Rep. Frank J. Mautino

Filed: 10/26/2011

 

 


 

 


 
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1
AMENDMENT TO SENATE BILL 1313

2    AMENDMENT NO. ______. Amend Senate Bill 1313 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The State Employee Health Savings Account Law
5is amended by changing Sections 10-5 and 10-10 as follows:
 
6    (5 ILCS 377/10-5)
7    Sec. 10-5. Definitions. As used in this Law:
8    (a) "Deductible" means the total deductible of a high
9deductible health plan for an eligible individual and all the
10dependents of that eligible individual for a calendar year.
11    (b) "Dependent" means a dependent as defined in Section 3
12of the State Employee Group Insurance Act of 1971, provided
13that any dependent age 26 or above, as defined under that
14Section, is eligible to be claimed by the eligible individual
15as a tax dependent under Section 152(a) of the Internal Revenue
16Code of 1986 an eligible individual's spouse or child, as

 

 

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1defined in Section 152 of the Internal Revenue Code of 1986.
2"Dependent" also includes a party to or the child of a party to
3a civil union, as defined under Section 10 of the Illinois
4Religious Freedom Protection and Civil Union Act, provided that
5the party to, or the child of a party to, the civil union is
6eligible to be claimed by the eligible individual as a tax
7dependent under Section 152(a) of the Internal Revenue Code of
81986.
9    (c) "Eligible individual" means an employee, as defined in
10Section 3 of the State Employees Group Insurance Act of 1971,
11who contributes to health savings accounts on the employees'
12behalf, who:
13        (1) is covered by a high deductible health plan
14    individually or with dependents; and
15        (2) is not covered under any health plan that is not a
16    high deductible health plan, except for:
17            (i) coverage for accidents;
18            (ii) workers' compensation insurance;
19            (iii) insurance for a specified disease or
20        illness;
21            (iv) insurance paying a fixed amount per day per
22        hospitalization; and
23            (v) tort liabilities; and
24        (3) establishes a health savings account or on whose
25    behalf the health savings account is established; .
26        (4) is not entitled to Medicare; and

 

 

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1        (5) cannot be claimed as a dependent on another
2    person's tax return.
3    (d) "Employer" means a State agency, department, or other
4entity that employs an eligible individual.
5    (e) "Health savings account" or "account" means a trust or
6custodial account established under a State program
7exclusively to pay the qualified medical expenses of an
8eligible individual, or his or her dependents, that meets all
9of the following requirements:
10        (1) Except in the case of a rollover contribution, no
11    contribution may be accepted:
12            (A) unless it is in cash; or
13            (B) to the extent that the contribution, when added
14        to the previous contributions to the Account for the
15        calendar year, exceeds the lesser of (i) 100% of the
16        eligible individual's deductible or (ii) the
17        contribution level set for that year by the Internal
18        Revenue Service.
19        (2) The trustee or custodian is a bank, an insurance
20    company, or another person approved by the Director of
21    Insurance.
22        (3) No part of the trust assets shall be invested in
23    life insurance contracts.
24        (4) The assets of the account shall not be commingled
25    with other property except as allowed for under Individual
26    Retirement Accounts.

 

 

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1        (5) Eligible individual's interest in the account is
2    nonforfeitable.
3    (f) "Health savings account program" or "program" means a
4program that includes all of the following:
5        (1) Participation The purchase by an eligible
6    individual in an employer-sponsored or by an employer of a
7    high deductible health plan.
8        (2) The contribution into a health savings account by
9    an eligible individual or on behalf of an employee or by
10    his or her employer. The total annual contribution may not
11    exceed the amount of the deductible or the amounts listed
12    in sub-item (B) of item (1) of subsection (e) (f) of this
13    Section.
14    (g) "High deductible" means:
15        (1) In the case of self-only coverage, an annual
16    deductible that is not less than the level set by the
17    Internal Revenue Service and that, when added to the other
18    annual out-of-pocket expenses required to be paid under the
19    plan for covered benefits, does not exceed the maximum
20    level set by the Internal Revenue Service $5,000; and
21        (2) In the case of family coverage, an annual
22    deductible of not less than the level set by the Internal
23    Revenue Service and that, when added to the other annual
24    out-of-pocket expenses required to be paid under the plan
25    for covered benefits, does not exceed the maximum level set
26    by the Internal Revenue Service $10,000.

