	316	+	THROUGH THE EXCHANGE AVAILABLE TO QUALIFIED RESIDENTS . 18
	317	+
	318	+	(C) BASED ON THE AVAILABI LITY OF FUNDS , THE EXCHANGE, IN 19
	319	+	CONSULTATION WITH TH E COMMISSIONER AND AS A PPROVED BY THE BOARD, 20
	320	+	SHALL ESTABLISH SUBS IDY ELIGIBILITY AND PAYM ENT PARAMETERS FOR 21
	321	+	CALENDAR YEAR 2025 AND EACH SUBSEQUENT CALENDAR YEAR . 22
	322	+
	323	+	(D) BEGINNING JANUARY 1, 2025, FUNDING FOR THE QUALIFIED 23
	324	+	RESIDENT ENROLLMENT PROGRAM MAY BE MADE U SING: 24
	325	+
	326	+	(1) ANY PASS–THROUGH FUNDS RECEIV ED FROM THE FEDERAL 25
	327	+	GOVERNMENT UNDER A W AIVER APPROVED UNDER § 1332 OF THE AFFORDABLE 26
	328	+	CARE ACT; 27
	329	+
	330	+	(2) ANY FUNDS DESIGNATED BY THE FEDERAL GOVER NMENT TO 28
	331	+	PROVIDE HEALTH COVER AGE FOR QUALIFIED RE SIDENTS; AND 29
	332	+
	333	+	(3) ANY FUNDS DESIGNATED BY THE STATE TO PROVIDE HEAL TH 30
	334	+	COVERAGE FO R QUALIFIED RESIDENT S. 31 8 HOUSE BILL 588
192	335
193	336
194	337
195		-	(iv) for the establishment and operation of the State–Based Young 1
196		-	Adult Health Insurance Subsidies Pilot Program; AND 2
	338	+	(E) THE IMPLEMENTATION OF THE QUALIFIED RESIDENT ENROLLMENT 1
	339	+	PROGRAM SHALL BE CONT INGENT ON APPROVAL F ROM THE U.S. SECRETARY OF 2
	340	+	HEALTH AND HUMAN SERVICES AND THE U.S. SECRETARY OF THE TREASURY OF A 3
	341	+	STATE INNOVATION WAIVER APPLICATI ON AMENDMENT UNDER § 1332 OF THE 4
	342	+	AFFORDABLE CARE ACT. 5
197	343
198		-	(V) ~~FOR~~ THE ~~ESTABLISHMEN T AND OPERATION OF T HE 3~~
199		-	~~QUALIFIED RESIDENT ENROLLMENT PROGRAM~~. 4
	344	+	(F) ON OR BEFORE JANUARY 1, 2025, THE EXCHANGE SHALL ADOPT 6
	345	+	REGULATIONS TO CARRY OUT THIS SECTION . 7
200	346
201		-	(2) In each of fiscal years 2023 through 2025, the Governor shall: 5
	347	+	SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect 8
	348	+	October 1, 2023. 9
202	349
203		-	(i) transfer $15,000,000 to the Health Equity Resource Community 6
204		-	Reserve Fund; and 7
205		-
206		-	(ii) include the funds transferred in accordance with item (i) of this 8
207		-	paragraph in the annual budget bill as an appropriation to the Health Equity Resource 9
208		-	Community Reserve Fund under § 20–1407 of the Health – General Article. 10
209		-
210		-	(g) (1) The Board shall maintain separate accounts within the Fund for 11
211		-	Exchange operations, for the State Reinsurance Program, [and] for the State–Based Young 12
212		-	Adult Health Insurance Subsidies Pilot Program, AND FOR THE ESTABLIS HMENT AND 13
213		-	OPERATION OF THE QUALIFIED RESIDENT ENROLLMENT PROGRAM. 14
214		-
215		-	(2) Accounts within the Fund shall contain the money that is intended to 15
216		-	support the purpose for which each account is designated. 16
217		-
218		-	(3) Funds received from the distribution of the premium tax under § 17
219		-	6–103.2 of this article shall be placed in the account for Exchange operations and may be 18
220		-	used only for the purpose of funding the operation and administration of the Exchange. 19
221		-
222		-	(4) The following funds may be used only for the purposes of funding the 20
223		-	State Reinsurance Program: 21
224		-
225		-	(i) EXCEPT AS PROVIDED I N PARAGRAPH (5) OF THIS 22
226		-	SUBSECTION, any pass–through funds received from the federal government under a 23
227		-	waiver approved under § 1332 of the Affordable Care Act to provide reinsurance to carriers 24
228		-	that offer individual health benefit plans in the State; 25
229		-
230		-	(ii) any funds designated by the federal government to provide 26
231		-	reinsurance to carriers that offer individual health benefit plans in the State; 27
232		-
233		-	(iii) any funds designated by the State to provide reinsurance to 28
