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art.014/1 | ||
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1 | ARTICLE 14 | |
2 | RELATING TO HEALTHCARE MARKET STABILITY | |
3 | SECTION 1. Section 27-18.5-2 of the General Laws in Chapter 27-18.5 entitled | |
4 | "Individual Health Insurance Coverage" is hereby amended to read as follows: | |
5 | 27-18.5-2. Definitions. | |
6 | The following words and phrases as used in this chapter have the following meanings | |
7 | unless a different meaning is required by the context: | |
8 | (1) "Bona fide association" means, with respect to health insurance coverage offered in this | |
9 | state, an association which: | |
10 | (i) Has been actively in existence for at least five (5) years; | |
11 | (ii) Has been formed and maintained in good faith for purposes other than obtaining | |
12 | insurance; | |
13 | (iii) Does not condition membership in the association on any health status-related factor | |
14 | relating to an individual (including an employee of an employer or a dependent of an employee); | |
15 | (iv) Makes health insurance coverage offered through the association available to all | |
16 | members regardless of any health status-related factor relating to the members (or individuals | |
17 | eligible for coverage through a member); | |
18 | (v) Does not make health insurance coverage offered through the association available | |
19 | other than in connection with a member of the association; | |
20 | (vi) Is composed of persons having a common interest or calling; | |
21 | (vii) Has a constitution and bylaws; and | |
22 | (viii) Meets any additional requirements that the director may prescribe by regulation; | |
23 | (2) "COBRA continuation provision" means any of the following: | |
24 | (i) Section 4980(B) of the Internal Revenue Code of 1986, 26 U.S.C. § 4980B, other than | |
25 | subsection (f)(1) of that section insofar as it relates to pediatric vaccines; | |
26 | (ii) Part 6 of subtitle B of Title I of the Employee Retirement Income Security Act of 1974, | |
27 | 29 U.S.C. § 1161 et seq., other than Section 609 of that act, 29 U.S.C. § 1169; or | |
28 | (iii) Title XXII of the United States Public Health Service Act, 42 U.S.C. § 300bb-1 et seq.; | |
29 | (3) "Creditable coverage" has the same meaning as defined in the United States Public | |
30 | Health Service Act, Section 2701(c), 42 U.S.C. § 300gg(c), as added by P.L. 104-191; | |
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1 | (4) "Director" means the director of the department of business regulation; | |
2 | (5) "Eligible individual" means an individual: | |
3 | (i) For whom, as of the date on which the individual seeks coverage under this chapter, the | |
4 | aggregate of the periods of creditable coverage is eighteen (18) or more months and whose most | |
5 | recent prior creditable coverage was under a group health plan, a governmental plan established or | |
6 | maintained for its employees by the government of the United States or by any of its agencies or | |
7 | instrumentalities, or church plan (as defined by the Employee Retirement Income Security Act of | |
8 | 1974, 29 U.S.C. § 1001 et seq.); | |
9 | (ii) Who is not eligible for coverage under a group health plan, part A or part B of title | |
10 | XVIII of the Social Security Act, 42 U.S.C. § 1395c et seq. or 42 U.S.C. § 1395j et seq., or any | |
11 | state plan under title XIX of the Social Security Act, 42 U.S.C. § 1396 et seq. (or any successor | |
12 | program), and does not have other health insurance coverage; | |
13 | (iii) With respect to whom the most recent coverage within the coverage period was not | |
14 | terminated based on a factor described in § 27-18.5-4(b)(relating to nonpayment of premiums or | |
15 | fraud); | |
16 | (iv) If the individual had been offered the option of continuation coverage under a COBRA | |
17 | continuation provision, or under chapter 19.1 of this title or under a similar state program of this | |
18 | state or any other state, who elected the coverage; and | |
19 | (v) Who, if the individual elected COBRA continuation coverage, has exhausted the | |
20 | continuation coverage under the provision or program; | |
21 | (6) "Group health plan" means an employee welfare benefit plan as defined in section 3(1) | |
22 | of the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1002(1), to the extent that | |
23 | the plan provides medical care and including items and services paid for as medical care to | |
24 | employees or their dependents as defined under the terms of the plan directly or through insurance, | |
25 | reimbursement or otherwise; | |
26 | (7) "Health insurance carrier" or "carrier" means any entity subject to the insurance laws | |
27 | and regulations of this state, or subject to the jurisdiction of the director, that contracts or offers to | |
