First Regular Session Sixty-sixth General Assembly STATE OF COLORADO INTRODUCED LLS NO. 07-0079.01 Kristen Forrestal HOUSE BILL 07-1016 HOUSE SPONSORSHIP Frangas, SENATE SPONSORSHIP Keller, House Committees Senate Committees Health and Human Services A BILL FOR AN ACT Concerning access to health insurance. Bill Summary (Note: This summary applies to this bill as introduced and does not necessarily reflect any amendments that may be subsequently adopted.) Health Care Task Force. Expands the coverage of CoverColorado to include employees who are eligible for small group insurance through a multiple employer welfare arrangement (MEWA), but who have a presumptive condition as determined by the CoverColorado board of directors. Requires a self-insured MEWA or a health insurance carrier for a fully insured MEWA to determine whether an individual in a MEWA has one of the presumptive conditions that under other circumstances would make this person eligible for CoverColorado. Requires information used to determine such individual's presumptive eligibility to remain confidential. Mandates that MEWAs and insurance carriers for MEWAs cede to CoverColorado any insurance risk of an employee or dependent of an employee who has such a presumptive condition. Requires the premium for a person enrolled in CoverColorado for each insurance risk ceded to CoverColorado to be paid by the MEWA ceded insurance risk fund, which is created to receive annual appropriations by the general assembly from the general fund. Requires the board of education in each school district to require each student, at the time of registration, to provide information as to whether the student is enrolled in a health benefit plan. Requires each board of education to provide, to each student it determines is not enrolled in a health benefit plan, information regarding the children's basic health plan. Directs the department of health care policy and financing (state department) to develop a plan to maximize enrollment for public health benefits and services. Expands eligibility for children to enroll in the children's basic health plan to include those whose family incomes exceed 250% of the federal poverty guidelines by 2009. Authorizes the state department to seek a waiver from the federal government to expand the children's basic health plan to include dental care for pregnant women and to include vaccination against the human papilloma virus for children from 12 to 18 years of age with parental consent. Be it enacted by the General Assembly of the State of Colorado: SECTION 1. 10-8-513 (2) (e), Colorado Revised Statutes, is amended to read: 10-8-513. Eligibility for coverage under the program. (2) The following individuals shall not be eligible for coverage under the program: (e) Those who are eligible for any other health benefit plan, including any public program, that provides coverage for health care services, regardless of whether such other health benefit plan covers all health care services or categories of services that such individuals may from time to time need, except as provided in subparagraphs (II) and (III) of paragraph (a) of subsection (1) of this section and except such individuals who meet the qualifications of paragraph (b) of subsection (1) of this section and who are covered for small employer group health benefits through a multiple employer welfare arrangement pilot program pursuant to part 9 of article 16 of this title; and SECTION 2. Part 5 of article 8 of title 10, Colorado Revised Statutes, is amended BY THE ADDITION OF A NEW SECTION to read: 10-8-531.5. CoverColorado for high-risk employees ceded by MEWAs. CoverColorado shall insure individuals whose insurance risk has been ceded to it pursuant to section 10-16-902.5. SECTION 3. 10-16-105, Colorado Revised Statutes, is amended BY THE ADDITION OF A NEW SUBSECTION to read: 10-16-105. Small group sickness and accident insurance - guaranteed issue - mandated provisions for basic health benefit plans - rules - benefit design advisory committee - repeal. (17) The commissioner shall work with members of the insurance industry to develop affordable basic health care services for individual and group plans. The plans shall include health care coverage by CoverColorado of an "eligible individual", as defined by section 10-8-503 (5), and shall allow for the use of a premium subsidy to pay for persons whose incomes exceed sixty percent of the federal poverty level. The premium subsidy shall work on a sliding scale basis determined by the income of the eligible individual. The plans shall be available on and after January 1, 2008. SECTION 4. 10-16-902 (3) (b), Colorado Revised Statutes, is amended to read: 10-16-902. Authority to self-fund - pilot program - rules - fees - cash fund. (3) (b) A MEWA shall guarantee issue health benefit coverage to all employees and dependents of an employee of an employer that is a member of a bona fide association within the same arrangement pursuant to section 10-16-105 (7.3); except that for newly issued or renewed plans, a self-insured MEWA or the carrier for a fully insured MEWA shall identify individuals who are presumptively eligible for CoverColorado pursuant to section 10-8-513 (1) (b), and upon issuance or renewal of a health benefit plan, shall cede the insurance risk of the presumptively eligible individuals to CoverColorado pursuant to section 10-16-902.5. SECTION 5. Part 9 of article 16 of title 10, Colorado Revised Statutes, is amended BY THE ADDITION OF THE FOLLOWING NEW SECTIONS to read: 10-16-902.5. Ceding insurance risks of high-risk individuals to CoverColorado - fund - rules. (1) (a) Upon the issuance or renewal of a health benefit plan pursuant to section 10-16-902, only the insurance risk for individuals who are presumptively eligible pursuant to section 10-8-513 (1) (b) shall be ceded to CoverColorado as provided by section 10-16-902 (3) (b). The number of presumptively eligible individuals whose risk is ceded to CoverColorado may be capped as determined by available funding pursuant to subsection (3) of this section. (b) If an individual's risk is ceded to CoverColorado and the individual ceases to meet the presumptive eligibility requirements for CoverColorado, that individual's risk shall cease to be ceded to CoverColorado at the beginning of the next plan year for the MEWA plan. Such individual shall be subject to the "Colorado High Risk Health Insurance Act", part 5 of article 8 of this title, and any rules promulgated pursuant to the act; except that the premiums for the individual shall be paid from the MEWA ceded insurance risk fund created in subsection (3) of this section. The administering carrier for CoverColorado shall maintain direct administrative functions for any individual whose insurance risk is ceded to CoverColorado. (2) The information derived from the identification of individuals whose risks are ceded to CoverColorado