Maryland 2023 Regular Session

Maryland Senate Bill SB365 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	sb0365
6	6
7	7	SENATE BILL 365
8	8	J5 3lr0531
9	9	SB 728/22 – FIN CF 3lr1153
10	10	By: Senator Lam
11	11	Introduced and read first time: January 31, 2023
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 Enrollment Program 2
19	19	(Access to Care Act) 3
20	20
21	21	FOR the purpose of altering the purpose for 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 Enrollment Program; requiring the Maryland Health Benefit 6
24	24	Exchange to make qualified plans available to qualified residents; requiring the 7
25	25	Maryland Health Benefit Exchange to establish and implement the Qualified 8
26	26	Resident Enrollment Program to allow qualified residents to obtain coverage, 9
27	27	facilitate the enrollment of qualified residents in qualified health plans, and, based 10
28	28	on the availability of funds, provide premium assistance and cost–sharing reductions 11
29	29	to qualified residents; providing that the implementation of the Program is 12
30	30	contingent on approval of a certain waiver application amendment; and generally 13
31	31	relating to the Qualified Resident Enrollment Program. 14
32	32
33	33	BY repealing and reenacting, without amendments, 15
34	34	Article – Insurance 16
35	35	Section 31–101(a) and 31–108(a) 17
36	36	Annotated Code of Maryland 18
37	37	(2017 Replacement Volume and 2022 Supplement) 19
38	38
39	39	BY adding to 20
40	40	Article – Insurance 21
41	41	Section 31–101(u–1), 31–123, and 31–124 22
42	42	Annotated Code of Maryland 23
43	43	(2017 Replacement Volume and 2022 Supplement) 24
44	44
45	45	BY repealing and reenacting, with amendments, 25
46	46	Article – Insurance 26
47	47	Section 31–107, 31–108(b)(1), and 31–115(b)(7) 27
48	48	Annotated Code of Maryland 28 2 SENATE BILL 365
49	49
50	50
51	51	(2017 Replacement Volume and 2022 Supplement) 1
52	52
53	53	SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 2
54	54	That the Laws of Maryland read as follows: 3
55	55
56	56	Article – Insurance 4
57	57
58	58	31–101. 5
59	59
60	60	(a) In this subtitle the following words have the meanings indicated. 6
61	61
62	62	(U–1) “QUALIFIED RESIDENT ” MEANS AN INDIVIDUAL , INCLUDING A MINOR , 7
63	63	REGARDLESS OF IMMIGR ATION STATUS, WHO AT THE TIME OF E NROLLMENT : 8
64	64
65	65	(1) IS SEEKING TO ENROLL IN A QUALIFIED HEALT H PLAN OFFERED 9
66	66	TO INDIVIDUALS THROU GH THE EXCHANGE; 10
67	67
68	68	(2) RESIDES IN THE STATE; 11
69	69
70	70	(3) IS NOT INCARCERATED , OTHER THAN INCARCERA TION PENDING 12
71	71	DISPOSITION OF CHARG ES; AND 13
72	72
73	73	(4) IS NOT ELIGIBLE FOR THE FEDERAL PREMIUM TAX CREDIT, THE 14
74	74	MARYLAND MEDICAL ASSISTANCE PROGRAM, MEDICARE, THE MARYLAND 15
75	75	CHILDREN’S HEALTH PLAN, OR EMPLOYER –SPONSORED MINIMUM ESSENTI AL 16
76	76	COVERAGE. 17
77	77
78	78	31–107. 18
79	79
80	80	(a) There is a Maryland Health Benefit Exchange Fund. 19
81	81
82	82	(b) (1) The purpose of the Fund is to: 20
83	83
84	84	(i) provide funding for the operation and administration of the 21
85	85	Exchange in carrying out the purposes of the Exchange under this subtitle; 22
86	86
87	87	(ii) provide funding for the establishment and operation of the State 23
88	88	Reinsurance Program authorized under this subtitle; 24
89	89
90	90	(iii) provide funding for the Medical Assistance Program and the 25
91	91	Senior Prescription Drug Assistance Program; 26
92	92
93	93	(iv) provide funding for the establishment and operation of Health 27
94	94	Equity Resource Communities under Title 20, Subtitle 14 of the Health – General Article; 28
95	95	[and] 29
96	96	SENATE BILL 365 3
97	97
98	98
99	99	(v) provide funding for the establishment and operation of the 1
100	100	State–Based Young Adult Health Insurance Subsidies Pilot Program authorized under this 2
101	101	subtitle; AND 3
102	102
103	103	(VI) PROVIDE FUNDING FOR THE ESTABLISHMENT AN D 4