 

 

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1    A plan shall not fail to be treated as a high deductible
2plan by reason of a failure to have a deductible for preventive
3care or, in the case of network plans, for having out-of-pocket
4expenses that exceed these limits on an annual deductible for
5services that are provided outside the network.
6    (h) "High deductible health plan" means a health coverage
7policy, certificate, or contract that provides for payments for
8covered benefits that exceed the high deductible.
9    (i) "Qualified medical expense" means an expense paid by
10the eligible individual for medical care described in Section
11213(d) of the Internal Revenue Code of 1986.
12(Source: P.A. 97-142, eff. 7-14-11.)
 
13    (5 ILCS 377/10-10)
14    Sec. 10-10. Application; authorized contributions.
15    (a) Beginning in calendar taxable year 2012 2011, each
16employer shall make available to each eligible individual a
17health savings account program, if that individual chooses to
18enroll in the program except that, for an employer who provides
19coverage pursuant to any one or more of subsections (i) through
20(n) of Section 10 of the State Employee Group Insurance Act,
21that employer may make available a health savings account
22program. An employer who makes a health savings account program
23available shall annually deposit an amount equal to one-third
24of the annual deductible $2,750 annually into an eligible
25individual's health savings account. Unused funds in a health

 

 

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1savings account shall become the property of the account holder
2at the end of a taxable year.
3    (b) Beginning in calendar taxable year 2012 2011, an
4eligible individual may deposit contributions into a health
5savings account in accordance with the restrictions set forth
6in subsection (e) of Section 10-5. The amount of deposit may
7not exceed the amount of the deductible for the policy.
8(Source: P.A. 97-142, eff. 7-14-11.)
 
9    Section 10. The Illinois Insurance Code is amended by
10adding Section 500-123 as follows:
 
11    (215 ILCS 5/500-123 new)
12    Sec. 500-123. Consulting. A producer shall be prohibited
13from selling, soliciting, or negotiating insurance or limited
14lines insurance after the producer or an employee or contractor
15of the producer has been hired by the purchaser or prospective
16purchaser within the previous 5 years as a consultant
17concerning the insurance or limited lines insurance being sold,
18solicited, or negotiated. For the purposes of this Section,
19"producer" means an insurance producer, limited line producer,
20or temporary insurance producer.
 
21    Section 15. The Illinois Health Benefits Exchange Law is
22amended by adding Sections 5-4, 5-8, 5-11, 5-12, 5-13, 5-14,
23and 5-18 and by changing Section 5-10 as follows:
 

 

 

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1    (215 ILCS 122/5-4 new)
2    Sec. 5-4. Definitions. For purposes of this Law:
3    "Board" means the Illinois Health Benefits Exchange Board
4established pursuant to this Law.
5    "Director" means the Director of Insurance.
6    "Essential health benefits" has the meaning provided under
7Section 1302(b) of the Federal Act.
8    "Exchange" means the Illinois Health Benefits Exchange
9established by this Law and includes the Individual Exchange
10and the SHOP Exchange, unless otherwise specified.
11    "Executive Director" means the Executive Director of the
12Illinois Health Benefits Exchange.
13    "Federal Act" means the federal Patient Protection and
14Affordable Care Act (Public Law 111-148), as amended by the
15federal Health Care and Education Reconciliation Act of 2010
16(Public Law 111-152), and any amendments thereto or regulations
17or guidance issued under those Acts.
18    "Health benefit plan" means a policy, contract,
19certificate, or agreement offered or issued by a health carrier
20to provide, deliver, arrange for, pay for, or reimburse any of
21the costs of health care services. "Health benefit plan" does
22not include:
23        (a) coverage for accident only or disability income
24    insurance or any combination thereof;
25        (b) coverage issued as a supplement to liability

 

 

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1    insurance;
2        (c) liability insurance, including general liability
3    insurance and automobile liability insurance;
4        (d) workers' compensation or similar insurance;
5        (e) automobile medical payment insurance;
6        (f) credit-only insurance;
7        (g) coverage for on-site medical clinics; or
8        (h) other similar insurance coverage, specified in
9    federal regulations issued pursuant to Pub. L. No. 104-191,
10    under which benefits for health care services are secondary
11    or incidental to other insurance benefits.
12    "Health carrier" or "carrier" means an entity subject to
13the insurance laws and regulations of this State, or subject to
14the jurisdiction of the Director, that contracts or offers to
15contract to provide, deliver, arrange for, pay for, or
16reimburse any of the costs of health care services, including a
17sickness and accident insurance company, a health maintenance
18organization, a non-profit hospital and health service
19corporation, or any other entity providing a plan of health
20insurance, health benefits, or health services.
21    "Individual Exchange" means the exchange marketplace
22established by this Law through which qualified individuals may
23obtain coverage through an individual market qualified health
24plan.
25    "Qualified dental plan" means a limited scope dental plan
26that has been certified in accordance with this Law.

