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SB-1255 Health insurance market: financial assistance.(2017-2018)

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Date Published: 03/21/2018 09:00 PM
SB1255:v98#DOCUMENT

Amended  IN  Senate  March 21, 2018

CALIFORNIA LEGISLATURE— 2017–2018 REGULAR SESSION

Senate Bill No. 1255


Introduced by Senator Hernandez

February 15, 2018


An act to amend Section 100504 of the Government Code, relating to health insurance.


LEGISLATIVE COUNSEL'S DIGEST


SB 1255, as amended, Hernandez. Health insurance market. market: financial assistance.
Existing federal law, the Patient Protection and Affordable Care Act (PPACA), requires each state to establish an American Health Benefit Exchange that facilitates the purchase of qualified health plans by qualified individuals and qualified small employers and that meets certain other requirements. Existing law creates the California Health Benefit Exchange, also known as Covered California, for the purpose of facilitating the enrollment of qualified individuals and qualified small employers in qualified health plans as required under the PPACA. Existing law specifies the powers of the Covered California executive board, including the power to assist in the administration of subsidies for individuals with coverage made available through Covered California.
This bill would state the intent of the Legislature to enact legislation to ensure a stable health insurance market in California. require Covered California to administer financial assistance to help low- and middle-income Californians access affordable coverage, as specified, if the Legislature appropriates funds for that purpose. The bill would provide that priority for financial assistance shall be given to an individual whose premium payment is equal to or greater than 8% of his or her annual household income, as specified, or an individual whose annual household income is equal to or greater than 200% of the federal poverty level, as specified.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: NOYES   Local Program: NO  

The people of the State of California do enact as follows:


SECTION 1.

 Section 100504 of the Government Code is amended to read:

100504.
 (a) The board may do the following:
(1) With respect to individual coverage made available in the Exchange, collect premiums and assist in the administration of subsidies.
(2) Enter into contracts.
(3) Sue and be sued.
(4) Receive and accept gifts, grants, or donations of moneys from any an agency of the United States, any an agency of the state, and any a municipality, county, or other political subdivision of the state.
(5) Receive and accept gifts, grants, or donations from individuals, associations, private foundations, and corporations, in compliance with the conflict of interest provisions to be adopted by the board at a public meeting.
(6) Adopt rules and regulations, as necessary. Until January 1, 2017, any necessary rules and regulations may be adopted as emergency regulations in accordance with the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2). Until January 1, 2019, any necessary rules and regulations to implement the eligibility, enrollment, and appeals processes for the individual and small business exchanges, changes to the small business exchange, or any an act in effect that amends this title that is operative on or before December 31, 2016, may be adopted as emergency regulations in accordance with the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2). The adoption of emergency regulations pursuant to this section shall be deemed to be an emergency and necessary for the immediate preservation of the public peace, health and safety, or general welfare. Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2, including subdivisions (e) and (h) of Section 11346.1, any an emergency regulation adopted pursuant to this section shall be repealed by operation of law unless the adoption, amendment, or repeal of the regulation is promulgated by the board pursuant to Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code within five years of the initial adoption of the emergency regulation. Notwithstanding subdivision (h) of Section 11346.1, until January 1, 2020, the Office of Administrative Law may approve more than two readoptions of an emergency regulation adopted pursuant to this section. The amendments made to this paragraph by the act adding this sentence shall apply to any an emergency regulation adopted pursuant to this section prior to before the effective date of the Budget Act of 2015.
(7) Collaborate with the State Department of Health Care Services and the Managed Risk Medical Insurance Board, to the extent possible, to allow an individual the option to remain enrolled with his or her carrier and provider network in the event the individual experiences a loss of eligibility of premium tax credits and becomes eligible for the Medi-Cal program or the Healthy Families Program, or loses eligibility for the Medi-Cal program or the Healthy Families Program and becomes eligible for premium tax credits through the Exchange.
(8) Share information with relevant state departments, consistent with the confidentiality provisions in Section 1411 of the federal act, necessary for the administration of the Exchange.
(9) Require carriers participating in the Exchange to make available to the Exchange and regularly update an electronic directory of contracting health care providers so that individuals seeking coverage through the Exchange can search by health care provider name to determine which health plans in the Exchange include that health care provider in their network. The board may also require a carrier to provide regularly updated information to the Exchange as to whether a health care provider is accepting new patients for a particular health plan. The Exchange may provide an integrated and uniform consumer directory of health care providers indicating which carriers the providers contract with and whether the providers are currently accepting new patients. The Exchange may also establish methods by which health care providers may transmit relevant information directly to the Exchange, rather than through a carrier.
(10) Make available supplemental coverage for enrollees of the Exchange to the extent permitted by the federal act, provided that no General Fund money is not used to pay the cost of that coverage. Any supplemental Supplemental coverage offered in the Exchange shall be subject to the charge imposed under subdivision (n) of Section 100503.
(b) The Exchange shall only collect information from individuals or designees of individuals necessary to administer the Exchange and consistent with the federal act.
(c) (1) The board shall have the authority to standardize products to be offered through the Exchange. Any products A product standardized by the board pursuant to this subdivision shall be discussed by the board during at least one properly noticed board meeting prior to before the board meeting at which the board adopts the standardized products to be offered through the Exchange.
(2) The adoption, amendment, or repeal of a regulation by the board to implement this subdivision is exempt from the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2).
(d) The Exchange shall administer financial assistance to help low- and middle-income Californians access affordable health care coverage, with respect to individual coverage made available in the Exchange as follows:
(1) The Exchange shall give priority for financial assistance to an individual whose premium payment is equal to or greater than 8 percent of his or her annual household income. Those individuals shall include an individual whose household income is less than 400 percent of the federal poverty level and who is not eligible for Medi-Cal, or an individual whose annual household income is greater than 400 percent of the federal poverty level.
(2) The Exchange shall also give priority for financial assistance to an individual with an annual income that is equal to or greater than 200 percent of the federal poverty level, but not more than 400 percent of the federal poverty level, who is subject to significant cost-sharing expenses.
(3) The Exchange shall administer financial assistance in a manner that maximizes federally funded subsidies for Californians to the greatest extent possible.
(4) For purposes of this subdivision, “financial assistance” includes, but is not limited to, direct premium assistance through an advanced or refundable credit toward premium payment or assistance with cost sharing.
(5) Notwithstanding Section 100520, the Exchange shall implement this subdivision only to the extent that the Legislature appropriates funding for this purpose.

SECTION 1.

It is the intent of the Legislature to enact legislation to ensure a stable health insurance market in California.