2011 State Legislation: Health Insurance Exchanges

Government Relations Division 2021 Massachusetts Avenue, NW Washington, DC 20036

As of December 31, 2011, all 50 states convened for legislative session. Legislators in 46 states are considering more than 556 bills referring to health insurance exchanges or a related term, such as connector or clearinghouse. The 89 bills in 33 states listed below concern studying, planning or creating a state exchange or participating in a regional exchange. Wyoming is the only state to enact legislation in 2011 concerning exchanges—HB 50 establishes a steering committee to study whether the state should establish or participate in a regional exchange. Most state legislation refers to the federal requirements established under the Patient Protection and Affordable Care Act, including provisions requiring exchanges to:

facilitate the purchase, sale and rating of qualified health plans;

require certified plans to: (1) include in networks essential community providers that serve low-income, underserved communities; (2) allow individuals to learn the cost-sharing under their plan for furnishing a specific item or service by a participating provider upon request through a website; and (3) contract with a health care provider only if they implement quality improvement mechanisms;

establish a small business health options program (SHOP) exchange;

maintain a website providing standardized comparative information on plans;

implement procedures for certification, recertification and decertification of plans;

coordinate eligibility of Medicaid, CHIP or other assistance programs;

select entities qualified to serve as Navigators;

review the rate of premium grown within and outside the exchange;

develop policies and procedures to minimize adverse selection;

enter into information-sharing agreements with federal and state agencies and other state exchanges;

become self-sustaining by January 1, 2015; and

consult with various stakeholders, including consumers, those with experience facilitating coverage in qualified health plans, representatives of small businesses, state Medicaid offices, and advocates for enrolling hard-to reach populations.

Under federal law, state exchanges (or entities overseeing an exchange) are allowed to charge assessments or user fees to insurers to generate necessary funding; publish average costs of licensing, regulatory fees and any other payment; and adopt regulations as needed. Exchanges cannot exclude a plan (1) because it is a fee-for-service plan; (2) by imposing premium price controls; or (3) because it provides treatment necessary to prevent deaths that the exchange determines are inappropriate or too costly. All 50 states convene for session in 2011 with Louisiana scheduled to begin April 25, and Virginia, Wyoming, Kentucky, Utah, and West Virginia the first to adjourn from regular session. Only New Jersey and Virginia carry over bills from 2010 to 2011. Most states are expected to continue considering legislation concerning exchanges in some form—from creating study committees to examine the feasibility of a state exchange to directing the state to seek federal funds to altering existing insurance statutes to prepare for the creation of a state-based exchange.

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This summary is only informational intended to provide background on the scope of projects currently before state legislatures. The reader should not consider this document to be comprehensive or to reflect AAFP policy.

Michelle Greenhalgh, Analyst, State Government Affairs, AAFP Robin Richardson, Analyst, State Government Affairs, AAFP Page 2 of 43 Last Revised:3/26/2012

For bill text and status of all active state exchanges legislation, please visit the AAFP bill tracking webpage:

http://www.aafp.org/online/en/home/policy/state/statetrack.html

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States Considering Legislation to

Study, Plan for the Implementation of, or Create a Health Insurance Exchange

ALABAMA ALASKA ARIZONA

ARKANSAS CALIFORNIA COLORADO

CONNECTICUT DELAWARE

FLORIDA GEORGIA HAWAII IDAHO

ILLINOIS INDIANA

IOWA KANSAS

KENTUCKY

LOUISIANA MAINE

MARYLAND MASSACHUSETTS

MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA

NEVADA NEW HAMPSHIRE

NEW JERSEY NEW MEXICO NEW YORK

NORTH CAROLINA NORTH DAKOTA

OHIO OKLAHOMA

OREGON PENNSYLVANIA RHODE ISLAND

SOUTH CAROLINA SOUTH DAKOTA

TENNESSEE TEXAS UTAH

VERMONT VIRGINIA

WASHINGTON WEST VIRGINIA

WISCONSIN WYOMING

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All States Considering Legislation Referring to Health Insurance Exchanges, 2011-2012

Source: American Academy of Family Physicians, 2012.

Michelle Greenhalgh, Analyst, State Government Affairs, AAFP Robin Richardson, Analyst, State Government Affairs, AAFP Page 3 of 43 Last Revised:3/26/2012

ALABAMA 2011 HB 401 – Health Department, Health Insurance Exchange established within, operated by a board,

members, duties, repealed if federal health reform laws requiring exchange repealed or ruled unconstitutional, Health Insurance Exchange Act__

Status: Referred to House Committee on Health – 3/31/2011 • This bill would create the Alabama Health Insurance Exchange within the Department of Health. The exchanged would be governed by a board and would provide for the membership terms and duties of the board. • The exchange would operate as an independent instrumentality of the state and would be recognized as a not-for-profit corporation for tax purposes. • It’s important to note that a provision in this bill declares that if parts of the federal health care reform act authorizing the exchange are repealed or declared unconstitutional, this act would also be repealed. • The bill defines a qualified employer as a small employer that elects to make its full-time employees eligible for one or more qualified health plans offered through the Small Employer Insurance Exchange.

ALASKA

2011 SB 70 – An Act Establishing the Alaska Benefit Exchange Status: Heard and Held by Senate Finance Committee – 3/28/2011

Establishes the Alaska Benefit Exchange as a public corporation of the state in the Department of Commerce, Community and Economic Development but with separate and independent legal existence.

Creates the Alaska Health Benefit Exchange Board to manage the exchange as provided for under the Patient Protection and Affordable Care Act, requiring it to:

o be made up of 12 Governor appointees, two of whom must be physicians licensed in the state; o apply for planning and establishment grants made available to the exchange; and o study the potential for interstate compacts.

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ARIZONA 2011 HB 2666 – Health Insurance; Exchange

Status: Amended and passed House Ways and Means Committee – 2/14/2011

Establishes the Arizona Health Insurance Exchange to serve as the American Health Benefit Exchange for Individuals and the Small Business Health Options Program—but keeps the individual and small group markets separate.

Creates the Arizona Health Insurance Exchange Board of Directors to oversee the exchange.

Establishes the Arizona Health Insurance Exchange Fund.

Prohibits the exchange from being the sole marketplace for individual and group health insurance in the state.

Determines that no other exchanges shall operate in the state, including subsidiary exchanges or state participation in a regional exchange.

Requires the exchange to: o adhere to requirements established by the Patient Protection and Affordable Care Act; o consult with relevant stakeholders, including advocates for enrolling hard-to-reach populations; and o be self-sustaining by January 1, 2015.

2011 SB 1524 – Health Insurance Exchange

Status: Referred to Senate Banking and Insurance Committee – 2/2/2011

Establishes the Arizona Health Insurance Exchange Board as the governing body of the Arizona Health Insurance Exchange to:

o determine the structure of and develop the exchange certified by January 1, 2013 and open for enrollment by July 1, 2013;

o contract with the Department of Insurance to conduct premium review; and

Michelle Greenhalgh, Analyst, State Government Affairs, AAFP Robin Richardson, Analyst, State Government Affairs, AAFP Page 4 of 43 Last Revised:3/26/2012

o consult with stakeholders, including advocates for hard-to-reach populations.

Establishes the Arizona Health Insurance Exchange to adhere to requirements provided in the Patient Protection and Affordable Care Act.

Prohibits members of the Board or staff of the exchange to be, be an employee of, or be affiliated with a health care provider, a health care facility or clinic, or a health insurer – with the exception of health care providers not receiving compensation for rendering services as a provider who do not have an ownership interest in a professional health care practice.

Establishes the Arizona Health Insurance Exchange Fund. ________________________________________________________________________________

ARKANSAS

2011 HB 2104 – To Authorize the Insurance Commissioner to Enforce the ACA Status: Died in House Committee at Sine Die adjournment – 4/27/2011

Authorizes the Insurance Commissioner to enforce the federal Affordable Care Act and to establish the Arkansas Health Benefit Exchange.

2011 HB 2138 – To allow the Insurance Commissioner to Protect Arkansans By the Continued Local

Regulation of Individual Health Insurance Coverage Status – Recommended for study in Interim by Joint Interim Committee on Insurance & Commerce – House –

3/31/2011

Chapter 23-104-102 establishes the second insurance marketplace in Arkansas called the Arkansas Health Benefits Exchange. The exchange will supplement the current insurance marketplace and facilitate the purchase and sale of qualified health plans in the individual market in the state

The bill also aims to provide for the establishment of a Small Business Health Options Program to assist qualified small employers in the state to facilitate the enrollment of their employees in qualified health plans offered through the exchange in the small group market.

The purpose of the Arkansas Health Benefits Exchange is to: o Increase the quality and affordable health care coverage o reduce the number of uninsured persons in Arkansas o increase the availability and consumer choice of health care coverage through the exchange

All health carriers licensed to sell accident and health insurance, or health maintenance organizations contracts may participate in the exchange

The exchange shall: o Facilitate the purchase and sale of qualified health plans; o Provide for the establishment of a Small Business Health Options Program to assist qualified

health plans o Meet the requirements identified in the chapter and any rules implemented under the chapter

The exchange may contract with an eligible entity for the functions described in the chapter (f) (1)(A) o An eligible entity includes without limitation the State Insurance Department or an entity that has

experience in individual and small group health insurance. o A health carrier or its affiliate is not an eligible entity

The exchange may enter into information-sharing agreements with federal and state agencies and other state exchanges to carry out its responsibilities under this chapter, provided that the agreements include adequate protection with respect to the confidentiality of the information to be shared and comply with state and federal laws.

23-104-105. General requirements.

(a) The Arkansas Health Benefits Exchange shall make qualified health plans available to qualified individuals and qualified employers beginning on or before January 1, 2014.

(b)(1) The exchange shall not make available a health benefit plan that is not a qualified health plan. o (2) The exchange shall allow a health carrier to offer a plan through the exchange that provides

limited-scope dental benefits meeting the requirements of section 9832(c)(2)(A) of the Internal Revenue Code of 1986, as it existed on January 1, 2011, separately or in conjunction with a qualified health plan, if the plan provides pediatric dental benefits meeting the requirements of

Michelle Greenhalgh, Analyst, State Government Affairs, AAFP Robin Richardson, Analyst, State Government Affairs, AAFP Page 5 of 43 Last Revised:3/26/2012

section 1302(b)(1)(J) of the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, as amended by the Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152.

(c) The exchange or a health carrier offering qualified health benefit plans through the exchange shall not charge an individual a fee or penalty for termination of coverage if the individual enrolls in another type of minimum essential coverage because the individual has become newly eligible for that coverage or because the individual's employer-sponsored coverage has become affordable under the standards of section 36B(c)(2)(C) of the Internal Revenue Code of 1986, as it existed on January 1, 2011.

2011 SB 113 – An Act to Prohibit Health Insurance Exchange Policies from Offering Coverage for Abortions Except Through a Separate Rider.

Status: Sine Die adjournment – 4/27/2011

This bill aimed to prohibit Arkansas health insurance exchange policies from offering coverage for abortions except through a separate rider.

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CALIFORNIA 2011 AB 171 – Autism Spectrum Disorder

Status: In committee: Hearing postponed by committee – 5/27/2011

This bill adds Section 1374.73 to the Health and Safety Code and adds Section 10144.51 to the Insurance Code, which relates to health care coverage.

The bill would require that health care service plan contracts and health insurance policies provide coverage for the screening, diagnosis, and treatment of autism spectrum disorders. It would however, provide that no benefits are required to be provided by a health benefit plan offered through the California Health Benefit Exchange that exceed the essential health benefits required under federal law.

The bill would prohibit coverage from being denied for specified reasons.

2011 AB 310 – Prescription Drugs Status: In committee: Hearing postponed by committee – 5/27/2011

This bill adds Section 1367.225 to the Health and Safety Code, and section 10123.197 to the Insurance Code relating to health care coverage.

The bill would prohibit health care service plans and health insurers that offer outpatient prescription drug coverage from requiring coinsurance, as defined, from the enrollee as a basis for cost sharing.

The bill would also impose certain limitations on copayments, as defined, and out-of-pocket expenses for outpatient prescription drugs.

The bill would make these provisions inoperative upon determination by the department and commissioner that these provisions would result in additional costs to the state as a result of laws governing federal health care reform.

2011 AB 714 – California Health Benefit Exchange

Status: In committee: Held under submission – 8/25/2011 Requires the state Department of Health Care Services and the Managed Risk Medical Insurance Board to

disclose information on health care coverage through the California Health Benefit Exchange to every individual who has ceased to be enrolled under the Medi-Cal and Family PACT programs, until June 30, 2013.

Requires the department and the board, after January 1, 2013, to provide to the Medi-Cal program and to the California Health Benefit Exchange information on every individual who has ceased to be enrolled under those programs, except the cancer treatment and Family PACT programs, for purposes of enrolling those individuals in the Exchange and to disclose that enrollment to those individuals.

2011 SB 728 – Health Care Coverage

Status: Set, second hearing. Hearing canceled at request of author – 7/5/2011

An act to add Section 100522 to the Government Code, relating to health care coverage.

Michelle Greenhalgh, Analyst, State Government Affairs, AAFP Robin Richardson, Analyst, State Government Affairs, AAFP Page 6 of 43 Last Revised:3/26/2012

This bill would require the board of the California Health Benefit Exchange, to the extent required by federal law, to work with the Office of Statewide Health Planning and Development, the Department of Insurance, and the Department of Managed Health Care to develop a risk adjustment system for products sold in the Exchange and outside of the Exchange, as specified

2011 AB 792 – California Health Benefit Exchange

Status: In committee: Held under submission – 8/25/2011Requires the disclosure of information on health care coverage through the California Health Benefit Exchange by health care service plans, health insurers, the Employment Development Department, upon an initial claim for disability benefits, or by the court, upon the filing of a petition for dissolution of marriage, nullity of marriage, legal separation, or adoption. Requires, as of January 1, 2014, specified health care service plans and health insurers to, upon a renewal

in coverage of an enrollee or insured, as specified, or with regard to COBRA or Cal-COBRA coverage under an employer-sponsored group plan, and the Employment Development Department with regard to an applicant for unemployment compensation, provide specified information to the California Health Benefit Exchange for purposes of enrolling those enrollees, insured’s, or applicants in the Exchange.

2011 AB 1083 – Health Care Coverage

Status: Ordered to inactive file at the request of Senator Hernandez – 9/8/2011

The bill would change the definition of small employer and would require employer contribution requirements to be consistent with the federal Patient Protection and Affordable Care Act. With regard to the sale of plan contracts or health benefit plans, the bill would prohibit specified persons or entities from encouraging or directing small employers to seek coverage from another plan or the voluntary purchasing pool established under the California Health Benefit Exchange.

The bill would authorize the director and commissioner to issue emergency regulations to carry out provisions related to the categories of age, family size, and geographic region to make them consistent with the federal Patient Protection and Affordable Care Act.