28 | contract to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care | |
29 | services, including, without limitation, an insurance company offering accident and sickness | |
30 | insurance, a health maintenance organization, a nonprofit hospital, medical or dental service | |
31 | corporation, or any other entity providing a plan of health insurance or health benefits by which | |
32 | health care services are paid or financed for an eligible individual or his or her dependents by such | |
33 | entity on the basis of a periodic premium, paid directly or through an association, trust, or other | |
34 | intermediary, and issued, renewed, or delivered within or without Rhode Island to cover a natural | |
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1 | person who is a resident of this state, including a certificate issued to a natural person which | |
2 | evidences coverage under a policy or contract issued to a trust or association; | |
3 | (8)(i) "Health insurance coverage" means a policy, contract, certificate, or agreement | |
4 | offered by a health insurance carrier to provide, deliver, arrange for, pay for or reimburse any of | |
5 | the costs of health care services. Health insurance coverage include short-term limited duration | |
6 | policies and any policy that pays on a cost-incurred basis, except as otherwise specifically exempted | |
7 | by subsections (ii), (iii), (iv), or (v) of this section. | |
8 | (ii) "Health insurance coverage" does not include one or more, or any combination of, the | |
9 | following: | |
10 | (A) Coverage only for accident, or disability income insurance, or any combination of | |
11 | those; | |
12 | (B) Coverage issued as a supplement to liability insurance; | |
13 | (C) Liability insurance, including general liability insurance and automobile liability | |
14 | insurance; | |
15 | (D) Workers' compensation or similar insurance; | |
16 | (E) Automobile medical payment insurance; | |
17 | (F) Credit-only insurance; | |
18 | (G) Coverage for on-site medical clinics; AND | |
19 | (H) Other similar insurance coverage, specified in federal regulations issued pursuant to | |
20 | P.L. 104-191, under which benefits for medical care are secondary or incidental to other insurance | |
21 | benefits; and | |
22 | (I) Short term limited duration insurance; | |
23 | (iii) "Health insurance coverage" does not include the following benefits if they are | |
24 | provided under a separate policy, certificate, or contract of insurance or are not an integral part of | |
25 | the coverage: | |
26 | (A) Limited scope dental or vision benefits; | |
27 | (B) Benefits for long-term care, nursing home care, home health care, community-based | |
28 | care, or any combination of these; | |
29 | (C) Any other similar, limited benefits that are specified in federal regulation issued | |
30 | pursuant to P.L. 104-191; | |
31 | (iv) "Health insurance coverage" does not include the following benefits if the benefits are | |
32 | provided under a separate policy, certificate, or contract of insurance, there is no coordination | |
33 | between the provision of the benefits and any exclusion of benefits under any group health plan | |
34 | maintained by the same plan sponsor, and the benefits are paid with respect to an event without | |
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1 | regard to whether benefits are provided with respect to the event under any group health plan | |
2 | maintained by the same plan sponsor: | |
3 | (A) Coverage only for a specified disease or illness; or | |
4 | (B) Hospital indemnity or other fixed indemnity insurance; and | |
5 | (v) "Health insurance coverage" does not include the following if it is offered as a separate | |
6 | policy, certificate, or contract of insurance: | |
7 | (A) Medicare supplemental health insurance as defined under section 1882(g)(1) of the | |
8 | Social Security Act, 42 U.S.C. § 1395ss(g)(1); | |
9 | (B) Coverage supplemental to the coverage provided under 10 U.S.C. § 1071 et seq.; and | |
10 | (C) Similar supplemental coverage provided to coverage under a group health plan; | |
11 | (9) "Health status-related factor" means any of the following factors: | |
12 | (i) Health status; | |
13 | (ii) Medical condition, including both physical and mental illnesses; | |
14 | (iii) Claims experience; | |
15 | (iv) Receipt of health care; | |
16 | (v) Medical history; | |
17 | (vi) Genetic information; | |
18 | (vii) Evidence of insurability, including conditions arising out of acts of domestic violence; | |
19 | and | |
20 | (viii) Disability; | |
21 | (10) "Individual market" means the market for health insurance coverage offered to | |
22 | individuals other than in connection with a group health plan; | |
23 | (11) "Network plan" means health insurance coverage offered by a health insurance carrier | |
24 | under which the financing and delivery of medical care including items and services paid for as | |
