2017 -- H 5529 SUBSTITUTE A

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LC000397/SUB A

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2017

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A N   A C T

RELATING TO BEHAVIORAL HEALTHCARE, DEVELOPMENTAL DISABILITIES AND

HOSPITALS -- SELF-INSURANCE OF DEVELOPMENTAL DISABILITY AGENCIES

     

     Introduced By: Representatives Hull, and Ruggiero

     Date Introduced: February 16, 2017

     Referred To: House Corporations

     It is enacted by the General Assembly as follows:

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     SECTION 1. Title 40.1 of the General Laws entitled "BEHAVIORAL HEALTHCARE,

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DEVELOPMENTAL DISABILITIES AND HOSPITALS" is hereby amended by adding thereto

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the following chapter:

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CHAPTER 24.6

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SELF-INSURANCE OF DEVELOPMENTAL DISABILITY AGENCIES

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     40.1-24.6-1. Definitions.

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      As used in this chapter:

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     (1) "Developmental disability agency" means any organization that has been established

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and licensed by the department of behavioral healthcare, developmental disabilities and hospitals

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for the purpose of providing either employment, vocational supports, residential and/or day

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support services for adults with developmental disabilities in Rhode Island.

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     (2) "Qualified third-party administrator" means an entity with at least five (5) years of

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experience creating and operating health benefit plans that maintain sufficiently capitalized self-

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insurance funds of similar characteristics of the fund being authorized in accordance with this

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chapter.

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     40.1-24.6-2. Purpose.

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     The purpose of this chapter is to authorize operators of developmental disability agencies

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acting as a group, to self-insure health care costs for employees, retirees and other beneficiaries

 

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and allow a qualified third-party administrator to administer said program.

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     40.1-24.6-3. Authorization to self-insure; Establishment of fund.

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     (a) Operators of two (2) or more developmental disability agencies are hereby authorized

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and empowered to:

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     (1) Create a separate corporation (the "corporation") for the purpose of issuing health care

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insurance to the corporation members' employees, and their dependents and their retirees and

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their dependents; and

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     (2) To develop and administer a sufficiently capitalized self-insured group risk

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management program (product).

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     (b) The corporation may have as their purposes the reduction of the risk of its members;

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distributing, sharing, and pooling risks; acquiring excess loss insurance; and processing and

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defending claims against the members of the corporation. Any contributions made to the

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corporation for the purpose of distributing, sharing, or pooling risks shall be made on an

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actuarially sound basis, and the corporation shall have an audit performed annually, copies of

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which shall be provided to the corporation membership.

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     (c) The corporation shall not be considered an insurance company, and shall not be

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subject to the provisions of the laws or regulations of the state of Rhode Island regulating

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insurance companies and multiple employer welfare arrangements, and therefore, shall not be

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subject to regulation by the Rhode Island department of business regulation, or the Rhode Island

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office of the health insurance commissioner.

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     (d) The corporation created pursuant to the provisions of this chapter will be created by

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filing articles of incorporation pursuant to chapter 6 of title 7 entitled "Rhode Island Nonprofit

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Corporation Act", and the articles of incorporation will be filed by an incorporating

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developmental disability agency (member).  The articles of incorporation creating the corporation

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pursuant to the provisions of this section may contain provisions, not inconsistent with this

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section, that the incorporators (members) determine to be desirable or useful in fulfilling the

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purposes set forth in this section. The corporation created pursuant to the provisions of this

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section will have all of the powers of a nonprofit corporation created under chapter 6 of title 7.

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     (e) Whenever the governing board of the corporation created pursuant to the provisions

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of this chapter determines that the purposes for which the corporation was created have been

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substantially fulfilled and all bonds, notes, or other obligations of the corporation have been fully

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paid or adequate provision has been made for their payment, the corporation may be dissolved in

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the manner provided for nonprofit corporations pursuant to chapter 6 of title 7 and, upon the

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corporation's dissolution, title to all financial resources and assets of the corporation shall vest in

 

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and become the property of the members of the corporation in proportions that are provided for in

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the corporation's articles of incorporation.

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     40.1-24.6-4. Obligations of participating entities.

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     Operators of developmental disability agencies intending to participate in the corporation

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shall enter into a contractual agreement with the corporation which shall, among other provisions,

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describe and define each member's obligations relative to funding, length of commitment,

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liabilities and participation in the program. Such an agreement shall also define and delineate the

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terms upon which an operator may disaffiliate from the corporation and agreement. Said

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agreements shall also include provisions that require members to be jointly and severally liable

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for losses of the self-insurance fund and shall include the mechanism for distributing such losses.

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The state of Rhode Island shall be immune from liability for losses of the self-insurance fund.

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     40.1-24.6-5. Establishment of fund.

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     A fund may be established to insure the health costs of the corporation members'

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employees, their covered dependents, the retirees and their covered dependents, not otherwise

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insured, to the extent determined by the corporation's articles of incorporation. Efforts will be

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made to establish uniformity among health benefit plans issued to these employees, retirees and

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dependents.

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     40.1-24.6-6. Payment to and from fund.

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     (a) The monies in the fund will be used as nonlapsing, revolving financial resources for

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carrying out the provisions of this chapter.

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     (b) The financial notes and obligations issued by the corporation, pursuant to the

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provisions of this chapter, will not be deemed to constitute a debt or liability of the state of Rhode

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Island, nor a political subdivision of the state, but will be payable solely from the revenues or

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assets of the fund. 

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     40.1-24.6-7.  Stop-loss coverage.

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     (a) The corporation established pursuant to this chapter for the purpose of providing

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health care costs for members' employees, retirees, and other beneficiaries must participate in a

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group stop-loss policy provided by a licensed insurance company.

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     (b) The group stop-loss policy coverage will include a specific deductible stop-loss

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policy, and aggregate stop-loss coverage, both of which will apply to the corporation's

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participating developmental disability agencies. 

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     (c) Under the specific deductible stop-loss coverage, the licensed insurance carrier will

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assume liability beyond the specific deductible amount up to the limits of the policy. 

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     (d) For the aggregate stop-loss coverage, the licensed insurance carrier will assume all of

 

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the claims threshold:

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     (1) Beyond one hundred and twenty percent (120%) of the expected claims for the policy

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year, up to the limits of the policy, or, if unavailable;

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     (2) Beyond a percentage rate that is consistent with market place standards for aggregate

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stop-loss insurance, but not to exceed one hundred and twenty-five percent (125%) of expected

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claims for the policy year. 

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     (e) In addition to stop-loss policy coverage, the corporation must place in reserve an

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appropriate amount of money to cover the estimated cost of claims incurred, but unpaid, during

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the term of the policy or contract which shall be added to the expected claim level. The reserves

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for unpaid claims shall be in addition to monies reserved to cover the claims paid during the term

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of the policy, or contract for payment of health care costs for the employees, retirees, and other

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beneficiaries.

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     SECTION 2. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO BEHAVIORAL HEALTHCARE, DEVELOPMENTAL DISABILITIES AND

HOSPITALS -- SELF-INSURANCE OF DEVELOPMENTAL DISABILITY AGENCIES

***

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     This act would authorize operators of developmental disability agencies acting as a

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group, to self-insure health care costs for employees, retirees and other beneficiaries, and allow a

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qualified third-party administrator to administer said program.

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     This act would take effect upon passage.

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