Bill Text: IA SF2112 | 2013-2014 | 85th General Assembly | Introduced


Bill Title: A bill for an act providing for the establishment of the Iowa health insurance marketplace and including effective date provisions. (See SF 2253.)

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2014-02-11 - Subcommittee, Hatch, Bolkcom, and Schneider. S.J. 234. [SF2112 Detail]

Download: Iowa-2013-SF2112-Introduced.html
Senate File 2112 - Introduced SENATE FILE 2112 BY HATCH A BILL FOR An Act providing for the establishment of the Iowa health 1 insurance marketplace and including effective date 2 provisions. 3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 4 TLSB 5289XS (2) 85 rj/rj
S.F. 2112 DIVISION I 1 IOWA HEALTH INSURANCE MARKETPLACE ACT 2 Section 1. NEW SECTION . 514M.1 Title. 3 This chapter shall be known and may be cited as the “Iowa 4 Health Insurance Marketplace Act” . 5 Sec. 2. NEW SECTION . 514M.2 Purpose and intent. 6 The purpose of this chapter is to provide for the 7 establishment of a health insurance marketplace in this 8 state to facilitate the sale and purchase of qualified health 9 insurance plans by qualified individuals in the individual 10 market in this state and by qualified small employers in the 11 small group market in this state. The intent of authorizing 12 the establishment of a health insurance marketplace in this 13 state is to reduce the number of uninsured individuals in 14 this state, provide a transparent marketplace and consumer 15 education, and assist individuals with access to relevant 16 federal and state programs, premium assistance tax credits, and 17 cost-sharing reductions. 18 Sec. 3. NEW SECTION . 514M.3 Definitions. 19 As used in this chapter, unless the context otherwise 20 requires: 21 1. “Board” means the board of directors of the Iowa health 22 insurance marketplace as provided in section 514M.5. 23 2. “Commissioner” means the commissioner of insurance. 24 3. “Executive director” means the executive director of the 25 Iowa health insurance marketplace. 26 4. “Federal Act” means the federal Patient Protection and 27 Affordable Care Act, Pub. L. No. 111-148, as amended by the 28 federal Health Care and Education Reconciliation Act of 2010, 29 Pub. L. No. 111-152, and any amendments thereto, or regulations 30 or guidance issued under, those Acts. 31 5. “Health carrier” means an entity subject to the insurance 32 laws and rules of this state, or subject to the jurisdiction 33 of the commissioner, that contracts or offers to contract to 34 provide, deliver, arrange for, pay for, or reimburse any of 35 -1- LSB 5289XS (2) 85 rj/rj 1/ 31
S.F. 2112 the costs of health care services, including an insurance 1 company offering sickness and accident plans, a health 2 maintenance organization, a nonprofit hospital or health 3 service corporation, or any other entity providing a plan of 4 health insurance, health benefits, or health services. 5 6. a. “Health insurance plan” means a policy, contract, 6 certificate, or agreement offered or issued by a health carrier 7 to provide, deliver, arrange for, pay for, or reimburse any of 8 the costs of health care services. 9 b. “Health insurance plan” does not include any of the 10 following: 11 (1) Coverage only for accident, or disability income 12 insurance, or any combination thereof. 13 (2) Coverage issued as a supplement to liability insurance. 14 (3) Liability insurance, including general liability 15 insurance and automobile liability insurance. 16 (4) Workers’ compensation or similar insurance. 17 (5) Automobile medical payment insurance. 18 (6) Credit-only insurance. 19 (7) Coverage for on-site medical clinics. 20 (8) Other similar insurance coverage, specified in federal 21 regulations issued pursuant to Tit. XXVII of the federal Public 22 Health Service Act, as enacted by the federal Health Insurance 23 Portability and Accountability Act of 1996, Pub. L. No. 24 104-191, and amended by the federal Act, under which benefits 25 for health care services are secondary or incidental to other 26 insurance benefits. 27 c. “Health insurance plan” does not include any of the 28 following benefits if they are provided under a separate 29 policy, certificate, or contract of insurance or are otherwise 30 not an integral part of the plan: 31 (1) Limited scope dental or vision benefits. 32 (2) Benefits for long-term care, nursing home care, home 33 health care, community-based care, or any combination thereof. 34 (3) Other similar, limited benefits specified in federal 35 -2- LSB 5289XS (2) 85 rj/rj 2/ 31
S.F. 2112 regulations issued pursuant to the federal Health Insurance 1 Portability and Accountability Act of 1996, Pub. L. No. 2 104-191. 3 d. “Health insurance plan” does not include any of the 4 following benefits if the benefits are provided under a 5 separate policy, certificate, or contract of insurance, there 6 is no coordination between the provision of the benefits 7 and any exclusion of benefits under any group health plan 8 maintained by the same plan sponsor, and the benefits are paid 9 with respect to an event without regard to whether benefits are 10 provided with respect to such an event under any group health 11 plan maintained by the same plan sponsor: 12 (1) Coverage only for a specified disease or illness. 13 (2) Hospital indemnity or other fixed indemnity insurance. 14 e. “Health insurance plan” does not include any of the 15 following if offered as a separate policy, certificate, or 16 contract of insurance: 17 (1) Medicare supplemental health insurance as defined under 18 section 1882(g)(1) of the federal Social Security Act. 19 (2) Coverage supplemental to the coverage provided under 10 20 U.S.C. ch. 55, by the civilian health and medical program of 21 the uniformed services. 22 (3) Supplemental coverage similar to that provided under a 23 group health insurance plan. 24 7. “Insurance producer” means a person required to be 25 licensed under chapter 522B. 26 8. “Marketplace” means the Iowa health insurance marketplace 27 established pursuant to section 514M.4. 28 9. “Navigator” means a person selected, licensed, and 29 regulated by the marketplace in accordance with section 1311(i) 30 of the federal Act, standards developed by the secretary, and 31 chapter 522D. 32 10. “Qualified dental plan” means a limited scope dental 33 plan that has been certified in accordance with section 34 514M.10. 35 -3- LSB 5289XS (2) 85 rj/rj 3/ 31
S.F. 2112 11. “Qualified employer” means a small employer that elects 1 to make its full-time employees eligible for one or more 2 qualified health insurance plans offered through the small 3 business health options program of the marketplace, and at 4 the option of the employer, make some or all of its part-time 5 employees so eligible, provided that the employer does either 6 of the following: 7 a. Has its principal place of business in this state and 8 elects to provide coverage through the marketplace to all of 9 its eligible employees wherever employed. 10 b. Elects to provide coverage through the marketplace to all 11 of its eligible employees who are principally employed in this 12 state. 13 12. “Qualified health plan” means a health plan that has in 14 effect a certification as described in section 1311(c) of the 15 federal Act and section 514M.10. 16 13. “Qualified individual” means an individual, including a 17 minor, who is all of the following: 18 a. Is seeking to enroll in a qualified health plan offered 19 to individuals through the marketplace. 20 b. Is a resident of this state. 21 c. At the time of enrollment, is not incarcerated, other 22 than incarceration pending the disposition of charges. 23 d. Is, and is reasonably expected to be, for the entire 24 period for which enrollment is sought, a citizen or national of 25 the United States or an alien lawfully present in the United 26 States. 27 14. “Secretary” means the secretary of the United States 28 department of health and human services. 29 15. “Secretary of the board” means the secretary of the 30 board of directors of the Iowa health insurance marketplace. 31 16. “Small business health options program” means the small 32 business health options program component of the marketplace 33 established under section 514M.8. 34 17. a. “Small employer” means an employer that employed 35 -4- LSB 5289XS (2) 85 rj/rj 4/ 31