25 | medical care are provided, in whole or in part, through a defined set of providers under contract | |
26 | with the carrier; | |
27 | (12) "Preexisting condition" means, with respect to health insurance coverage, a condition | |
28 | (whether physical or mental), regardless of the cause of the condition, that was present before the | |
29 | date of enrollment for the coverage, for which medical advice, diagnosis, care, or treatment was | |
30 | recommended or received within the six (6) month period ending on the enrollment date. Genetic | |
31 | information shall not be treated as a preexisting condition in the absence of a diagnosis of the | |
32 | condition related to that information; and | |
33 | (13) "High-risk individuals" means those individuals who do not pass medical underwriting | |
34 | standards, due to high health care needs or risks; | |
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1 | (14) "Wellness health benefit plan" means that health benefit plan offered in the individual | |
2 | market pursuant to § 27-18.5-8; and | |
3 | (15) "Commissioner" means the health insurance commissioner. | |
4 | SECTION 2. Section 35-4-27 of the General Laws in Chapter 35-4 entitled "State Funds" | |
5 | is hereby amended to read as follows: | |
6 | 35-4-27. Indirect cost recoveries on restricted receipt accounts. | |
7 | Indirect cost recoveries of ten percent (10%) of cash receipts shall be transferred from all | |
8 | restricted-receipt accounts, to be recorded as general revenues in the general fund. However, there | |
9 | shall be no transfer from cash receipts with restrictions received exclusively: (1) From contributions | |
10 | from non-profit charitable organizations; (2) From the assessment of indirect cost-recovery rates | |
11 | on federal grant funds; or (3) Through transfers from state agencies to the department of | |
12 | administration for the payment of debt service. These indirect cost recoveries shall be applied to all | |
13 | accounts, unless prohibited by federal law or regulation, court order, or court settlement. The | |
14 | following restricted receipt accounts shall not be subject to the provisions of this section: | |
15 | Executive Office of Health and Human Services | |
16 | Organ Transplant Fund | |
17 | HIV Care Grant Drug Rebates | |
18 | Department of Human Services | |
19 | Veterans' home -- Restricted account | |
20 | Veterans' home -- Resident benefits | |
21 | Pharmaceutical Rebates Account | |
22 | Demand Side Management Grants | |
23 | Veteran's Cemetery Memorial Fund | |
24 | Donations -- New Veterans' Home Construction | |
25 | Department of Health | |
26 | Pandemic medications and equipment account | |
27 | Miscellaneous Donations/Grants from Non-Profits | |
28 | State Loan Repayment Match | |
29 | Department of Behavioral Healthcare, Developmental Disabilities and Hospitals | |
30 | Eleanor Slater non-Medicaid third-party payor account | |
31 | Hospital Medicare Part D Receipts | |
32 | RICLAS Group Home Operations | |
33 | Commission on the Deaf and Hard of Hearing | |
34 | Emergency and public communication access account | |
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1 | Department of Environmental Management | |
2 | National heritage revolving fund | |
3 | Environmental response fund II | |
4 | Underground storage tanks registration fees | |
5 | Rhode Island Historical Preservation and Heritage Commission | |
6 | Historic preservation revolving loan fund | |
7 | Historic Preservation loan fund -- Interest revenue | |
8 | Department of Public Safety | |
9 | Forfeited property -- Retained | |
10 | Forfeitures -- Federal | |
11 | Forfeited property -- Gambling | |
12 | Donation -- Polygraph and Law Enforcement Training | |
13 | Rhode Island State Firefighter's League Training Account | |
14 | Fire Academy Training Fees Account | |
15 | Attorney General | |
16 | Forfeiture of property | |
17 | Federal forfeitures | |
18 | Attorney General multi-state account | |
19 | Forfeited property -- Gambling | |
20 | Department of Administration | |
21 | OER Reconciliation Funding | |
22 | Health Insurance Market Integrity Fund | |
23 | RI Health Benefits Exchange | |
24 | Information Technology Investment Fund | |
25 | Restore and replacement -- Insurance coverage | |
26 | Convention Center Authority rental payments | |
27 | Investment Receipts -- TANS | |
28 | OPEB System Restricted Receipt Account | |
29 | Car Rental Tax/Surcharge-Warwick Share | |
30 | Executive Office of Commerce | |
31 | Housing Resources Commission Restricted Account | |
32 | Department of Revenue | |
33 | DMV Modernization Project | |
34 | Jobs Tax Credit Redemption Fund | |
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1 | Legislature | |
2 | Audit of federal assisted programs | |
3 | Department of Children, Youth and Families | |
4 | Children's Trust Accounts -- SSI | |
