HB0579ham002 103RD GENERAL ASSEMBLY

Rep. Robyn Gabel

Filed: 3/23/2023

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AMENDMENT TO HOUSE BILL 579

AMENDMENT NO. ______. Amend House Bill 579 by replacing everything after the enacting clause with the following:

"Section 5. The Illinois Administrative Procedure Act is amended by adding Section 5-45.35 as follows:

(5 ILCS 100/5-45.35 new)

Sec. 5-45.35. Emergency rulemaking; Illinois Health Benefits Exchange Law. To provide for the expeditious and timely implementation of Section 5-23 of the Illinois Health Benefits Exchange Law, emergency rules implementing Section 5-23 of the Illinois Health Benefits Exchange Law may be adopted in accordance with Section 5-45 of this Act by the Department of Insurance and the Department of Healthcare and Family Services. The adoption of emergency rules authorized by Section 5-45 and this Section is deemed to be necessary for the public interest, safety, and welfare.

This Section is repealed January 1, 2025.

Section 10. The Illinois Health Benefits Exchange Law is amended by changing Section 5-5 and by adding Sections 5-21, 5-22, 5-23, and 5-24 as follows:

(215 ILCS 122/5-5)

Sec. 5-5. State health benefits exchange. It is declared that this State, beginning October 1, 2013, in accordance with Section 1311 of the federal Patient Protection and Affordable Care Act, shall establish a State health benefits exchange to be known as the Illinois Health Benefits Exchange in order to help individuals and small employers with no more than 50 employees shop for, select, and enroll in qualified, affordable private health plans that fit their needs at competitive prices. The Exchange shall separate coverage pools for individuals and small employers and shall supplement and not supplant any existing private health insurance market for individuals and small employers. The Department of Insurance shall operate the Illinois Health Benefits Exchange as a State-based exchange using the federal platform by plan year 2025 and as a State-based exchange by plan year 2026. The Director of Insurance may require that all plans in the individual and small group markets, other than grandfathered health plans, be made available for comparison on the Illinois Health Benefits Exchange, but may not require that all plans in the individual and small group markets be purchased exclusively on the Illinois Health Benefits Exchange. The Director of Insurance may require that plans offered on the exchange conform with standardized plan designs that provide for standardized cost sharing for covered health services. Except when it is inconsistent with State law, the Department of Insurance shall enforce the coverage requirements under the federal Patient Protection and Affordable Care Act, including the coverage of all United States Preventive Services Task Force Grade A & B preventive services without cost sharing notwithstanding any federal overturning or repeal of 42 U.S.C. 300gg-13(a)(1), that apply to the individual and small group markets. The Director of Insurance may elect to add a small business health options program to the Illinois Health Benefits Exchange to help small employers enroll their employees in qualified health plans in the small group market. The General Assembly shall appropriate funds to establish the Illinois Health Benefits Exchange.

(Source: P.A. 97-142, eff. 7-14-11.)

(215 ILCS 122/5-21 new)

Sec. 5-21. Monthly assessments.

(a) The Director of Insurance may apply a monthly assessment to each health benefits plan sold on the Illinois Health Benefits Exchange. The assessment shall be paid by the issuer and to the Department of Insurance and shall be used only for the purpose of supporting the exchange through exchange operations, outreach, enrollment, and other means of supporting the exchange, including any efforts that may increase market stabilization and that may result in a net benefit to policyholders. The assessment may be applied at a rate of:

(1) 0.5% of the total monthly premium charged by an issuer for each health benefits plan during any period that the State is on a State-based exchange using the federal platform; or

(2) 2.75% of the total monthly premium charged by an issuer for each health benefits plan during any period that the State is on the State-based exchange. The Director of Insurance shall adjust this rate to ensure that the Illinois Health Benefits Exchange is fully funded, but in no case shall the assessment be applied at a rate that exceeds 4% of the total monthly premium charged by a carrier. If the Director determines it is necessary to adjust the rate pursuant to this paragraph, the Director shall, in advance of the adjustment, post on the Department's website a report describing the reasons and justifications for the adjustment, which shall be consistent with the purposes of supporting the Illinois Health Benefits Exchange as provided in this Section.

(b) The Director of Insurance shall notify an issuer of its assessment rate for the subsequent year. Issuers must remit the assessment due in monthly installments to the Department of Insurance.

(c) The assessment described in this Section shall be considered a special purpose obligation and may not be applied by issuers to vary premium rates at the plan level.

(d) There is created a revolving fund to be known as the Illinois Health Benefits Exchange Fund, to be held by the Department of Insurance. The Illinois Health Benefits Exchange Fund shall be the repository for moneys collected pursuant to fees or assessments on exchange issuers, federal financial participation as appropriate, and other moneys received as grants or otherwise appropriated for the purposes of supporting health insurance outreach, enrollment efforts, and plan management operations through an exchange. All moneys in the Fund shall be used only for the purpose of supporting the exchange through exchange operations, outreach, enrollment, and other means of supporting the exchange, including any efforts that may increase market stabilization and that may result in a net benefit to policyholders.