S.F. 2112 an average of at least one and not more than fifty employees 1 during the preceding calendar year. 2 b. For the purposes of this subsection: 3 (1) All persons treated as a single employer under 4 subsection (b), (c), (m), or (o) of section 414 of the Internal 5 Revenue Code of 1986 shall be treated as a single employer. 6 (2) An employer and any predecessor employer shall be 7 treated as a single employer. 8 (3) All employees shall be counted, including part-time 9 employees and employees who are not eligible for coverage 10 through the employer. 11 (4) If an employer was not in existence throughout the 12 preceding calendar year, the determination of whether that 13 employer is a small employer shall be based on the average 14 number of employees that the employer is reasonably expected to 15 employ on business days in the current calendar year. 16 (5) An employer that makes enrollment in qualified health 17 plans available to its employees through the small business 18 health options program component of the marketplace, and 19 would cease to be a small employer by reason of an increase 20 in the number of its employees, shall continue to be treated 21 as a small employer for purposes of this chapter as long as 22 the employer continuously makes enrollment through the small 23 business health options program component of the marketplace 24 available to its employees. 25 Sec. 4. NEW SECTION . 514M.4 Establishment of Iowa health 26 insurance marketplace. 27 1. The Iowa health insurance marketplace is established 28 as a nonprofit corporation. The marketplace shall be 29 established for the purpose of facilitating the sale and 30 purchase of qualified health plans by qualified individuals 31 in the individual market in this state and by qualified small 32 employers in the small group market in this state. 33 2. The powers and duties of the marketplace are vested in 34 and shall be exercised by a board of directors established 35 -5- LSB 5289XS (2) 85 rj/rj 5/ 31
S.F. 2112 under section 514M.5. 1 3. The marketplace shall operate under a plan of operation 2 established and approved by the board of directors, in 3 consultation with the commissioner. The plan shall effectuate 4 the purposes of this chapter and assure the fair, reasonable, 5 and equitable administration of the marketplace. The board 6 shall do all of the following pursuant to the plan, including 7 but not limited to: 8 a. Plan, direct, coordinate, and execute the administrative 9 functions of the marketplace. 10 b. Employ professional and clerical staff as necessary. 11 c. Keep an accurate account of all activities, receipts, 12 and expenditures of the marketplace and annually submit a 13 report to the commissioner, governor, general assembly, and 14 the auditor of state concerning such accountings pursuant to 15 section 514M.14. 16 4. The marketplace shall be operated on a statewide basis. 17 5. The marketplace shall include separate marketplace 18 components which facilitate the sale and purchase of qualified 19 health plans to eligible individuals and to small employers as 20 described in this chapter and in the federal Act. 21 6. The marketplace may establish a reimbursement system for 22 health insurance plans issued in this state that all health 23 carriers and health care providers may join to facilitate fair 24 and reasonable payments for the cost of health care services 25 provided pursuant to a health insurance plan. 26 7. The marketplace shall do all of the following: 27 a. Facilitate the purchase and sale of qualified health 28 plans to qualified individuals and qualified employers as 29 described in this chapter and in the federal Act. 30 b. Establish rate schedules for commissions paid to 31 insurance producers by qualified health plans offered through 32 the marketplace. 33 c. Meet the requirements of this chapter and any rules 34 adopted pursuant to this chapter. 35 -6- LSB 5289XS (2) 85 rj/rj 6/ 31
S.F. 2112 8. a. A person who selects, purchases, or enrolls in a 1 qualified health plan offered through the marketplace shall be 2 enrolled in the plan by an insurance producer or may enroll in 3 the plan directly through the marketplace internet site. The 4 commission paid to an insurance producer who enrolls a person 5 in a plan offered through the marketplace shall be established 6 by the marketplace. 7 b. On the anniversary date of coverage obtained through 8 the marketplace, an enrollee may renew or enroll in coverage 9 offered through the marketplace through any insurance producer 10 of the enrollee’s choice or may enroll directly through the 11 marketplace internet site. A commission shall be paid to an 12 insurance producer who renews or enrolls a person in coverage 13 under this paragraph in the same manner as is provided in 14 paragraph “a” . 15 9. The marketplace may contract with an experienced and 16 reputable entity to develop and maintain the marketplace’s 17 internet site. The entity shall preferably have relevant 18 experience in developing and maintaining similar state health 19 insurance plan internet sites. 20 10. The marketplace may employ staff to carry out 21 the functions of the marketplace, but no employee of the 22 marketplace shall sell, solicit, or negotiate enrollment in a 23 health insurance plan or otherwise offer services for which 24 a license as an insurance producer is required pursuant to 25 chapter 522B. 26 11. The marketplace may contract with an eligible entity to 27 fulfill any of its specialized duties or responsibilities as 28 described in this chapter. An eligible entity includes but is 29 not limited to an entity that has experience in individual and 30 small group health insurance plans, benefit administration, or 31 other experience relevant to the responsibilities to be assumed 32 by the entity. However, a health carrier or an affiliate of a 33 health carrier is not an eligible entity for the purposes of 34 this subsection. 35 -7- LSB 5289XS (2) 85 rj/rj 7/ 31
S.F. 2112 12. The marketplace may enter into information-sharing 1 agreements with federal and state agencies to carry out 2 its responsibilities under this chapter provided such 3 agreements include adequate protections with respect to the 4 confidentiality of the information to be shared and comply with 5 all state laws and rules and federal laws and regulations. 6 13. Each qualified health plan offered through the 7 marketplace shall be assigned a rating by the marketplace in 8 accordance with criteria developed by the secretary under 9 section 1311(c)(3) of the federal Act, and the marketplace 10 shall determine the level of coverage of each qualified health 11 plan in accordance with regulations issued by the secretary 12 under section 1302(d)(2)(A) of the federal Act and applicable 13 state law. 14 14. If a qualified health plan offered through the 15 marketplace meets or exceeds the criteria for a qualified 16 health plan set forth by the secretary, the plan shall be 17 reviewed and assigned a rating by the marketplace. 18 Sec. 5. NEW SECTION . 514M.5 Board of directors —— executive 19 director —— secretary. 20 1. The board of directors of the Iowa health insurance 21 marketplace shall effectuate the powers and duties of the 22 marketplace as set forth in this chapter. 23 2. a. The board shall consist of seven members. The 24 members shall be appointed by the governor, subject to 25 confirmation by the senate. The members of the board shall 26 annually elect one member as chairperson and one member as vice 27 chairperson. 28 b. The members shall be appointed by the governor as 29 follows: 30 (1) Two persons who represent the interests of small 31 business from nominations made to the governor by nationally 32 recognized groups that represent the interests of small 33 business. 34 (2) Three persons who represent the interests of consumers 35 -8- LSB 5289XS (2) 85 rj/rj 8/ 31