104	104	OPERATION OF THE QUALIFIED RESIDENT ENROLLMENT PROGRAM. 5
105	105
106	106	(2) The operation and administration of the Exchange, the State 6
107	107	Reinsurance Program, [and] the State–Based Young Adult Health Insurance Subsidies 7
108	108	Pilot Program, AND THE QUALIFIED RESIDENT ENROLLMENT PROGRAM may include 8
109	109	functions delegated by the Exchange to a third party under law or by contract. 9
110	110
111	111	(c) The Exchange shall administer the Fund. 10
112	112
113	113	(d) (1) The Fund is a special, nonlapsing fund that is not subject to § 7–302 of 11
114	114	the State Finance and Procurement Article. 12
115	115
116	116	(2) The State Treasurer shall hold the Fund separately, and the 13
117	117	Comptroller shall account for the Fund. 14
118	118
119	119	(e) The Fund consists of: 15
120	120
121	121	(1) any user fees or other assessments collected by the Exchange; 16
122	122
123	123	(2) all revenue deposited into the Fund that is received from the 17
124	124	distribution of the premium tax under § 6–103.2 of this article; 18
125	125
126	126	(3) income from investments made on behalf of the Fund; 19
127	127
128	128	(4) interest on deposits or investments of money in the Fund; 20
129	129
130	130	(5) money collected by the Board as a result of legal or other actions taken 21
131	131	by the Board on behalf of the Exchange or the Fund; 22
132	132
133	133	(6) money donated to the Fund; 23
134	134
135	135	(7) money awarded to the Fund through grants; 24
136	136
137	137	(8) any pass–through funds received from the federal government under a 25
138	138	waiver approved under § 1332 of the Affordable Care Act; 26
139	139
140	140	(9) any funds designated by the federal government to provide reinsurance 27
141	141	to carriers that offer individual health benefit plans in the State; 28
142	142
143	143	(10) any funds designated by the State to provide reinsurance to carriers 29
144	144	that offer individual health benefit plans in the State; 30 4 SENATE BILL 365
145	145
146	146
147	147
148	148	(11) any funds designated by the State to provide State–based health 1
149	149	insurance subsidies to young adults in the State; 2
150	150
151	151	(12) any federal funds received in accordance with § 31–121 of this subtitle 3
152	152	for the administration of small business tax credits; [and] 4
153	153
154	154	(13) ANY FUNDS DESIGNATED BY THE STATE TO PROVIDE 5
155	155	STATE–BASED HEALTH INSURANCE SUBSIDIES TO QUALIFI ED RESIDENTS IN THE 6
156	156	STATE; AND 7
157	157
158	158	(14) any other money from any other source accepted for the benefit of the 8
159	159	Fund. 9
160	160
161	161	(f) (1) The Fund may be used only: 10
162	162
163	163	(i) 1. for the operation and administration of the Exchange in 11
164	164	carrying out the purposes authorized under this subtitle; 12
165	165
166	166	2. for the establishment and operation of the State 13
167	167	Reinsurance Program; and 14
168	168
169	169	3. for appropriations to the Health Equity Resource 15
170	170	Community Reserve Fund under § 20–1407 of the Health – General Article; 16
171	171
172	172	(ii) in fiscal years 2021 and 2022, for the Medical Assistance 17
173	173	Program within the Medical Care Programs Administration of the Maryland Department 18
174	174	of Health; 19
175	175
176	176	(iii) in fiscal year 2022, for the Senior Prescription Drug Assistance 20
177	177	Program established under Title 15, Subtitle 10 of the Health – General Article; [and] 21
178	178
179	179	(iv) for the establishment and operation of the State–Based Young 22
180	180	Adult Health Insurance Subsidies Pilot Program; AND 23
181	181
182	182	(V) FOR THE ESTABLISHMEN T AND OPERATION OF T HE 24
183	183	QUALIFIED RESIDENT ENROLLMENT PROGRAM. 25
184	184
185	185	(2) In each of fiscal years 2023 through 2025, the Governor shall: 26
186	186
187	187	(i) transfer $15,000,000 to the Health Equity Resource Community 27