The bill would require health care service plans and health insurers to report to the departments the number of enrollees and covered lives that receive health care coverage under specified contracts or policies, and would require the departments to post that information on their Internet Web sites.

2011 AB 1296 – Health Care Eligibility, Enrollment, and Retention Act.

Status: Chaptered by Secretary of State – Chapter 641, Statutes of 2011. – 10/9/2011

This act adds Part 3.8 (commencing with Section 15925) to Division 9 of the Welfare and Institutions Code, relating to Public Health.

This bill would enact the aforementioned Act which would require the California Health and Human Services Agency, in consultation with specified entities, to establish standardized single, accessible application forms and related renewal procedures for state health subsidy programs, as defined, in accordance with specified requirements.

It specifies the duties of the agency and the State Department of Health Care Services under the act,

Requires the agency to provide specified information to the Legislature by July 1, 2012 regarding policy changes needed to implement the bill. The application development requirements of the bill would otherwise be operative January 1, 2014, except as specified.

2011 AB 1394 – Health Care facilities: financing Status: Chaptered by Secretary of State – Chapter 330, Statutes of 2011 – 9/26/2011

This bill aimed to provide a working capital loan of up to $5,000,000 to assist in the establishment and to operation of the California Health Benefit Exchange established under Section 100500.

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COLORADO 2011 SB 200 – Colorado Health Benefit Exchange Act

Status: Signed by Governor – 6/1/2011

Michelle Greenhalgh, Analyst, State Government Affairs, AAFP Robin Richardson, Analyst, State Government Affairs, AAFP Page 7 of 43 Last Revised:3/26/2012

This bill creates the Colorado health benefit exchange as a nonprofit unincorporated public entity as well as creates a process for the implementation of the health benefit exchange in Colorado.

The bill requires that the state makes sufficient progress in the creation of the exchange by January 1, 2013, or default to the federally run national health benefit exchange.

The bill is intended to facilitate the access to and enrollment in health plans in the individual market in CO

Will also include a small business health options program to assist small employers in CO to facilitate the enrollment of their employees in health plans offered in the small employer market.

The overall intent of the exchange, is to increase access, affordability, and choice for individuals and small employers purchasing health insurance in CO. _______________________________________________________________________________

CONNECTICUT

2011 HB 6305 – An Act Concerning Implementation of the Sustinet Plan Status: House Recommitted to Human Services – 6/3/2011

This bill implements the SustiNet Plan, which is a health insurance program that consists of multiple, coordinated individual health insurance plans that provide or offer, over a phased-in period of time, health insurance products to state employees, Medicaid enrollees, HUSKY Plan, Part A and Part B enrollees, HUSKY Plus enrollees, municipalities, municipal-related employers, nonprofit employers, small employers, other employers and individuals in the state and which, with respect to all health plans offered, implements innovative, cost-controlling mechanisms and measures to improve the quality of health care services and improve the health of SustiNet Plan enrollees.

The bill includes details about the exchange planning and implementation, governance, and stipulations on what is and is not to be included in the exchange.

2011 HB 6308 – An Act Concerning Healthcare Reform

Status: Became Law, Not Signed by the Governor – 7/1/2011

This bill allows for non-state public employers, municipal-related employers, small employers, and non-profit employers to join the state employee health plan, which includes an insurance exchange.

The bill ensures, in consultation with the Connecticut Health Insurance Exchange and the Department of Social Services, the necessary coordination between said exchange and Medicaid enrollment planning

The bill also charges the SustiNet Health Care Cabinet to evaluate, in partnership with the chief executive officer of the Connecticut Health Insurance Exchange, the feasibility of implementing a basic health program option as set forth in Section 1331 of the Affordable Care Act.

2011 HB 6323 – An Act Conforming Changes to the Insurance Statutes Pursuant to the Federal PPACA

Status: (LCO) File Number 620 – 4/26/2011 Establishes the Connecticut Health Partnership Exchange as a body politic and corporate, constituting a

public instrumentality and political subdivision of the state. Requires the exchange to:

o report at least annually to the General Assembly; and o adhere to all requirements established in the Patient Protection and Affordable Care Act; o consult with stakeholders, including individuals knowledgeable about the health care system and

have backgrounds or experience making informed decisions regarding health, medical and scientific matters, and advocates with experience in enrolling hard-to-reach populations in public assistance programs;

o collaborate with the Department of Social Services, to the extent possible, to allow an individual to remain enrolled in such individual’s plan and provider network in the event such individual changes eligibility status; and

o determine applicants' eligibility within 90 days of receiving an application.

Michelle Greenhalgh, Analyst, State Government Affairs, AAFP Robin Richardson, Analyst, State Government Affairs, AAFP Page 8 of 43 Last Revised:3/26/2012

Requires qualified health plans to have an adequate number of providers in the plan’s network, including providers that serve predominantly low-income, medically underserved individuals, and provide individuals with information about the availability of in-network and out-of-network providers.

Establishes the Board of Directors made up of 11 appointed members who shall not be, be employed by or be affiliated with a health care provider, a health care facility, a medical clinic or an insurer – with the exception of health care providers not receiving compensation for rendering services as a provider who do not have an ownership interest in a professional health care practice.

Authorizes the exchange to commission surveys of consumers, employers and providers on issues related to health care and coverage.

2011 SB 55 – An Act Establishing a State Health Insurance Exchange

Status: Referred to Joint Committee on Insurance and Real Estate – 1/10/2011 **full bill text not yet available—below is text of proposed bill shell**

Creates a state health insurance exchange pursuant to the federal Patient Protection and Affordable Care Act.

2011 SB 170 – An Act Concerning Dental Benefits in a State Health Insurance Exchange

Status: Referred to Joint Committee on Insurance and Real Estate – 1/18/2011

The act requires, upon establishment and enactment of the state health insurance exchange, preventative dental benefits and additional dental services to be offered as options in health insurance plans sold through such exchange.

2011 SB 921 – An Act Establishing a State Health Insurance Exchange

Status: Signed by the Governor – 7/1/2011 Establishes the Connecticut Health Insurance Exchange as a body politic and corporate, constituting a

public instrumentality and political subdivision of the state. Creates a Board of Directors to oversee the exchange made up of appointees, at least one of whom must

be a representative of health care providers. Requires exchange to consult with stakeholders, including: (1) individuals knowledgeable about the health

care system, have backgrounds or experience making informed decisions regarding health, medical and scientific matters, and are enrollees in qualified health plans; and (2) advocates for enrolling hard-to-reach populations.

Allows the exchange to borrow money for the purpose of obtaining working capital. Prohibits the exchange and health carriers from charging an individual fee or penalty for termination of

coverage if the individual enrolls in another type of minimum essential because the individual has become new eligible for that coverage or the individual's employer-sponsored coverage has become affordable.

2011 SB 1204 – An Act Establishing the Connecticut Health Insurance Exchange

Status: Favorable Report, Tabled for Calendar, Senate – 5/24/2011

This act would establish the state health insurance exchange pursuant to the PPACA.

APP & PH Joint Favorable Substitutes accepted and Raised Bill tabled.

Similar to above, see above bill (SB 921). ____________________________________________________________________________________

DELAWARE ***none***

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FLORIDA 2011 H 7109 – Medicaid

Status: Chapter No. 2011-135, companion bill(s) passed, see CS/HB 7107 (Ch. 2011-134), SB 2144 (Ch. 2011-61) – 6/2/2011

Michelle Greenhalgh, Analyst, State Government Affairs, AAFP Robin Richardson, Analyst, State Government Affairs, AAFP Page 9 of 43 Last Revised:3/26/2012

Requires APD to collect premiums or cost sharing for home & community-based delivery system; provides that implementation of Medicaid waiver programs & services authorized under ch. 393, F.S., are subject to certain funding limitations; prohibits agency from imposing sanctions related to patient day utilization by patients eligible for care under Title XIX of Social Security Act for nursing home, effective on specified date; extends certificate-of-need moratorium for additional community nursing home beds, etc.

2011 H 7255 – State Group Insurance Program

Status: H Died, reference deferred – 5/7/2011

Would have enumerated group insurance plans that may have been included in the state group insurance program; revised duties of DMS relating to group insurance programs; provided state contribution toward cost of health insurance plans in state group insurance programs for specified plan years; revised authorized benefits; directed department to contract with certain number of HMOs; require data to be reported to department by HMOs; provides for specified benefit levels for specified plan years; repeal certain duties of department on future dates, etc.

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GEORGIA 2011 HB 476 – Georgia Health Exchange Authority; Establish

Status: House Withdrawn, Recommitted – 3/16/2011

Establishes the Georgia Health Exchange Authority as a body corporate and politic, an instrumentality of the state, and a public corporation.

Creates a board of directors composed of nine members, seven of whom shall be appointed by the Governor from the general public, one representing a consumer or health advocacy organization, one to represent small business, and others with expertise on individual health coverage, small employer health coverage, health plan administration, health care finance, administering a public or private health care delivery system, purchasing health plan coverage and state employee coverage.

Prohibits members of the board or Authority staff from being employed by or being affiliated with an insurer, a health insurance agent or broker, a health care provider, or a health care facility or clinic.

Establishes the Georgia Health Care Exchange Trust Fund.

Requires the Governor to appoint an Exchange Advisory Committee to allow for the involvement of the health care industry, business leaders and other stakeholders.

Charges the advisory committee with basing recommendations on increasing the number of Georgians with quality health coverage; supporting provider viability; building real competition in the insurance market; making Georgia small business friendly; promoting keeping all family members together on the same plan; promoting customer service and the importance of brokers and navigators; and seeking solutions that are sustainable and best for Georgians whether specifically part of federal law or not.

2011 HB 644 – Commission to Implement the Patient Protection and Affordable Care Act; enact

Status: House First Readers – 4/14/2011

This bill aims to amend Title 31 of the Official Code of Georgia Annotated, relating to health, so as to enact the “Commission to Implement the Patient Protection and Affordable Care Act”

The bill defines terms used in the legislation, provides for legislative findings and intent, establishes the Commission to implement the PPACA, provides guidelines for the Commission’s composition, duties, and powers, provides rules for advisory councils, an automatic repeal on a certain date, provides an effective date, and to repeal conflicting laws, among other things.

The bill charges the Commission with working with the Department of Insurance to develop recommendations for the design and implementation of the health insurance exchange in conformity with the requirements established by ACA, including whether to designate a state agency or nonprofit entity to house the exchange (Section 31-48-5 (6)).

2011 SB 177 – Health Care Compact; adopt Status: House Passed/Adopted – 4/12/2011

Michelle Greenhalgh, Analyst, State Government Affairs, AAFP Robin Richardson, Analyst, State Government Affairs, AAFP Page 10 of 43 Last Revised:3/26/2012

This bill aims to amend Title 33 of the Official Code of Georgia Annotated, relating to insurance, so as to provide that health insurance exchange plans shall specifically prohibit use of tax credits and cost-sharing reduction payments to pay for abortion services; to provide for segregation of such plans’ to require independent audits; to provide for an effective date and applicability; to provide for related matters; to repeal conflicting laws; and for other purposes.

Section 33-65-1 states that any health insurance exchange plan established in GA pursuant to or as a result of PPACA shall specifically prohibit the use of tax credits and cost-sharing reduction payments to pay for abortion services by any such health insurance exchange plan. Any health insurance exchange plans operating in this state shall comply with strict payment and accounting requirements to ensure that federal funds are not used for abortion services.

Section 33-65-2 states that insurance plans created to comply with the PPACA should be segregated, as required by Section 1303 of the act by insurance companies in accordance with generally accepted accounting principles, funds management circulators of the Office of management and Budget, and accounting guidelines provided by the Government Accountability Office, and by the model segregation guidelines set forth by the director of the Office of Management and Budget and the secretary of the Department of Health and Human Services.

Section 33-65-3 states that the Commissioner shall require regular independent audits of insurance companies that participate in health insurance exchange plans to ensure their compliance with the requirements stated in the chapter and rules and regulations promulgated by the Commissioner in relation to such insurance exchange plans.

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HAWAII 2011 HB 272 – Hawaii Health Authority; Establishment; Appropriation Status: Referred to House Health and Finance Committees – 1/24/2011

Creates the Hawaii Health Authority within the office of the governor for administrative purposes, as an autonomous public body corporate and politic and an instrumentality of the state.

Requires that the Authority be composed of nine governor-appointed members, two of whom shall be practicing physicians.

Charges the authority will the overall health planning for the state, guiding the governor and director of health, and developing a comprehensive health plan to include recommendations for the implementation of the federal Affordable Care Act, including:

o current and long-term capacity needs of health providers and facilities; o initiatives to increase the number of primary care physicians in Hawaii, including loan repayment

programs, o recommendations regarding patient-centered medical homes; and o implementation of a health insurance exchange.

2011 HB 1048 – Health Insurance Exchange

Status: Deferred by House Health and Finance Committee – 2/4/2011 Determines Hawaiians will best be served by a health insurance exchange operated in the state. Because a federal grant to support the operations of a health insurance exchange will become available

and the Secretary of the United States Department of Health and Human Services will determine whether Hawaii can implement a health insurance exchange, the legislature finds that moving forward in the 2011 legislative session with an enabling statute is prudent.

2011 HB 1201 – Hawaii Health Benefit Exchange

Status: Referred to Senate Commerce & Consumer Protection, Health, and Ways & Means Committees – 3/10/2011

Creates a private, nonprofit health insurance exchange, the Hawaii Health Benefit Exchange. Establishes a board of directors to govern the exchange. Charges the exchange with working with the state health insurance exchange task force established in the

Department of Commerce and Consumer Affairs to develop policies and necessary proposed legislation.

Michelle Greenhalgh, Analyst, State Government Affairs, AAFP Robin Richardson, Analyst, State Government Affairs, AAFP Page 11 of 43 Last Revised:3/26/2012

2011 SB 594 – Hawaii Health Authority; Establishment; Appropriation

Status: Amended, passed the Senate Health Committee and referred to Ways and Means Committee – 2/14/2011

Creates the Hawaii Affordable Health Care Coordinator within the Office of the Governor for administrative purposes, as an autonomous public body corporate and politic and an instrumentality of the state.

Charges the Coordinator will the overall health planning for the state, guiding the governor and director of health, and developing a comprehensive health plan to include recommendations for the implementation of the federal Affordable Care Act, including the health insurance exchange.

2011 SB 1275 – Health Insurance Exchange

Status: Referred to Senate Commerce & Consumer Protection, Health, and Ways & Means Committees – 1/26/2011

This measure is a companion of the above 2011 HB 1048. The current versions have the same bill summary.

2011 SB 1348 – Hawaii Health Insurance Exchange Status: H Act 205, on 7/8/2011 (Gov. Msg. No. 1309) – 7/11/2011

Establishes a state health insurance exchange, the Hawaii Health Connector as a public, nonprofit organization, enabling consumers to purchase coverage and manage plans electronically and serving as a clearinghouse for information on all qualified plans.