S.F. 2112 from nominations made to the governor by nationally recognized 1 groups that represent the interests of consumers. 2 (3) One person who is an insurance producer licensed under 3 chapter 522B. 4 (4) One person who is a health care provider. 5 3. The governor shall not appoint to the board any person 6 who is either the spouse or a relative within the first degree 7 of consanguinity of a serving member of the board. 8 4. Each member of the board appointed by the governor shall 9 be a resident of this state and the composition of members of 10 the board shall be in compliance with sections 69.16, 69.16A, 11 and 69.16C. 12 5. The members of the board shall be appointed for staggered 13 terms of three years as provided in section 69.19. The initial 14 terms of the members of the board shall be staggered at the 15 discretion of the governor. A member of the board is eligible 16 for reappointment. The governor shall fill a vacancy on the 17 board in the same manner as the original appointment for the 18 remainder of the term. A member of the board may be removed 19 by the governor for misfeasance, malfeasance, willful neglect 20 of duty, failure to actively participate in the affairs of the 21 board, or other cause after notice and a public hearing unless 22 the notice and hearing are waived by the member in writing. 23 6. A member of the board shall not be an employee of, 24 a consultant to, a member of the board of directors of, 25 affiliated with, have an ownership interest in, or otherwise 26 be a representative of any health carrier, insurance producer 27 agency, insurance consultant organization, trade association of 28 insurers, or association offering health insurance plans to its 29 members, while serving on the board. 30 7. Members of the board shall be reimbursed from the moneys 31 of the marketplace for all actual and necessary expenses 32 incurred in the performance of their duties as members, and 33 shall receive per diem at the rate of fifty dollars per day for 34 their services. 35 -9- LSB 5289XS (2) 85 rj/rj 9/ 31
S.F. 2112 8. A majority of the members of the board constitutes a 1 quorum. The affirmative vote of a majority of the members is 2 necessary for any action taken by the board. The majority 3 shall not include a member who has a conflict of interest and a 4 statement by a member of a conflict of interest is conclusive 5 for this purpose. A vacancy in the membership of the board 6 does not impair the right of a quorum to exercise the rights 7 and perform the duties of the board. An action taken by the 8 board under this chapter may be authorized by resolution at 9 a regular or special meeting and each resolution shall take 10 effect immediately and need not be published or posted. 11 9. The members of the board shall give bond as required for 12 public officers by chapter 64. 13 10. The members of the board are subject to and are 14 officials within the meaning of chapter 68B. 15 11. The board shall meet at the call of the chairperson, 16 or in the absence of the chairperson, at the call of the vice 17 chairperson, or when any four members of the board file a 18 written request with the chairperson for a meeting. Written 19 notice of the time and place of each meeting shall be given to 20 each member of the board. 21 12. a. The members of the board shall appoint an executive 22 director, subject to confirmation by the senate, to supervise 23 the administrative affairs and general management and 24 operations of the marketplace. 25 b. The members of the board may appoint other officers as 26 the members of the board determine. The officers shall not be 27 members of the board and shall serve at the pleasure of the 28 members of the board, and shall receive compensation as fixed 29 by the board. 30 c. The board may employ other staff to carry out the 31 functions of the marketplace, but no employee of the 32 marketplace shall sell, solicit, or negotiate enrollment in a 33 health insurance plan or otherwise offer services for which 34 a license as an insurance producer is required pursuant to 35 -10- LSB 5289XS (2) 85 rj/rj 10/ 31
S.F. 2112 chapter 522B. All employees of the marketplace are exempt from 1 chapter 8A, subchapter IV, and chapter 97B. 2 13. a. The members of the board shall appoint a secretary 3 of the board who shall keep a record of the proceedings of the 4 board, and shall be the custodian of all books, documents, and 5 papers filed with the board, including information filed in an 6 electronic format, and the minute book or journal of the board. 7 b. The secretary of the board shall serve at the pleasure 8 of the board, and shall receive compensation as fixed by the 9 board. 10 14. Members of the board, or persons acting on behalf of 11 the marketplace, while acting in the scope of their agency or 12 employment, are not subject to personal liability resulting 13 from carrying out the powers and duties in this chapter. 14 Sec. 6. NEW SECTION . 514M.6 General powers. 15 1. The marketplace has any and all powers necessary and 16 convenient to carry out its purposes and duties and exercise 17 its specific powers, including but not limited to the power to: 18 a. Sue and be sued in its own name. 19 b. Have and alter a corporate seal. 20 c. Make and alter bylaws for its management consistent with 21 the provisions of this chapter. 22 d. Make and execute agreements, contracts, and other 23 instruments of any and all types on such terms and conditions 24 as the marketplace may find necessary or convenient to the 25 purpose of the marketplace, with any public or private entity, 26 including but not limited to contracts for goods and services. 27 All political subdivisions, other public agencies, and state 28 departments and agencies may enter into contracts and otherwise 29 cooperate with the marketplace. 30 e. Adopt procedures relating to competitive bidding, 31 including the identification of those circumstances under 32 which competitive bidding by the marketplace, either 33 formally or informally, shall be required. In any bidding 34 process, the marketplace may administer its own bidding and 35 -11- LSB 5289XS (2) 85 rj/rj 11/ 31