(215 ILCS 122/5-22 new)

Sec. 5-22. State medical assistance program coordination.

(a) The Department of Insurance and the Department of Healthcare and Family Services shall coordinate the operations of the exchange with the operations of State medical assistance programs. The Department of Healthcare and Family Services shall oversee and operate the exchange eligibility rules engine to ensure accurate assessments and determinations of exchange and State medical assistance program eligibility.

(b) The exchange may determine eligibility for State medical assistance programs that use the modified adjusted gross income methodology.

(c) The exchange may be used for enrollment into State medical assistance program health plans.

(d) The Department of Healthcare and Family Services shall request federal financial participation funds from the Centers for Medicare and Medicaid Services for any integrated eligibility and enrollment functions of the exchange.

(215 ILCS 122/5-23 new)

Sec. 5-23. Department of Insurance and Department of Healthcare and Family Services authority.

(a) The Department of Insurance and the Department of Healthcare and Family Services, in addition to the powers granted under the Illinois Insurance Code and the Illinois Public Aid Code, have the power necessary to establish and operate the Illinois Health Benefits Exchange, including, but not limited to, the authority to:

(1) adopt rules deemed necessary by the departments to implement this Law;

(2) employ or retain sufficient personnel to provide administration, staffing, and necessary related support required to adequately discharge the duties described in this Law from funds held in the Illinois Health Benefits Exchange Fund;

(3) procure services, including a call center, and goods for the purpose of establishing the Illinois Health Benefits Exchange as emergency purchases as set forth in Section 20-30 of the Illinois Procurement Code;

(4) require any exchange vendor to have experience operating a State-based exchange in another state; and

(5) implement programs that increase the affordability of or access to health insurance coverage, including for populations currently not eligible to enroll in the Illinois Health Benefits Exchange, through Section 1332 waivers under the federal Patient Protection and Affordable Care Act or other available federal waivers and authorities.

(b) The Department of Insurance has the authority to employ a Chief Operating Officer of the Illinois Health Benefits Exchange. The Chief Operating Officer shall be subject to confirmation by the Senate.

(215 ILCS 122/5-24 new)

Sec. 5-24. Illinois Health Benefits Exchange Advisory Committee.

(a) The Director of Insurance shall establish the Illinois Health Benefits Exchange Advisory Committee no later than December 31, 2023. The Illinois Health Benefits Exchange Advisory Committee shall be tasked with making recommendations to the Chief Operating Officer of the Illinois Health Benefits Exchange concerning the operation of the exchange, and the Committee shall hold its first meeting no later than 90 days following the establishment of the Committee and shall meet quarterly thereafter. The Chief Operating Officer shall make a quarterly report to the Committee.

(b) The Department of Insurance shall present regular and timely reports to the Illinois Health Benefits Exchange Advisory Committee regarding the progress in the development of the Illinois Health Benefits Exchange before its establishment by plan year 2026. The reports shall be posted to the Department of Insurance's website and include information on the Department of Insurance's progress toward establishing and maintaining the Illinois Health Benefits Exchange with the goal of ensuring an effective and efficient transition from the federal platform to the State-based exchange for individuals, employers, and health insurance issuers while mitigating loss of health insurance coverage for any potential consumer. The Department of Insurance's progress reports shall include information regarding transparency, user understandability, plan compliance, outreach and education, and systems operations. The Department of Insurance shall gather stakeholder input in developing operational plans and preparing the reports for the Illinois Health Benefits Exchange Advisory Committee.

(c) The Illinois Health Benefits Exchange Advisory Committee shall include 9 members, as follows:

(1) The Director of Insurance, or the Director's designee, who shall serve ex officio and as co-chair;

(2) The Director of Healthcare and Family Services, or the Director's designee, who shall serve ex officio and as co-chair;

(3) The Secretary of Human Services, or the Secretary's designee, who shall serve ex officio; and

(4) 6 public members, who shall be residents of the State, appointed by the Director of Insurance. The Director shall consider the diversity of this State in the selection of the committee members. Each public member shall have demonstrated experience in one or more of the following areas: health insurance consumer advocacy; enrollment and consumer assistance; individual health insurance coverage; providing health care services; or academic or professional research relating to health insurance.

(d) Members of the Illinois Health Benefits Exchange Advisory Committee shall serve for a term of 2 years, shall serve without compensation, and shall not be entitled to reimbursement. The Department of Insurance shall provide administrative support to the Illinois Health Benefits Exchange Advisory Committee.

(e) The Committee's quarterly meetings shall be open to the public and subject to the Open Meetings Act.

Section 99. Effective date. This Act takes effect upon becoming law.".