Creates a Board of Directors comprised of 15 appointed members reflecting geographic diversity and the diverse interests of stakeholders including consumer, employers, insurers, and government entities.

Requires the board of directors to submit an annual report to the legislature, including a recent audit report. Allows the connector to receive contributions, grants, endowments, fees or gifts. Provides that the insurance commissioner shall retain full regulatory jurisdiction over all insurers and plans

included in the Connector. Requires the existing state health insurance exchange task force to recommend to the legislature policies

and procedures to further define and operate the Connector. Authorizes the task force to work collaboratively with stakeholders to propose legislation to the 2012

legislature implementing the Connector, to ensure the state’s compliance with federal law. ________________________________________________________________________________

IDAHO

***none*** ________________________________________________________________________________

ILLINOIS

2011 HB 223 – Health Care Implementation Status: House Third Reading – Standard Debate – Lost 042-058-000 – 4/5/2011

Amends current state statutes (20 ILCS 4045) to eliminate the Adequate Health Care Task Force.

Creates the Health Care Justice Implementation Task Force to monitor the implementation of federal reforms and make recommendations.

Authorizes the Task Force to consult with health care providers, health care consumers, hospitals, labor unions, businesses, insurers, pharmaceutical manufacturers and other appropriate individuals and organizations.

Charges the Task Force with making recommendations by March 1, 2013 on implementing the Illinois State Health Insurance Plan—available to all state residents to purchase medical care and services available to recipients of medical assistance—as an affordable option under a state health insurance exchange.

2011 HB 1701 – Health Insurance Exchange Act

Status: House Rule 19(a) / Re-referred to Rules Committee – 5/31/2011

Michelle Greenhalgh, Analyst, State Government Affairs, AAFP Robin Richardson, Analyst, State Government Affairs, AAFP Page 12 of 43 Last Revised:3/26/2012

**full bill text not yet available—below is text of short title provision** Creates the Illinois Health Insurance Exchange Act, contains only a short title provision

2011 SB 1313 – INS CD-TECH Status: Senate added as Chief Co-Sponsor Sen. Iris Y. Martinez – 11/29/2011

This bill amends the Comprehensive Health Insurance Plan Act by making changes to provisions concerning findings and definitions.

In addition, it provides that assessments (instead of appropriated funds) and other revenues collected or received by the Comprehensive Health Insurance Board shall be included in the Comprehensive Health Insurance Plan Fund.

The bill also deletes a provision concerning eligibility and makes changes to the provision concerning a deficit or surplus.

2011 SB 1555 – Illinois Health Benefits Exchange Law Status – Senate Public Act…….97-0142 – 7/14/2011

This act establishes health benefit exchanges in the state, as authorized by the PPACA.

The exchange is slated to begin on October 1, 2013 and will be known as the Illinois Health Benefits Exchange.

The act helps individuals and small employers with no more than 50 employees shop for, select, and enroll in qualified, affordable private health plans that fit their needs at competitive prices.

2011 SB 1729 – Regulation-Tech Status: Senate Rule 2-10 Third Reading Deadline Established As November 10, 2011 – 10/24/2011

This act amends the Illinois Insurance Code. It makes a technical change in a section (Section 5 of the Insurance Code in Section 357.29) concerning provisions in accident and health insurance policies permitted or required by other jurisdictions.

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INDIANA 2011 SB 580 – Indiana Health Exchange

Status: Referred to Senate Health and Provider Services Committee, S. Senator Miller added as second author (1/27/11) – 1/20/2011

Requires the Insurance Commissioner to establish the Indiana Health Exchange to facilitate the purchase of qualified health plans by individuals in the individual insurance market, provide for establishing a small business health options program, and apply for federal certification of the exchange no later than October 1, 2012.

Charges the commissioner and the Secretary of Family and Social Services with: o holding public meetings with stakeholders, including health care providers, consumers, and

insurers, concerning the design, establishment, and administration of the exchange; and o making recommendations to the Health Finance Commission on: (1) whether the exchange should

be administered by an agency of the state or a nonprofit organization; (2) a list of state with which Indiana could form an interstate exchange; and (3) other provisions necessary to implementation of the exchange, by September 30, 2011.

Requires the Health Finance Commission, by October 1, 2012, to study and make a recommendation to the General Assembly for legislation necessary to design, establish, and implement the exchange.

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IOWA 2011 HF 559 (formerly HSB 159) – A Bill Authorizing the Establishment of Health Insurance Exchanges

Status: Referred to Commerce. H.J. 1162 – 5/9/2011

Authorizes the establishment of the Iowa Health Insurance Exchange, operated by the Insurance Division of the Department of Commerce – which may be on a statewide, regional or multistate basis – and authorizes additional exchanges to be formed.

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Charges the Insurance Commissioner with: o establishing a provider reimbursement system for health benefit plans issued in the state that all

carriers and providers may join to facilitate fair and reasonable payments; and o creating a value- or outcome-based reimbursement system for plans to which all carriers may

subscribe.

Requires that applicants be enrolled by an insurance producer, who shall receive a commission of at least five percent of the premium paid by the enrollee.

Charges the exchange or exchanges that are established with requesting a five-year waiver from the certification requirements to enable the exchange to offer mandate-free plans in addition to qualified plans through the exchange.

Related to bill SF 235 – o includes new section 514M.2 – establishes the purpose and intent – The purpose of the act is to

provide for the establishment of health insurance exchanges in the state to facilitate the sale and purchase of qualified health benefit plans in the individual market in the state and to assist qualified small employers in the state in facilitating the availability of qualified health benefit plans offered in the small group market. The intent of authorizing the establishment of health insurance exchanges in the state is to reduce the number of uninsured, provide a transparent marketplace and consumer education, and assist individuals with access to programs, premium assistance tax credits, and cost sharing reductions.

o Also includes new section 514.3 – new Definitions

2011 HF 576 – A bill for an act prohibiting the inclusion of health plans that provide coverage for abortion in a state health benefit exchange and including effective date provisions

Status: Referred to Commerce. H.J. 872 – 4/1/2011

This bill provides that if a health benefit exchange is established in IA pursuant to the PPACA, a health benefit plan that offers coverage for abortions shall not be certified as a qualified health benefit plan to be offered through the exchange.

The bill shall not be construed as creating or recognizing a right to an abortion or making lawful an abortion that is unlawful. A provision of the bill that is held to be invalid or unenforceable is severable so that the validity or enforceability of the remainder of the bill or application of the bill is not affected.

2011 HSB 57 – A study bill for prohibiting the inclusion of health plans that provide coverage for

abortion in a state health benefit exchange and including effective date provisions Status: Voted – Commerce. – 3/2/2011

This bill provides that if a health benefit exchange is established in this state pursuant to the PPACA, a health benefit plan that offers coverage for abortions shall not be certified as a qualified health benefit plan to be offered through the exchange.

The bill shall not be construed as creating or recognizing a right to an abortion or making lawful an abortion that is unlawful. A provision of the bill that is held to be invalid or unenforceable is severable so that the validity or enforceability of the remainder of the bill or application of the bill is not affected.

2011 HSB 159 – A study bill for authorizing the establishment of health insurance exchanges in the

state and including effective date provisions Status: Voted – Commerce – 3/2/2011

This bill authorizes the establishment of health insurance exchanges in the state. The bill creates new Code chapter 514M, which authorizes the establishment of health insurance exchanges in the state to facilitate the purchase and sale of qualified health benefit plans in the individual market in this state and to assist qualified small employers in facilitating the availability of qualified health benefit plans offered in the small group market.

The intent of establishing of such exchanges is to reduce the number of uninsured, provide a transparent marketplace and consumer education, and assist individuals with access to programs, premium assistance tax credits, and cost sharing reductions.

Chapter 514M contains new definitions.

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2011 SF 117 – A Bill Relating to Health Care and Policy and Health Care Infrastructure and Integration

of Public and Private Programs Status: Subcommittee, Hatch, Bolkcom, and Seymour. S.J. 196 – 2/1/2011

Directs the Department of Human Services, Division of Insurance of the Department of Commerce, Department of Public Health, Department of Revenue, Department of Workforce Development, and other appropriate agencies to develop a plan to meet the requirements of the federal Patient Protection and Affordable Care Act relating to a health benefit exchange, addressing:

o issues related to eligibility determinations for Medicaid, Hawk-I, and tax credit subsidies; information technology and process reengineering;

o necessary policy, statutory and regulatory changes; o financing; o tools and strategies necessary for implementation; o an all-payer claims database; o evaluation of trends; o rural health care resources; o workforce resources; o a provider payment system; and o a blueprint for a healthy Iowa.

Charges the division of health policy with completing and submitting the components relating to the all-payer claims database, and the provider payment system to the governor and the general assembly by October 1, 2011.

Related bill SF 480 – Status: Fiscal note. HCS – 4/13/2011 – relates to health care and health policy. o Division I of the bill relates to certificate of need determinations. The bill amends certificate of

need exclusions relating to institutional health facilities, including outpatient surgical facilities, hospitals, and nursing facilities. The bill also provides for retention of certificate of need fees by the department for administration of the program.

o Division II of the bill relates to the office of health policy. It provides guidelines for medication therapy management.

o Division III of the bill provides directives for integration of private and public programs in the insurance exchange.

2011 SF 348 (formerly SSB 1063) – A Bill Relating to Establishment of Health Benefit Exchange

Status: Referred to State Government S.J. – 3/31/2011 Establishes the Iowa Health Benefit Exchange as a nonprofit corporation under the purview of the Office of

the Governor, overseen by the Board of Directors. Allows the board, in developing the electronic clearinghouse, to require participating health carriers to

make available and regularly update an electronic directory of contracting health care providers so individuals seeking coverage can search by providers’ names to determine which plans include a provider in their network, and whether that provider is accepting new patients for that plan.

Requires the board to establish one or more advisory committees consisting of representatives from the insurance industry, producer organizations, consumer advocacy groups, labor unions, employers, health care providers and other interested parties.

Requires the exchange to: o adhere to federal law; o provide referrals to the Office Of Health Insurance Consumer Assistance; o consult with stakeholders, including educated health care consumers who are knowledgeable about

the health care system, have a background or experience in making informed decisions regarding health, medical and scientific matters and who are enrollees;

o seek and receive federal grants; o assist in the implementation of reinsurance and risk adjustment mechanisms; o encourage cross-agency consultation and coordination with the Commissioner, Department of

Human Services, Department of Public Health and the Attorney General; and o coordinate activities with the state Medicaid program.

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2011 SF 391 (formerly SF 235) – A Bill Authorizing the Establishment of Health Insurance Exchanges

Status: Substituted SF 235 and passed Senate Commerce Committee S.J. 1265 – 6/30/2011

This measure is similar to the above 2011 HF 559. The current versions have the same bill summary. _______________________________________________________________________________

KANSAS

2011 HB 2075 – Insurance; group life insurance; review of adverse health care decisions; uninsurable health insurance plan act; exclusion of abortion coverage

Status: House Approved by Governor – 5/25/2011

This act concerns insurance, pertaining to review of healthcare decisions; pertaining to group life insurance; excluding insurance coverage for certain abortions; pertaining to the Kansas uninsurable health plan act; and amending various sections of existing law

A small section in the act states that no health insurance exchange established within the state or any health insurance exchange administered by the federal government or its agencies within the state shall offer health insurance contracts, plans, or policies that provide coverage for elective abortions, nor shall any health insurance exchange operating within the state offer coverage for elective abortions through the purchase of an optional rider.

o Similar to section in HB 2292 and HB 2377 that prohibit elective abortion coverage through state or federally administered health insurance exchanges and create a no-taxpayer funding for abortion act while also amending laws relating to late-term abortions, respectively.) Status: HB 2292 was rereferred to the House committee on insurance on 2/23/2011 and HB 2377 was Referred to the Committee on Federal and State Affairs on 3/10/2011

o Also similar to SB65 – which also prevents health insurance exchanges administered by the state, or federally, to offer health insurance contracts, plans or policies that provide coverage for elective abortions, and also prevent all health insurance exchanges operating within the state to offer coverage for elective abortions through the purchase of an optional rider. – Status: Stricken from House Calendar by Rule 1507 – 3/28/2011

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KENTUCKY 2011 HB 61 – An ACT relating to the exclusion of abortion coverage for health insurance exchanges

Status: Sent to Health & Welfare (H) – 1/5/2011

This bill establishes Subtitle 17D of KRS Chapter 304 and creates a new section to define “abortion,” “elective abortion,” and “health benefit exchange” ; creates a new section to prohibit qualified health benefit plans in Kentucky from offering abortion coverage through a health benefit exchange, but permits individuals to purchase optional supplemental coverage for elective abortions outside of the state exchange if a separate premium is paid for the coverage; and sets forth provisions regarding the calculations in determining the estimated cost premium of covering elective abortions.

2011 HB 105 – An ACT relating to health care mandates

Status: Sent to Health & Welfare (H) – 1/5/2011

This bill establishes Subtitle 17D of KRS Chapter 304 and creates new sections thereof to define terms and prohibit any federal or state law that compels a person, employer, or health care provider to participate in a health care system; defines ‘abortion,’ ‘elective abortion,’ ‘health benefit exchange,’ and ‘small group’; prohibits elective abortion coverage by a qualified health benefit plan delivered or issued by a health benefit exchange in accordance with the opt-out provision of the PPACA.

2011 HB 176 – AN ACT relating to the exclusion of abortion coverage for health insurance exchanges

Status: Referred to Health & Welfare (H) – 1/5/2011

This bill created Subtitle 17D of KRS Chapter 304, which defines ‘health benefit exchange’ and ‘small employer’ for the purposes of health benefit exchange group health plans; creates a new section of

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Subtitle 17D of KRS Chapter 304 to prohibit abortion coverage by a qualified health benefit plan through a health benefit exchange in accordance with an opt-out provisions of the federal PPACA.

Similar / related to HB 185 – same status

2011 SB 27 – AN ACT relating to the exclusion of abortion coverage for health insurance exchanges Status: introduced in the Senate; to Banking & Insurance (S) – 1/4/2011

Establish Subtitle 17D of KRS Chapter 304 and create new sections thereof to define "health benefit exchange" and "small employer" for the purposes of health benefit exchange individual and small group health plans; prohibit abortion coverage by a qualified health benefit plan through a health benefit exchange in accordance with the opt-out provision of the federal Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010.

BR 338 is related. ________________________________________________________________________________________

LOUISIANA ***none***

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MAINE 2011 LD 1043 - An Act Making Unified Appropriations and Allocations for the Expenditures of State

Government, General Fund and Other Funds, and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government for the Fiscal Years Ending June 30, 2012 and June 30,

2013 Status: Signed by the Governor – 6/20/2011

This amendment makes a number of technical changes to Committee Amendment "A."