S.F. 2112 procurement or may utilize the services of the department of 1 administrative services or any other agency. Except when such 2 rules apply, the marketplace and all contracts entered into 3 by the marketplace in carrying out its public and essential 4 governmental functions with respect to any of its purposes 5 shall be exempt from the provisions and requirements of all 6 laws or rules of the state which require competitive bids in 7 connection with the letting of such contracts. 8 f. Acquire, hold, improve, mortgage, lease, and dispose of 9 real and personal property, including but not limited to the 10 power to sell at public or private sale, with or without public 11 bidding, any such property, or other obligation held by it. 12 g. Procure insurance against any loss in connection with its 13 operations and property interests. 14 h. Accept appropriations, gifts, grants, loans, or other 15 aid from public or private entities. A record of all gifts or 16 grants, stating the type, amount, and donor, shall be clearly 17 set out in the marketplace’s annual report along with the 18 record of other receipts. 19 i. Provide to public and private entities technical 20 assistance and counseling related to the marketplace’s 21 purposes. 22 j. In cooperation with other local, state, or federal 23 governmental agencies, conduct research studies, develop 24 estimates of unmet health insurance needs, gather and compile 25 data useful to facilitating decision making, and enter into 26 agreements to carry out programs within or without the state 27 which the marketplace finds to be consistent with the goals of 28 the marketplace. 29 k. Enter into agreements with the federal government, 30 tribes, and other states to facilitate the sale or purchase of 31 qualified health plans by qualified individuals and qualified 32 small employers in this state. 33 l. Own or acquire intellectual property rights including 34 but not limited to copyrights, trademarks, service marks, and 35 -12- LSB 5289XS (2) 85 rj/rj 12/ 31
S.F. 2112 patents, and enforce the rights of the marketplace with respect 1 to such intellectual property rights. 2 m. Form committees or panels as necessary to facilitate the 3 marketplace’s duties. Committees or panels formed pursuant to 4 this paragraph shall be subject to the provisions of chapters 5 21 and 22. 6 n. Establish one or more funds within the state treasury 7 under the control of the marketplace. Notwithstanding section 8 8.33 or 12C.7, or any other provision to the contrary, moneys 9 invested by the treasurer of state pursuant to this paragraph 10 shall not revert to the general fund of the state and interest 11 accrued on the moneys shall be moneys of the marketplace and 12 shall not be credited to the general fund of the state. The 13 nonreversion of moneys allowed under this paragraph does not 14 apply to moneys appropriated to the marketplace by the general 15 assembly. 16 o. Exercise generally all powers typically exercised by 17 private enterprises engaged in business pursuits unless the 18 exercise of such a power would violate the terms of this 19 chapter or the Constitution of the State of Iowa. 20 2. Notwithstanding any other provision of law, any purchase 21 or lease of real property, other than on a temporary basis, 22 when necessary in order to implement the purposes of the 23 marketplace or protect the investments of the marketplace, 24 shall require written notice from the marketplace to the 25 government oversight committees of the general assembly or 26 their successor committees and the prior approval of the 27 executive council. 28 3. The powers enumerated in this section are cumulative of 29 and in addition to those powers enumerated elsewhere in this 30 chapter and such powers do not limit or restrict any other 31 powers of the marketplace. 32 Sec. 7. NEW SECTION . 514M.7 Specific powers. 33 1. In addition to the general powers described in section 34 514M.6, the marketplace shall have all powers convenient and 35 -13- LSB 5289XS (2) 85 rj/rj 13/ 31
S.F. 2112 necessary to carry out the purpose and intent of this chapter. 1 2. The marketplace established pursuant to section 514M.4 2 shall make qualified health plans that are effective on January 3 1, 2016, available to qualified individuals and qualified 4 employers in this state. 5 3. At such time as applications for waivers from the 6 requirements of the federal Act are accepted by the secretary, 7 the marketplace may request such waivers from the secretary. 8 4. The marketplace shall allow a health carrier to offer a 9 plan that provides limited scope dental benefits meeting the 10 requirements of section 9832(c)(2)(A) of the Internal Revenue 11 Code of 1986 through the marketplace, either separately or in 12 conjunction with a qualified health plan, if the plan provides 13 pediatric dental benefits meeting the requirements of section 14 1302(b)(1)(J) of the federal Act. 15 5. The marketplace or a health carrier offering qualified 16 health plans through the marketplace shall not charge an 17 individual a fee or penalty for termination of coverage if 18 the individual enrolls in another type of minimum essential 19 coverage because the individual has become newly eligible for 20 that coverage or because the individual’s employer-sponsored 21 coverage has become affordable using the standards of the 22 federal Act, as codified at section 36B(c)(2)(C) of the 23 Internal Revenue Code of 1986. 24 Sec. 8. NEW SECTION . 514M.8 Duties of the marketplace. 25 The marketplace shall do all of the following: 26 1. Implement procedures for the certification, 27 recertification, and decertification of health insurance plans 28 as qualified health plans, consistent with guidelines developed 29 by the secretary under section 1311(c) of the federal Act and 30 applicable state law. 31 2. Provide for the operation of an internet site, a 32 toll-free telephone hotline, and in-person support staff 33 available in selected locations in the state to respond to 34 requests for assistance. 35 -14- LSB 5289XS (2) 85 rj/rj 14/ 31
S.F. 2112 3. Provide for enrollment periods, as determined by the 1 secretary under section 1311(c)(6) of the federal Act and 2 applicable state law. 3 4. Utilize a standardized format for presenting health 4 insurance plan options in the marketplace, including the use of 5 the uniform outline of coverage established under section 2715 6 of the Public Health Service Act and applicable state law. 7 5. In accordance with section 1413 of the federal Act 8 and applicable state law, inform individuals of eligibility 9 requirements for the Medicaid program under Tit. XIX of the 10 federal Social Security Act, the children’s health insurance 11 program under Tit. XXI of the federal Social Security Act, or 12 any applicable state or local public program and, if through 13 screening of an application by the marketplace, the marketplace 14 determines that any individual is eligible for any such 15 program, enroll that individual in that program. 16 6. Establish and make available by electronic means a 17 calculator to determine the actual cost of coverage after 18 application of any premium tax credit for which an individual 19 is eligible using the standards of the federal Act as codified 20 at section 36B(c)(2)(C) of the Internal Revenue Code of 1986 21 and any cost-sharing reductions under section 1402 of the 22 federal Act. 23 7. Establish a small business health options program 24 component of the marketplace through which individuals 25 employed by a qualified employer may enroll in any qualified 26 health plan offered through the small business health options 27 program at the level of coverage specified by the employer. 28 In establishing a small business health options program 29 marketplace component, the marketplace shall do all of the 30 following: 31 a. Provide consolidated billing and premium payment 32 by qualified employers including detailed information to 33 those employers about health insurance plans chosen by their 34 employees and the cost of those plans. 35 -15- LSB 5289XS (2) 85 rj/rj 15/ 31