5 | Military Staff | |
6 | RI Military Family Relief Fund | |
7 | RI National Guard Counterdrug Program | |
8 | Treasury | |
9 | Admin. Expenses -- State Retirement System | |
10 | Retirement -- Treasury Investment Options | |
11 | Defined Contribution -- Administration - RR | |
12 | Violent Crimes Compensation -- Refunds | |
13 | Treasury Research Fellowship | |
14 | Business Regulation | |
15 | Banking Division Reimbursement Account | |
16 | Office of the Health Insurance Commissioner Reimbursement Account | |
17 | Securities Division Reimbursement Account | |
18 | Commercial Licensing and Racing and Athletics Division Reimbursement Account | |
19 | Insurance Division Reimbursement Account | |
20 | Historic Preservation Tax Credit Account | |
21 | Judiciary | |
22 | Arbitration Fund Restricted Receipt Account | |
23 | Third-Party Grants | |
24 | RI Judiciary Technology Surcharge Account | |
25 | Department of Elementary and Secondary Education | |
26 | Statewide Student Transportation Services Account | |
27 | School for the Deaf Fee-for-Service Account | |
28 | School for the Deaf -- School Breakfast and Lunch Program | |
29 | Davies Career and Technical School Local Education Aid Account | |
30 | Davies -- National School Breakfast & Lunch Program | |
31 | School Construction Services | |
32 | Office of the Postsecondary Commissioner | |
33 | Higher Education and Industry Center | |
34 | Department of Labor and Training | |
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1 | Job Development Fund | |
2 | SECTION 3. Chapter 44-30 of the General Laws entitled “Personal Income Tax” is hereby | |
3 | amended by adding thereto the following sections: | |
4 | 44-30-101. Requirements concerning qualifying health insurance coverage. | |
5 | (a) Definitions. For purposes of this section: | |
6 | (1) “Applicable individual” has the same meaning as set forth in 26 U.S.C. § 5000A(d). | |
7 | (2) “Minimum essential coverage” has the same meaning as set forth in 26 U.S. C. § | |
8 | 5000A(f). | |
9 | (3) “Shared Responsibility Payment Penalty” means the penalty imposed pursuant to | |
10 | subsection (c) of this section. | |
11 | (4) “Taxpayer” means any resident individual, as defined in section 44-30-5 of the general | |
12 | laws. | |
13 | (b) Requirement to maintain minimum essential coverage. Every applicable individual | |
14 | must maintain minimum essential coverage for each month beginning after December 31, 2019. | |
15 | (c) Shared Responsibility Payment Penalty imposed for failing to maintain minimum | |
16 | essential coverage. As of January 1, 2020, every applicable individual required to file a personal | |
17 | income tax return pursuant to section 44-30-51 of the general laws, shall indicate on the return, in | |
18 | a manner to be prescribed by the tax administrator, whether and for what period of time during the | |
19 | relevant tax year the individual and his or her spouse and dependents who are applicable individuals | |
20 | were covered by minimum essential coverage. If a return submitted pursuant to this subsection | |
21 | fails to indicate that such coverage was in force or indicates that any applicable individuals did not | |
22 | have such coverage in force, a Shared Responsibility Payment Penalty shall hereby be assessed as | |
23 | a tax on the return. | |
24 | (d) Shared Responsibility Payment Penalty calculation. Except as provided in subsection | |
25 | (e), the Shared Responsibility Payment Penalty imposed shall be equal to a taxpayer’s federal | |
26 | shared responsibility payment for the taxable year under section 5000A of the Internal Revenue | |
27 | Code of 1986, as amended, and as in effect on the 15th day of December 2017. | |
28 | (e) Exceptions. | |
29 | (1) Penalty cap. The amount of the Shared Responsibility Payment Penalty imposed under | |
30 | this section shall be determined, if applicable, using the statewide average premium for bronze- | |
31 | level plans offered through the Rhode Island health benefits exchange rather than the national | |
32 | average premium for bronze-level plans. | |
33 | (2) Hardship exemption determinations. Determinations as to hardship exemptions shall | |
34 | be made by the exchange under section 42-157-11 of the general laws. | |
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1 | (3) Religious conscience exemption determinations. Determinations as to religious | |
2 | conscience exemptions shall be made by the exchange under section 42-157-11 of the general laws. | |
3 | (4) Taxpayers with gross income below state filing threshold. No penalty shall be imposed | |
4 | under this section with respect to any applicable individual for any month during a calendar year if | |
5 | the taxpayer’s household income for the taxable year as described in section 1412(b)(1)(B) of the | |
6 | Patient Protection and Affordable Care Act is less than the amount of gross income requiring the | |
