2012 -- S 2483

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LC01611

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STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2012

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A N A C T

RELATING TO HUMAN SERVICES -- THE HEALTHY RHODE ISLAND PROGRAM

     Introduced By: Senators Perry, Miller, Jabour, Metts, and Ottiano

     Date Introduced: February 16, 2012

     Referred To: Senate Health & Human Services

It is enacted by the General Assembly as follows:

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     SECTION 1. Title 40 of the General Laws entitled "HUMAN SERVICES" is hereby

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amended by adding thereto the following chapter:

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     CHAPTER 8.11

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THE HEALTHY RHODE ISLAND PROGRAM

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     40-8.11-1. Legislative findings. – The general assembly finds that:

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     (1) It is in the best interest of Rhode Islanders to have affordable access to health

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insurance and to facilitate policies that make affordable health coverage accessible for as many

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Rhode Islanders as possible;

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     (2) Under the Affordable Care Act (ACA), most Rhode Islanders will need to have health

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insurance coverage;

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     (3) One hundred forty thousand (140,000) Rhode Islanders are currently uninsured and

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up to thirty-one thousand (31,000) Rhode Islanders between one hundred thirty-three percent

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(133%) federal poverty level (FPL) and two hundred percent (200%) FPL will need to access

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affordable insurance in the year 2014;

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     (4) These individuals are most likely able to afford health insurance through the Healthy

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Rhode Island Program established herein; and

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     (5) Section 1331 of the ACA provides states with additional flexibility in order to

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increase affordability of health insurance for its residents with incomes between one hundred

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thirty-three percent (133%) FPL and two hundred percent (200%) FPL.

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     40-8.11-2. Purpose. – It is the purpose of the chapter to establish a “Healthy Rhode

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Island Program,” a basic health program option pursuant to section 1331 of the federal patient

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protection and affordable care act (ACA).

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     40-8.11-3. Definitions. – As used in this chapter:

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     (1) “Basic Health Program” means the program authorized by section 1331 of ACA.

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     (2) “Eligible individual” shall have the same meaning as set forth in subdivision (e) of

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section 1331 of ACA.

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     (3) “EOHHS” means the executive office of health and human services.

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     (4) “Essential health benefits” shall have the same meaning as set forth in section 1302 of

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ACA.

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     (5) “Fund” means the healthy Rhode Island program trust fund established by section 6.

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     (6) “Health Insurance Exchange” or “Health Benefits Exchange” shall mean the Rhode

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Island health insurance exchange.

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     (7) “Health plan” means a private health insurer licensed in Rhode Island meeting the

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requirements established by EEOHS as a qualified health plan to contract to provide services for

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eligible individuals for the healthy Rhode Island program.

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     (8) “Healthy Rhode Island Program” means the Rhode Island program established

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pursuant to the authority of section 1331 of ACA.

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     (9) “Affordable Care Act” or “ACA” means public law 111-148, as amended by the

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federal healthcare and education reconciliation act of 2010 (public law 111-152), and any

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amendments to, or regulations or guidance issued under, those acts.

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     40-8.11-4. Administration of program. – (a) The healthy Rhode Island program is

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hereby created and shall be administered by EOHHS.

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     (b) EOHHS shall enter into a contract with the United States secretary of health and

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human services to implement the healthy Rhode Island program, a basic health program, to

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provide coverage to eligible individuals.

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     (c) EOHHS shall permit enrollment in the healthy Rhode Island program by the date that

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the health insurance exchange opens for enrollment, and shall begin providing coverage on

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January 1, 2014.

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     40-8.11-5. Healthy Rhode Island trust fund. – The healthy Rhode Island program trust

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fund is hereby created in the state treasury for the purpose of administration of this chapter. All

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federal funds received pursuant to section 1331 of ACA shall be placed in the healthy Rhode

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Island program trust fund. All moneys in the fund shall be continuously appropriated without

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regard to fiscal year for the purposes of this part. Any moneys in the fund that are unexpended or

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unencumbered at the end of a fiscal year may be carried forward to the next succeeding fiscal

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year. EOHHS is authorized to seek appropriations from the general fund in the form of loans to

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the healthy Rhode Island program trust fund.

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     All general revenues that would otherwise have been spent on parents currently enrolled

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in the RIte Care or RIte Share programs shall be appropriated for the healthy Rhode Island

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program trust fund.

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     40-8.11-6. Eligibility and enrollment process. – (a) EOHHS shall administer the

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healthy Rhode Island program in conjunction with the Medicaid and children’s health insurance

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programs, and shall provide an eligibility and enrollment process that coordinates enrollment for

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family members in families where a child is eligible for a Medicaid or children’s health insurance

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program administered by EOHHS and other family members are eligible for the healthy Rhode

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Island program.