234		-	carriers that offer individual health benefit plans in the State; and 29
235		-
236		-	(iv) except as provided in subsection (f) of this section, funds received 30
237		-	from the distribution of the assessment under § 6–102.1 of this article. 31
238		-	6 HOUSE BILL 588
239		-
240		-
241		-	(5) IF THE FEDERAL GOVERN MENT APPROVES AN AME NDMENT TO 1
242		-	THE STATE’S § 1332 WAIVER OF THE AFFORDABLE CARE ACT TO INCLUDE ANY 2
243		-	PROGRAM IN ADDITION TO THE STATE REINSURANCE PROGRAM, ANY FEDERAL 3
244		-	PASS–THROUGH FUNDS MAY BE USED FOR THE ADDITIO NAL PROGRAM AS 4
245		-	APPROVED UNDER THE A MENDED § 1332 WAIVER. 5
246		-
247		-	(h) (1) Expenditures from the Fund for the purposes authorized by this 6
248		-	subtitle may be made only: 7
249		-
250		-	(i) with an appropriation from the Fund approved by the General 8
251		-	Assembly in the State budget; or 9
252		-
253		-	(ii) by the budget amendment procedure provided for in Title 7, 10
254		-	Subtitle 2 of the State Finance and Procurement Article. 11
255		-
256		-	(2) Notwithstanding § 7–304 of the State Finance and Procurement Article, 12
257		-	if the amount of the distribution from the premium tax under § 6–103.2 of this article 13
258		-	exceeds in any State fiscal year the actual expenditures incurred for the operation and 14
259		-	administration of the Exchange, funds in the Exchange operations account from the 15
260		-	premium tax that remain unspent at the end of the State fiscal year shall revert to the 16
261		-	General Fund of the State. 17
262		-
263		-	(3) If operating expenses of the Exchange may be charged to either State 18
264		-	or non–State fund sources, the non–State funds shall be charged before State funds are 19
265		-	charged. 20
266		-
267		-	(i) (1) The State Treasurer shall invest the money of the Fund in the same 21
268		-	manner as other State money may be invested. 22
269		-
270		-	(2) Any investment earnings of the Fund shall be credited to the Fund. 23
271		-
272		-	(3) Except as provided in subsection (h)(2) of this section, no part of the 24
273		-	Fund may revert or be credited to the General Fund or any special fund of the State. 25
274		-
275		-	(j) A debt or an obligation of the Fund is not a debt of the State or a pledge of 26
276		-	credit of the State. 27
277		-
278		-	31–108. 28
279		-
280		-	(a) On or before January 1, 2014, the functions and operations of the Exchange 29
281		-	shall include at a minimum all functions required by § 1311(d)(4) of the Affordable Care 30
282		-	Act. 31
283		-
284		-	(b) In compliance with § 1311(d)(4) of the Affordable Care Act, the Exchange 32
285		-	shall: 33
286		-	HOUSE BILL 588 7
287		-
288		-
289		-	(1) make qualified plans available to qualified individuals, QUALIFIED 1
290		-	RESIDENTS, and qualified employers; 2
291		-
292		-	31–115. 3
293		-
294		-	(b) To be certified as a qualified health plan, a health benefit plan shall: 4
295		-
296		-	(7) be in the interest of qualified individuals, QUALIFIED RESIDENTS , and 5
297		-	qualified employers, as determined by the Exchange; 6
298		-
299		-	31–123. 7
300		-
301		-	(A) ON OR BEFORE JULY 1, 2024, THE EXCHANGE, IN CONSULTATION WITH 8
302		-	THE COMMISSIONER AND AS APPROVED BY THE BOARD, SHALL SUBMIT A STATE 9
303		-	INNOVATION WAIVER APPLICATION AM ENDMENT UNDER § 1332 OF THE 10
304		-	AFFORDABLE CARE ACT TO ESTABLISH A QUALIFIED RESIDENT ENROLLMENT 11
305		-	PROGRAM AND SEEK FEDE RAL PASS–THROUGH FUNDING TO A LLOW QUALIFIED 12
306		-	RESIDENTS TO OBTAIN COVERAGE THROUGH THE EXCHANGE. 13
307		-
308		-	(B) ON OR BEFORE DECEMBER 31, 2024, THE COMMISSIONER MAY WAIV E 14
309		-	ANY NOTIFICATION OR OTHER REQUIREMENTS T HAT APPLY TO A CARRI ER UNDER 15