7 | taxpayer to file a return as set forth in section 44-30-51 of the general laws. | |
8 | (5) Out of State Residents. No penalty shall be imposed by this section with respect to any | |
9 | applicable individual for any month during which the individual is a bona fide resident of another | |
10 | state. | |
11 | (f) Health Insurance Market Integrity Fund. The tax administrator is authorized to withhold | |
12 | from any state tax refund due to the taxpayer an amount equal to the calculated Shared | |
13 | Responsibility Payment Penalty and shall place such amounts in the Health Insurance Market | |
14 | Integrity Fund created pursuant to section 42-157.1-5 of the general laws. | |
15 | (g) Deficiency. If, upon examination of a taxpayer’s return, the tax administrator | |
16 | determines there is a deficiency because any refund due to the taxpayer is insufficient to satisfy the | |
17 | Shared Responsibility Penalty or because there was no refund due, the tax administrator may notify | |
18 | the taxpayer of such deficiency in accordance with section 44-30-81 and interest shall accrue on | |
19 | such deficiency as set forth in section 44-30-84. All monies collected on said deficiency shall be | |
20 | placed in the Health Insurance Market Integrity Fund created pursuant to section 42-157.1-5 of the | |
21 | general laws. | |
22 | (h) Data Sharing. | |
23 | (1) The tax administrator, upon written request from the exchange pursuant to section 42- | |
24 | 157-13 of the general laws, shall disclose to officers, employees, and contractors of the exchange, | |
25 | the name, age, mailing address, income and penalty amount of any such applicable individual who, | |
26 | for the applicable year, did not have the minimum essential coverage required by subsection 44- | |
27 | 30-101(b). | |
28 | (2) Definition of applicable year. For purposes of this subsection, the term “applicable | |
29 | year” means the most recent taxable year for which information is available in the Rhode Island | |
30 | Department of Revenue’s taxpayer data information systems, or, if there is no return filed for such | |
31 | taxpayer for such year, the prior taxable year. | |
32 | (3) Restriction on use of disclosed information. Taxpayer information disclosed under this | |
33 | subsection may be used only for the purposes authorized by section 42-157-13 of the general laws. | |
34 | (4) Privacy and Security. The exchange and the tax administrator shall develop a detailed | |
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1 | set of data privacy and data security safeguards to govern the conveyance of data between their | |
2 | agencies under this section. With respect to information disclosed by the tax administrator to the | |
3 | exchange pursuant to this subsection, the exchange its officers, employees and contractors shall be | |
4 | subject to R.I. Gen. Laws subsection 44-30-95(c). | |
5 | (i) Application of Federal law. The Shared Responsibility Payment Penalty shall be | |
6 | assessed and collected as set forth in this chapter and, where applicable, consistent with regulations | |
7 | promulgated by the federal government, the exchange and/or the tax administrator. Any federal | |
8 | regulation implementing section 5000A of the Internal Revenue Code of 1986, as amended, and in | |
9 | effect on the 15th day of December 2017, shall apply as though incorporated into the Rhode Island | |
10 | Code of Regulations. Federal guidance interpreting these federal regulations shall similarly apply. | |
11 | Except as provided in subsections (j) and (k), all references to federal law shall be construed as | |
12 | references to federal law as in effect on December 15, 2017, including applicable regulations and | |
13 | administrative guidance that were in effect as of that date. | |
14 | (j) Unavailability of Federal premium tax credits. For any taxable year in which federal | |
15 | premium tax credits available pursuant to 26 U.S.C. section 36B become unavailable due to the | |
16 | federal government repealing that section or failing to fund the premium tax credits, the Shared | |
17 | Responsibility Payment Penalty under this section shall not be enforced. | |
18 | (k) Imposition of Federal shared responsibility payment. For any taxable year in which a | |
19 | federal penalty under section 5000A of the Internal Revenue Code of 1986 is imposed on a taxpayer | |
20 | in an amount comparable to the Shared Responsibility Payment Penalty assessed under this section, | |
21 | the state penalty shall not be enforced. | |
22 | (m) Agency Coordination. Where applicable, the tax administrator shall implement this | |
23 | section in consultation with the office of the health insurance commissioner, the office of | |
24 | management and budget, the executive office of health and human services, and the Rhode Island | |