S.F. 2112 b. Establish an electronic interface and facilitate the flow 1 of funds between health carriers, employers, and employees, 2 including subsidiaries. 3 c. Provide for the dissemination of health insurance plan 4 enrollment information to employers. 5 8. Establish an individual health options marketplace 6 component through which individuals may enroll in any qualified 7 health plan for individuals. 8 9. Select entities qualified and licensed to serve as 9 navigators in accordance with section 1311(i) of the federal 10 Act, standards developed by the secretary, section 514M.9, and 11 chapter 522D, and award grants to facilitate the function of 12 navigators as provided in section 514M.9. 13 10. Encourage and review the development of cafeteria plans 14 pursuant to section 125 of the Internal Revenue Code of 1986, 15 for use by employers participating in the marketplace. 16 11. Maintain an internet site through which enrollees, 17 employers, and prospective enrollees of qualified health 18 plans, at a minimum, may obtain standardized comparative 19 information on qualified health plans and health plans that 20 are not offered through the marketplace. In developing the 21 electronic clearinghouse, the marketplace may require health 22 carriers participating in the marketplace to make available 23 and regularly update an electronic directory of contracting 24 health care providers so individuals seeking coverage through 25 the marketplace can search by health care provider name to 26 determine which qualified health plans in the marketplace 27 include that health care provider in their network, and whether 28 that health care provider is accepting new patients for that 29 particular health plan. 30 12. Consult with stakeholders who are relevant to carrying 31 out the activities required under this chapter. 32 13. Assist in the implementation of reinsurance and risk 33 adjustment mechanisms, as required by state and federal law. 34 14. Establish guidelines for determining qualifications for 35 -16- LSB 5289XS (2) 85 rj/rj 16/ 31
S.F. 2112 marketplace employees and entities or persons who are licensed 1 and selected as navigators. 2 15. Subject to section 1411 of the federal Act and 3 applicable state law, grant a certification attesting that, for 4 purposes of the individual responsibility penalty under the 5 standards of the federal Act, as codified at section 5000A of 6 the Internal Revenue Code of 1986, an individual is exempt from 7 the individual responsibility requirement or from the penalty 8 imposed by that section because of any of the following: 9 a. There is no affordable qualified health plan available 10 through the marketplace, or the individual’s employer, covering 11 the individual. 12 b. The individual meets the requirements for any other such 13 exemption from the individual responsibility requirement or 14 penalty. 15 16. Transfer to the United States secretary of the treasury 16 all of the following: 17 a. A list of the individuals who are issued a certification 18 under subsection 15, paragraph “a” , including the name and 19 taxpayer identification number of each individual. 20 b. The name and taxpayer identification number of each 21 individual who was an employee of an employer but who was 22 determined to be eligible for the premium tax credit using 23 the standards of the federal Act as codified at section 24 36B(c)(2)(C) of the Internal Revenue Code of 1986, because of 25 either of the following: 26 (1) The employer did not provide minimum essential health 27 benefits coverage. 28 (2) The employer provided minimum essential health benefits 29 coverage, but it was determined using the standards of the 30 federal Act, as codified at section 36B(c)(2)(C) of the 31 Internal Revenue Code of 1986, to either be unaffordable to 32 the employee or not to provide the required minimum actuarial 33 value. 34 c. The name and taxpayer identification number of all of the 35 -17- LSB 5289XS (2) 85 rj/rj 17/ 31
S.F. 2112 following: 1 (1) Each individual who notifies the marketplace under 2 section 1411(b)(4) of the federal Act that the individual has 3 changed employers. 4 (2) Each individual who ceases coverage under a qualified 5 health plan during a plan year and the effective date of that 6 cessation. 7 17. Provide to each employer the name of each employee of 8 the employer described in subsection 16, paragraph “b” , who 9 ceases coverage under a qualified health plan during a plan 10 year and the effective date of the cessation. 11 18. Perform duties required of, or delegated to, the 12 marketplace by the secretary, the United States secretary 13 of the treasury, or the commissioner related to determining 14 eligibility for premium tax credits, reduced cost-sharing, or 15 individual responsibility requirement exemptions. 16 19. In consultation with the commissioner, review the 17 rate of premium growth of health insurance plans within the 18 marketplace and outside the marketplace, and consider the 19 information obtained in developing recommendations on whether 20 to continue limiting qualified employer status to small 21 employers. 22 Sec. 9. NEW SECTION . 514M.9 Navigators. 23 1. The marketplace may select entities qualified and 24 licensed to serve as navigators in accordance with section 25 1311(i) of the federal Act, standards developed by the 26 secretary, and applicable state law including chapter 522D, and 27 award grants to enable navigators to do all of the following: 28 a. Conduct public education activities to raise awareness 29 of the availability of qualified health plans through the 30 marketplace. 31 b. Distribute fair and impartial information concerning 32 enrollment in qualified health plans, and the availability of 33 premium tax credits for which an individual may be eligible 34 using the standards of the federal Act, as codified at section 35 -18- LSB 5289XS (2) 85 rj/rj 18/ 31
S.F. 2112 36B(c)(2)(C) of the Internal Revenue Code of 1986, and any 1 cost-sharing reductions under section 1402 of the federal Act. 2 c. Facilitate enrollment in qualified health plans offered 3 through the marketplace or in health insurance plans offered 4 outside the marketplace by referring consumers to insurance 5 producers and to the marketplace internet site for enrollment. 6 d. Provide referrals to the office of health insurance 7 consumer assistance established under the federal Act pursuant 8 to section 2793 of the federal Public Health Service Act 9 and the office of the commissioner or any other appropriate 10 state agency, for any enrollee with a grievance, complaint, 11 or question regarding the enrollee’s health insurance plan or 12 coverage, or a determination under that plan or coverage. 13 e. Provide information in a manner that is culturally and 14 linguistically appropriate to the needs of the population being 15 served by the marketplace. 16 2. An entity selected and licensed as a navigator shall not 17 engage in any activities that require licensure as an insurance 18 producer under chapter 522B unless the entity is also licensed 19 as an insurance producer. 20 Sec. 10. NEW SECTION . 514M.10 Health insurance plan 21 certification. 22 1. The marketplace may certify a health insurance plan as a 23 qualified health plan if the plan meets all of the following 24 criteria: 25 a. The plan provides the essential health benefit package 26 described in section 1302(a) of the federal Act, except that 27 the plan is not required to provide essential benefits that 28 duplicate the minimum benefits of qualified dental plans as 29 provided in subsection 6 if all of the following occur: 30 (1) The marketplace determines that at least one qualified 31 dental plan is available to supplement the plan’s coverage. 32 (2) The health carrier makes a prominent disclosure at the 33 time it offers the plan, in a form approved by the marketplace, 34 that the plan does not provide the full range of essential 35 -19- LSB 5289XS (2) 85 rj/rj 19/ 31
