Second Regular Session Sixty-ninth General Assembly STATE OF COLORADO INTRODUCED LLS NO. 14-0644.01 Brita Darling x2241 HOUSE BILL 14-1115 HOUSE SPONSORSHIP Stephens, SENATE SPONSORSHIP (None), House Committees Senate Committees Public Health Care & Human Services A BILL FOR AN ACT Concerning establishing the medicaid expansion premium assistance pilot program. Bill Summary (Note: This summary applies to this bill as introduced and does not reflect any amendments that may be subsequently adopted. If this bill passes third reading in the house of introduction, a bill summary that applies to the reengrossed version of this bill will be available at http://www.leg.state.co.us/billsummaries.) The bill establishes the medicaid expansion premium assistance pilot program (pilot program) to provide healthcare coverage for up to 2,000 adults with incomes between 100% and 133% of the federal poverty line who are newly eligible for the Colorado medical assistance program. Program participants will be enrolled in a health plan through the state's health insurance exchange that offers essential health benefits. The health insurance premiums for the health plan will be paid by the state directly to the insurance company. The bill also includes provisions for pilot program participation that must be included in the pilot program. The state department of health care policy and financing (state department) and the commissioner of insurance shall enter into memorandums of understanding with private insurers concerning, in part, the payment of premiums, reporting, and data-sharing requirements relating to the pilot program. After the second full year of pilot program implementation, the state auditor shall conduct a performance and fiscal audit of the pilot program and shall report the results to the general assembly. To the extent possible, the audit shall determine the effectiveness of the pilot program, including among its effectiveness indicators access to providers, use of services, frequency and duration of hospital admissions, and the cost to the state of the pilot program relative to similar populations enrolled in the state's traditional medical assistance program. The pilot program repeals, effective July 1, 2019. Be it enacted by the General Assembly of the State of Colorado: SECTION 1. In Colorado Revised Statutes, add 25.5-5-323 as follows: 25.5-5-323. Medicaid expansion premium assistance pilot program - definitions - rules - federal authorization - report - repeal. (1) As used in this section, unless the context otherwise requires: (a) "Eligible person" means a person who: (I) Qualifies for medical assistance solely pursuant to section 25.5-5-201 (1) (p) and who was not already eligible for or receiving medical assistance on January 1, 2013; (II) Is between nineteen and sixty-four years of age; (III) Has an income from one hundred one percent up to one hundred thirty-three percent of the federal poverty line; and (IV) Is not medically frail. (b) "Pilot program" means a medicaid expansion premium assistance pilot program established pursuant to this section. (2) There is established a medicaid expansion premium assistance pilot program for insurance premium assistance for eligible persons to purchase qualified health insurance on the state exchange in lieu of participation in the medical assistance program. (3) The state department shall seek an amendment to the state's medical assistance plan or a waiver, if necessary, to implement the pilot program and shall enroll eligible persons in the pilot program no later than ninety days after receiving any necessary approval. (4) To the extent authorized by federal approval, the pilot program must include the following provisions: (a) The state department shall determine the number of pilot program participants; except that the pilot program must include, at a minimum, two thousand participants, or such greater number as is necessary to determine the efficacy of the pilot program. The state department shall determine the method for selecting pilot program participants; except that program participants must include some eligible persons who have access to cost-effective, employer-sponsored insurance. (b) Pilot program participants without employer-sponsored insurance shall select between at least two silver-level state exchange qualified health plans and may choose among all silver-level plans offered on the state exchange in the participant's geographic region. The health plans must include essential health benefits as defined by the commissioner of insurance and approved by the general assembly. Pilot program participants who do not choose a plan will be automatically assigned to a plan. The state department shall ensure that participants understand their plan options and the automatic enrollment provision. (c) The state department will pay monthly premiums for participants directly to the qualified health plans; (d) Prescription drug coverage is limited to the qualified health plan formulary; (e) After the first year of enrollment in a health plan, pilot program participants may be required to pay a portion of the insurance premium, not to exceed two percent of the participant's annual income; except that the state department may establish conditions under which the premium may be waived by meeting specified healthy behavior activities, such as completing a health risk assessment and obtaining a wellness examination; (f) Pilot program participants are required to share the cost of nonemergency use of the emergency room, which cost-sharing shall not be waived; (g) Pilot program participants who become medically frail after enrollment in the pilot program may terminate participation in the pilot program; and (h) The state department shall require data from pilot program participants relating to access to care, use of medical benefits, and health plan performance. (5) The state department and the commissioner of insurance shall enter into memorandums of understanding with qualified health plans concerning enrollment, payment of premiums and cost-sharing reductions, reporting, data requirements, notices, audits, and any other provisions that either the state department or commissioner of insurance deem necessary to safeguard public moneys and to ensure the effective audit of the pilot program pursuant to subsection (7) of this section. (6) The state board shall promulgate any rules necessary to implement the pilot program. (7) (a) Starting with the second full state fiscal year following the implementation of the pilot program and thereafter at the discretion of the legislative audit committee, the state auditor shall conduct or cause to be conducted a performance and fiscal audit of the pilot program and shall report the audit results to the audit committee and the joint budget committee of the general assembly and to the public health and human services committee of the house of representatives and the health and human services committee of the senate, or any successor committees. (b) To the extent possible given available data, the state auditor shall determine the effectiveness of the pilot program in serving the medical needs of participants in relation to similarly situated persons enrolled in the medical assistance program with respect to: (I) Access to providers; (II) Use of services; (III) Nonemergency use of emergency rooms; (IV) Frequency and duration of hospital admissions and readmissions; (V) Prescription medications; (VI) Provider reimbursement rates; (VII) Per-client cost to the state; and (VIII) Use of preventative wellness benefits and services. (8) The joint budget committee of the general assembly shall consider using any demonstrated savings of state moneys resulting from the pilot program to reduce the number of persons with intellectual and developmental disabilities who are waiting to participate in programs, services, and supports pursuant to article 10.5 of this title. (9) This section is repealed, effective July 1, 2019. SECTION 2. Act subject to petition - effective date. This act takes effect at 12:01 a.m. on the day following the expiration of the ninety-day period after final adjournment of the general assembly (August 6, 2014, if adjournment sine die is on May 7, 2014); except that, if a referendum petition is filed pursuant to section 1 (3) of article V of the state constitution against this act or an item, section, or part of this act within such period, then the act, item, section, or part will not take effect unless approved by the people at the general election to be held in November 2014 and, in such case, will take effect on the date of the official declaration of the vote thereon by the governor.