25 | health benefits exchange. | |
26 | 44-30-102. Reporting Requirement for Applicable Entities providing Minimum | |
27 | Essential Coverage. | |
28 | (a) Findings. | |
29 | (1) Ensuring the health of insurance markets is a responsibility reserved for states under | |
30 | the McCarran-Ferguson Act and other federal law. | |
31 | (2) There is substantial evidence that being uninsured causes health problems and | |
32 | unnecessary deaths. | |
33 | (3) The Shared Responsibility Payment Penalty imposed by subsection 44-30-101(c) of the | |
34 | general laws is necessary to protect the health and welfare of the state’s residents. | |
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1 | (4) The reporting requirement provided for in this section is necessary for the successful | |
2 | implementation of the Shared Responsibility Payment Penalty imposed by subsection 44-30-101(c) | |
3 | of the general laws. This requirement provides the only widespread source of third-party reporting | |
4 | to help taxpayers and the tax administrator verify whether an applicable individual maintains | |
5 | minimum essential coverage. There is compelling evidence that third-party reporting is crucial for | |
6 | ensuring compliance with tax provisions. | |
7 | (5) The Shared Responsibility Payment Penalty imposed by subsection 44-30-101(c) of | |
8 | the general laws, and therefore the reporting requirement in this section, is necessary to ensure a | |
9 | stable and well-functioning health insurance market. There is compelling evidence that, without | |
10 | an effective Shared Responsibility Payment Penalty in place for those who go without coverage, | |
11 | there would be substantial instability in health insurance markets, including higher prices and the | |
12 | possibility of areas without any insurance available. | |
13 | (6) The Shared Responsibility Payment Penalty imposed by subsection 44-30-101(c) of the | |
14 | general laws, and therefore the reporting requirement in this section, is also necessary to foster | |
15 | economic stability and growth in the state. | |
16 | (7) The reporting requirement in this section has been narrowly tailored to support | |
17 | compliance with the Shared Responsibility Payment Penalty imposed by subsection 44-30-101(c) | |
18 | of the general laws, while imposing only an incidental burden on reporting entities. In particular, | |
19 | the information that must be reported is limited to the information that must already be reported | |
20 | under a similar federal reporting requirement under section 6055 of the Internal Revenue Code of | |
21 | 1986. In addition, this section provides that its reporting requirement may be satisfied by providing | |
22 | the same information that is currently reported under such federal requirement. | |
23 | (b) Definitions. For purposes of this section: | |
24 | (1) “Applicable entity” means: | |
25 | (i) An employer or other sponsor of an employment-based health plan that offers | |
26 | employment-based minimum essential coverage to any resident of Rhode Island. | |
27 | (ii) The Rhode Island Medicaid single state agency providing Medicaid or Children’s | |
28 | Health Insurance Program (CHIP) coverage. | |
29 | (iii) Carriers licensed or otherwise authorized by the Rhode Island office of the health | |
30 | insurance commissioner to offer health coverage providing coverage that is not described in | |
31 | subparagraphs (i) or (ii). | |
32 | (2) “Minimum essential coverage” has the meaning given such term by section 44-30- | |
33 | 101(a)(2) of the general laws. | |
34 | (c) For purposes of administering the Shared Responsibility Payment Penalty to individuals | |
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1 | who do not maintain minimum essential coverage under subsection 44-30-101(b) of the general | |
2 | laws, every applicable entity that provides minimum essential coverage to an individual during a | |
3 | calendar year shall, at such time as the tax administrator may prescribe, file a form in a manner | |
4 | prescribed by the tax administrator. | |
5 | (d) Form and manner of return. | |
6 | (1) A return, in such form as the tax administrator may prescribe, contains the following | |
7 | information: | |
8 | (i) the name, address and TIN of the primary insured and the name and TIN of each other | |
9 | individual obtaining coverage under the policy; | |
10 | (ii) the dates during which such individual was covered under minimum essential coverage | |
11 | during the calendar year, and | |
12 | (iii) such other information as the tax administrator may require. | |
13 | (2) Sufficiency of information submitted for federal reporting. Notwithstanding the | |
14 | requirements of paragraph (1), a return shall not fail to be a return described in this section if it | |
15 | includes the information contained in a return described in section 6055 of the Internal Revenue | |