310		-	THIS ARTICLE IN CALE NDAR YEAR 2024 DUE TO THE IMPLEMENT ATION OF A WAIVER 16
311		-	APPROVED UNDER § 1332 OF THE AFFORDABLE CARE ACT. 17
312		-
313		-	31–124. 18
314		-
315		-	(A) THE EXCHANGE, IN CONSULTATION WITH THE COMMISSIONER AND AS 19
316		-	APPROVED BY THE BOARD, SHALL ESTABLISH AND IMPLEMENT A QUALIFIED 20
317		-	RESIDENT ENROLLMENT PROGRAM: 21
318		-
319		-	(1) TO FACILITATE THE EN ROLLMENT OF QUALIFIE D RESIDENTS IN 22
320		-	QUALIFIED HEALTH PLANS; 23
321		-
322		-	(2) BASED ON THE AVAILAB ILITY OF FUNDS , TO PROVIDE STATE 24
323		-	PREMIUM ASSISTANCE A ND COST–SHARING REDUCTIONS T O QUALIFIED RESIDENT S 25
324		-	ENROLLED IN QUALIFIE D HEALTH PLANS ; 26
325		-
326		-	(3) THAT, AS NECESSARY , MEETS THE REQUIREMEN TS OF A WAIVER 27
327		-	APPROVED UNDER § 1332 OF THE AFFORDABLE CARE ACT; AND 28
328		-
329		-	(4) THAT IS CONSISTENT W ITH FEDERAL AND STATE LAW. 29
330		-
331		-	(B) THE QUALIFIED RESIDENT ENROLLMENT PROGRAM SHALL BE 30
332		-	DESIGNED TO MAKE IND IVIDUAL MARKET HEALTH INSURANCE COVERAGE O FFERED 31
333		-	THROUGH THE EXCHANGE AVAILABLE TO QUALIFIED RESIDENTS . 32 8 HOUSE BILL 588
334		-
335		-
336		-
337		-	(C) BASED ON THE AVAILABI LITY OF FUNDS, AND SUBJECT TO SUBSE CTION 1
338		-	(E) OF THIS SECTION, THE EXCHANGE, IN CONSULTATION WITH THE COMMISSIONER 2
339		-	AND AS APPROVED BY T HE BOARD, SHALL ESTABLISH SUBS IDY ELIGIBILITY AND 3
340		-	PAYMENT PARAMETERS F OR CALENDAR YEAR 2025 AND EACH SUBSEQUENT 4
341		-	CALENDAR YEAR . 5
342		-
343		-	(D) BEGINNING JANUARY 1, 2025, FUNDING FOR THE QUALIFIED 6
344		-	RESIDENT ENROLLMENT PROGRAM MAY BE MADE U SING: 7
345		-
346		-	(1) ANY PASS–THROUGH FUNDS RECEIVED FROM THE FE DERAL 8
347		-	GOVERNMENT UNDER A W AIVER APPROVED UNDER § 1332 OF THE AFFORDABLE 9
348		-	CARE ACT; 10
349		-
350		-	(2) ANY FUNDS DESIGNATED BY THE FEDERAL GOVER NMENT TO 11
351		-	PROVIDE HEALTH COVER AGE FOR QUALIFIED RE SIDENTS; AND 12
352		-
353		-	(3) ANY FUNDS DESIGNATED BY THE STATE TO PROVIDE HEALTH 13
354		-	COVERAGE FOR QUALIFI ED RESIDENTS. 14
355		-
356		-	(E) (1) THE IMPLEMENTATION OF SUBSIDIES UNDER THE QUALIFIED 15
357		-	RESIDENT ENROLLMENT PROGRAM SHALL BE CONT INGENT ON APPROVAL F ROM 16
358		-	THE U.S. SECRETARY OF HEALTH AND HUMAN SERVICES AND THE U.S. 17
359		-	SECRETARY OF THE TREASURY OF A STATE INNOVATION WAIVER APPLICATION 18
360		-	AMENDMENT UNDER § 1332 OF THE AFFORDABLE CARE ACT. 19
361		-
362		-	(2) WITHIN 6 MONTHS BEFORE A FISC AL YEAR IN WHICH THE 20
363		-	EXCHANGE IMPLEMENTS S UBSIDIES UNDER THE QUALIFIED RESIDENT 21
364		-	ENROLLMENT PROGRAM, THE EXCHANGE SHALL SUBMIT A REPORT TO T HE 22
365		-	GENERAL ASSEMBLY, IN ACCORDANCE WITH § 2–1257 OF THE STATE GOVERNMENT 23
366		-	ARTICLE, ON ITS PLAN TO IMPLE MENT THE SUBSIDIES , INCLUDING: 24
367		-
368		-	(I) THE AMOUNT AND SOURC E OF THE FUNDING ; 25
369		-
370		-	(II) THE PARAMETERS OF TH E SUBSIDIES; AND 26
371		-
372		-	(III) THE NUMBER OF INDIVID UALS ANTICIPATED TO BE 27
373		-	ELIGIBLE FOR THE SUB SIDIES. 28
374		-
375		-	(F) ON OR BEFORE JANUARY 1, 2025, THE EXCHANGE SHALL ADOPT 29
376		-	REGULATIONS TO CARRY OUT THIS SECTION . 30
377		-
378		-	SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect 31
379		-	October 1, 2023. 32 HOUSE BILL 588 9
380		-
381		-
382		-
383		-
384		-
385		-
386		-	Approved:
387		-	________________________________________________________________________________
388		-	Governor.
389		-	________________________________________________________________________________
390		-	Speaker of the House of Delegates.
391		-	________________________________________________________________________________
392		-	President of the Senate.