S.F. 2112 pediatric benefits and that qualified dental plans providing 1 those benefits and other dental benefits not covered by the 2 plan are offered through the marketplace. 3 b. The premium rates and contract language have been 4 approved by the commissioner. 5 c. The plan provides at least a bronze level of coverage, 6 as that level is defined by the federal Act, unless the plan 7 is certified as a qualified catastrophic plan, meets the 8 requirements of the federal Act for catastrophic plans, and 9 will only be offered to individuals eligible for catastrophic 10 coverage. 11 d. The plan’s cost-sharing requirements do not exceed the 12 limits established under section 1302(c)(1) of the federal Act, 13 and if the plan is offered through the small business health 14 options program component of the marketplace that offers plans 15 to small employers, the plan’s deductible does not exceed the 16 limits established under section 1302(c)(2) of the federal Act. 17 e. The plan offers wellness programs. 18 f. The health carrier offering the plan provides greater 19 transparency and disclosure of information about the plan 20 benefits, provider networks, claim payment practices, and 21 solvency ratings, and establishes a process for consumers to 22 compare features of health insurance plans offered through the 23 marketplace. 24 g. The health carrier offering the plan meets all of the 25 following criteria: 26 (1) Is licensed and in good standing to offer health 27 insurance coverage in this state. 28 (2) Offers at least one qualified health plan in the silver 29 level and at least one qualified health plan in the gold level, 30 as those levels are defined in the federal Act, through each 31 component of the marketplace in which the health carrier 32 participates, where component refers to the components of the 33 marketplace which offer individual coverage and coverage for 34 small employers. 35 -20- LSB 5289XS (2) 85 rj/rj 20/ 31
S.F. 2112 (3) Charges the same premium rate for each qualified health 1 plan without regard to whether the plan is offered through the 2 marketplace. 3 (4) Does not charge any termination of coverage fees or 4 penalties in violation of section 514M.7. 5 (5) Complies with the regulations developed by the 6 secretary under section 1311(d) of the federal Act, applicable 7 state laws, and such other requirements as the marketplace may 8 establish. 9 h. The plan meets the requirements of certification as 10 adopted by rule pursuant to this section and by the secretary 11 under section 1311(c) of the federal Act, which include but 12 are not limited to minimum standards in the areas of marketing 13 practices, network adequacy, essential community providers in 14 underserved areas, accreditation, quality improvement, uniform 15 enrollment forms and descriptions of coverage, and information 16 on quality measures for plan performance. 17 i. The marketplace determines that making the plan available 18 through the marketplace is in the interest of qualified 19 individuals and qualified employers in this state. 20 2. The marketplace shall not exclude a health insurance plan 21 from certification for any of the following reasons: 22 a. On the basis that the plan is a fee-for-service plan. 23 b. Through the imposition of premium price controls. 24 c. On the basis that the plan provides treatments necessary 25 to prevent patients’ deaths in circumstances the marketplace 26 determines are inappropriate or too costly. 27 3. The marketplace shall require each health carrier 28 seeking certification of a health insurance plan as a qualified 29 health plan to do all of the following: 30 a. Provide notice of any proposed premium increase and 31 a justification for the increase to the marketplace and to 32 affected policyholders before implementation of that increase. 33 The health carrier shall prominently post the information 34 on its internet site. The marketplace shall take this 35 -21- LSB 5289XS (2) 85 rj/rj 21/ 31
S.F. 2112 information, along with the information and the recommendations 1 provided to the marketplace by the commissioner under the 2 federal Act pursuant to section 2794(b) of the federal Public 3 Health Service Act and applicable state law, into consideration 4 when determining whether to allow the health carrier to make 5 plans available through the marketplace. 6 b. Make available to the public, in the format described in 7 paragraph “c” , and submit to the marketplace, the secretary, and 8 the commissioner, accurate and timely disclosure of all of the 9 following: 10 (1) Claims payment policies and practices. 11 (2) Periodic financial disclosures. 12 (3) Data on enrollment. 13 (4) Data on disenrollment. 14 (5) Data on the number of claims that are denied. 15 (6) Data on rating practices. 16 (7) Information on cost-sharing and payments with respect 17 to any out-of-network coverage. 18 (8) Information on enrollee and participant rights under 19 Tit. I of the federal Act and applicable state law. 20 (9) Other information as determined appropriate by the 21 secretary, the marketplace, or the commissioner. 22 c. The information required in paragraph “b” shall be 23 provided in plain language, as that term is defined in section 24 1311(e) of the federal Act, as amended by section 10104 of the 25 federal Act, and applicable state law. 26 4. The marketplace shall permit individuals to learn, 27 in a timely manner upon the request of an individual, the 28 amount of cost-sharing, including deductibles, copayments, 29 and coinsurance, under the individual’s health insurance plan 30 or coverage for which the individual would be responsible 31 for paying with respect to the furnishing of a specific item 32 or service by a participating health care provider. At a 33 minimum, this information shall be made available to the 34 individual through an internet site and through other means for 35 -22- LSB 5289XS (2) 85 rj/rj 22/ 31
S.F. 2112 individuals without access to the internet. 1 5. The marketplace shall not exempt any health carrier 2 seeking certification of a health insurance plan, regardless 3 of the type or size of the health carrier, from applicable 4 state licensure or solvency requirements and shall apply the 5 criteria of this section in a manner that assures a level 6 playing field between or among health carriers participating 7 in the marketplace. 8 6. a. The provisions of this chapter that are applicable to 9 qualified health plans shall also apply to the extent relevant 10 to qualified dental plans except as modified in accordance with 11 the provisions of paragraphs “b” , “c” , and “d” , or by rules 12 adopted by the marketplace. 13 b. A health carrier to offer dental coverage shall be 14 licensed, but is not required to be licensed to offer other 15 health benefits. 16 c. A qualified dental plan shall be limited to dental and 17 oral health benefits, without substantially duplicating the 18 benefits typically offered by health insurance plans without 19 dental coverage and shall include, at a minimum, the essential 20 pediatric dental benefits prescribed by the secretary pursuant 21 to section 1302(b)(1)(J) of the federal Act, and such other 22 dental benefits as the marketplace or the secretary may specify 23 by rule or regulation. 24 d. A comprehensive plan may be offered through the 25 marketplace in which dental benefits are included either as 26 part of a qualified health plan, or by a qualified dental 27 plan offered in conjunction with a qualified health plan, 28 provided that the medical and dental benefits offered by the 29 comprehensive plan are priced separately and are offered for 30 purchase separately at the same price. 31 Sec. 11. NEW SECTION . 514M.11 Funding —— publication of 32 costs. 33 1. The marketplace may charge assessments or user fees to 34 health carriers that offer health insurance plans through the 35 -23- LSB 5289XS (2) 85 rj/rj 23/ 31