 

 

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1    "Qualified employee" means an eligible individual employed
2by a qualified employer who has been offered health insurance
3coverage by that qualified employer through the SHOP on the
4Exchange.
5    "Qualified employer" means a small employer that elects to
6make its full-time employees eligible for one or more qualified
7health plans or qualified dental plans offered through the SHOP
8Exchange, and at the option of the employer, some or all of its
9part-time employees, provided that the employer has its
10principal place of business in this State and elects to provide
11coverage through the SHOP Exchange to all of its eligible
12employees, wherever employed.
13    "Qualified health plan" or "QHP" means a health benefit
14plan that has in effect a certification that the plan meets the
15criteria for certification described in Section 1311(c) of the
16Federal Act.
17    "Qualified health plan issuer" or "QHP issuer" means a
18health insurance issuer that offers a health plan that the
19Exchange has certified as a qualified health plan.
20    "Qualified individual" means an individual, including a
21minor, who:
22        (1) is seeking to enroll in a qualified health plan or
23    qualified dental plan offered to individuals through the
24    Exchange;
25        (2) resides in this State;
26        (3) at the time of enrollment, is not incarcerated,

 

 

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1    other than incarceration pending the disposition of
2    charges; and
3        (4) is, and is reasonably expected to be, for the
4    entire period for which enrollment is sought, a citizen or
5    national of the United States or an alien lawfully present
6    in the United States.
7    "Secretary" means the Secretary of the federal Department
8of Health and Human Services.
9    "SHOP Exchange" means the Small Business Health Options
10Program established under this Law through which a qualified
11employer can provide small group qualified health plans to its
12qualified employees.
13    "Small employer" means, in connection with a group health
14plan with respect to a calendar year and a plan year, an
15employer who employed an average of at least 2 but not more
16than 50 employees on business days during the preceding
17calendar year and who employs at least one employee on the
18first day of the plan year. Beginning January 1, 2016, the
19definition of a "small employer" shall mean, in connection with
20a group health plan with respect to a calendar year and a plan
21year, an employer who employed an average of at least 2 but not
22more than 100 employees on business days during the preceding
23calendar year and who employs at least one employee on the
24first day of the plan year.
 
25    (215 ILCS 122/5-8 new)

 

 

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1    Sec. 5-8. Exchange Board. There is created the Illinois
2Health Benefits Exchange Board. The purpose of the Board is to
3administer the State health benefits exchange created pursuant
4to this Law and to conduct such other business as may further
5the administration of the State health benefits exchange. The
6Exchange shall operate subject to the supervision and control
7of the Board. The Exchange is created as a quasigovernmental
8agency and as such is not a State agency.
 
9    (215 ILCS 122/5-10)
10    Sec. 5-10. Exchange functions. On or before January 1,
112014, in compliance with paragraph (4) of subdivision (d) of
12Section 1311 of the federal Patient Protection and Affordable
13Care Act, the Exchange shall, at a minimum, do all of the
14following to implement Section 1311 of the federal Patient
15Protection and Affordable Care Act:
16        (1) Make qualified health plans available to qualified
17    individuals and qualified employers.
18        (2) Implement procedures for the certification,
19    recertification, and decertification, consistent with
20    guidelines established by the U.S. Secretary of Health and
21    Human Services, of health plans as qualified health plans.
22    The Board shall require health plans seeking certification
23    as qualified health plans to do all of the following:
24            (A) Submit a justification for any premium
25        increase prior to the implementation of the increase.

 

 

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1        The plans shall prominently post that information on
2        their Internet web sites. The Board shall take this
3        information, and the information and the
4        recommendations provided to the Board by the
5        Department of Insurance or the Department of Managed
6        Health Care under paragraph (1) of subdivision (b) of
7        Section 2794 of the federal Public Health Service Act,
8        into consideration when determining whether to make
9        the health plan available through the Exchange. The
10        Board shall take into account any excess of premium
11        growth outside the Exchange as compared to the rate of
12        that growth inside the Exchange, including information
13        reported by the Department of Insurance and the
14        Department of Managed Health Care.
15            (B) Make available to the public and submit to the
16        Board, the U.S. Secretary of Health and Human Services,
17        and the Department of Insurance or the Department of
18        Public Health, as applicable, accurate and timely
19        disclosure of the following information:
20                (i) Claims payment policies and practices.
21                (ii) Periodic financial disclosures.
22                (iii) Data on enrollment.
23                (iv) Data on disenrollment.
24                (v) Data on the number of claims that are
25            denied.
26                (vi) Data on rating practices.