Sec. BBB-3. Planning for Affordable Care Act health insurance exchange implementation report. The Board of Trustees of Dirigo Health and the Executive Director of Dirigo Health shall evaluate the impact of the changes in this Part and their implications on planning for the transition to and implementation of a health insurance exchange in this State pursuant to the federal Patient Protection and Affordable Care Act. The Board of Trustees of Dirigo Health shall report its findings and recommendations for implementation of such an exchange in this State to the Joint Standing Committee on Appropriations and Financial Affairs and to the Joint Standing Committee on Insurance and Financial Services no later than March 1, 2012.

2011 LD 1179 - An Act To Require Advance Review and Approval of Certain Small Group Health

Insurance Rate Increases and To Implement the Requirements of the Federal Patient Protection and Affordable Care Act

Status: (S) CARRIED OVER TO ANY SPECIAL OR REGULAR SESSION OF THE 125th LEGISLATURE PURSUANT TO JOINT ORDER HP 1190, IN CONCURRENCE - 06/29/2011

Part A of the bill makes the rate review process for small group health insurance rates the same as the process for individual health insurance. Part A requires that, if a filing proposes an increase in rates in a small group health plan, the Superintendent of Insurance shall hold a hearing on the proposed rate increase at the request of the Attorney General. Part A makes it clear that in any hearings the burden of proving proposed rates are not excessive, inadequate or unfairly discriminatory

Sec. B-17. 24-A MRSA 4301-A, sub- 7, as enacted by PL 1999, c. 742, 3, is amended to read: o 7. Health plan. "Health plan" means a plan offered or administered by a carrier that provides for

the financing or delivery of health care services to persons enrolled in the plan, other than a plan that provides only accidental injury, specified disease, hospital indemnity, Medicare supplement, disability income, long-term care or other limited benefit coverage not subject to the requirements of the federal act. Any plan that is subject to the requirements of the federal act and offered in this State by a carrier, including, but not limited to, any qualified health plan offered through an American Health Benefits Exchange or Small Business Health Options

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Program Exchange pursuant to the federal act, is considered a health plan for purposes of this chapter.

Sec. B-35. 24-A MRSA 4320-E is enacted to read: o 4320-E. Oversight of plans offered through an exchange established in state law pursuant to the

federal act o 1. Superintendent's authority preserved. Except as otherwise expressly provided by applicable

law, all requirements established by Title 24, this Title and rules adopted by the superintendent continue to apply to carriers and health plans, and are not extinguished or modified in any way by:

o A. Certification of a health plan as a qualified health plan, or any other determination made by an exchange pursuant to the federal act; or

o B. Recognition by the applicable federal agency of a carrier as a qualified nonprofit health insurance issuer or as an issuer of qualified multistate health plans, or of a health plan as a qualified multistate health plan, pursuant to the federal act.

o 2. Coordination with exchanges. The superintendent has all additional powers and duties conferred upon a state insurance regulator with respect to American Health Benefit Exchanges and Small Business Health Option Program Exchanges by the federal act and regulations adopted pursuant to the federal act. The superintendent may enter into agreements with an exchange established under state law relating to coordination of responsibilities and such agreements may provide for the superintendent to assume additional authority relating to the certification of qualified health plans or the authorization of a carrier to participate in any exchange.

2011 LD 1333 - An Act To Modify Rating Practices for Individual and Small Group Health Plans and To

Encourage Value-based Purchasing of Health Care Services Status: Signed by Governor – 5/17/2011

This bill gradually modifies the community rating provisions for individual and small group health plans. It expands in 3 increments the rating bands from the current ratio of 1.5:1 to 3:1 by January 1, 2014.

The bill allows financial incentives except for emergency care services.

It maintains the requirement that plans must provide reasonable access to services for all members.

It allows plans to provide financial incentives to members to reward providers for quality and efficiency.

2011 LD 1436 – An Act to Reform Maine’s Health Insurance Laws Status: (S) Pursuant to Joint Rule 310.3 Placed in Legislative Files (DEAD) - 05/05/2011

Part A of this bill makes the following changes to the community rating laws for individual and small group health insurance:

o 1. It changes the maximum rate differential for individual health plans on the basis of age, health status and geographic area from 1.5:1 to 4:1; and

o 2. It changes the maximum rate differential for small group health plans on the basis of age, health status, occupation or industry and geographic area from 1.5:1 to 4:1.

Part B of this bill amends the laws relating to carriers. o Carriers providing individual health plans must offer all health plans approved by the Maine

High-risk Reinsurance Pool Association pursuant to section 3958, subsection 1 as a condition of offering individual health plans in this State. Carriers must meet the following requirements on issuance and renewal.

2011 LD 1497 - An Act To Comply with the Health Insurance Exchange Provision of the Patient

Protection and Affordable Care Act Status: (S) CARRIED OVER TO ANY SPECIAL OR REGULAR SESSION OF THE 125th LEGISLATURE

PURSUANT TO JOINT ORDER HP 1190, IN CONCURRENCE - 06/29/2011

This bill establishes the Maine Health Benefit Exchange pursuant to the federal Patient Protection and Affordable Care Act. The exchange is established as authorized by federal law to facilitate the purchase of health care coverage by individuals and small businesses. The bill requires coverage to be available

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through the exchange no later than January 1, 2014. The bill authorizes the use of an assessment or user fee on health insurance carriers to support the operations of the exchange.

2011 LD 1498 - An Act To Phase Out Dirigo Health and Establish the Maine Health Benefit Exchange for

Small Businesses and Individuals Status: (S) CARRIED OVER TO ANY SPECIAL OR REGULAR SESSION OF THE 125th LEGISLATURE

PURSUANT TO JOINT ORDER HP 1190, IN CONCURRENCE - 06/29/2011

This bill repeals Dirigo Health effective January 1, 2014 and, in its place, establishes the Maine Health Benefit Exchange.

The exchange is established as authorized by federal law to facilitate the purchase of health care coverage by individuals and small businesses.

The bill requires coverage to be available through the exchange no later than January 1, 2014. Coverage of individuals and small businesses under the current Dirigo Health program will end on January 1, 2014 as coverage will transition to the exchange.

2011 LD 1554 – An Act to Implement the Requirements of the Federal Patient Protection and Affordable

Care Act Status: Signed by the Governor – 6/16/2011

This bill amends the state health insurance laws to incorporate changes to implement the requirements of the federal Patient Protection and Affordable Care Act adopted in 2010.

2011 LD 1582 – Resolve, Creating the Advisory Committee on Maine’s Health Insurance Exchange

Status: Signed by the Governor – 7/6/2011

This resolve is reported out pursuant to joint order by the Joint Standing Committee on Insurance and Financial Services. The resolve creates the Advisory Committee on Maine's Health Insurance Exchange. The charge of the advisory committee is to make recommendations to the Legislature and to the Governor on courses of action to ensure federal funding for the creation of a health insurance exchange and to provide draft enabling legislation for the creation of a health insurance exchange

2011 LD 1583 – An Act to Provide Oversight in Certain Negotiations

Status: Signed by the Governor – 7/6/2011

This bill prohibits the inclusion of so-called "most favored nation" clauses in the participation agreements between health insurance carriers and health care service providers and authorizes the Superintendent of Insurance to waive this restriction upon finding that the inclusion of such a clause will not be anticompetitive. This bill also prohibits carriers from discriminating against providers for opposing requests for such waivers.

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MASSACHUSETTS 2011 HB 346 – An Act relative to the Massachusetts health insurance connector

Status: Hearing Scheduled JHC – 8/2/2011

This bill articulates that nothing in Section 3 of Chapter 176Q of the General Laws shall be construed as to authorize the Connector to actively solicit potential participants in their health insurance plans if such participants already have coverage for such plans from private companies.

2011 HV 1228 – An Act to establish a Public Health Insurance Option

Status: Hearing Scheduled JHC – 12/15/2011

This bill directs Commonwealth Connector Authority to provide for the offering a public health benefits plan - the public health insurance option - to eligible individuals and large groups, to ensure choice, competition, and stability of affordable, high quality coverage throughout Massachusetts

It also requires that the public option shall: o (a) be made available exclusively through the Commonwealth Connector, alongside health benefit

plans receiving the Connector seal of approval,

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o (b) meet all the requirements established for health benefit plans to receive the Commonwealth Connector seal of approval

o (c) meet the Connector’s standards for minimum creditable coverage o (d) comply with subsections 9b), (c), and (d) of section 5 of Chapter 176Q.

2011 HB 1849 – An Act relative to improving the quality of health care and controlling costs by

reforming health systems and payments Status: Hearing Scheduled JHC – 7/8/2011

This bill requires Commissioner of the Division of Insurance Authority to consider several new criteria when deciding whether or not to disapprove excessive health insurance premium increases

It also regulates the formation and use of integrated care organizations, comprised of groups of providers that work together to achieve improved health outcomes for patients at lower costs;

The bill also imposes benchmarks and timelines for the transition to alternatives to fee for service and the predominant use of integrated care organizations by 2015.

2011 HB 2895 – An Act to ensure quality, affordability and access to primary and preventative health

care, to eliminate health disparities, and to enhance economic growth throughout the Commonwealth Status: Hearing Scheduled JPH – 5/3/3011

Establishes a State Health Service Corps for the purpose of uniting community health centers with caring health professionals, and supporting community-based care at community health centers;

Establishes an Office of State Health Policy which shall be responsible for health access and primary care development, planning, coordination and federal designations;

Establishes the Essential Community Health Center Trust Fund and the Commonwealth Community Health Center Innovation and Improvement Fund.

2011 HB 3401 - Printed as amended version of the Bill making appropriations for the fiscal year

2012 for the maintenance of departments, boards, commissions, institutions and certain activities of the Commonwealth, for interest, sinking fund and serial bond requirements and for certain

permanent improvements Status: Conference committee recommended substituting new draft - see HB3565 - 07/01/2011

The House Engrossed budget for fiscal year 2012 includes $28,167,935,815 in direct appropriations, $433,395,305 in chargebacks, $476,121,105 in retained revenue, for a total of $29,077,452,225. Federal grant spending of $2,550,618,543 and consolidated transfers of $1,899,596,490 bring the total up to $33,527,667,258.

Section 1 sets forth what the budget appropriations are generally for, and that all appropriations are from General Fund unless another fund is designated.

2011 SB 500 – An Act establishing a public health insurance option Status: Hearing scheduled JHC – 12/15/2011

Directs Commonwealth Connector Authority to provide for the offering a public health benefits plan - the public health insurance option - to eligible individuals and large groups, to ensure choice, competition, and stability of affordable, high quality coverage throughout Massachusetts;

Requires that the public option shall: o (a) be made available exclusively through the Commonwealth Connector, alongside health

benefit plans receiving the Connector seal of approval, o (b) meet all the requirements established for health benefit plans to receive the

Commonwealth Connector seal of approval o (c) meet the Connector’s standards for minimum creditable coverage o (d) comply with subsections (b), (c), and (d) of section 5 of Chapter 176Q

The public option shall be made available to eligible individuals and eligible small groups through the Connector no later than January 1, 2011, and the public option shall be made available to eligible large groups no later than July 1, 2011.

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2011 SB 518 – An Act relative to shared responsibility in health reform Status: Hearing scheduled JHC – 8/2/2011

Directs and authorizes the Secretary of Administration and Finance and the Secretary of Health and Human Services shall implement a health reform employer responsibility revenue program in order to increase revenue available to fund health programs authorized by Chapter 58 of the Acts of 2006;

Directs and authorizes the Division of Health Care Finance and Policy and the Department of Workforce Development shall assess benefiting employers a health benefit compensation payment for each benefiting employee enrolled in the Commonwealth Care Health Insurance Program

2011 SB 522 – An Act to provide immediate relief to small businesses on health care cost

Status: Hearing scheduled JHC – 8/2/2011

SECTION 5. The Division of Unemployment Assistance, in conjunction with the Commonwealth Health Insurance Connector Authority and the Division of Medical Assistance shall make recommendations to the legislature by June 30, 2011on how best to provide health insurance to unemployed residents of the Commonwealth who qualify for benefits under Chapter 151A of the general laws, by expanding MassHealth programs or the Connector's existing programs, provided that such programs will be paid for from the General Funds of the Commonwealth and not through a special assessment on employers and provided further such program shall maximize federal reimbursement to the extent possible.

2011 SB 526 – An Act relative to equitable reimbursement rates

Status: Hearing scheduled JHC – 7/19/2011

Requires health care providers, not included in a managed care organization network contracting with the Commonwealth, to accept a rate equal to the rate paid by Medicaid for services previously approved by a managed care organization for similar services to MassHealth enrollees, this provision also applies to every acute care hospital, health care facility, ambulatory surgical center, or outpatient facility licensed in the commonwealth, who does not agree to participate in a payers network.

2011 SB 1105 – An Act to ensure quality, affordability and access to primary and preventive health

care, to eliminate health disparities, and to enhance economic growth throughout the Commonwealth Status: Hearing scheduled JPH – 5/3/2011

Requires the establishment of a State Health Services Corps (SHSC), and requiring these to form partnerships with community health centers serving medically underserved areas or populations, educational institutions, and community and professional organizations;

Recruit culturally competent clinicians for community health centers; work to establish systems of care that remain after an SHSC clinician departs;

Build a community of dedicated health professionals who continue to work with the underserved even after their SHSC commitment has been fulfilled

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MARYLAND 2011 HB 70 – Budget Bill Fiscal Year 2012

Status: Assigned a chapter number – Chapter 395 – 5/10/2011

Making the proposed appropriations contained in the State Budget for the fiscal year ending June 30, 2012, in accordance with Article III, Section 52 of the Maryland Constitution

Contingent on enactment of HV166/SB182 creating an independent Health Benefit Exchange agency, appropriations may be transferred to that agency by approved budget amendment.

Adds budget language permitting the transfer of appropriation for grants in Executive Direction to an independent Health Benefit Exchange agency that may be created by legislation.

2011 HB 166 – Maryland Health Benefit Act of 2011

Status: Approved by Governor – Chapter 2 – 4/.12/2011

Establishes a Maryland Health Benefit Exchange as a body politic, corporate, and instrumentality of the state.

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Requires the exchange, in carrying out its duties, through advisory committees or through other means, to consult with stakeholders, including representatives of health care providers.

Creates a Board of Trustees to oversee the exchange.

Allows the Board to appoint advisory committees composed of experts and individuals knowledgeable about individual and employer-sponsored health coverage, health benefit plan administration, health care finance, administration of public and private health care delivery systems, purchasing and facilitating enrollment in plan coverage, health care delivery models and payment reform, and others as appropriate;

Establishes a Maryland Health Benefit Exchange Fund to provide funding to the operation and administration of the exchange.

Seeks to have the exchange become self-sustaining by 2016.

2011 HB 516 – Health Benefit Exchanges – Establishment and Operation Status: H Unfavorable Report by Health and Government Operations Withdrawn – 3/25/2011

Requires that an exchange be established as a nonprofit entity to focus on carrying out functions established under the federal Patient Protection and Affordable Care Act.