16 | Code of 1986, as that section is in effect and interpreted on the 15th day of December 2017. | |
17 | (e) Statements to be furnished to individuals with respect to whom information is reported. | |
18 | (1) Any applicable entity providing a return under the requirements of this section shall | |
19 | also provide to each individual whose name is included in such return a written statement | |
20 | containing the name, address and contact information of the person required to provide the return | |
21 | to the tax administrator and the information included in the return with respect to the individuals | |
22 | listed thereupon. Such written statement must be provided on or before January 31 of the year | |
23 | following the calendar year for which the return was required to be made or by such date as may | |
24 | be determined by the tax administrator. | |
25 | (2) Sufficiency of federal statement. Notwithstanding the requirements of paragraph (1), | |
26 | the requirements of this subsection (e) may be satisfied by a written statement provided to an | |
27 | individual under section 6055 of the Internal Revenue Code of 1986, as that section is in effect and | |
28 | interpreted on the 15th day of December 2017. | |
29 | (f) Reporting responsibility. | |
30 | (1) Coverage provided by governmental units. In the case of coverage provided by an | |
31 | applicable entity that is any governmental unit or any agency or instrumentality thereof, the officer | |
32 | or employee who enters into the agreement to provide such coverage (or the person appropriately | |
33 | designated for purposes of this section) shall be responsible for the returns and statements required | |
34 | by this section. | |
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1 | (2) Delegation. An applicable entity may contract with third-party service providers, | |
2 | including insurance carriers, to provide the returns and statements required by this section. | |
3 | SECTION 4. Chapter 42-157 of the General Laws entitled "Rhode Island Health Benefit | |
4 | Exchange" is hereby amended by adding thereto the following section: | |
5 | 42-157-11. Exemptions from the shared responsibility payment penalty. | |
6 | (a) Establishment of program. The exchange shall establish a program for determining | |
7 | whether to grant a certification that an individual is entitled to an exemption from the Shared | |
8 | Responsibility Payment Penalty set forth in section 44-30-101(c) of the general laws by reason of | |
9 | religious conscience or hardship. | |
10 | (b) Eligibility determinations. The exchange shall make determinations as to whether to | |
11 | grant a certification described in subsection (a). The exchange shall notify the individual and the | |
12 | tax administrator for the Rhode Island Department of Revenue of any such determination in such | |
13 | a time and manner as the exchange, in consultation with the tax administrator, shall prescribe. In | |
14 | notifying the tax administrator, the exchange shall adhere to the data privacy and data security | |
15 | standards adopted in accordance with section 44-30-101(i)(4) of the general laws and 45 C.F.R. | |
16 | 155.260. The exchange shall only be required to notify the tax administrator to the extent that the | |
17 | exchange determines such disclosure is permitted under 45 C.F.R. 155.260. | |
18 | (c) Appeals. Any person aggrieved by the exchange’s determination of eligibility for an | |
19 | exemption under this section has the right to an appeal in accordance with the procedures contained | |
20 | within chapter 35 of title 42. | |
21 | 42-157-12. Special enrollment period for qualified individuals assessed a shared | |
22 | responsibility payment penalty. | |
23 | (a) Definitions. The following definition shall apply for purposes of this section: | |
24 | (1) “Special enrollment period” means a period during which a qualified individual who is | |
25 | assessed a penalty in accordance with section 44-30-101 may enroll in a qualified health plan | |
26 | through the exchange outside of the annual open enrollment period. | |
27 | (b) In the case of a qualified individual who is assessed a shared responsibility payment in | |
28 | accordance with section 44-30-101 of the general laws and who is not enrolled in a qualified health | |
29 | plan, the exchange must provide a special enrollment period consistent with this section and the | |
30 | Federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the | |
31 | Federal Care and Reconciliation Act of 2010 (Public Law 111-152), and any amendments to, or | |
32 | regulations or guidance issued under, those acts. | |
33 | (c) Effective Date. The exchange must ensure that coverage is effective for a qualified | |
34 | individual who is eligible for a special enrollment period under this section on the first day of the | |
