STATE OF OKLAHOMA

1st Session of the 52nd Legislature (2009)

SENATE BILL 846	By:	Crain

AS INTRODUCED

An Act relating to state employee benefits; amending 56 O.S. 2001, Section 1010.1, as last amended by Section 1, Chapter 412, O.S.L. 2008 (56 O.S. Supp. 2008, Section 1010.1), which relates to the premium assistance program; expanding certain program for specified persons; amending 74 O.S. 2001, Section 1371, as last amended by Section 6, Chapter 269, O.S.L. 2007 (74 O.S. Supp. 2008, Section 1371), which relates to election of benefit plans; allowing certain state employees to participate in the premium assistance program; specifying when the required participation will become effective; providing an effective date; and declaring an emergency.

BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1.     AMENDATORY     56 O.S. 2001, Section 1010.1, as last amended by Section 1, Chapter 412, O.S.L. 2008 (56 O.S. Supp. 2008, Section 1010.1), is amended to read as follows:
Section 1010.1  A.  Sections 1010.1 et seq. of this title shall be known and may be cited as the “Oklahoma Medicaid Program Reform Act of 2003”.
B.  Recognizing that many Oklahomans do not have health care benefits or health care coverage, that many small businesses cannot afford to provide health care benefits to their employees, and that, under federal law, barriers exist to providing Medicaid benefits to the uninsured, the Oklahoma Legislature hereby establishes provisions to lower the number of uninsured, assist businesses in their ability to afford health care benefits and coverage for their employees, and eliminate barriers to providing health coverage to eligible enrollees under federal law.
C.  Unless otherwise provided by law, the Oklahoma Health Care Authority shall provide coverage under the state Medicaid program to children under the age of eighteen (18) years whose family incomes do not exceed one hundred eighty-five percent (185%) of the federal poverty level.
D.  1.  The Authority is directed to apply for a waiver or waivers to the Centers for Medicaid and Medicare Services (CMS) that will accomplish the purposes outlined in subsection B of this section.  The Authority is further directed to negotiate with CMS to include in the waiver authority provisions to:
a.	increase access to health care for Oklahomans,
b.	reform the Oklahoma Medicaid Program to promote personal responsibility for health care services and appropriate utilization of health care benefits through the use of public-private cost sharing,
c.	enable small employers, and/or employed, uninsured adults with or without children to purchase employer-sponsored, state-approved private, or state-sponsored health care coverage through a state premium assistance payment plan.  If by January 1, 2012, the Employer/Employee Partnership for Insurance Coverage Premium Assistance Program is not consuming more than seventy-five percent (75%) of its dedicated source of funding, then the program will be expanded to include parents of children eligible for Medicaid, and
d.	develop flexible health care benefit packages based upon patient need and cost.
2.  The Authority may phase in any waiver or waivers it receives based upon available funding.
3.  The Authority is authorized to develop and implement a premium assistance plan to assist small businesses and/or their eligible employees to purchase employer-sponsored insurance or “buy-in” to a state-sponsored benefit plan.
4.  a.	The Authority is authorized to seek from the Centers for Medicare and Medicaid Services any waivers or amendments to existing waivers necessary to accomplish an expansion of the premium assistance program to:
(1)	include for-profit employers with two hundred fifty employees or less up to any level supported by existing funding resources; and
(2)	include not-for-profit employers with five hundred employees or less up to any level supported by existing funding resources.
b.	Foster parents employed by employers with greater than two hundred fifty employees shall be exempt from the qualifying employer requirement provided for in this paragraph and shall be eligible to qualify for the premium assistance program provided for in this section if supported by existing funding.
E.  For purposes of this paragraph, “for-profit employer” shall mean an entity which is not exempt from taxation pursuant to the provisions of Section 501(c)(3) of the Internal Revenue Code and “not-for-profit employer” shall mean an entity which is exempt from taxation pursuant to the provisions of Section 501(c)(3) of the Internal Revenue Code.
F.  The Authority is authorized to seek from the Centers for Medicare and Medicaid Services any waivers or amendments to existing waivers necessary to accomplish an extension of the premium assistance program to include qualified employees whose family income does not exceed two hundred fifty percent (250%) of the federal poverty level, subject to the limit of federal financial participation.