S.F. 2112 marketplace or may otherwise generate the funding necessary to 1 support the operation of the marketplace, as provided pursuant 2 to the plan of operation of the marketplace. 3 2. The marketplace may charge user fees in the form of a 4 transaction fee set at a percentage of the premium paid for a 5 health insurance plan sold through the marketplace. 6 3. The marketplace may accept donations consistent with the 7 purpose and intent of this chapter as stated in section 514M.2. 8 4. The marketplace shall publish the average costs of 9 licensing, regulatory fees, and any other payments required 10 by the marketplace, and the administrative costs of the 11 marketplace, on an internet site for the purpose of educating 12 consumers about the costs of operating the marketplace. The 13 information provided shall include information on moneys lost 14 due to waste, fraud, and abuse of the health care system. 15 5. State funding shall not be appropriated or allocated 16 for the operation or administration of the marketplace. Any 17 assessments or user fees charged pursuant to this section 18 shall provide for the sharing of losses and expenses of the 19 marketplace on an equitable and proportionate basis among 20 health carriers in this state as provided in the plan of 21 operation of the marketplace. 22 6. The marketplace may accept for the benefit of the 23 marketplace funds from the federal government and funds held 24 by the Iowa comprehensive health insurance association as 25 established in chapter 514E in the form of member assessments 26 or other moneys not necessary for the payment of the 27 association’s obligations under chapter 514E. 28 Sec. 12. NEW SECTION . 514M.12 Rules. 29 In consultation with and subject to the approval of the 30 board, the commissioner shall adopt rules pursuant to chapter 31 17A to effectuate and administer the provisions of this 32 chapter. Rules adopted under this section shall not conflict 33 with or prevent the application of regulations promulgated by 34 the secretary under the federal Act. 35 -24- LSB 5289XS (2) 85 rj/rj 24/ 31
S.F. 2112 Sec. 13. NEW SECTION . 514M.13 Advisory committee. 1 1. The board shall be advised by a legislative health 2 insurance marketplace implementation review committee 3 consisting of members of the general assembly appointed by the 4 legislative council. 5 2. The advisory committee shall offer input to the board 6 regarding rules proposed by the commissioner, the plan of 7 operation for the marketplace, and any other topics relevant 8 to the marketplace. 9 Sec. 14. NEW SECTION . 514M.14 Annual report. 10 1. The marketplace shall submit an annual report to the 11 commissioner, governor, general assembly, and the auditor of 12 state by January 15. The report shall include an accurate 13 accounting of all the activities of the marketplace and of all 14 its receipts and expenditures during the prior fiscal year. 15 2. The report shall describe how the operations and 16 activities of the marketplace serve the interests of the state 17 and further the purposes set forth in this chapter. 18 Sec. 15. NEW SECTION . 514M.15 Relation to other laws. 19 This chapter, and action taken by the marketplace pursuant 20 to this chapter, shall not be construed to preempt or supersede 21 the authority of the commissioner to regulate the business 22 of insurance in this state. Except as expressly provided to 23 the contrary in this chapter, all health carriers offering 24 qualified health plans in this state shall comply fully with 25 all applicable health insurance laws of this state and rules 26 adopted and orders issued by the commissioner. 27 Sec. 16. NEW SECTION . 514M.16 Transition provisions. 28 1. a. Beginning on or before March 1, 2015, upon their 29 appointment, the board of directors of the marketplace 30 shall meet, and in consultation with the commissioner, shall 31 begin plans to implement the transition of the functions and 32 administration of the federal-state partnership exchange in 33 full operation in this state as of January 1, 2014, pursuant 34 to the federal Act, to the marketplace established pursuant to 35 -25- LSB 5289XS (2) 85 rj/rj 25/ 31
S.F. 2112 this chapter, in accordance with the federal Act and standards 1 developed by the secretary, and applicable state law. 2 b. The marketplace established pursuant to this chapter 3 shall be operational and shall offer enrollment in qualified 4 health plans to qualified individuals and qualified employers 5 in this state on or before October 1, 2015. The qualified 6 health plans that are offered through the marketplace shall be 7 effective on January 1, 2016. 8 2. The commissioner shall transfer the functions and 9 administration of the Iowa insurance information exchange 10 established in section 505.32 to the marketplace established 11 pursuant to this chapter on or before January 1, 2016. 12 DIVISION II 13 CORRESPONDING PROVISIONS 14 Sec. 17. Section 249N.5, Code 2014, is amended by adding the 15 following new subsection: 16 NEW SUBSECTION . 3. Beginning January 1, 2016, the Iowa 17 health and wellness plan shall be administered through the Iowa 18 health insurance marketplace established in chapter 514M. 19 Sec. 18. Section 505.32, Code 2013, is amended by adding the 20 following new subsection: 21 NEW SUBSECTION . 6. This section is repealed on July 1, 22 2016. 23 DIVISION III 24 EFFECTIVE DATE 25 Sec. 19. EFFECTIVE DATE. This Act takes effect January 1, 26 2015. 27 EXPLANATION 28 The inclusion of this explanation does not constitute agreement with 29 the explanation’s substance by the members of the general assembly. 30 This bill provides for the establishment of the Iowa health 31 insurance marketplace. 32 The bill creates new Code chapter 514M, which provides for 33 the establishment of an Iowa health insurance marketplace, in 34 place of the federal-state partnership exchange created and 35 -26- LSB 5289XS (2) 85 rj/rj 26/ 31
S.F. 2112 fully operational as of January 1, 2014, to facilitate the 1 sale and purchase of qualified health plans in this state by 2 qualified individuals in the individual market and by qualified 3 small employers in the small group market. The intent of 4 establishing such a marketplace is to reduce the number of 5 uninsured individuals in this state, provide a transparent 6 marketplace and consumer education, and assist individuals 7 with access to relevant federal and state programs, premium 8 assistance tax credits, and cost-sharing reductions. 9 For purposes of the bill, a qualified employer that can 10 participate in the small business health options program 11 component of the marketplace is an employer that employs an 12 average of at least one and not more than 50 employees during 13 the preceding calendar year and elects to make its full-time 14 employees, and at the employer’s option, some or all of its 15 part-time employees, eligible for one or more qualified health 16 plans offered through the small business health options program 17 component of the marketplace. A qualified employer must 18 either have its principal place of business in this state and 19 elect to provide health coverage through the marketplace to 20 all of its eligible employees wherever employed, or elect to 21 provide coverage through the marketplace to all of its eligible 22 employees who are principally employed in this state. 23 The Iowa health insurance marketplace is established as a 24 nonprofit corporation. The marketplace shall be operated on 25 a statewide basis pursuant to a plan of operation established 26 and approved by its board of directors in consultation 27 with the commissioner of insurance. The marketplace shall 28 include separate components which facilitate the purchase 29 of qualified health plans by eligible individuals and small 30 employers as described in new Code chapter 514M and the federal 31 Patient Protection and Affordable Care Act, as amended. The 32 marketplace may contract with an experienced and reputable 33 entity to develop and maintain the marketplace’s internet site. 34 The marketplace may employ staff to carry out its duties but 35 -27- LSB 5289XS (2) 85 rj/rj 27/ 31