 

 

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1                (vii) Information on cost sharing and payments
2            with respect to any out-of-network coverage.
3                (viii) Information on enrollee and participant
4            rights under Title I of the federal Patient
5            Protection and Affordable Care Act.
6                (ix) Other information as determined
7            appropriate by the U.S. Secretary of Health and
8            Human Services.
9            The information required under this paragraph (b)
10        shall be provided in plain language, as defined in
11        subparagraph (B) of paragraph (3) of subdivision (e) of
12        Section 1311 of the federal Patient Protection and
13        Affordable Care Act.
14            (C) Permit individuals to learn, in a timely manner
15        upon the request of the individual, the amount of cost
16        sharing, including, but not limited to, deductibles,
17        copayments, and coinsurance, under the individual's
18        plan or coverage that the individual would be
19        responsible for paying with respect to the furnishing
20        of a specific item or service by a participating
21        provider. At a minimum, this information shall be made
22        available to the individual through an Internet web
23        site and through other means for individuals without
24        access to the Internet.
25        (3) Provide for the operation of a toll-free telephone
26    hotline to respond to requests for assistance.

 

 

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1        (4) Maintain an Internet web site through which
2    enrollees and prospective enrollees of qualified health
3    plans may obtain standardized comparative information on
4    those plans.
5        (5) With respect to each qualified health plan offered
6    through the Exchange, do both of the following:
7            (A) assign a rating to each qualified health plan
8        offered through the Exchange in accordance with the
9        criteria developed by the U.S. Secretary of Health and
10        Human Services; and
11            (B) determine each qualified health plan's level
12        of coverage in accordance with regulations adopted by
13        the Secretary under paragraph (A) of subdivision (2) of
14        Section 1302(d) of the federal Patient Protection and
15        Affordable Care Act and any additional regulations
16        adopted by the Exchange under this Law.
17        (6) Utilize a standardized format for presenting
18    health benefits plan options in the Exchange, including the
19    use of the uniform outline of coverage established under
20    Section 2715 of the federal Public Health Service Act.
21        (7) Inform individuals of eligibility requirements for
22    the Medicaid program, the Covering ALL KIDS Health
23    Insurance Program, or any applicable State or local public
24    program and, if through screening of the application by the
25    Exchange the Exchange determines that an individual is
26    eligible for any such program, enroll that individual in

 

 

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1    the program.
2        (8) Establish and make available by electronic means a
3    calculator to determine the actual cost of coverage after
4    the application of any premium tax credit under Section 36B
5    of the Internal Revenue Code of 1986 and any cost sharing
6    reduction under Section 1402 of the federal Patient
7    Protection and Affordable Care Act.
8        (9) Grant a certification attesting that, for purposes
9    of the individual responsibility penalty under Section
10    5000A of the Internal Revenue Code of 1986, an individual
11    is exempt from the individual requirement or from the
12    penalty imposed by that Section because of either of the
13    following:
14            (A) There is no affordable qualified health plan
15        available through the Exchange or the individual's
16        employer covering the individual.
17            (B) The individual meets the requirements for any
18        other exemption from the individual responsibility
19        requirement or penalty.
20        (10) Transfer to the Secretary of the Treasury all of
21    the following:
22            (A) a list of the individuals who are issued a
23        certification, including the name and taxpayer
24        identification number of each individual;
25            (B) the name and taxpayer identification number of
26        each individual who was an employee of an employer but

 

 

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1        who was determined to be eligible for the premium tax
2        credit under Section 36B of the Internal Revenue Code
3        of 1986 because:
4                (i) the employer did not provide the minimum
5            essential coverage or the employer provided the
6            minimum essential coverage but it was determined
7            under item (C) of paragraph (2) of subdivision (c)
8            of Section 36B of the Code to either be
9            unaffordable to the employee or not provide the
10            required minimum actuarial value; and
11                (ii) the name and taxpayer identification
12            number of each individual who notifies the
13            Exchange under paragraph (4) of subdivision (b) of
14            Section 1411 of the federal Patient Protection and
15            Affordable Care Act that they have changed
16            employers and of each individual who ceases
17            coverage under a qualified health plan during a
18            plan year, and the effective date of such
19            cessation;
20        (11) Provide to each employer the name of each employee
21    of the employer described in subdivision (i) of Section
22    1311 of the federal Patient Protection and Affordable Care
23    Act who ceases coverage under a qualified health plan
24    during a plan year and the effective date of that
25    cessation.
26        (12) Perform duties required of, or delegated to, the