G.  The Authority is authorized to seek from the Centers for Medicare and Medicaid Services any waivers or amendments to existing waivers necessary to accomplish an extension of the premium assistance program to include state employees who have a household income at or under two hundred fifty percent (250%) of the federal poverty level.  The flexible benefit allowance provided in Section 1370 of Title 74 of the Oklahoma Statutes shall be used to cover the employee’s portion of the premium.
H.  1.  There is hereby created in the State Treasury a revolving fund to be designated the “Health Employee and Economy Improvement Act (HEEIA) Revolving Fund”.
2.  The fund shall be a continuing fund, not subject to fiscal year limitations, and shall consist of:
a.	all monies received by the Authority pursuant to this section and otherwise specified or authorized by law,
b.	monies received by the Authority due to federal financial participation pursuant to Title XIX of the Social Security Act, and
c.	interest attributable to investment of money in the fund.
3.  All monies accruing to the credit of the fund are hereby appropriated and shall be budgeted and expended by the Authority to implement a premium assistance plan, unless otherwise provided by law.
SECTION 2.     AMENDATORY     74 O.S. 2001, Section 1371, as last amended by Section 6, Chapter 269, O.S.L. 2007 (74 O.S. Supp. 2008, Section 1371), is amended to read as follows:
Section 1371.  A.  All Except as otherwise provided by subsection D of this section, all participants must purchase at least the basic plan unless, to the extent that it is consistent with federal law, the participant is a person who has retired from a branch of the United States military and has been provided with health coverage through a federal plan and that participant provides proof of that coverage.  On or before January 1 of the plan year beginning July 1, 2001, and July 1 of any plan year beginning after January 1, 2002, the Oklahoma State Employees Benefits Council shall design the basic plan for the next plan year to insure that the basic plan provides adequate coverage to all participants.  All benefit plans, whether offered by the State and Education Employees Group Insurance Board, a health maintenance organization or other vendors shall meet the minimum requirements set by the Council for the basic plan.
B.  The Board shall offer health, disability, life and dental coverage to all participants and their dependents.  For health, dental, disability and life coverage, the Board shall offer plans at the basic benefit level established by the Council, and in addition, may offer benefit plans that provide an enhanced level of benefits.  The Board shall be responsible for determining the plan design and the benefit price for the plans that they offer.  Effective for the plan year beginning January 1, 2007, and for each plan year thereafter, in setting health insurance premiums for active employees and for retirees under sixty-five (65) years of age, the Board shall set the monthly premium for active employees to be equal to the monthly premium for retirees under sixty-five (65) years of age.
Nothing in this subsection shall be construed as prohibiting the Board from offering additional medical plans, provided that any medical plan offered to participants shall meet or exceed the benefits provided in the medical portion of the basic plan.
C.  In lieu of electing any of the preceding medical benefit plans, a participant may elect medical coverage by any health maintenance organization made available to participants by the Council.  The benefit price of any health maintenance organization shall be determined on a competitive bid basis.  Contracts for said plans shall not be subject to the provisions of the Oklahoma Central Purchasing Act, Section 85.1 et seq. of this title.  The Council shall promulgate rules establishing appropriate competitive bidding criteria and procedures for contracts awarded for flexible benefits plans.  All plans offered by health maintenance organizations meeting the bid requirements as determined by the Council shall be accepted.  The Council shall have the authority to reject the bid or restrict enrollment in any health maintenance organization for which the Council determines the benefit price to be excessive.  The Council shall have the authority to reject any plan that does not meet the bid requirements.  All bidders shall submit along with their bid a notarized, sworn statement as provided by Section 85.22 of this title.  Effective for the plan year beginning January 1, 2007, and for each plan year thereafter, in setting health insurance premiums for active employees and for retirees under sixty-five (65) years of age, HMOs, self-insured organizations and prepaid plans shall set the monthly premium for active employees to be equal to the monthly premium for retirees under sixty-five (65) years of age.
