HB 1428

Abstract

Virginia Health Benefit Exchange. Creates the Virginia Health Benefit Exchange, which will be established and operated by a new division within the State Corporation Commission (SCC). The Exchange shall facilitate the purchase and sale of qualified health plans and qualified dental plans to qualified individuals and qualified employers. The Exchange shall make qualified plans available to qualified individuals and qualified employers by July 1, 2023, unless the SCC postpones this date. The measure authorizes the SCC to review and approve accident and sickness insurance premium rates applicable to health benefit plans in the individual and small group markets and health benefit plans providing health insurance coverage in the individual market through certain non-employer group plans. The Exchange will be funded by an assessment on health insurers, which is limited to three percent of total monthly premiums, except the SCC may, after a public hearing, adjust the rate as necessary to ensure the Exchange is fully funded. A health plan will not be required to cover any state-mandated health benefit if federal law does not require it to be covered as part of the essential benefits package. The essential health benefits are items and services included in the benchmark health insurance plan, which is the largest plan in the largest product in the Commonwealth's small group market as supplemented in order to provide coverage for the items and services within the statutory essential health benefits categories. The SCC may contract with other eligible entities and enter into memoranda of understanding with other agencies of the Commonwealth to carry out any of the functions of the Exchange, including agreements with other states or federal agencies to perform joint administrative functions. Such contracts are not subject to the Virginia Public Procurement Act (§ 2.2-4300 et seq.). The measure repeals a provision enacted in 2013 that prohibits an agent, employee, officer, or agency of the Commonwealth from taking any action to establish a health benefit exchange.The measure requires the Department of Taxation to include on the appropriate individual tax return forms a checkoff box or similar mechanism for indicating whether the individual, or spouse in the case of a married taxpayer filing jointly, or any dependent of the individual (i) is an uninsured individual at the time the return is filed and (ii) voluntarily consents to the Department of Taxation providing the individual's tax information to the Department of Medical Assistance Services for purposes of affirming that the individual, the individual's spouse, or any dependent of the individual meets the income eligibility for medical assistance. Finally, the measure requires the Secretary of Health and Human Resources to convene a work group that includes representatives from the SCC, the Department of Medical Assistance Services, the Department of Social Services, and the Department of Taxation and a consumer advocate to develop systems, policies, and practices to leverage state income tax returns to facilitate the enrollment of eligible individuals in insurance affordability programs through the Virginia Health Benefit Exchange established in this measure. The Secretary shall report the work group's recommendations to the Governor and the General Assembly by September 15, 2020. This measure is identical to SB 732.

Virginia Health Benefit Exchange. Creates the Virginia Health Benefit Exchange, which will be established and operated by a new division within the State Corporation Commission (SCC). The Exchange shall facilitate the purchase and sale of qualified health plans and qualified dental plans to qualified individuals and qualified employers. The Exchange shall make qualified plans available to qualified individuals and qualified employers by July 1, 2023, unless the SCC postpones this date. The measure authorizes the SCC to review and approve accident and sickness insurance premium rates applicable to health benefit plans in the individual and small group markets and health benefit plans providing health insurance coverage in the individual market through certain non-employer group plans. The Exchange will be funded by an assessment on health insurers, which is limited to three percent of total monthly premiums, except the SCC may, after a public hearing, adjust the rate as necessary to ensure the Exchange is fully funded. A health plan will not be required to cover any state-mandated health benefit if federal law does not require it to be covered as part of the essential benefits package. The essential health benefits are items and services included in the benchmark health insurance plan, which is the largest plan in the largest product in the Commonwealth's small group market as supplemented in order to provide coverage for the items and services within the statutory essential health benefits categories. The SCC may contract with other eligible entities and enter into memoranda of understanding with other agencies of the Commonwealth to carry out any of the functions of the Exchange, including agreements with other states or federal agencies to perform joint administrative functions. Such contracts are not subject to the Virginia Public Procurement Act (§ 2.2-4300 et seq.). The measure repeals a provision enacted in 2013 that prohibits an agent, employee, officer, or agency of the Commonwealth from taking any action to establish a health benefit exchange.The measure requires the Department of Taxation to include on the appropriate individual tax return forms a checkoff box or similar mechanism for indicating whether the individual, or spouse in the case of a married taxpayer filing jointly, (i) is an uninsured individual at the time the return is filed and (ii) consents to the Department of Taxation providing the individual's tax information to the Department of Medical Assistance Services for purposes of determining the uninsured individual's or spouse's eligibility for medical assistance. Finally, the measure requires the Secretary of Health and Human Resources to convene a work group that includes representatives from the SCC, the Department of Medical Assistance Services, the Department of Social Services, and the Department of Taxation to develop systems, policies, and practices to leverage state income tax returns to facilitate the enrollment of eligible individuals in insurance affordability programs through the Virginia Health Benefit Exchange established in this measure. The Secretary shall report the work group's recommendations to the Governor and the General Assembly by September 15, 2020.

Virginia Health Benefit Exchange. Creates the VirginiaHealth Benefit Exchange, which will be established and operated by a newdivision within the State Corporation Commission (SCC). The Exchange shall facilitatethe purchase and sale of qualified health plans and qualified dental plans toqualified individuals and qualified employers. The Exchange shall makequalified plans available to qualified individuals and qualified employers byJuly 1, 2023, unless the SCC postpones this date. The measure authorizes theSCC to review and approve accident and sickness insurance premium ratesapplicable to health benefit plans in the individual and small group marketsand health benefit plans providing health insurance coverage in the individualmarket through certain non-employer group plans. The Exchange will be funded byassessments on health insurers. A health plan will not be required to cover anystate-mandated health benefit if federal law does not require it to be coveredas part of the essential benefits package. The essential health benefits areitems and services included in the benchmark health insurance plan, which isthe largest plan in the largest product in the Commonwealth's small groupmarket as supplemented in order to provide coverage for the items and serviceswithin the statutory essential health benefits categories. The SCC may contractwith other eligible entities and enter into memoranda of understanding withother agencies of the Commonwealth to carry out any of the functions of theExchange, including agreements with other states or federal agencies to performjoint administrative functions. Such contracts are not subject to the VirginiaPublic Procurement Act (§ 2.2-4300 et seq.). The measure repeals a provisionenacted in 2013 that prohibits an agent, employee, officer, or agency of theCommonwealth from taking any action to establish a health benefit exchange.The measure requires the Department of Taxation to include onthe appropriate individual tax return forms a checkoff box or similar mechanismfor indicating whether the individual, or spouse in the case of a marriedtaxpayer filing jointly, (i) is an uninsured individual at the time the returnis filed and (ii) consents to the Department of Taxation providing theindividual's tax information to the Department of Medical Assistance Servicesfor purposes of determining the uninsured individual's or spouse's eligibilityfor medical assistance. Finally, the measure requires the Secretary of Healthand Human Resources to convene a work group that includes representatives fromthe SCC, the Department of Medical Assistance Services, the Department ofSocial Services, and the Department of Taxation to develop systems, policies,and practices to leverage state income tax returns to facilitate the enrollmentof eligible individuals in insurance affordability programs through theVirginia Health Benefit Exchange established in this measure. The Secretaryshall report the work group's recommendations to the Governor and the GeneralAssembly by September 15, 2020.The provisions of the bill expire upon any ruling by theSupreme Court of the United States declaring unconstitutional, or action by thePresident or Congress that repeals or defunds, the provisions of the PatientProtection and Affordable Care Act in a manner that renders it impossible toperform the duties integral to the Virginia Health Benefit Exchange.