 

 

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1    Exchange by the U.S. Secretary of Health and Human Services
2    or the Secretary of the Treasury related to the following:
3            (A) Determining eligibility for premium tax
4        credits, reduced cost sharing, or individual
5        responsibility exemptions.
6            (B) Establishing procedures necessary for the
7        operation of the program, including, but not limited
8        to, procedures for application, enrollment, risk
9        assessment, risk adjustment, plan administration,
10        performance monitoring, and consumer education.
11            (C) Arranging for collection of contributions from
12        participating employers and individuals.
13            (D) Arranging for payment of premiums and other
14        appropriate disbursements based on the selections of
15        products and services by the individual participants.
16            (E) Establishing criteria for disenrollment of
17        participating individuals based on failure to pay the
18        individual's share of any contribution required to
19        maintain enrollment in selected products.
20            (F) Establishing criteria for exclusion of
21        vendors.
22            (G) Developing and implementing a plan for
23        promoting public awareness of and participation in the
24        program.
25            (H) Evaluating options for employer participation
26        which may conform with common insurance practices.

 

 

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1            (I) Providing for initial, annual, and special
2        enrollment periods, in accordance with guidelines
3        adopted by the Secretary under paragraph (6) of
4        subdivision (c) of Section 1311 of the federal Patient
5        Protection and Affordable Care Act.
6        (13) Establish the Navigator Program in accordance
7    with subdivision (i) of Section 1311 of the federal Patient
8    Protection and Affordable Care Act. The Exchange shall
9    award grants to certain entities to do the following:
10            (A) Conduct public education activities to raise
11        awareness of the availability of qualified health
12        plans.
13            (B) Distribute fair and impartial information
14        concerning enrollment in qualified health plans and
15        the availability of premium tax credits under Section
16        36B of the Internal Revenue Code of 1986 and
17        cost-sharing reductions under Section 1402 of the
18        federal Patient Protection and Affordable Care Act.
19            (C) Facilitate enrollment in qualified health
20        plans.
21            (D) Provide referrals to any applicable office of
22        health insurance consumer assistance or health
23        insurance ombudsman established under Section 2793 of
24        the federal Public Health Service Act, or any other
25        appropriate State agency or agencies, for any enrollee
26        with a grievance, complaint, or question regarding his

 

 

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1        or her health plan, coverage, or a determination under
2        that plan or coverage.
3            (E) Refer individuals with a grievance, complaint,
4        or question regarding a plan, a plan's coverage, or a
5        determination under a plan's coverage to a customer
6        relations unit established by the Exchange.
7            (F) Provide information in a manner that is
8        culturally and linguistically appropriate to the needs
9        of the population being served by the Exchange.
10        (14) Establish the Small Business Health Options
11    Program, separate from the activities of the Board related
12    to the individual market, to assist qualified small
13    employers in facilitating the enrollment of their
14    employees in qualified health plans offered through the
15    Exchange in the small employer market in a manner
16    consistent with paragraph (2) of subdivision (a) of Section
17    1312 of the Federal Act. (a) The Illinois Health Benefits
18    Exchange shall meet the core functions identified by
19    Section 1311 of the Patient Protection and Affordable Care
20    Act and subsequent federal guidance and regulations.
21    (b) In order to meet the deadline of October 1, 2013
22established by federal law to have operational a State
23exchange, the Department of Insurance and the Commission on
24Governmental Forecasting and Accountability is authorized to
25apply for, accept, receive, and use as appropriate for and on
26behalf of the State any grant money provided by the federal

 

 

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1government and to share federal grant funding with, give
2support to, and coordinate with other agencies of the State and
3federal government or third parties as determined by the
4Governor.
5(Source: P.A. 97-142, eff. 7-14-11.)
 
6    (215 ILCS 122/5-11 new)
7    Sec. 5-11. Exchange powers. The Exchange shall have the
8power to do the following acts.
9        (1) Have perpetual successions as a body politic and
10    corporate and to adopt bylaws for the regulation of its
11    affairs and the conduct of its business.
12        (2) Adopt an official seal and alter the same at
13    pleasure.
14        (3) Maintain an office in the State at such place or
15    places as it may designate.
16        (4) Employ such assistants, agents, managers, and
17    other employees as may be necessary or desirable.
18        (5) Acquire, lease, purchase, own, manage, hold, and
19    dispose of real and personal property.
20        (6) Receive and accept, from any source, aid or
21    contributions, including money, property, labor, and other
22    things of value.
23        (7) Charge assessments or user fees to generate funding
24    necessary to support the operations of the Exchange.
25        (8) Exclude plans that fail to deliver robust consumer