D.  In lieu of electing any of the medical benefit plans provided for in subsections B or C of this section, any participant whose household income is at or under two hundred fifty percent (250%) of the federal poverty level may participate in the premium assistance program authorized in Section 1010.1 of Title 56 of the Oklahoma Statutes.  The provisions of this subsection shall become effective for the next plan year after the waiver required by subsection G of Section 1010.1 of Title 56 of the Oklahoma Statutes is granted from the Centers for Medicare and Medicaid Services.
E.  Nothing in this section shall be construed as prohibiting the Council from offering additional qualified benefit plans or currently taxable benefit plans.
E. F.  Each employee of a participating employer who meets the eligibility requirements for participation in the flexible benefits plan shall make an annual election of benefits under the plan during an enrollment period to be held prior to the beginning of each plan year.  The enrollment period dates will be determined annually and will be announced by the Council, providing the enrollment period shall end no later than thirty (30) days before the beginning of the plan year.
Each such employee shall make an irrevocable advance election for the plan year or the remainder thereof pursuant to such procedures as the Council shall prescribe.  Any such employee who fails to make a proper election under the plan shall, nevertheless, be a participant in the plan and shall be deemed to have purchased the default benefits described in this section.
F. G.  The Council shall prescribe the forms that participants will be required to use in making their elections, and may prescribe deadlines and other procedures for filing the elections.
G. H.  Any participant who, in the first year for which he or she is eligible to participate in the plan, fails to make a proper election under the plan in conformance with the procedures set forth in this section or as prescribed by the Council shall be deemed automatically to have purchased the default benefits.  The default benefits shall be the same as the basic plan benefits.  Any participant who, after having participated in the plan during the previous plan year, fails to make a proper election under the plan in conformance with the procedures set forth in this section or prescribed by the Council, shall be deemed automatically to have purchased the same benefits which the participant purchased in the immediately preceding plan year, except that the participant shall not be deemed to have elected coverage under the health care reimbursement account plan or the dependent care reimbursement account plan.
H. I.  Benefit plan contracts with the Board, health maintenance organizations, and other third party insurance vendors shall provide for a risk adjustment factor for adverse selection that may occur, as determined by the Council, based on generally accepted actuarial principles.
I. J.  1.  For the plan year ending December 31, 2004, employees covered or eligible to be covered under the State and Education Employees Group Insurance Act and the State Employees Flexible Benefits Act who are enrolled in a health maintenance organization offering a network in Oklahoma City, shall have the option of continuing care with a primary care physician for the remainder of the plan year if:
a.	that primary care physician was part of a provider group that was offered to the individual at enrollment and later removed from the network of the health maintenance organization, for reasons other than for cause, and
b.	the individual submits a request in writing to the health maintenance organization to continue to have access to the primary care physician.
2.  The primary care physician selected by the individual shall be required to accept reimbursement for such health care services on a fee-for-service basis only.  The fee-for-service shall be computed by the health maintenance organization based on the average of the other fee-for-service contracts of the health maintenance organization in the local community.  The individual shall only be required to pay the primary care physician those co-payments, coinsurance and any applicable deductibles in accordance with the terms of the agreement between the employer and the health maintenance organization and the provider shall not balance bill the patient.
3.  Any network offered in Oklahoma City that is terminated prior to July 1, 2004, shall notify the health maintenance organization, Oklahoma State Employees Benefits Council and State and Education Employees Group Insurance Board by June 11, 2004, of the network’s intentions to continue providing primary care services as described in paragraph 2 of this subsection offered by the health maintenance organization to state and public employees.
SECTION 3.  This act shall become effective July 1, 2009.
SECTION 4.  It being immediately necessary for the preservation of the public peace, health and safety, an emergency is hereby declared to exist, by reason whereof this act shall take effect and be in full force from and after its passage and approval.

52-1-815	ARE	1/14/2009 5:03:41 PM