Prohibits an exchange from: o being established as a governmental agency; o soliciting business from individuals or small employers already participating in the individual market

or small group market outside of the exchange; and o depending on funding from the public (excluding federal grants) or from fees paid by individuals not

enrolled in the exchange.

Directs the Insurance Commissioner to examine the duties of persons employed by an exchange related to the sale, solicitation or negotiation of health insurance, and to ensure appropriate regulation of such persons, including licensure.

2011 SB 107 – Health Benefit Exchanges – Establishment and Operation

Status: S Unfavorable Report by Finance – 3/25/2011

This measure is a companion of the above 2011 HB 516. The current versions have the same bill summary.

2011 SB 182 – Maryland Health Benefit Exchange Act of 2011

Status: Approved by the Governor - - Chapter 1 - 04/12/2011

This measure is a companion of the above 2011 HB 166. The current versions have the same bill summary.

2011 SB 724 – Health Insurance – Exchange Option for Small Business Status: Reported Unfavorably by Senate Finance Committee – 2/21/2011

Requires a Small Business Health Options Program (SHOP) exchange to offer health insurance to employers that have 100 or fewer employees.

Allows employers in the state to purchase health insurance outside of a SHOP exchange.

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MICHIGAN 2011 SB 595 - Insurance; health; Michigan basic health program for certain low-income residents; establish in lieu of benefits under a health exchange as allowed under the patient protection and

affordable care act. Status: Referred to Committee on Health Policy – 9/7/2011

This bill establishes a basic health program; creates a basic health program trust fund; provides for the powers and duties of certain state and local governmental officers and entities; allows for the promulgation of rules; and to promote the availability and affordability of health coverage in Michigan.

2011 SB 693 – Insurance; health; MIHealth marketplace

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Status: Referred to Committee on Health Policy – 11/10/2011

This bill provides for the establishment of the MIHealth marketplace as a nonprofit corporation;

It also creates the board of the MIHealth marketplace and prescribe its powers and duties;

And it provides for assessments and user fees and for the powers and duties of certain state and local governmental officers and agencies.

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MINNESOTA 2011 HF 497 – Health Insurance Exchange Created

Status: Referred to House Health and Human Services Reform Committee – 2/14/2011 – Authors stricken McDonald and McElfatrick – 5/18/2011

Establishes an exchange as a nonprofit entity to facilitate access to qualified health plans available to individuals and employers effective January 1, 2014.

Creates a board of directors to oversee the exchange. Requires the exchange to:

o develop a plan of operations; o adhere to federal law; and o consult with stakeholders, including health plan companies and advocates for enrolling hard-to-

reach populations. Requires individuals employed by or affiliated with Navigators to be health insurance agents licensed and

regulated by the Insurance Commissioner.

2011 HF 1204 – Minnesota health benefit exchange act Status: Authors added Slocum and Tillberry – 3/23/2011

This bill creates the Minnesota health benefit exchange and proposes coding for a new law as Minnesota Statutes in chapter 62V.

The act creates an insurance exchange within the state for both individuals and small employers.

Section 3 [62V.03] Establishes the nine-member board of directors to govern the exchange.

The exchange is charged with: o Facilitating the purchase and sale of qualified health plans o providing for the establishment of a SHOP exchange to assist qualified small employers in the

state in facilitating the enrollment for their employees in qualified health plans o The exchange may enter into information-sharing agreements with federal and state agencies

and other state exchanges to carry out its responsibilities o The exchange shall make qualified health plans available to qualified individuals and qualified

employers beginning on or before January 1, 2014.

2011 HF 1552 – Health Insurance exchange creating, operation, or existence prohibited in Minnesota Status: Referred to Health and Human Services Reform Committee – 4/26/2011

This bill attempts to prohibit the creation, operation or existence of a health insurance exchange in the state of Minnesota.

Related Bill – SF 1343.

2011 SF 837 – Single public health care program establishment plan requirement Status: Referred to Health and Human Services – 3/16/2011

This bill relates to the human services department and requires the commissioner of human services to recommend a plan to establish a single public health care program in the state

It also requires the commissioner to simplify eligibility and the enrollment process, as well as develop an automating system.

2011 SF 866 – State Health care program purchasing county role modifications; county-based purchasing arrangements authorization; administrative reporting process establishment

Status: Referred to Health and Human Services – 3/17/2011

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This ,bill relates to the health care Article 1 – local and county roles in state healthcare program purchasing by modifying the prepaid medical assistance (MA) MinnesotaCare, and state health care programs county authority, county-based purchasing plans, county proposals, and dispute resolution.

It also modifies sole-source or single-plan managed care contracts. The bill also changes Article 2 – rural health care delivery demonstration projects, by requiring the commissioner of human services to consult with rural hospitals, primary care providers, county boards, health plans, and other key stakeholders primarily domiciled in the service area regarding the development and approval of alternative rural health care delivery demonstration projects.

The bill also charges HHS to reduce state-mandated administrative reports as it claims that they are redundant, unnecessary, and obsolete, under Article 3.

2011 SF 917 – Minnesota Health Benefit Exchange Act Status: Referred to Commerce & Consumer Protection – 3/21/2011

This act creates the Minnesota health benefit exchange by defining certain terms, establishing the actual exchange, specifying the general requirements and duties of the exchange, authorizing the exchange to certify a health benefit plan as qualified, provided it meets certain criteria.

It also authorizes the exchange to establish an all-payer rate settling system to govern provider payments made under private and public sector health plans offered inside and outside of the exchange.

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MISSISSIPPI 2011 HB 377 – Health Insurance Exchange Study Committee; extend repealer

Status: Approved by Governor – 4/26/2011

Amends current state law (SB 2554 enacted in 2010), which created the Health Insurance Exchange Study Committee to conduct a study on health insurance exchanges as proposed at the federal level and to make implementation recommendations.

Changes the repeal date of the Study Committee from July 1, 2011 to July 1, 2012.

2011 HB 774 – Create Health Benefit Exchange Act Status: FAILED in House Medicaid and Insurance Committees – 2/1/2011

Amends current state law (43-13-115, 43-13-121, 41-86-15).

Directs the Division of Medicaid to cooperate with the Mississippi Health Benefit Exchange and to accept the enrollment of those eligible for Medicaid or CHIP by the exchange.

Establishes the Mississippi Health Benefit Exchange as an Office within the Department of Insurance.

2011 HB 904 – Small Business Health Insurance Pool; Create Status: FAILED in House Insurance and Ways and Means Committees – 2/1/2011

Creates a Small Business Health Insurance Pool to provide employer premium incentive payments, employee premium assistance payments, and tax credits for eligible small employers who provide certain group health plan coverage to eligible employees.

Establishes a Board of Directors to: (1) determine an operating plan, assistance amounts, and eligibility and application requirements, (2) approve no more than six fully insured group health plans with different benefit levels to be offered to participating employers, and (3) contract with no more than three health insurance issuers to underwrite the plans offered.

Authorizes the Division of Medicaid to pursue Medicaid funding for employee premium assistance.

2011 HB 1220 – Mississippi Health Benefit Exchange Act Status: FAILED in Conference – 3/28/2011

Establishes the Mississippi Health Benefit Exchange, as a not-for-profit corporation independent of the state, operating under a Board of Directors.

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Requires the board to consist of 16 members, two of whom must be a health care provider—one appointed by the Mississippi State Medical Association and one by the Mississippi State Medical and Surgical Association—both to be approved by the Speaker of the House of Representatives.

Requires the exchange to be self-sustaining by January 1, 2015 (added by bill substitution).

2011 HB 1336 – Mississippi Health Benefit Exchange Act Status: FAILED in House Insurance Committee – 2/1/2011

Establishes the Mississippi Health Benefit Exchange, as a not-for-profit corporation with legal existence separate from the state, operating under a Board of Directors.

Requires the Board to consist of 16 members, one of whom must be a health care provider appointed by the Mississippi Medical Association and one of whom must be a member of the Mississippi Hospital Association approved by—both must be approved by the commission.

2011 SB 2267 – Health Insurance Exchange Study Committee; extend repealer

Status: FAILED in House Insurance Committee – 3/11/2011

This measure is a companion of the above 2011 HB 377. The current versions have the same bill summary.

2011 SB 2991 – Mississippi Health Benefit Exchange Act Status: FAILED in Senate Insurance Committee – 2/1/2011

This measure is a companion of the above 2011 HB 1336. The current versions have the same bill summary.

2011 SB 2992 – Mississippi Health Benefit Exchange Act Status: FAILED in House Insurance Committee – 3/9/2011

This measure is a companion of the above 2011 HB 1336. The current versions have the same bill summary.

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MISSOURI 2011 HB 609 – Establishes the Show-Me Health Insurance Exchange Act

Status: Placed on Informal Calendar – SCS PENDING – 5/9/2011 Establishes the Show-Me Health Insurance Exchange as a quasi-governmental agency under the direction

of a board of trustees. Requires the executive director of the board to employ employees as authorized by the board to conduct

business of the exchange, and requires the board to take into account salaries paid by health carriers, health benefit plans, and health care providers in establishing appropriate pay schedules for employees.

Requires participating health carriers to provide timely updates regarding the plan’s provider network, including the addition of new providers or withdrawal of an existing provider through a publicly accessible website.

Requires the exchange to: o adhere to federal law; o establish a broker referral network as part of the Navigator program; and o consult with stakeholders, including health care providers.

2011 SR 60 – Relating to a health insurance exchange

Status: Referred to S Rules, Joint Rules, Resolutions and Ethics Committee – 10/17/2011

An act that resolves members of the Missouri government to refrain from applying for any other federal grants relating to the establishment of a health insurance exchange as envisioned under the PPACA and to refrain from adopting any policies relating to the establishment of a health insurance exchange.

2011 SB 464 – Prohibits the establishment and operation of health insurance exchanges in Missouri unless certain criteria are met

Status: Prefiled – 12/1/2011

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This act prohibits the establishment, creation, or operation of a state-based health insurance exchange unless the exchange is created by a legislative act, an initiative petition, or referendum. The act specifically prohibits the establishment of a state-based health insurance exchange by an executive order issued by the Governor. The act further prohibits state agencies from establishing programs or promulgating any rules or policies to establish, create, administer or otherwise operate a state-based health benefit exchange described in the federal health care act unless such department, agency, instrumentally, or political subdivision has received statutorily authority to do so.

2011 SB 560 – Prohibits the establishment and operation of health insurance exchanges in Missouri unless certain criteria are met

Status: Prefiled – 12/13/2011

This act prohibits the establishment, creation, or operation of a state-based health insurance exchange unless the exchange is created by a legislative act, an initiative petition, or referendum.

The act specifically prohibits the establishment of a state-based health insurance exchange by an executive order issued by the Governor.

The act further prohibits state agencies from establishing programs or promulgating any rules or policies to establish, create, administer or otherwise operate a state-based health benefit exchange described in the federal health care act unless such department, agency, instrumentally, or political subdivision has received statutorily authority to do so.

2011 SB 565 - Increases the membership of the Missouri Health Insurance Pool from 9 members to 13

members by adding 2 members of the Senate and 2 members of the House of Representatives Status: Prefiled – 12/14/2011

This act increases the membership of the Missouri Health Insurance Pool from 9 members to 13 members by adding 2 members of the Senate and 2 members of the House of Representatives.

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MONTANA 2011 HB 124 – An Act Creating a Montana Health Insurance Exchange Authority

Status: FAILED in Standing committee – 4/28/2011

Creates a Montana Health Insurance Exchange Authority, a quasi-governmental entity, subject to supervision of the Insurance Commissioner, and incorporated as a nonprofit corporation.

Establishes an oversight board, required to consult with stakeholders, including the advisory committee, consumers who are enrollees in qualified health plans, and advocates for enrolling hard-to-reach populations.

Establishes an advisory board with 15 members from the insurance industry, producer organizations, consumer advocacy groups, labor unions, employers, health care providers and other interested parties.

Authorizes the Insurance Commissioner to: o approve or disapprove the plan of operation that the board proposes; o develop a uniform health insurance application form and require use both inside and outside of the

exchange authority; o approve or disapprove the assessment fees that the board proposes to impose to pay for the

ongoing administration of the exchange authority; o conduct periodic financial and performance audits of the exchange authority; o adopt rules necessary to implement provisions; and o investigate any complaints received from the public concerning the operation of the exchange

authority.

Requires all health issuers participating in the exchange: o to offer at least one gold and one silver plan both inside and outside the exchange, unless the

issuer does not operate outside the exchange; o that offer individual or small employer group preferred provider organization health plans, other

plans with incentives for using particular networks of providers, or managed care plans outside the exchange to also offer those network-based plans inside the exchange;

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o to comply with existing network adequacy rules or any network adequacy rules for preferred providers adopted by the commissioner for plans issued both inside and outside the exchange;

o to use the same network of providers for health plans offered inside the exchange for plans offered outside.

Charges the board and the Commissioner of Insurance with jointly researching, investigating and producing reports by August 31, 2012 on strategies to reduce health care costs and an assessment of how implementation of such strategies would affect health care costs and health insurance premiums for exchange enrollees.

2011 HB 128 – Revise health insurance laws

Status: FAILED – died in Standing Committee – 4/28/2011

This bill prohibits preexisting condition exclusions for children under 19 years of age and provides for open enrollment periods

It removes certain dollar amounts and lifetime limits, while also providing enrollment options for loss of coverage under certain circumstances

The bill also provides for coverage of preventative services with no cost sharing and also provides a choice of primary care providers

It prohibits rescissions and providing exceptions while also expanding coverage for children under 26 years old as dependents

It also delineates changes that apply to grandfathered plan coverage including plans for government entities, and extends rulemaking authority while also increasing amounts to be paid for mammograms

2011 HB 324 – Revise Montana comprehensive health association

Status: Chapter Number Assigned – 4/7/2011

This bill revises the Montana Comprehensive Health Association and Plan by reducing the number of insurance rejections or restrictions required under the ‘eligible person’ definition; it also increases the number of public members of the association board; changes the premium limits; increases eligibility for premium assistance; increases lifetime benefits; etc.

2011 HB 445 – Allow health care choice thru out-of-state policies

Status: Died in Process (H) – 4/28/2011

This bill allows Montanans to purchase out-of-state individual or group health insurance policies and removes certain Montana requirements and regulatory provisions from policies sold in the state by out-of-state insurers or local agents acting on their behalf.

Also allows in-state insurers a waiver to provide similarly limited policies

This is related to bill LC 20 – Status - (C) draft ready for delivery – 2/4/2011

2011 HB 590 – Create health insurance pooling for certain public employees Status: Died in Standing Committee – 4/28/2011

Bill establishes a statewide risk pool and health benefit plan for public school districts and education cooperatives that requires certain school districts to participate and provides options for health plans and core benefits. Also maintains collective bargaining roles in districts that have collective bargaining.

2011 HB 644 – Require a study of a health insurance exchange

Status: FAILED in Standing Committee – 4/28/2011

This bill requires the legislative council to appoint a joint interim committee to study the feasibility of creating a state-based or a regional health insurance exchange and requires the committee to make recommendations, provide an appropriation and an immediate effective date for such a committee.