 

 

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1    protections, quality care, and reasonable costs,
2    particularly if the plan has a history of unreasonable rate
3    increases.
4        (9) Procure insurance against loss in connection with
5    its property and other assets in such amounts and from such
6    insurers as it deems desirable.
7        (10) Invest any funds not needed for immediate use or
8    disbursement in obligations issued or guaranteed by the
9    U.S. of America or the State and in obligations that are
10    legal investments for savings banks in the State.
11        (11) Issue bonds, bond anticipation notes, and other
12    obligations of the Exchange for any of its corporate
13    purposes, and to fund or refund the same and provide for
14    the rights of the holders thereof, and to secure the same
15    by pledge of revenues, notes, and mortgages of others.
16        (12) Borrow money for the purpose of obtaining working
17    capital.
18        (13) Account for and audit funds of the Exchange and
19    any recipients of funds from the Exchange.
20        (14) Make and enter into any contract or agreement
21    necessary or incidental to the performance of its duties
22    and execution of its powers (copies of all contracts of the
23    Exchange shall be maintained by the Exchange as public
24    records, subject to the proprietary rights of any party to
25    the contract).
26        (15) To the extent permitted under its contract with

 

 

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1    other persons, consent to any termination, modification,
2    forgiveness, or other change of agreement of any kind to
3    which the Exchange is a party.
4        (16) Award grants to Navigators (applications for
5    grants from the Exchange shall be made on a form prescribed
6    by the Board).
7        (17) Limit the number of plans offered, and use
8    selective criteria in determining which plans to offer,
9    through the Exchange, provided individuals and employers
10    have an adequate number and selection of choices.
11        (18) Sue and be sued, plead and be impleaded.
12        (19) Adopt regular procedures that are not in conflict
13    with other provisions of the general statutes, for
14    exercising the power of the Exchange.
15        (20) Apply for federal grants to cover the cost
16    associated with setting up the Exchange.
17        (21) Do all acts and things necessary and convenient to
18    carry out the purposes of the Exchange, provided such acts
19    or things shall not conflict with the provisions of the
20    federal Patient Protection and Affordable Care Act,
21    regulations adopted there under, or federal guidance
22    issued pursuant to the federal Patient Protection and
23    Affordable Care Act.
 
24    (215 ILCS 122/5-12 new)
25    Sec. 5-12. Composition of the Board.

 

 

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1    (a) The Exchange shall be governed by a Board of Directors
2comprised as follows:
3        (1) Four ex officio, non-voting members to include:
4            (A) the Director of Insurance or his or her
5        designee with expertise in insurance regulation;
6            (B) the Director of Healthcare and Family Services
7        or his or her designee;
8            (C) the Director of Human Services or his or her
9        designee; and
10            (D) the Director of Public Health or his or her
11        designee.
12        (2) Two members appointed by the Attorney General to
13    include:
14            (A) one attorney with experience with public
15        programs such as Medicaid; and
16            (B) one attorney with experience working with the
17        Attorney General's Health Care Bureau.
18        (3) Seven members appointed by the Governor with the
19    advice and confirmation of the Senate pursuant to
20    subsection (b) of this Section to include:
21            (A) one consumer representative;
22            (B) one small employer representative;
23            (C) one employee representative of a small
24        employer in this State;
25            (D) one certified health actuary or health
26        economist;

 

 

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1            (E) one representative of the organized labor
2        community in this State;
3            (F) one individual who qualifies for Medicaid
4        under current or expanded Medicaid eligibility rules;
5        and
6            (G) one community-based provider that mainly
7        serves vulnerable individuals living under 200% of the
8        federal poverty level.
9    The Governor shall make the appointments so as to reflect
10no less than proportional representation of the minority racial
11composition of the State.
12    (b) All appointments of members to the Board shall be
13subject to the advice and consent of the Senate pursuant to
14this Section. Appointments by the Governor pursuant to
15paragraph (3) of subsection (a) of this Section shall require
16the advice and consent of a 2/3 vote of the members elected to
17the Senate.
18    The Senate shall confirm or reject appointments within 30
19session days or 60 calendar days after they are submitted by
20the Governor, whichever occurs first. Except in the case of
21appointments to fill vacancies, the confirmation time period
22specified in this Section shall not commence until all
23appointments required to be made in that year have been
24submitted by the Governor.
 