S.F. 2112 no employees of the marketplace may offer services for which 1 a license as an insurance producer is required pursuant to 2 Code chapter 522B. The marketplace is also authorized to 3 contract with an eligible entity to fulfill any of its duties 4 or responsibilities as described in new Code chapter 514M. 5 The board of directors of the marketplace is comprised 6 of seven members appointed by the governor for three-year 7 staggered terms with two representing the interests of small 8 business; three representing the interests of consumers; one 9 who is a licensed insurance producer; and one who is a health 10 care provider. The members must be appointed on or before 11 March 1, 2015. 12 The members of the board are required to appoint an 13 executive director, subject to confirmation by the senate, to 14 supervise the administrative affairs and general management 15 and operations of the marketplace. The board may appoint 16 other officers as the board deems necessary. The board is 17 also required to appoint a secretary of the board who keeps 18 a record of the board proceedings, is the custodian of all 19 books, documents, and papers filed with the board, including 20 information filed in an electronic format, and of the minute 21 book or journal of the board. 22 The marketplace has all the general powers of a nonprofit 23 corporation that are necessary and convenient to carry out its 24 purposes and duties and to exercise its specific powers as 25 provided in new Code chapter 514M. 26 The marketplace is required to make qualified health plans 27 that are effective on or before January 1, 2016, available to 28 qualified individuals and qualified employers in the state. 29 The specific duties and powers of the marketplace are set 30 forth in new Code chapter 514M. The specific duties include 31 responding to requests for assistance through an internet site, 32 a toll-free telephone hotline, and in-person support staff 33 available in selected locations in the state. 34 The marketplace is authorized to select entities licensed 35 -28- LSB 5289XS (2) 85 rj/rj 28/ 31
S.F. 2112 and qualified to act as navigators in accordance with the 1 requirements of state and federal law for the purpose of 2 conducting public education activities, distributing fair and 3 impartial information concerning enrollment in qualified health 4 plans, facilitating such enrollment, providing referrals to the 5 appropriate federal or state entity for grievances, complaints, 6 or questions regarding an enrollee’s health plan, and providing 7 culturally and linguistically appropriate information to 8 persons served by the marketplace. An entity licensed as a 9 navigator under Code chapter 522D shall not engage in any 10 activities that require licensure as an insurance producer 11 unless the entity is also licensed as an insurance producer 12 under Code chapter 522B. The marketplace is authorized to 13 certify a health insurance plan as a qualified health plan if 14 the plan meets specified criteria. 15 The marketplace may charge assessments or user fees, 16 including transaction fees set at a percentage of premiums 17 paid, on health insurance plans sold through the marketplace, 18 or otherwise generate the funding necessary to support the 19 operation of the marketplace, including through donations, 20 as provided in the marketplace’s plan of operation. The 21 marketplace is required to publish the average costs of 22 licensing, regulatory fees, and any other payments required 23 by the marketplace, as well as the administrative costs 24 of the marketplace on an internet site for the purpose 25 of educating consumers about the costs of operating the 26 marketplace. No state funding can be appropriated or allocated 27 for the operation or administration of the marketplace. Any 28 assessments or user fees charged must provide for sharing 29 the losses and expenses of the marketplace on an equitable 30 and proportionate basis among health carriers in the state. 31 The marketplace may accept federal funds as well as moneys 32 available from the Iowa comprehensive health insurance 33 association established in Code chapter 514E. 34 In consultation with and subject to the approval of the 35 -29- LSB 5289XS (2) 85 rj/rj 29/ 31
S.F. 2112 board, the commissioner of insurance is required to adopt rules 1 pursuant to Code chapter 17A to effectuate and administer 2 the provisions of new Code chapter 514M. The board is to 3 be advised regarding implementation of the marketplace by 4 a committee consisting of members of the general assembly 5 appointed by the legislative council. 6 The marketplace is required to submit an annual report to the 7 commissioner, governor, general assembly, and the auditor of 8 state by January 15, which includes an accurate accounting of 9 all the activities of the marketplace and of all its receipts 10 and expenditures during the prior fiscal year. The report 11 shall also describe how the operations and activities of the 12 marketplace serve the interests of the state and further the 13 purposes of new Code chapter 514M. 14 The enactment of the Code chapter and actions taken by 15 the marketplace are not to be construed as preempting or 16 superseding the authority of the commissioner to regulate 17 insurance in this state. 18 The new Code chapter contains transition provisions 19 that require the new marketplace board to be appointed and 20 meet on or before March 1, 2015, and in consultation with 21 the commissioner of insurance, begin plans to implement 22 the transition of the functions and administration of the 23 federal-state partnership exchange in full operation in this 24 state as of January 1, 2014, pursuant to the federal Act, to 25 the marketplace established pursuant to new Code chapter 514M. 26 The marketplace must be operational and offer enrollment in 27 qualified health plans to qualified individuals and qualified 28 employers in this state on or before October 1, 2015. The 29 qualified health plans that are offered through the marketplace 30 must be effective on January 1, 2016. The Iowa health and 31 wellness plan will be administered through the marketplace 32 beginning January 1, 2016. 33 The commissioner of insurance is also directed to transfer 34 the functions and administration of the Iowa insurance 35 -30- LSB 5289XS (2) 85 rj/rj 30/ 31
S.F. 2112 information exchange established in Code section 505.32 to the 1 marketplace on or before January 1, 2016, and Code section 2 505.32 is repealed on that date. 3 The bill is effective January 1, 2015. 4 -31- LSB 5289XS (2) 85 rj/rj 31/ 31
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