2011 HJ 33 – Interim study on state health insurance exchange Status: (H) Filed with Secretary of State – 4/29/2011

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This is a joint resolution of the house and senate requesting that an interim study on the implications, options, and repercussions of a health insurance exchange in the state of Montana. It requires the final report of results of the study to be reported to the 63rd legislature.

2011 LC 270 – Create a state-level health insurance exchange

Status: (c) Pre-Introduction Letter Sent – 12/14/2010

This bill creates the Montana Health Insurance Exchange Authority and establishes an oversight board.

The bill also provides a purpose and defines the powers and duties of the exchange and board while also describing the duties of the commissioner of insurance related to the exchange authority and board. The bill also provides the commissioner with rulemaking authority.

2011 LC 271 – Revise Health Insurance Laws

Status: (C) Pre-Introduction Letter Sent – 12/14/2010

This act generally revises the health insurance laws by prohibiting preexisting condition exclusions for children under 19 years of age and provides open enrollment periods;

Also removes certain dollar limits and lifetime limits and provides enrollment options for loss of coverage under certain circumstances

Also provides for coverage of preventative services.

2011 LC 612 – Prohibit state government from administering federal health insurance purchase requirement

Status: (C) Draft delivered to Requester – 1/5/2011 ***Text of bill not yet available***

2011 LC 877 – Revise Montana comprehensive care association

Status: (C) Draft delivered to the Requester – 1/21/2011 ***Text of bill not yet available***

2011 LC 984 – Create health insurance pooling for certain public employees

Status: (C) Draft delivered to Requester – 2/15/2011 ***Text of bill not yet available***

2011 LC 1340 – Interim study on health insurance exchange

Status: Draft ready for delivery – 4/1/2011 ***Text of bill not yet available***

2011 LC 1471 – Require a study of a health insurance exchange

Status: (C) Draft delivered to Requester – 3/28/2011 ***Text of bill not yet available***

2011 LC 1506 – Prohibit creation of state-based health insurance exchange

Status: (C) Draft delivered to Requester – 1/25/2011 ***Text of bill not yet available***

2011 SB 125 – Prohibit state government from administering federal health insurance purchase

requirement Status: Chapter Number Assigned – 5/13/2011

This bill prohibits the state from administering federal health insurance purchase requirements

2011 SB 176 – Prohibit qualified health plans from covering abortion services through exchange Status: FAILED Died in Process – 4/28/2011

An act prohibiting qualified health insurance plans offered through a health insurance exchange in the state from covering abortion services

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Same as LC 1851

2011 SB 228 – Prohibit Creation of Health Insurance Exchange under PPACA Status: FAILED – Died in Process – 4/28/2011

Prohibits the state from creating an American Health Benefit Exchange as provided for in federal law.

Requires the state to return to the federal government the unexpended portions of any grants obtained to plan for or implement a state-based exchange.

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NEBRASKA 2011 LB 22 – Adopt the Mandate Opt-Out and Insurance Coverage Clarification Act

Status: Approved by Governor – 5/18/2011

Bill prohibits the use of public health insurance exchange funds to subsidize abortion procedures within the state.

Also limits the coverage of abortion in all health insurance plans, contracts, or policies delivered or issued for delivery in NE.

Similar to LB 132 – Notice of hearing for 2/15/2011

2011 LB 240 – Create the Nebraska Insurance Choices Exchange Task Force Status: Notice of hearing for February 14, 2011

Creates the Nebraska Insurance Choices Exchange Task Force as of July 1, 2011 to study, evaluate and develop recommendations regarding the establishment, governance and requirements of the health insurance exchange required by the federal Patient Protection and Affordable Care Act to facilitate the purchase and sale of qualified plans in the individual and small market group market and to evaluate the establishment of a small business health options program exchange to assist qualified small employers in facilitation the enrollment of employees.

Requires the task force to report to the Legislature on or before December 1, 2011 with recommendations to ensure the exchange will reduce health care costs, reduce the number of uninsured individuals, provide a transparent marketplace, and provide consumer education to assist individual with access to programs, premium assistance tax credits and cost-sharing reductions.

Charges the task force with overseeing implementation of the exchange until June 30, 2012.

2011 LB 422 – Change eligibility provisions under the Comprehensive Health Insurance Pool Status: Notice of hearing – 2/15/2011

This act amends sections 44-4221 and 44-4228 in the Comprehensive Health Insurance Pool ct (Reissue Revised Statutes of Nebraska) to expand eligibility for pool coverage and to require notice of ineligibility as prescribed.

The act also aims to harmonize provisions and repeal the original sections as listed above.

2011 LB 493 – Provide dependent health insurance up to age twenty-six Status: Notice of hearing 2/15/2011

Provides dependent health insurance up to age twenty-six.

2011 LR 85 – Interim Study to Determine How Insurance Laws Should Be Amended Status: Referred to Banking, Commerce and Insurance Committee – 5/23/2011

Forms a study committee to review the development and final provisions of the legislative proposals for exchange implementation resulting from the activities by the state under the federal State Planning and Establishment Grant.

Charges the study committee with seeking assistance from the Department of Insurance and cooperating with other affected agencies.

2011 LR 138 – Interim Study to find a solution to the exit of insurers from the health insurance

marketplace

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Status: Referred to Banking, Commerce and Insurance Committee – 5/23/2011

This bill calls for an interim study to be conducted in order to find a solution to ease the exit of insurers from the health insurance marketplace for stand-alone health insurance policies for children.

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NEVADA ***none***

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NEW HAMPSHIRE 2011 HB 601 – An Act Relative to Implementation of Federal Health Care Reform

Status: H Law without Signature – 7/14/2011

This bill establishes an oversight committee to provide legislative oversight, policy direction and recommendations for legislation with respect to the Patient Protection and Affordable Care Act of 2009 Public Law 111-148, as amended by the Health Care and Education Reconciliation Act of 2010, Public Law 111-152.

This bill requires the insurance commissioner to obtain approval from the oversight committee before implementing any of the federal changes.

This bill also directs the insurance commissioner to decline certain exchange planning grant funds and to indicate to the Secretary of the Department of Health and Human Services that the money is to be used to reduce the federal budget deficit.

2011 HB 619 – Requiring the state of NH to opt out of the PPACA’s individual mandate

Status: H Committee report – Inexpedient to Legislate – 11/2/2011

This bill requires the state of New Hampshire to opt out of the requirement that individuals purchase health insurance contained in the Patient Protection and Affordable Care Act.

2011 HB 1297 – Relative to health care exchanges

Status: H Public Hearing: 1/19/2012 11:00 AM LOB 302 =Insurance Division= - 12/15/2011

This bill prohibits the state of New Hampshire from planning, creating, or participating in a state health care exchange, or a federal health exchange.

2011 SB 163 – Relative to the New Hampshire Health Benefit Exchange

Status: Re-referred bill – 9/6/2011

Establishes the New Hampshire Health Benefit Exchange as a public body deemed to be an instrumentality of the state and a public corporation.

Determines that the Act shall not preclude the establishment of separate, privately-run exchanges or the distribution of coverage outside an exchange.

Creates the exchange board to provide procedures to facilitate the exchange, ensuring to meet the requirements of the Patient Protection and Affordable Care Act.

Requires that the board be made up of three persons affiliated with an insurer, two health insurance producers, three public members not employed by or affiliated with an insurer, hospital or other health care provider, the commission of the department of health and human services, and the insurance commissioner.

Provides the state insurance commissioner with rulemaking authority over the exchange. ________________________________________________________________________________

NEW JERSEY

2010 AB 1930 – New Jersey Health Benefit Exchange Act

Status: Received in the Senate, Referred to Senate Commerce Committee - 07/07/2011Establishes in the executive branch of state government the New Jersey Health Benefit Exchange.

Creates a board of directors that may require carriers participating in the exchange to:

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o make available to the exchange and regularly update an electronic directory of contracting health care providers so exchange enrollees can search by provider to determine which plans include the provider in their network; and

o provide regularly updated information to the exchange as to whether a provider is accepting new patients in a particular plan.

Requires the Commissioner of Banking and Insurance to report to the Governor and the Legislature by January 1, 2018 with recommendations for appropriate administrative and legislative action.

2010 AB 3561 – New Jersey Health Insurance Exchange Act

Status: Referred to Assembly Health Senior Services Committee and carried over to 2011 session – 12/6/2010

Establishes the New Jersey Health Insurance Exchange as an independent public entity, in but not of the Department of Banking and Insurance, with certain authority to facilitate the availability and choice of health benefits plans offered to employees of small employers that employ between two and 50 employees, and other eligible persons not employed by small employers.

Establishes a board of directors to implement the functions of the exchange.

Requires an annual study and a report on exchange operations to the Governor and Legislature.

Authorizes the exchange, in consultation with the Commissioner of Banking and Insurance and the Commissioner of Health and Senior Services, to adopt rules and regulations as necessary.

2011 AB 3733 – New Jersey Healthcare Exchange Act

Status: Referred to Assembly Financial Institutions and Insurance Committee – 1/11/2011

This measure is similar to above 2010 AB 1930. The current versions have the same bill summary.

2010 SB 1288 – New Jersey Health Benefit Exchange Act Status: Referred to Senate Commerce Committee – 2/8/2010

This measure is a companion of the above 2010 AB 3561. The current versions have the same bill summary.

2010 SB 2553 – New Jersey Health Benefit Exchange Act

Status: Referred to Senate Commerce Committee and carried over to 2011 session – 12/9/2010

This measure is a companion of the above 2010 AB 1930. The current versions have the same bill summary.

2010 SB 2597 – New Jersey Healthcare Exchange Act Status: Referred to Senate Commerce Committee and carried over to 2011 session – 12/30/2010

This measure is a companion of the above 2010 AB 3733, which is similar to 2010 AB 1930. The current versions have the same bill summary.

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NEW MEXICO 2011 HB 33 – New Mexico Health Insurance Exchange Act

Status: Referred to House Health & Government Affairs Committee – 2/24/2010

Creates the New Mexico health insurance exchange as a nonprofit public corporation, separate from the state and supervised by a board of directors, to provide increased access to health insurance in the state.

Requires the board to: o consist of 11 voting members who shall not have any affiliation with or any income derived from

current or active employment as a contract or consultation for a health care provider or health care services finance or coverage sector;

o create and duly consider the recommendations of standing advisory committees made up of representatives of carriers, health care providers, health care consumers, representatives of employers, advocates for low-income or underserved residents and representatives of American Indians or Alaska Natives;

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o implement strategies to avoid adverse selection; o provide quarterly reports on implementation to the legislative health and human services and

finance committees; and o submit recommendations on (1) changing the number of full-time employees as defined in “small

employer,” (2) extending coverage to large employers,(3) combining markets into a single risk pool, and (4) entering into an exchange with other states.

Requires carriers that offer health benefit plans in the individual or small market in the state to offer qualified health plans through the exchange at the silver and gold levels of coverage.

2011 HB 246 – Amend Health Insurance Alliance Act

Status: Referred to House Health & Government Affairs Committee – 1/31/2010

Amends current state statutes (59A-56-2 to 59A-56-20), the Health Insurance Alliance Act.

Adds large employers to those eligible to receive voluntary health insurance coverage under the existing New Mexico Health Insurance Alliance.

2011 HB 584 – New Mexico Benefit Exchange Act

Status: Referred to House Health & Government Affairs Committee – 1/31/2010

Creates the New Mexico Health Benefit Exchange as a nonprofit public corporation, separate and apart from the state.

Establishes a Board of Directs to govern the exchange by: o consisting of 11 voting members who shall not have any affiliation with or any income derived from

current or active employment as a contract or consultation for a health care provider or health care services finance or coverage sector;

o creating and duly considering the recommendations of standing advisory committees made up of representatives of carriers, health care providers, health care consumers, representatives of employers, advocates for low-income or underserved residents and representatives of American Indians or Alaska Natives;

o coordinating with the Superintendent of Insurance to review the establishment and operation of the internet portal;

o consulting with representatives of New Mexico Native American nations, tribes and pueblos; o reporting findings and submitting recommendations on how to avoid adverse selection to the

governor, Legislative Health and Human Services Committee, the Legislative Finance Committee and the superintendent; and

o meeting with the board of directors of the New Mexico Health Insurance Alliance and the New Mexico Medical Insurance Pool.

Authorizes the superintendent to promulgate rules for resolving disputes within the exchange.

2011 SB 6 – New Mexico Health Insurance Exchange Act Status: Filed or pre-filed – 1219/2011

This bill enacts the New Mexico Health Insurance Exchange Act, and delineates the duties and powers of the exchange, it also provides for the appointment, powers and duties of a board of directors for the exchange.

Also provides the superintendent of insurance of the public regulation commission with rulemaking powers relating to the exchange.

Repeals the health insurance alliance act.

2011 SB 38 – New Mexico Health Insurance Exchange Act Status: Amended, passed House Consumer & Public Affairs Committee, and referred to Appropriations &

Finance Committee – 3/2/2011

Creates the New Mexico health insurance exchange as a nonprofit public corporation, separate from the state and supervised by a board of directors, to provide increased access to health insurance in the state.

Provides that the exchange is a governmental entity for purposes of the Tort Claims Act.

Charges the board with:

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o consisting of 11 voting members who shall not have any affiliation with or any income derived from current or active employment as a contract or consultation for a health care provider or health care services finance or coverage sector;

o creating and duly considering the recommendations of standing advisory committees made up of representatives of carriers, health care providers, health care consumers, representatives of employers, advocates for low-income or underserved residents and representatives of American Indians or Alaska Natives;

o annually reporting to the legislative health and human services and finance committees; and o submitting recommendations on (1) avoiding adverse selection, (2) changing the number of full-time

employees as defined in “small employer,” (3) extending coverage to large employers, (4) combining markets into a single risk pool, and (5) entering into an exchange with other states.

Requires carriers that offer health benefit plans in the individual or small market in the state to offer qualified health plans through the exchange at the silver and gold levels of coverage.

Requires the board to cooperate with the human services department to share information and facilitate transitions between the exchange, Medicaid, CHIP and any other state public health coverage program.

Requires the human services department to cooperate with the exchange to provide funding for implementation, to share information, and to facilitate transitions between the exchange, Medicaid, CHIP and any other state public health coverage program.

Requires the Insurance Division to cooperate with the exchange to share information and assist in implementation.

2011 SB 90 – Health Insurance Access for Large Employers

Status: Referred to Senate Public Affairs Committee – 1/18/2011

This measure is similar to the above 2011 HB 246. The current versions have the same bill summary.

2011 SB 370 – Enact “NM Health Insurance Exchange Act” Status: Amended, passed Senate Public Affairs Committee, and referred to Corporations & Transportation

Committee – 2/14/2011

This measure is similar to the above 2011 HB 38. The current versions have the same bill summary.