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1 | month after the qualified individual completes enrollment in a qualified health plan through the | |
2 | exchange. | |
3 | (d) Availability and length of special enrollment period. A qualified individual has sixty | |
4 | (60) days from the date he or she is assessed a penalty in accordance with section 44-30-101 of the | |
5 | general laws to complete enrollment in a qualified health plan through the exchange. The date of | |
6 | assessment shall be determined in accordance with section 44-30-82 of the general laws. | |
7 | 42-157-13. Outreach to Rhode Island residents and individuals assessed a shared | |
8 | responsibility payment penalty. | |
9 | Outreach. The exchange, in consultation with the Office of the Health Insurance | |
10 | Commissioner and the Division of Taxation, is authorized to engage in coordinated outreach efforts | |
11 | to educate Rhode Island residents about the importance of health insurance coverage, their | |
12 | responsibilities to maintain minimum essential coverage as defined in section 44-30-101 of the | |
13 | general laws, the penalties for failure to maintain such coverage, and information on the services | |
14 | available through the exchange. | |
15 | 42-157-14. Regulatory authority. | |
16 | (a) Regulatory Authority. The exchange may promulgate regulations as necessary to carry | |
17 | out the purposes of this chapter. | |
18 | SECTION 5. Sections 42-157.1-1 and 42-157.1-5 of the General Laws in Chapter 42-157.1 | |
19 | entitled "Rhode Island Market Stability and Reinsurance Act" are hereby amended to read as | |
20 | follows: | |
21 | 42-157.1-1. Short title and purpose. | |
22 | (a) This chapter shall be known and may be cited as the "Rhode Island Market Stability | |
23 | and Reinsurance Act." | |
24 | (b) The purpose of this chapter is to authorize the director to create the Rhode Island | |
25 | reinsurance program to stabilize health insurance rates and premiums in the individual market and | |
26 | provide greater financial certainty to consumers of health insurance in this state. | |
27 | (c) Nothing in this chapter shall be construed as obligating the state to appropriate funds or | |
28 | make payments to carriers. | |
29 | 42-157.1-5. Establishment of program fund. | |
30 | (a) A fund shall be The Health Insurance Market Integrity Fund is hereby established to | |
31 | provide funding for the operation and administration of the program in carrying out the purposes | |
32 | of the program under this chapter. | |
33 | (b) The director is authorized to administer the fund. | |
34 | (c) The fund shall consist of: | |
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1 | (1) Any pass-through funds received from the federal government under a waiver approved | |
2 | under 42 U.S.C. § 18052; | |
3 | (2) Any funds designated by the federal government to provide reinsurance to carriers that | |
4 | offer individual health benefit plans in the state; | |
5 | (3) Any funds designated by the state to provide reinsurance to carriers that offer individual | |
6 | health benefit plans in the state; and | |
7 | (4) Any other money from any other source accepted for the benefit of the fund. | |
8 | (d) Nothing in this chapter shall be construed as obligating the state to appropriate funds | |
9 | or make payments to carriers. | |
10 | (d) A restricted receipt account shall be established for the fund which may be used for the | |
11 | purposes set forth in this section and shall be exempt from the indirect cost recovery provisions of | |
12 | section 35-4-27 of the general laws. | |
13 | (e) Monies in the fund shall be used to provide reinsurance to health insurance carriers as | |
14 | set forth in this chapter and its implementing regulations, and to support the personnel costs, | |
15 | operating costs and capital expenditures of the exchange and the division of taxation that are | |
16 | necessary to carry out the provisions of this chapter, sections 44-30-101 through 44-30-102 and | |
17 | sections 42-157-11 through 42-157-14 of the general laws. | |
18 | (f) Any excess monies remaining in the fund, not including any monies received from the | |
19 | federal government pursuant to paragraphs (1) or (2) and after making the payments required by | |
20 | subsection (f), may be used for preventative health care programs for vulnerable populations in | |
21 | consultation with the executive office of health and human services. | |
22 | 42-157.1-7. Program contingent on federal waiver and appropriation of state funding. | |
23 | If the state innovation waiver request in § 42-157.1-6 is not approved, the director shall not | |
24 | implement the program or provide reinsurance payments to eligible carriers. | |
25 | SECTION 6. This article shall take effect upon passage. | |
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