188	188	Reserve Fund; and 28
189	189
190	190	(ii) include the funds transferred in accordance with item (i) of this 29
191	191	paragraph in the annual budget bill as an appropriation to the Health Equity Resource 30
192	192	Community Reserve Fund under § 20–1407 of the Health – General Article. 31 SENATE BILL 365 5
193	193
194	194
195	195
196	196	(g) (1) The Board shall maintain separate accounts within the Fund for 1
197	197	Exchange operations, for the State Reinsurance Program, [and] for the State–Based Young 2
198	198	Adult Health Insurance Subsidies Pilot Program, AND FOR THE ESTABLIS HMENT AND 3
199	199	OPERATION OF THE QUALIFIED RESIDENT ENROLLMENT PROGRAM. 4
200	200
201	201	(2) Accounts within the Fund shall contain the money that is intended to 5
202	202	support the purpose for which each account is designated. 6
203	203
204	204	(3) Funds received from the distribution of the premium tax under § 7
205	205	6–103.2 of this article shall be placed in the account for Exchange operations and may be 8
206	206	used only for the purpose of funding the operation and administration of the Exchange. 9
207	207
208	208	(4) The following funds may be used only for the purposes of funding the 10
209	209	State Reinsurance Program: 11
210	210
211	211	(i) any pass–through funds received from the federal government 12
212	212	under a waiver approved under § 1332 of the Affordable Care Act to provide reinsurance to 13
213	213	carriers that offer individual health benefit plans in the State; 14
214	214
215	215	(ii) any funds designated by the federal government to provide 15
216	216	reinsurance to carriers that offer individual health benefit plans in the State; 16
217	217
218	218	(iii) any funds designated by the State to provide reinsurance to 17
219	219	carriers that offer individual health benefit plans in the State; and 18
220	220
221	221	(iv) except as provided in subsection (f) of this section, funds received 19
222	222	from the distribution of the assessment under § 6–102.1 of this article. 20
223	223
224	224	(h) (1) Expenditures from the Fund for the purposes authorized by this 21
225	225	subtitle may be made only: 22
226	226
227	227	(i) with an appropriation from the Fund approved by the General 23
228	228	Assembly in the State budget; or 24
229	229
230	230	(ii) by the budget amendment procedure provided for in Title 7, 25
231	231	Subtitle 2 of the State Finance and Procurement Article. 26
232	232
233	233	(2) Notwithstanding § 7–304 of the State Finance and Procurement Article, 27
234	234	if the amount of the distribution from the premium tax under § 6–103.2 of this article 28
235	235	exceeds in any State fiscal year the actual expenditures incurred for the operation and 29
236	236	administration of the Exchange, funds in the Exchange operations account from the 30
237	237	premium tax that remain unspent at the end of the State fiscal year shall revert to the 31
238	238	General Fund of the State. 32
239	239
240	240	(3) If operating expenses of the Exchange may be charged to either State 33
241	241	or non–State fund sources, the non–State funds shall be charged before State funds are 34 6 SENATE BILL 365
242	242
243	243
244	244	charged. 1
245	245
246	246	(i) (1) The State Treasurer shall invest the money of the Fund in the same 2
247	247	manner as other State money may be invested. 3
248	248
249	249	(2) Any investment earnings of the Fund shall be credited to the Fund. 4
250	250
251	251	(3) Except as provided in subsection (h)(2) of this section, no part of the 5
252	252	Fund may revert or be credited to the General Fund or any special fund of the State. 6
253	253
254	254	(j) A debt or an obligation of the Fund is not a debt of the State or a pledge of 7
255	255	credit of the State. 8
256	256
257	257	31–108. 9
258	258
259	259	(a) On or before January 1, 2014, the functions and operations of the Exchange 10