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NEW YORK 2011 AB 2474 – The Health Care Consumer and Provider Protection Act

Status: Print number 2474a – 5/6/2011

This bill amends the public health law in relation to requirements for collective negotiations by health care providers with certain health benefit plans.

The bill displaces competition between health care providers by regulating health plan-provider agreements and authorizing collective negotiations on the terms and conditions of the relationship between health care plans and health care providers to the imbalances between the two will not result in adverse conditions for health care.

Related bill – SB 3186 – Referred to ways and means 6/23/2011 – Referred to Senate – 1/4/2012

2011 AB 8116 – Act providing for the role of agents/brokers in the health benefit exchange Status: referred to insurance – 6/2/2011

This bill provides for the role of agents and brokers in an American health benefit exchange created in compliance with the federal Patient Protection and Affordable Care Act.

It requires the commissioner of insurance to establish procedures by which agents or brokers may enroll individuals in qualified health plans, assist individuals in applying for tax credits and cost-sharing reductions for such plans, and receive compensation through the insurance carriers.

2011 AB 8514 – The New York Health Benefit Exchange Act Status: Returned to Assembly – 1/4/2012

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This act amends the public authorities law and public officers law in relation to the establishment of the New York Health Benefit Exchange, which will facilitate the purchase and sale of qualified health plans in the individual market in NY and will incorporate a small business health options program to assist qualified employers in facilitating the enrollment of their employees in qualified health plans offered in the group market.

2011 SB 5652 – The New York State Health Benefit Exchange Act Status: Recommitted to Rules Committee – 6/24/2011

This bill publically establishes the New York State Health Benefit Exchange in accordance with the PPACA. It delineates what the exchange is, what it’s powers will be, who will be on the board of directors, etc.

2011 SB 5849 – New York Health Benefit Exchange Act

Status: Recommitted to Rules – 6/24/2011

This bill adds Article 10-E SS3980 – 3993, Public Authority L, and amends SS17 & 19.

It publically establishes the New York Health Benefit Exchange, which will facilitate the purchase and sale of qualified health plans in the individual market in NY and will incorporate a small business health options program to assist qualified employers in facilitating the enrollment of their employees in qualified health plans offered in the group market.

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NORTH CAROLINA 2011 HB 115 – North Carolina Health Benefit Exchange Act

Status: Referred to Senate Rules & Operations Committee – 5/31/2011

Creates the North Carolina Health Benefit Exchange as a nonprofit entity, meeting the requirements of the Affordable Care Act.

Establishes the Board of the North Carolina Health Benefit Exchange: o consisting of 11 members, one representative of a health carrier, two members of the general public

not employed by or affiliated with an insurance company, hospital or other health care provider, one health carrier who sells individual policies, one who represents the insurance industry as recommended by the largest carrier in the state, two who represent the medical provider community, one who represents small business, and one who is either a health policy researcher or health economist; and

o consulting with stakeholders including educated health care consumers and advocates for enrolling hard to reach populations.

2011 HB 126 – North Carolina Benefit Exchange Act

Status: Referred to House Health and Human Services Committee – 2/21/2011

Creates the North Carolina Health Benefit Exchange as a nonprofit entity, meeting the requirements of the Affordable Care Act.

Establishes the Board of the Exchange to consult with stakeholders including advocates for enrolling hard to reach populations and health care professionals and provider groups.

Requires the exchange to establish an advisory committee made up of stakeholders, including insurers who sell individual policies, insurers who sell small group policies, agents or brokers, organizations that represent consumer interests, educated health consumers, individuals and entities with experience in facilitating enrollment, qualified employers, advocates for hard to reach populations, health care professionals, essential community providers, and other necessary representatives.

2011 S 418 – North Carolina Health Benefit Exchange Act Status: Referred to Senate Committee on Rules and Operations – 3/28/2011

Establishes the North Carolina Health Benefit Exchange to be supported in part or in whole from the State funds, and in part from Federal funds.

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Preserves state base authority to regulate the North Carolina health insurance market and to prevent federal encroachment on state authority by establishing the North Carolina Health Benefit Exchange.

Establishes a Board of Directors to govern the North Carolina Health Benefit Exchange.

The exchange will make qualified health plans available to qualified individuals and qualified employers beginning with effective dates on January 1, 2014.

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NORTH DAKOTA 2011 HB 1126 – Creation of a Health Insurance Exchange

Status: Signed by Governor 5/9/2011

Requires the Insurance Commissioner, to ensure that an American benefit exchange is created in the state, and to plan and implement an exchange.

Instructs the Commissioner to take all actions necessary to ensure that the exchange is determined, not later than January 1, 2013, by the federal government to be ready to operate no later than January 1, 2014.

Allows the Commissioner to consider seeking federal grant funds for the planning and implementation of the exchange, to contract with outside entities as necessary, and to adopt needed rules.

2011 HB 1474 – Legislative Management (Health Care Reform Review Committee-not titled)

Status: FAILED on second reading – 11/10/2011

Creates and enacts chapters 54-66 of the North Dakota Century Code, relating to the creation of the North Dakota health benefit exchange. Also repeals chapter 26.1-54 of the North Dakota Century Code and section 3 of chapter 225 of the 2011 Session Laws, which relates to the insurance commissioner’s and department of human services’ duties to establish a health benefit exchange and provide updates to the legislative management.

Also provides a statement of legislative intent, reports to the legislative management, an appropriation and continuing appropriation, and to provide an effective date and contingent and expiration date for the law.

2011 HB 1475 - Legislative Management (Health Care Reform Review Committee-not titled)

Status: Filed with Secretary of State – 11/11/2011

This act provides appropriations for certain medical services, health insurance, economic assistance, and information technology systems for the health care reform review committee.

It also provides for an effective date for the appropriations from November 14, 2011 thru June 30, 2013. ________________________________________________________________________________________

OHIO 2012 SB 277 – Ohio Health Benefit Exchange Program (revise code)

Status: Introduced 1/3/2011

This bill establishes the Ohio Health Benefit Exchange Agency and to establish the Ohio Health Benefit Exchange Program consisting of an exchange for individual coverage and a Small Business Health Options Program

It amends sections 124.14 (job classification and pay ranges) and 3924.01 (small employer health benefit plans – provision of all health care coverage definitions) and enacts sections 3924.01 to 3965.14 of the revised code to establish the exchange.

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OKLAHOMA 2011 SB 960 – Creating the Oklahoma Individual Market Review Act

Status: Pending authorship representatives – 2/23/2011 **full bill text not yet available—below is text of proposed bill shell**

The Patient Protection and Affordable Care Act includes an option for a state to create a health insurance exchange to facilitate the purchase of individual and small group health coverage and to provide assistance with enrollment of eligible individuals in qualified health plans in lieu of the federal government operating a health insurance exchange in the state for that purpose. It is the intent of the Legislature that it would be in

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the best interest of the State of Oklahoma to create its own health insurance exchange. The design of the exchange shall maximize state control over the exchange and its component functions while at the same time minimizing the associated costs and risks to the state.

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OREGON 2011 HB 2918 – Relating to Small Businesses

Status: Referred to House Health Care and Ways and Means Committees – 1/21/2011

Creates the Small Business Health Insurance Pool in Oregon Health Authority, to be administered by the Oregon Medical Insurance Pool Board, to provide quality, affordable health insurance coverage to small employers in the state.

Specifies that eligible employers have no more than 50 employees.

Prohibits carriers from canceling coverage because of an inability to reach an agreement with the health care providers or organization of health care providers to provide services under the plans within the service area.

Requires insurers to participate for at least three years.

Establishes the Small Business Health Insurance Pool Fund in the State Treasury, separate from the General Fund, consisting of moneys appropriated by the Legislative Assembly and premiums and other fees collected from small employers and insurers.

2011 HB 3137 – Relating to Oregon Health Insurance Exchange

Status: Referred to House Health Care, and Ways & Means Committees – 2/14/2011

Requires the Oregon Health Authority to establish the Oregon Health Insurance Exchange, as a statewide public corporation to perform governmental functions, governed by the board of directors.

Requires the exchange to provide uniform information to consumers on costs, benefits, provider networks and other information to assist individual and small businesses in making informed health care decisions.

2011 HB 3510 – Relating to Statewide Coverage of Health Care

Status: Referred to House Health Care, and Ways & Means Committees – 2/28/2011

Amends current state statutes (Section 17 of Chapter 595 Oregon Laws 2009).

Repeals the Oregon Health Insurance Exchange established in 2009.

2011 SB 91 – Relating to Health Benefit Plans Status: Referred to Health Care Reform Subcommittee of Senate Health Care, Human Services and Rural

Health Policy Committee – 1/27/2011

Amends current state statutes (743.730 – 743.773) to instruct the Oregon Health Authority in consultation with the Department of Consumer and Business Services to prescribe by rule the requirements for a bronze plan to be used by carriers in the health benefit plan market in the state.

Requires all carriers to offer a bronze plan: (1) through the Oregon Health Insurance Exchange if the carrier offers a plan through the exchange; and (2) in the market outside of the exchange, if the carrier offers a plan outside of the exchange.

Authorizes carrier to offer a catastrophic plan only through the exchange to an individual who is under 30 years old and is exempt from any state or federal penalties imposed for failing to maintain minimum coverage during the plan year.

2011 SB 99 – Relating to Oregon Health Insurance Exchange

Status: Referred to Health Care Reform Subcommittee of Senate Health Care, Human Services and Rural Health Policy Committee – 1/27/2011

Similar to above 2011 HB 3137.

2011 SB 100 – Relating to Health Benefit Plans Status: Referred to Health Care Reform Subcommittee of Senate Health Care, Human Services and Rural

Health Policy Committee – 1/27/2011

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This measure is similar to above 2011 SB 91. The current versions have the same bill summary.

2011 SB 888 – Relating to Statewide Coverage of Health Care Status: Referred to Senate Health Care, Human Services & Rural Health Policy, and Ways & Means

Committees – 2/25/2011

This measure is similar to above 2011 HB 3510. The current versions have the same bill summary. ________________________________________________________________________________

PENNSYLVANIA

2011 HB 627 – An Act Providing for the American Health Benefit Exchange Act Status: Referred to House Insurance Committee – 2/14/2011

Establishes the Pennsylvania Health Insurance Exchange to meet requirements established under federal law.

Requires the exchange to consult with stakeholders, including educated health care consumers and advocates for enrolling hard to reach populations.

2011 HB 912 – Amends Title 40 of the Pennsylvania Consolidated Statutes

Status: Referred to Insurance – 3/3/2011

The bill amends Title 40 (Insurance) of the Pennsylvania Consolidated Statutes, providing for compliance with Federal health care legislation.

It redefines “abortion,” “complication,” and “health insurance exchange” and also prohibits certain abortion coverage in qualified health plans offered through the health insurance exchange under the subsection.

Very similar to o HB 1942 – Status – Referred to HEALTH – 10/31/2011 o HB 1977 – Status – Referred to Banking & Insurance – 12/14/2011 o SB 3 – Status – Laid on the table – 10/17/2011

2011 SB 940 – Pennsylvania Health Insurance Exchange

Status: Referred to Banking and Insurance – 4/25/2011

This act would establish the Pennsylvania Health Insurance Exchange; impose the duties on the Insurance Department, and providing for the powers and duties of the exchange, for health benefit plan certification, for funding and publication of costs and for regulations.

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RHODE ISLAND 2011 HB 5498 – An Act Relating to State Affairs and Government – Health Care – Health Benefit

Exchange Status: Committee recommended measure be held for further study – 4/13/2011

Establishes the Rhode Island Health Benefit Exchange, as a corporation constituted a public instrumentality exercising public and essential governmental functions.

Requires that the exchange be governed by an executive board that is required to: o consist of 11 members representing individual health coverage, small employer health coverage,

health benefits plan administration, health care finance, delivery system administration, coverage purchasing, and state employee health purchasing;

o not have members employed by, a consultant to, or affiliated with an insurer, a health insurance agent or broker, a health care provider (unless the member is no longer receiving compensation for providing health care services or has no ownership interest in a professional health care practice), or a health care facility or clinic, while serving on the board;

o apply for federal grants to use for planning and establishing the exchange; o submit a report to the Governor and the General Assembly on: (1) plans for IT needed to support

the exchange; (2) recommendations regarding costs, benefits and market impacts associated with expanding the exchange functions and scope; and (3) elements needed to achieve financial self-sufficiency.

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Prohibits the functions and operations of the exchange from expanding beyond the minimum requirements of federal law.

2011 SB 87 – An Act Relating to State Affairs and Government – Health Care – Health Benefit Exchange Status: Referred to House H.E.W. – 4/6/2011

This measure is similar to above 2011 HB 5498. The current versions have the same bill summary. ________________________________________________________________________________

SOUTH CAROLINA

2011 HB 3738 – Health Benefit Exchange Act Status: Referred to House Ways and Means Committee – 2/24/2011

Establishes the South Carolina Health Benefit Exchange within the Office of the Governor.

Requires that the exchange be governed by the Health Benefit Exchange Board of Directors whose members include three representatives of the health insurance industry, two insurance producers, three consumer advocates, one business owner, one business owner recommended by the National Federation of Independent Business, one member recommended by the South Carolina Small Business Chamber of Commerce, one member recommended by the SC Chamber of Commerce, one member recommended by the SC Nurses Association, one member recommended by the SC Primary Care Association, one physician recommended by the SC Medical Association, one member recommended by the SC Hospital Association, and one actuary recommended by the American Academy of Actuaries.

Prohibits persons appointed to the Board from being employed by, a consultant to or affiliated with an entity in the business of the exchange, including carriers that provide coverage of benefits, producers, vendors, and providers selling services directly to the exchange.

Authorizes the exchange to create advisory committees to the board consisting of stakeholders.

2011 S 927 – S.C. Health Planning Committee Status: Senate Referred to Committee on Finance – 5/26/2011

This resolution urges the governor to promote the credibility and balance of the SC Health Planning Committee by ensuring the membership of the committee represents the broad spectrum of state residents who would be served by the state health insurance exchange created by the committee.

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SOUTH DAKOTA ***none***

TENNESSEE

***none***

TEXAS

2011 HB 636 – Relating to the Creation of the Texas Health Insurance Connector Status: FAILED to pass House Public Health Committee – 3/1/2011

Establishes the Texas Health Insurance Connector as the American Health Benefit Exchange and the Small Business Health Options Program Exchange as required by Section 1311 of the Patient Protection and Affordable Care Act.

Creates a board of directors to govern the connector.

Requires the connector, the department of insurance, and the Health and Human Services Commission to cooperate fully in operating the connector.

Provides that the connector is not an insurer or HMO, is not subject to regulation by the department, is not subject to any state tax, and is subject to review and expiration September 1, 2019.

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Establishes the connector fund as a special trust fund, outside of the state treasury in the custody of the comptroller, separate from all public money, where the connector can deposit assessments, donations, and any federal funding.