25    (215 ILCS 122/5-13 new)

 

 

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1    Sec. 5-13. Terms of Board members.
2    (a) Initial members shall be appointed to the Board as
3follows: 4 members to serve one year, and until their
4successors are appointed and qualified; 4 members to serve 2
5years, and until their successors are appointed and qualified;
66 members to serve 3 years, and until their successors are
7appointed and qualified; and 3 members to serve 4 years, and
8until their successors are appointed and qualified. As terms of
9initial members expire, their successors shall be appointed for
10terms to expire the first day in July 4 years thereafter, and
11until their successors are appointed and qualified. Any member
12is eligible for reappointment. A vacancy on the Board shall be
13filled for the unexpired portion of the term in the same manner
14as the original appointment.
15    (b) The Board shall elect a chairperson and a vice
16chairperson on an annual basis.
17    (c) Appointed Board members may not designate a
18representative to perform in their absence their respective
19duties. Meetings of the Board shall be held at such times as
20shall be specified in the bylaws adopted by the Board and at
21such other time or times as the chairperson deems necessary.
22All meetings of the Board shall be conducted in accordance with
23the Open Meetings Act. The Board must afford an opportunity for
24public comment at each of its meetings.
25    (d) Any Board member who fails to attend more than 50% of
26all meetings held during any calendar year shall be deemed to

 

 

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1have resigned from the Board.
2    (e) A majority of members appointed shall constitute a
3quorum for the transaction of any business or the exercise of
4any power of the Exchange.
5    (f) For the transaction of any business or the exercise of
6any power of the Exchange, the Exchange may act by a majority
7of the Board members present at any meeting at which a quorum
8is in attendance. No vacancy in the membership of the Board
9shall impair the right of the Board members to exercise all the
10rights and perform all the duties of the Board. Any action
11taken by the Board may be authorized by resolution approved by
12a majority of the Board members present at any regular or
13special meeting, which resolution shall take effect
14immediately unless otherwise provided in the resolution.
15    (g) Board members are entitled to receive, from funds of
16the Board, reimbursement for per diem and travel expenses. No
17other compensation is authorized.
18    (h) There is no liability on the part of, and no cause of
19action shall arise against, any member of the Board or its
20employees or agents for any action taken by them in the
21performance of their powers and duties under this Law.
22    (i) No Board member shall, for one year after the end of
23the member's service on the Board, accept employment with any
24health carrier that offers a qualified health benefit plan
25through the Exchange.
26    (j) The Board may exercise all powers granted to it

 

 

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1necessary to carry out the purposes of this Section, including,
2but not limited to, the power to receive and accept grants,
3loans, or advances of funds from any public or private agency
4and to receive and accept from any source contributions of
5money, property, labor, or any other thing of value to be held,
6used, and applied for the purposes of this Section.
7    (k) A member of the Board or of the staff of the Exchange
8shall not be employed by or be affiliated with a health care
9provider, a health care facility, a medical clinic, or an
10insurer, with the exception of health care providers not
11receiving compensation for rendering services as a provider who
12do not have an ownership interest in a professional health care
13practice.
14    (l) The Board shall hire an Executive Director to organize,
15administer, and manage the operations of the Exchange. The
16Executive Director shall be responsible for the selection of
17such other staff as may be authorized by the Board's operating
18budget as adopted by the Board. The Executive Director shall be
19exempt from civil service and shall serve at the pleasure of
20the Board.
21    (m) No employee of the Exchange shall be a member of the
22Board or an employee of a trade association of (i) insurers,
23(ii) insurance producers or brokers, (iii) health care
24providers, or (iv) health care facilities or health or medical
25clinics while serving on the Board or on the staff of the
26Exchange.

 

 

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1    (n) No employee of the Exchange shall, for one year after
2terminating employment with the Exchange, accept employment
3with any health carrier that offers a qualified health benefit
4plan through the Exchange.
5    (o) Any employee of the Exchange who sells, solicits, or
6negotiates insurance or will sell, solicit, or negotiate
7insurance to individuals and small employers shall be licensed
8not later than one year after such employee begins employment
9with the Exchange.
10    (p) The Exchange has the authority to enter into an
11agreement with an eligible entity to carry out responsibilities
12of the Exchange.
13    (q) The Board may establish advisory panels consisting of
14interested parties, including consumers, health care
15providers, individuals with expertise in insurance regulation,
16and insurers.
17    (r) No member of the Board nor employee of the Exchange
18shall make, participate in making, or in any way attempt to use
19his or her official position to influence the making of any
20decision that he or she knows or has any reason to know will
21have a reasonably foreseeable material financial effect,
22distinguishable from its effect on the public generally, on him
23or her or a member of his or her family or on either of the
24following:
25        (1) any source of income provided to, received by, or
26    promised to a member within 12 months prior to the time