260	260	shall include at a minimum all functions required by § 1311(d)(4) of the Affordable Care 11
261	261	Act. 12
262	262
263	263	(b) In compliance with § 1311(d)(4) of the Affordable Care Act, the Exchange 13
264	264	shall: 14
265	265
266	266	(1) make qualified plans available to qualified individuals, QUALIFIED 15
267	267	RESIDENTS, and qualified employers; 16
268	268
269	269	31–115. 17
270	270
271	271	(b) To be certified as a qualified health plan, a health benefit plan shall: 18
272	272
273	273	(7) be in the interest of qualified individuals, QUALIFIED RESIDENTS , and 19
274	274	qualified employers, as determined by the Exchange; 20
275	275
276	276	31–123. 21
277	277
278	278	(A) ON OR BEFORE JULY 1, 2024, THE EXCHANGE, IN CONSULTATION WITH 22
279	279	THE COMMISSIONER AND AS A PPROVED BY THE BOARD, SHALL SUBMIT A STATE 23
280	280	INNOVATION WAIVER APPLICATION AMENDMENT UNDER § 1332 OF THE 24
281	281	AFFORDABLE CARE ACT TO ESTABLISH A QUALIFIED RESIDENT ENROLLMENT 25
282	282	PROGRAM AND SEEK FEDERAL PAS S–THROUGH FUNDING TO ALLOW QUALIFIED 26
283	283	RESIDENTS TO OBTAIN COVERAGE THROU GH THE EXCHANGE. 27
284	284
285	285	(B) ON OR BEFORE DECEMBER 31, 2024, THE COMMISSIONER MAY WAIV E 28
286	286	ANY NOTIFICATION OR OTHER REQUIREMENTS T HAT APPLY TO A CARRI ER UNDER 29
287	287	THIS ARTICLE IN CALE NDAR YEAR 2024 DUE TO THE IMPLEMENT ATION OF A WAIVER 30
288	288	APPROVED UNDER § 1332 OF THE AFFORDABLE CARE ACT. 31
289	289	SENATE BILL 365 7
290	290
291	291
292	292	31–124. 1
293	293
294	294	(A) THE EXCHANGE, IN CONSULTATION WITH THE COMMISSIONER AND AS 2
295	295	APPROVED BY THE BOARD, SHALL ESTABLISH AND IMPLEMENT A QUALIFIED 3
296	296	RESIDENT ENROLLMENT PROGRAM: 4
297	297
298	298	(1) TO FACILITATE THE ENROL LMENT OF QUALIFIED RESIDENTS IN 5
299	299	QUALIFIED HEALTH PLANS ; 6
300	300
301	301	(2) BASED ON THE AVAILAB ILITY OF FUNDS , TO PROVIDE STATE 7
302	302	PREMIUM ASSISTANCE A ND COST–SHARING REDUCTIONS T O QUALIFIED RESIDENT S 8
303	303	ENROLLED IN QUALIFIE D HEALTH PLANS ; 9
304	304
305	305	(3) THAT MEETS THE REQUI REMENTS OF A WAIVER APPROVED 10
306	306	UNDER § 1332 OF THE AFFORDABLE CARE ACT; AND 11
307	307
308	308	(4) THAT IS CONSISTENT W ITH FEDERAL AND STATE LAW. 12
309	309
310	310	(B) THE QUALIFIED RESIDENT ENROLLMENT PROGRAM SHALL BE 13
311	311	DESIGNED TO MAKE IND IVIDUAL MARKET HEALT H INSURANCE COVERAGE OFFERED 14
312	312	THROUGH THE EXCHANGE AVAILABLE TO QUALIFIED RESIDEN TS. 15
313	313
314	314	(C) BASED ON THE AVAILABI LITY OF FUNDS , THE EXCHANGE, IN 16
315	315	CONSULTATION WITH TH E COMMISSIONER AND AS A PPROVED BY THE BOARD, 17
316	316	SHALL ESTABLISH SUBS IDY ELIGIBILITY AND PAYMENT PARAMETE RS FOR 18
317	317	CALENDAR YEAR 2025 AND EACH SUBSEQUENT CALENDAR YEAR. 19
318	318
319	319	(D) BEGINNING JANUARY 1, 2025, FUNDING FOR THE QUALIFIED 20
320	320	RESIDENT ENROLLMENT PROGRAM MAY BE MADE U SING: 21
321	321
322	322	(1) ANY PASS–THROUGH FUNDS RECEIV ED FROM THE FEDERAL 22
323	323	GOVERNMENT UNDER A W AIVER APPROVE D UNDER § 1332 OF THE AFFORDABLE 23
324	324	CARE ACT; 24
325	325
326	326	(2) ANY FUNDS DESIGNATED BY THE FEDERAL GOVER NMENT TO 25
327	327	PROVIDE HEALTH COVER AGE FOR QUALIFIED RE SIDENTS; AND 26
328	328
329	329	(3) ANY FUNDS DESIGNATED BY THE STATE TO PROVIDE HEAL TH 27
330	330	COVERAGE FOR QUALIFI ED RESIDENTS. 28
331	331
332	332	(E) THE IMPLEMENTATION OF THE QUALIFIED RESIDENT ENROLLMENT 29
333	333	PROGRAM SHALL BE CONT INGENT ON APPROVAL F ROM THE U.S. SECRETARY OF 30
334	334	HEALTH AND HUMAN SERVICES AND THE U.S. SECRETARY OF THE TREASURY OF A 31 8 SENATE BILL 365
335	335
336	336
337	337	STATE INNOVATION WAIVER APPLICATION AMENDMENT UNDER § 1332 OF THE 1
338	338	AFFORDABLE CARE ACT. 2
339	339
340	340	(F) ON OR BEFORE JANUARY 1, 2025, THE EXCHANGE SHALL ADOPT 3
341	341	REGULATIONS TO CARRY OUT THIS SECTION . 4
342	342
343	343	SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect 5
344	344	October 1, 2023. 6
345	345