2011 HB 3402 – Relating to Regulation of Health Benefit Plan Issuers in this State

Status: Filed – 3/11/2011

Establishes the Texas Health Insurance Connector as the American Health Benefit Exchange and the Small Business Health Options Program Exchange as required by Section 1311 of the Patient Protection and Affordable Care Act.

Establishes a Board of Directors consisting of seven members, five of whom must have demonstrated experience in at least two of the following areas: individual health coverage, small employer health coverage, health benefit plan administration, health care finance or economics, actuarial science, administration of public or private health care delivery system, and purchasing health plan coverage.

Prohibits board members or exchange staff from being employed or affiliated with an insurer, an agent or broker, a healthcare provider (unless the member no longer receives compensation for providing health care services and does not have ownership interest in a professional health care practice), or a health care facility or clinic.

Requires health carriers to make available to the exchange and regularly update an electronic directory of contracting health care providers so that enrollees can search by provider name to determine which plans include the provider in their network.

Requires the Board to appoint an advisory committee—allowing for involvement of the health care and health insurance industries and other stakeholders—to provide expertise and recommendations to the board but not to adopt rules or enter into contracts.

2011 SB 1510 – Relating to the Creation of the Texas Health Insurance Connector

Status: Filed – 3/10/2011

This measure is similar to above 2011 HB 636. The current versions have the same bill summary.

2011 SB 1782 – Relating to Regulation of Health Benefit Plan Issuers in this State Status: Filed – 3/11/2011

This measure is similar to above 2011 HB 3402. The current versions have the same bill summary. ________________________________________________________________________________

UTAH

2011 HB 128 – Health Reform Amendments Status: Passed Senate – 3/4/2011

Amends current state statutes (31A-22-613.5, 31A-22-635, 31A-30-205, 31A-30-209, 63M-1-2504, 63M-1-2506) to adhere to federal requirements.

Changes certain responsibilities concerning the exchange from the Department of Insurance to the Insurance Commissioner.

Changes membership requirements for the Health Data Committee, increasing membership consisting of two, rather than one, physician.

Requires that reports are published on or after July 1, 2010, based on clinical data that compare a clinic’s aggregate results for a physician who practices at a clinic with five or more physicians and a geographic region’s aggregate results for a physician who practices a clinic with less than five physicians, unless the physician requests physician-level data to be published on a clinic level.

Creates the Health System Reform Task Force charged with reviewing and making recommendations on legislation necessary to implement the governance structure for the Health Insurance Exchange, risk adjustment, cost containment, including progress on the demonstration projects and grants that involve health care providers and payers to provide system-wide aligned incentives for the appropriate delivery of, and payment for, health care.

Removes the large group market from the Health Insurance Exchange.

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2011 HB 29 – Insurance Amendments Status: Signed by Governor – 3/23/2011

This bill modified the Insurance code to make various changes related to the regulation of health insurance, including, modifying the definition provisions, addresses when uniform waiver of coverage forms may be combined or modified, etc.

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VERMONT 2011 HB 80 – An Act relating to a Single-Payer Health Care System

Status: Referred to House Committee on Health Care – 1/20/2011

Creates a single-payer health care system in the state.

Directs the secretary of human services to seek an exemption from federal requirements to set up and operate a health benefit exchange pursuant to the Patient Protection and Affordable Care Act.

Requires that no later than February 1, 2012, in the event that the secretary cannot obtain such an exemption by November 30, 2011, the Ethan Allen Health board to propose to the general assembly a process and design by which the board would operate an exchange in Vermont and as of January 1, 2014, Ethan Allen Health shall be the secondary payer with respect to any health service covered by a health benefit plan operating within the exchange.

Prohibits, as of October 1, 2012, private insurance companies from selling health insurance policies in Vermont that cover services covered by Ethan Allen Health, if the secretary obtains an exemption from the exchange requirement.

Establishes the Ethan Allen Health Board to promote the delivery of high quality, coordinated health care services that enhance health; prevent illness, disease and disability; slow the progression o f chronic disease; and improve personal health management.

Requires the Board to: o consist of 15 members, six of whom must be providers—on primary care physician, one registered

nurse, one mental health provider, one dentist, on nursing home director, and one hospital director; and

o establish payment rates for providers which may reflect regional differences to address provider shortages.

2011 HB 82 – An Act Relating to a Vermont Hospital Security Plan

Status: Referred to House Committee on Health Care – 1/21/2011

Creates a Vermont hospital security fund special committee to recommend to the general assembly the appropriate funding mechanisms for the Vermont hospital security plan—a plan to provide access to and coverage for health services provided in hospitals, while reducing cost.

Requires the committee to consider various factors including how to operate the program in the event that Vermont is unable to secure an exemption from the federal requirement to set up and operate a health benefit exchange pursuant to the Patient Protection and Affordable Care Act.

Directs the secretary of human services: o to seek an exemption from federal requirements to set up and operate a health benefit exchange

pursuant to the Patient Protection and Affordable Care Act; o if such an exemption cannot be obtained, to seek a limited exemption to enable the state to exclude

hospital services from exchange plans and receive federal funds to deposit in the Vermont hospital security trust fund in a sufficient amount to provide hospital services for individuals eligible for federal subsidies under the exchange; and

o if such an exemption cannot be obtained, to seek a waiver from the exchange requirement to take effect on the first day.

2011 HB 146 – An Act Relating to a Public Health Care Coverage Option

Status: Referred to House Committee on Health Care – 2/1/2011

Requires the Commissioner of Banking, Insurance, Securities and Health Care Administration, by January 15, 2012, to recommend to the House Committees on Health Care and on Human Services and the Senate

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Committees on Health and Welfare and on Finance a method by which Green Mountain Care—the public-private single-payer health system established in the bill—may obtain an insurance license and offer the public option through Vermont’s Health Benefit Exchange pursuant to the Patient Protection and Affordable Care Act.

2011 HB 202 – An Act Relating to a Single-Payer and Unified Health System

Status: Signed by Governor 5/26/2011

Charges Green Mountain Care with including health coverage provided under the health benefit exchange with the intent for the exchange to become the foundation for a single-payer health system.

Requires the exchange, by November 1, 2016, to begin enrolling employers with more than 100 employees for coverage beginning January 1, 2017.

Requires that, by January 1, 2014, all individual and small group health insurance products be sold only through the exchange and all large group insurance products be aligned with administrative requirements and essential benefits required in the exchange.

Requires the Secretary of Health to supervise the planning efforts, reports of which due January 15, 2012, including integration of multiple payers into the exchange.

Requires the Department of Vermont Health Access to establish the Vermont Health Benefit Exchange to be administered by the Department in consultation with an advisory board.

Establishes a Vermont Health Reform Board consisting of one chair and four members, one of whom must be a practicing physician.

2011 HB 233 – An Act Relating to Global Hospital Budgets and Health Care Reform Status: Referred to House Committee on Health Care – 2/11/2011

Directs the Secretary of Human Services to seek an exemption from the requirement to set up and operate a health benefit exchange pursuant to the Patient Protection and Affordable Care Act.

Directs the Secretary to, if unable to obtain such an exemption by December 31, 2011, seek a limited exemption from the requirement to enable Vermont to:

o exclude hospital services from exchange plans; and o receive federal funds to deposit in the Vermont Hospital Security Trust Fund.

2011 SB 57 – An Act Relating to a Single-Payer and Unified Health System

Status: Referred to Senate Committee on Health and Welfare – 2/8/2011

This measure is similar to above 2011 HB 202. The current versions have the same bill summary.

2012 SB 163 – An Act Relating to the Financing Plan for Green Mountain Care and the Health Benefit Exchange

Status: Senate read 1st time & referred to Committee on health & Welfare – 1/3/2012

This bill summarizes the financing plan for the Green Mountain Care program and the health benefit exchange – it moves the deadline for the secretary of administration to recommend two plans for sustainable financing to the house committees on health care and on ways and means and the senate committees on health and welfare and finance to September 15, 2012 instead of January 15, 2013.

2012 SB 208 – An Act Relating to the Vermont Health Benefit Exchange

Status: Senate read 1st time and referred to Committee on Health and Welfare – 1/3/2012

This bill proposes to define a small employer for purposes of Vermont’s health benefit exchange as an employer with 50 or fewer employees in 2014 and 2015, as an employer with 100 or fewer employees in 2016, and as an employer of any size in 2017 and subsequent years.

The bill would direct employers offering exchange plans to their employees to contribute a defined amount toward the cost of the employee’s plan and would require the employee pay the difference. It would require health insurance be available for purchase in the individual and small group markets both inside and outside the exchange and would direct the department of banking, insurance, securities, and health care administration to propose a mechanism for merging the individual and small group markets.

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VIRGINIA

2011 HB 2434 – Health Benefits Exchange; Intent to Develop Status: Passed Senate – 2/17/2011

Provides that it is the intent of the General Assembly that the Commonwealth creates and operates its own health benefits exchange or exchanges, to facilitate the purchase and sale of qualified health plans in the individual market and to assist qualified small employers in facilitating the enrollment of employees.

Requires the Virginia Exchange to, at a minimum, meet the relevant requirements of the Patient Protection and Affordable Care Act.

Requests the Governor, through the Secretary of Health and Human Resources, to work with the General Assembly, relevant experts, and stakeholders to provide recommendations for consideration by the 2012 session of the General Assembly regarding the structure and governance of the Virginia Exchange.

Requires the Governor's recommendations—to be presented to the General Assembly by October 1, 2011—to address:

o whether to create the exchange within an existing governmental agency, as a new governmental agency, or as a not-for-profit private entity;

o the make-up of a governing board for the exchange; o an analysis of resource needs and sustainability of such resources; o a delineation of specific functions to be conducted by the exchange; and o an analysis of the potential effects of the interactions between the exchange and relevant insurance

markets or health programs, including Medicaid.

2011 SB 1366 – Health Benefits Exchange; Intent to Develop Status: Amended, passed House, and returned to Senate – 2/18/2011

This measure is similar to the above 2011 HB 2434. The current versions have the same bill summary. ________________________________________________________________________________

WASHINGTON

2011 HB 1740 – Establishing a Health Benefit Exchange Status: By resolution, reintroduced and retained in present status – 11/2r8/2011

Directs the state to establish a health benefit exchange consistent with the federal Affordable Care Act to be governed by a public-private partnership, with a governing board, whose structure shall be established in legislation by July 1, 2012.

Requires the Washington State Health Care Authority in consultation with the Joint Select Committee on Health Reform Implementation, to:

o apply for and implement planning and establishment grants; o develop a broad range of options for establishing and implementing a state-administered exchange;

and o consult with the Insurance Commissioner and stakeholders, including facilities and providers of

health care.

2011 HB 1839 – Concerning a Waiver Request for the Preservation of the State’s and Health Carriers’ Ability to Provide Coverage in the Individual Health Benefits Market

Status: By resolution, reintroduced and retained in present status – 11/28/2011

Directs the Insurance Commissioner to submit a waiver request, by January 1, 2012, to the Center for Medicaid and Medicare Services to preserve the state of Washington’s ability to provide health coverage to high-risk individuals through the Washington State Health Insurance Pool.

Requires the waiver request to include: o the state shall continue to operate the Washington State Health Insurance Pool; o a health carrier shall continue to have the authority to require any person applying for an individual

health benefit plan to complete the standard health questionnaire;

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o the health carrier shall continue to have the authority to decide not to accept an application for enrollment if, based on results of the questionnaire, the individual qualifies for coverage under the pool; and

o individuals enrolled in the pool shall receive the same federal premium subsidies available in the exchange.

2011 SB 5445 – Establishing a Health Benefit Exchange

Status: Signed into law – 5/11/2011 - Effective date – 7/22/2011

This measure is a companion of the above 2011 HB 1740. The current versions have the same bill summary. ________________________________________________________________________________

WEST VIRGINIA

2011 HB 3018 – West Virginia Health Benefit Exchange Act Status: Referred to House Judiciary Committee – 2/7/2011

Establishes the West Virginia Health Benefit Exchange—as a body corporate and politic that is a governmental instrumentality of the state—within the office of the Insurance Commissioner.

Establishes a board of directors to oversee the exchange composed of 10 members, one of whom shall represent the interests of health care providers selected by the majority vote of an advisory group comprised of: West Virginia Hospital Association, WV State Medical Association, WV Primary Care Association, WV Nurses Association, WV Society of Osteopathic Medicine, WV Academy of Family Physicians, WV Pharmacists Association, and WV Dental Association.

Creates a West Virginia Health Benefits Exchange Fund.

2011 SB 408 – Creating WV Health Benefit Exchange Act Status: Sent to Governor – 3/12/2011

This measure is similar to above 2011 HB 3018. The current versions have the same bill summary. _____________________________________________________________________________________

WISCONSIN

2011 AB 154 – Prohibiting coverage of abortions through health plans sold through exchanges Status: A. public hearing held – 11/17/2011

This bill prohibits a qualified health plan offered through any exchange operating in WI from covering any abortion the performance of which is ineligible for funding from the state, a local government, or a long-term care district or from federal funds passing through the state treasury.

2011 SB 92 – Prohibiting coverage of abortions through health plans sold through exchanges Status: A. Received from Senate – 10/27/2011

This bill prohibits a qualified health plan offered through any exchange operating in this state from covering any abortion the performance of which is ineligible for funding from the state, a local government, or a long-term care district or from federal funds passing through the state treasury.

2011 SB 273 - The Badger Health Benefit Authority, health benefit exchange operation, granting

rule-making authority, and providing a penalty Status: Referred to Committee on health – 11/1/2011

This bill creates the Badger Health Benefit Authority (authority) that is a public body corporate and politic that is created by state law but that is not a state agency.

The authority is governed by a board of directors consisting of the commissioner of insurance (commissioner), the secretary of employee trust funds, the director of the state Medical Assistance program, the executive director of the Health Insurance Risk-Sharing Plan Authority, etc.

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WYOMING 2011 HB 50 – Health Insurance Exchanges

Status: SIGNED BY GOVERNOR – 3/10/2011

Requires the Governor to: o conduct a reconnaissance study of whether to create a Wyoming health insurance exchange or

participate in a regional exchange as provided in the Patient Protection and Affordable Care Act; o pay for the study, to the extent possible, with a federal grant awarded to the state for planning and

establishing insurance exchanges; and o designate a study oversight task force to conduct the study—which is authorized to contract with

outside experts and consultants—to determine whether the exchange will help the operation of the private marketplace, and identify additional work needed to facilitate implementation;

Creates the Wyoming Health Insurance Exchange Steering Committee, which shall include two representatives from the business community, two from domestic insurance companies, one medical provider, one person representing hospitals, and one person representing consumers.

Directs the study to consider: o the experiences of Utah, Massachusetts, and other states developing and operating exchanges; o whether litigation against the federal government for not creating a state exchange is reasonable; o if an exchange can facilitate the sale of health insurance across state lines; and o if opting-out of the Medicaid program or other federal provisions would affect the ability of other

states to join Wyoming in the sale of insurance across state lines.