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     (b) To the extent permitted by federal law and EOHHS policy, EOHHS shall continue

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administering the RIte Share Program, and run RIte Share in conjunction with the Healthy Rhode

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Island Program.

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     (c) EOHHS shall coordinate with the health benefits exchange to assure the eligibility

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system required to administer Medicaid and children’s health insurance programs and the healthy

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Rhode Island program are integrated to share the cost of development, and streamline eligibility

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procedures.

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     (d) EOHHS shall determine, through negotiation with participating health plans, premium

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and cost-sharing amounts. However, the amount of premium and cost-sharing for all health

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programs administered through EOHHS for one family shall not exceed five percent (5%) of

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family income. Premium and cost-sharing amounts for individuals enrolled in the healthy Rhode

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Island program, likewise, shall not exceed five percent (5%) of income.

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     (e) EOHHS shall develop a system of uniform invoicing and administration of plans for

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families with members enrolled in both the healthy Rhode Island program and another Medicaid

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or children’s health insurance program administered by EOHHS.

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     (f) EOHHS shall collect premiums and pay contracted health plans actuarially sound

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rates.

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     (g) EOHHS may authorize expenditures from the fund to pay program expenses that

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exceed eligible individual premium contributions and to administer healthy Rhode Island

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program as necessary.

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     (h) EOHHS shall maintain enrollment and expenditures to ensure that expenditures do

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not exceed amounts available in the fund, and if sufficient funds are not available to cover the

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estimated cost of program expenditures, EOHHS shall institute appropriate measures to reduce

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costs.

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     (i) EOHHS may issue rules and regulations, as necessary.

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     (j) EOHHS may exercise all powers reasonably necessary to carry out the powers and

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responsibilities expressly granted or imposed by this part and by section 1331 of ACA.

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     (k) In implementing this part, eligibility for coverage under, and the benefits, premiums,

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and cost sharing in, the healthy Rhode Island program shall meet the requirements of section

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1331 of ACA. In addition to the essential health benefits package required by section 1302 of

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ACA, FQHC services, dental services at a level determined by EOHHS, and any other benefits to

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be offered to healthy Rhode Island program participants shall be determined by EOHHS.

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     (l) EOHHS shall do the following amend existing contracts with MCOs to allow the

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parents of children enrolled in RIte Care to enroll in the same plan as their child or children

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through the healthy Rhode Island program, health plans to participate in all Medicaid and

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children’s health insurance programs administered by EOHHS, as may be required by EOHHS.

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     40-8.11-7. Risk mitigation programs. – To the extent permitted by federal law, and

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consistent with policies established by EOHHS and or the health insurance exchange, the healthy

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Rhode Island program may be a full participant in any risk mitigation programs or strategies

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initiated under the authority of section 1343 of the ACA.

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     40-8.11-8. Application acceptance process. – To the extent permitted by federal law,

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applications for healthy Rhode Island programs shall be accepted in coordination with the

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Medicaid and children’s health insurance programs administered by EOHHS. To the extent

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EOHHS and other state policy allows, applications shall be made through the Rhode Island health

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insurance exchange, which may determine a methodology by which to cover administrative costs

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of the exchange for serving this function.

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     40-8.11-9. Program funding. – (a) EOHHS shall ensure that the establishment,

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operation, and administrative functions of healthy Rhode Island program do not exceed the

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combination of federal funds, private donations, premiums paid by eligible individuals, and other

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non-general Fund moneys not specified in this chapter and otherwise available for this purpose.

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     (b) In the event that EOHHS reasonably expects that the cost of healthy Rhode Island

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program will exceed the available funds, coverage for eligible individuals shall continue until the

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annual redetermination of each eligible individual, after which time EOHHS shall immediately

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transfer the eligible individual to coverage in the state’s health insurance exchange. To the extent

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permitted by federal law, EOHHS shall contract with the federal government to allow federal

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funds made available under paragraph (e) of subdivision (d) of section 1331 of ACA, relating to

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ninety-five percent (95%) of the premium tax credits under section 36B of the Internal Revenue

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Code of 1986, and the cost-sharing reduction under section 1402, to be used for the costs of

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EOHHS in implementing and administering this part.

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     SECTION 2. This act shall take effect upon passage.

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LC01611

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N A C T

RELATING TO HUMAN SERVICES -- THE HEALTHY RHODE ISLAND PROGRAM

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     This act would create the healthy Rhode Island program which applies the federal health

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program codified in section 1331 of ACA to Rhode Island.

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     This act would take effect upon passage.

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LC01611

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