shall not be used by an insurance carrier as a basis of acceptance or rejection of health benefit coverage for a MEWA. The confidential medical information of all covered persons shall be protected and shall comply with the federal "Health Insurance Portability and Accountability Act of 1996", as amended, P.L. No. 104-191. (3) The premium required for CoverColorado, as determined by section 10-8-512, shall be paid to CoverColorado from the MEWA ceded insurance risk fund, which fund is hereby created in the state treasury. The general assembly shall appropriate moneys from the general fund, subject to available moneys as determined by the joint budget committee, to the MEWA ceded insurance risk fund. Moneys in the fund shall be transferred to the administering carrier for CoverColorado as needed for the recovery of premiums pursuant to section 10-8-509. Any unexpended and unencumbered moneys in the fund at the end of any fiscal year shall remain in the fund and shall not revert to any other fund. (4) The commissioner may promulgate rules as necessary to implement this section. 10-16-902.7. Division of insurance - formation of MEWA. The division shall actively assist any interested bona fide association in the formation of a MEWA and shall actively work with insurers to encourage the formation of fully funded MEWAs and underwriting by the insurers. SECTION 6. 10-16-910 (1) and the introductory portion to 10-16-910 (2), Colorado Revised Statutes, are amended to read: 10-16-910. Repeal. (1) This part 9 is repealed, effective July 1, 2008 2011. (2) Prior to such repeal and no later than October 15, 2007 2010, the department of regulatory agencies shall evaluate and report to the general assembly concerning the following: SECTION 7. Article 1 of title 22, Colorado Revised Statutes, is amended BY THE ADDITION OF A NEW SECTION to read: 22-1-126. Documentation of health insurance status at registration - school district requirements - public benefits information. (1) Beginning no later than July 1, 2007, the board of education in each school district shall require each student in the district to provide, at the time of registration, information as to whether the student is enrolled in a health benefit plan. (2) The board of education in each school district shall review the health benefit information provided by each student and determine which students are not enrolled in a health benefit plan. To each such student, the board of education shall provide written information regarding access to the children's basic health plan as defined in section 25.5-8-103 (2), C.R.S. The information shall include, but is not limited to, the toll-free number established by the department of health care policy and financing to access information about the application and enrollment process for the children's basic health plan. SECTION 8. 25.5-4-202, Colorado Revised Statutes, is amended to read: 25.5-4-202. Comprehensive plan for other services and benefits - plan to maximize enrollment for benefits and services. (1) In accordance with federal requirements pertaining to the development of a broad-based medical care program for low-income families, the state department shall prepare a comprehensive medical plan for consideration by the house and senate committees on health and human services, or any successor committees. The comprehensive plan shall include alternate means of expanding the medical care benefits and coverage provided in this article and articles 5 and 6 of this title. The comprehensive plan shall be reevaluated annually and shall be based upon a documented review of medical needs of low-income families in Colorado, a detailed analysis of priorities of service, coverage, and program costs, and an evaluation of progress. The medical advisory council appointed pursuant to this article shall assist the state department in the preparation of the comprehensive plan. (2) On or before August 1, 2007, the state department shall establish a plan to maximize enrollment for benefits and services provided in this article and articles 5 and 6 of this title. SECTION 9. 25.5-8-103 (4) (a), Colorado Revised Statutes, is amended to read: 25.5-8-103. Definitions. As used in this article, unless the context otherwise requires: (4) "Eligible person" means: (a) A person who: (I) Is less than under nineteen years of age, whose family income does not exceed two hundred percent of the federal poverty level, adjusted for family size; (II) On and after July 1, 2007, is under nineteen years of age, whose family income does not exceed two hundred ten percent of the federal poverty level, adjusted for family size; (III) On and after July 1, 2008, is under nineteen years of age, whose family income does not exceed two hundred twenty-five percent of the federal poverty level, adjusted for family size; (IV) On and after July 1, 2009, is under nineteen years of age, whose family income does not exceed two hundred fifty percent of the federal poverty level, adjusted for family size; or SECTION 10. 25.5-8-109 (3) and (5) (c), Colorado Revised Statutes, are amended to read: 25.5-8-109. Eligibility - children - pregnant women - repeal. (3) (a) The department may establish procedures such that children with family incomes that exceed one hundred eighty-five percent of the federal poverty guidelines may enroll in the plan, but are not eligible for subsidies from the department. (b) The department shall seek approval from the federal department of health and human services to increase the income thresholds for eligibility as set forth in section 25.5-8-103 (4) (a). (c) Until the department receives federal approval to increase eligibility in the plan for children whose family incomes exceed one hundred eighty-five percent of the federal poverty guidelines but do not exceed the amount specified for each year in section 25.5-8-103 (4) (a), a child shall not be eligible for the plan. (d) The department is authorized to seek a medicaid waiver from the federal department of health and human services to include coverage for vaccination against the human papilloma virus for children from twelve to eighteen years of age with parental consent. (5) (c) The addition of coverage under the plan for pregnant women shall only be implemented if the department obtains a waiver from the federal department of health and human services. The department is authorized to seek a medicaid waiver from the federal department of health and human services to provide dental care to pregnant women on and after July 1, 2007. SECTION 11. Effective date. (1) Sections 1, 2, 3, 4, 5, 6, and 10 of this act shall take effect January 1, 2008. (2) Sections 7, 8, 9, 11, and 12 of this act shall take effect upon passage. SECTION 12. Safety clause. The general assembly hereby finds, determines, and declares that this act is necessary for the immediate preservation of the public peace, health, and safety.