 

 

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1    when a decision is made; or
2        (2) any business entity in which the member is a
3    director, officer, partner, trustee, or employee or holds
4    any position of management.
5    (s) The Board shall develop and adopt bylaws and other
6corporate procedures as necessary for the operation of the
7Board and carrying out the purposes of this Section. The bylaws
8shall do the following:
9        (1) specify procedures for selection of officers and
10    qualifications for reappointment, provided that no Board
11    member shall serve more than 9 consecutive years;
12        (2) require an annual membership meeting that provides
13    an opportunity for input and interaction with individual
14    participants in the program; and
15        (3) specify policies and procedures regarding
16    conflicts of interest; the policies and procedures shall
17    also require public disclosure of the interest that
18    prevents the member from participating in a decision on a
19    particular matter.
 
20    (215 ILCS 122/5-14 new)
21    Sec. 5-14. Illinois Health Benefits Exchange Legislative
22Oversight Committee.
23    (a) There is created an Illinois Health Benefits Exchange
24Legislative Oversight Committee within the Commission on
25Government Forecasting and Accountability to provide

 

 

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1accountability for the Illinois Health Benefits Exchange and to
2ensure that Exchange operations and functions align with the
3goals and duties outlined by this Law. The Committee shall also
4be responsible for providing policy recommendations to ensure
5that the Exchange aligns with the Federal Act, amendments to
6the Federal Act, and regulations promulgated pursuant to the
7Federal Act.
8    (b) Members of the Legislative Oversight Committee shall be
9appointed as follows: 3 members of the Senate shall be
10appointed by the President of the Senate; 3 members of the
11Senate shall be appointed by the Minority Leader of the Senate;
123 members of the House of Representatives shall be appointed by
13the Speaker of the House of Representatives; and 3 members of
14the House of Representatives shall be appointed by the Minority
15Leader of the House of Representatives. Each legislative leader
16shall select one member to serve as co-chair of the Committee.
17    (c) Members of the Legislative Oversight Committee shall be
18appointed within 30 days after the effective date of this
19amendatory Act of the 97th General Assembly. The co-chairs
20shall convene the first meeting of the Committee no later than
2145 days after the effective date of this Law.
22    (d) The Executive Director of the Exchange must provide
23updates to the Legislative Oversight Committee in person about
24the Exchange's progress every quarter for the first 2 years
25beginning at the start of employment on the Exchange.
 

 

 

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1    (215 ILCS 122/5-18 new)
2    Sec. 5-18. Illinois Health Benefit Exchange Fund. There is
3hereby created as a special fund outside of the State treasury
4the Illinois Health Benefit Exchange Fund to be used, subject
5to appropriation, exclusively by the Exchange to provide
6funding for the operation and administration of the Exchange in
7carrying out the purposes authorized in this Law. The Fund
8shall consist of the following:
9        (1) any user fees or other assessment collected by the
10    Exchange;
11        (2) income from investments made on behalf of the Fund;
12        (3) interest on deposits or investments of money in the
13    Fund;
14        (4) money collected by the Board as a result of legal
15    or other action taken by the Board on behalf of the
16    Exchange or the Fund;
17        (5) money donated to the Fund;
18        (6) money awarded to the Fund through grants; and
19        (7) any other money from any other source accepted for
20    the benefit of the Fund.
21    Any investment earnings of the Fund shall be credited to
22the Fund. No part of the Fund may revert or be credited to the
23General Revenue Fund or any special fund in the State Treasury.
24A debt or an obligation of the Fund is not a debt of the State
25or a pledge of credit of the State.
 

 

 

09700SB1313ham002- 32 -LRB097 06593 AMC 59149 a

1    Section 90. The State Finance Act is amended by adding
2Section 5.809 as follows:
 
3    (30 ILCS 105/5.809 new)
4    Sec. 5.809. The Illinois Health Benefit Exchange Fund.
 
5    (215 ILCS 122/5-15 rep.)
6    (215 ILCS 122/5-20 rep.)
7    Section 95. The Illinois Health Benefits Exchange Law is
8amended by repealing Sections 5-15 and 5-20.
 
9    Section 97. Severability. The provisions of this Act are
10severable under Section 1.31 of the Statute on Statutes.
 
11    Section 99. Effective date. This Act takes effect upon
12becoming law.".