Bill Text: NJ S49 | 2018-2019 | Regular Session | Introduced
Bill Title: Authorizes DOBI to establish State-based exchange for certain health insurance plans; requires DHS to apply for federal funds for integration of Medicaid eligibility platform and exchange.**
Spectrum: Partisan Bill (Democrat 4-0)
Status: (Introduced - Dead) 2019-06-27 - Substituted by A5499 (ACS/2R) [S49 Detail]
Download: New_Jersey-2018-S49-Introduced.html
Sponsored by:
Senator NELLIE POU
District 35 (Bergen and Passaic)
SYNOPSIS
Authorizes DOBI to establish State-based exchange for Medicaid and certain health insurance plans.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning health insurance and supplementing P.L.1992, c.161 (C.17B:27A-2 et seq.).
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. There is established in the Department of the Treasury a nonlapsing revolving fund to be known as the "Health Insurance Exchange Trust Fund." This fund shall be the repository for monies collected pursuant to subsection c. of this section, any federal financial participation received for the administration of the State Medicaid plan through the exchange, and other monies received as grants or otherwise appropriated for the purposes of supporting health insurance outreach, enrollment, and reinsurance efforts. The monies in the fund shall be used only for the purpose of supporting the exchange through initial start-up costs associated with establishment of the exchange, exchange operations, outreach, enrollment, reinsurance, and other means of supporting the exchange.
b. The State Treasurer shall be the custodian of the fund and all disbursements from the fund shall be made by the State Treasurer upon vouchers signed by the Commissioner of Banking and Insurance. The monies in the fund shall be invested and reinvested by the Director of the Division of Investment in the Department of the Treasury to the same extent that other trust funds that are in the custody of the State Treasurer are invested and reinvested, in the manner provided by law. Interest received on the monies in the fund shall be credited to the fund.
c. The commissioner may apply a monthly assessment to each health benefits plan offered by a carrier. The assessment shall be paid by the carrier and deposited into the fund and shall be used only for the purpose of supporting the exchange through initial start-up costs associated with establishment of the exchange, exchange operations, outreach, enrollment, reinsurance, and other means of supporting the exchange. The assessment may be applied at a rate of:
(1) .5 percent of the total monthly premium charged by a carrier for each health benefits plan during any period that the State is on a federally-facilitated exchange;
(2) 1 percent of the total monthly premium charged by a carrier for each health benefits plan during any period that the State is on a State-based exchange using the federal platform; or
(3) 3.5 percent of the total monthly premium charged by a carrier for each health benefits plan during any period that the State is on a State-based exchange. The commissioner shall have the discretion to adjust this rate to ensure that the State-based exchange is fully funded.
2. a. Notwithstanding any other law to the contrary, the Department of Banking and Insurance shall have the authority to operate a State-based exchange and coordinate the operations of the exchange with the operations of the New Jersey Individual Health Coverage Program and the New Jersey Small Employer Health Benefits Program, including reorganization of the boards, as the commissioner deems appropriate. The department shall also have the authority to coordinate the operations of the exchange with the operations of the State Medicaid program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.) and the NJ FamilyCare Program established pursuant to P.L.2005, c.156 (C.30:4J-8 et al.).
b. The Commissioner of Banking and Insurance shall, to the extent practicable, secure the maximum federal financial participation for the exchange as a State administrative expenditure necessary for the proper and efficient administration of the State Medicaid plan.
c. The commissioner shall have the authority to require that plans offered on the exchange conform with standardized plan designs that provide for standardized cost-sharing for covered health services.
3. The commissioner shall present a report to the Governor, and to the Legislature pursuant to section 2 of P.L.1991, c.164 (C.52:14-19.1), no later than January 1, 2022, which contains the commissioner's findings and recommendations, including such recommendations for administrative or legislative action as the commissioner deems appropriate, concerning whether to:
a. continue the New Jersey Individual Health Coverage Program established pursuant to P.L.1992, c.161 (C.17B:27A-2 et seq.) and the New Jersey Small Employer Health Benefits Program established pursuant to P.L.1992, c.162 (C.17B:27A-17 et seq.), as provided under current law;
b. revise these programs to reflect the provisions of this act; or
c. phase out these programs and transition the health care coverage provided thereunder to coverage provided under health benefits plans through the exchange, in which case the commissioner shall specify a projected schedule for effecting this transition in the most efficient and effective manner possible.
4. The Department of Banking and Insurance shall adopt rules and regulations pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), to effectuate the purposes of this act.
5. This act shall take
effect on January 1, 2020, except the commissioner may take any anticipatory
administrative action in advance as shall be necessary for the implementation
of this act.
STATEMENT
This bill authorizes the Department of Banking and Insurance to establish, operate, and fund a State-based exchange for Medicaid and certain health benefits plans.
Specifically, the bill establishes in the Department of the Treasury a nonlapsing revolving fund to be known as the "Health Insurance Exchange Trust Fund." This fund is to be the repository for monies collected pursuant to the bill, any federal financial participation received for the administration of the State Medicaid plan through the exchange, and other monies received as grants or otherwise appropriated for the purposes of supporting health insurance outreach, enrollment, and reinsurance efforts. The monies in the fund are to be used only for the purpose of supporting the exchange through initial start-up costs associated with establishment of the exchange, exchange operations, outreach, enrollment, reinsurance, and other means of supporting the exchange.
The bill allows the Commissioner of Banking and Insurance to apply a monthly assessment to each individual health benefits plan offered by a carrier. The assessment is to be deposited into the fund and is to be used only for the purpose of supporting the exchange through initial start-up costs associated with establishment of the exchange, exchange operations, outreach, enrollment, reinsurance, and other means of supporting the exchange. The assessment may be applied at a rate of:
(1) .5 percent of the total monthly premium charged by a carrier for each health benefits plan during any period that the State is on a federally-facilitated exchange;
(2) 1 percent of the total monthly premium charged by a carrier for each health benefits plan during any period that the State is on a State-based exchange using the federal platform; or
(3) 3.5 percent of the total monthly premium charged by a carrier for each health benefits plan during any period that the State is on a State-based exchange. The bill provides that the commissioner has discretion to adjust this rate to ensure that the State-based exchange is fully funded.
New Jersey's health insurance exchange is currently operated through the federally-facilitated exchange. This bill takes into account that the State may opt to continue to use the federally-facilitated exchange, or to establish a State-based exchange using the federal platform or a wholly Stated-based exchange.
The bill specifically authorizes the department to operate a State-based exchange in the department and to coordinate the exchange operations with the operations of the New Jersey Individual Health Coverage Program and the New Jersey Small Employer Health Benefits Program, including reorganization of the boards, as the commissioner deems appropriate. The bill also authorizes the department to coordinate the operations of the exchange with the operations of the State Medicaid program and the NJ FamilyCare program.
The bill authorizes the commissioner to require that plans offered on the exchange conform with standardized plan designs that provide for standardized cost-sharing for covered health services.
The bill provides that the commissioner shall, to the extent practicable, secure the maximum federal financial participation for the exchange as a State administrative expenditure necessary for the proper and efficient administration of the State Medicaid plan.
The bill requires the commissioner to present a report to the Governor and Legislature, no later than January 1, 2022, which contains the commissioner's findings and recommendations, including recommendations for administrative or legislative action as the commissioner deems appropriate, concerning whether to continue, revise, or phase out the New Jersey Individual Health Coverage and Small Employer Health Benefits Programs.
