HB 100 — HEALTH INSURANCE EXCHANGE CHANGES

"qualified employer" means a e e , gh n d d i small employer that elects to make, at a minimum, all of the = = o h l ] b ,d i a º r employer's full-time employees eligible for one or more e r = t e w d qualified health plans in the small group market offered mthrough a nsmall oHJC/HB d100/a mPage :4 business health options program;

bM. r e t º o t n = .217021.1AIC February 17, 2020 (4:55pm) s k m e - 5 - e a n e d r e l u [ A d HJC/HB 100 through a small business health options program;

SFCºN»SFC SFCºM»SFC.

SFCºO»SFCN. SFCºN»SFC.

SFCºP»SFCO. SFCºO»SFC.

hP. SFCºQ»SFC SFCºP»SFC.

"small business health u » r options program" means a program operated by the exchange t h g e l i through which a qualified employer can provide its employees h r i s and their dependents with access to one or more qualified h , e h health plans;

and tQ. u g e b l e e , gh [H.] SFCºR»SFC SFCºQ»SFC.

"superintendent" means n d d i = = o h the superintendent of insurance." l ] b ,d i a º r SECTION 3.

Section 59A-23F-3 NMSA 1978 (being Laws 2013, e r = t e w d m a n o Chapter 54, Section 3, as amended) is amended to read:

d"59A-23F-3. m :

bNEW rMEXICO eHEALTH tINSURANCE ºEXCHANGE oCREATED--BOARD tCREATED.-- nHJC/HB =100/a .217021.1AICPage February5 17,A. 2020 (4:55pm) s k m e - 6 - e a n e d r e l u [ A d HJC/HB 100 "59A-23F-3.

NEW MEXICO HEALTH INSURANCE EXCHANGE CREATED--BOARD CREATED.-- A.

The exchange shall not duplicate, impair, enhance, supplant, infringe upon or replace, in whole or in any part, the powers, duties or authority of the superintendent, h including the superintendent's authority to review and approve g o premium rates pursuant to the provisions of the [New Mexico ] t hr g e Insurance Code.

iC. k h r i s [C.

TheAll exchangehealth shallinsurance notissuers purchaseand qualifiedhealth hmaintenance ,organizations t,authorized healthto plansconduct frombusiness insurancein healththis issuersstate and meeting the requirements of the rules promulgated by the superintendent pursuant to offerSection for59A-23F-7 eNMSA u1978, gthe eregulations bunder lfederal purchaselaw throughand the requirements established by the board shall be eligible to participate in the exchange.

eHJC/HB e100/a hPage n6 dD. d i D.] C.

All health insurance issuers and health = = o h l ] b ,d i a º e maintenance organizations authorized to conduct business in r i = r t e w d this state and meeting the requirements of the rules m a n o d m :

b e d s º o t n = .217021.1AIC February 17, 2020 (4:55pm) s k m e - 7 - e a n e d r e l u [ A d HJC/HB 100 promulgated by the superintendent pursuant to Section 59A-23F-7 NMSA 1978, [as well as meeting ] the [rules] regulations under [the] federal [act] law and the requirements established by the board shall be eligible to participate in the exchange.

[E.

] D.

and (3) six voting directors, three appointed by the president pro tempore of the senate, including one health care provider, and three appointed by the speaker of the house h of representatives, including one health insurance issuer.

One g o of the directors appointed by the president pro tempore of the t hr g e i k senate and one of the directors appointed by the speaker of the h r i s house of representatives shall be from a list of at least two h , t, candidates provided, respectively, by the minority floor leader e u g e b l e e h of the senate and by the minority floor leader of the house of n d d i = = o h representatives.

lE. ] b ,d i a º e [F.

]Except E.as provided in Subsection F of this section, managerial and full-time staff of the exchange shall be subject to applicable provisions of the Governmental Conduct Act and shall not have any direct or indirect affiliation with any health care provider, health insurance issuer or health care service provider.

ExceptHJC/HB as100/a providedPage in7 SubsectionF. [G] F of r i = r t e w d this section, managerial and full-time staff of the exchange m a n o d m :

bEach edirector d s º o t n = .217021.1AIC February 17, 2020 (4:55pm) s k m e - 8 - e a n e d r e l u [ A d HJC/HB 100 shall becomply subjectwith tothe applicableconflict- of-interest provisions of theSubsection GovernmentalE Conductof Actthis andsection, shallexcept notas havefollows: any direct or indirect affiliation with any health care provider, health insurance issuer or health care service provider.

[G.(1) directors who may be appointed from the board of directors of the New Mexico medical insurance pool shall not be considered to have a conflict of interest with respect to their association with that entity;

](2) F.the secretary of human services, or the secretary's designee, shall not be considered to have a conflict of interest with respect to the secretary's performance of the secretary's duties as secretary of human services;

Each(3) the director who is a health care provider shall complynot withbe theconsidered conflict-of-interestto provisionshave a conflict of Subsectioninterest [Farising ]from Ethat director's receipt of thispayment section,for exceptservices as follows:a health care provider;

(1)and (4) directors who mayare berepresentatives appointed from the [boards] board of directors of the New Mexico medical insurance pool [and the New Mexico health insurance allianceissuers ] shall not be considered to have a conflict of interest with respect to theirthose directors' association with [thosetheir entitiesrespective ]health thatinsurance entity;issuers.

(2)G. the secretary of human services, or the secretary's designee, shall not be considered to have a conflict of interest with respect to the secretary's performance of the secretary's duties as secretary of human h services;

g o (3) the director who is a health care provider t hr g e shall not be considered to have a conflict of interest arising i k h r i s from that director's receipt of payment for services as a h , t, health care provider;

and e u g e b l (4) directors who are representatives of e e h n d d i health insurance issuers shall not be considered to have a = = o h l ] b ,d i a º e conflict of interest with respect to those directors' r i = r t e w d association with their respective health insurance issuers.

m a n o d m :

b e d s º o t n = .217021.1AIC February 17, 2020 (4:55pm) s k m e - 9 - e a n e d r e l u [ A d HJC/HB 100 [H.

] G.

[I.HJC/HB 100/a Page 8 H.

] H.

[J.I.

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h (4) health care economics or health care g o actuarial science;

t hr g e i k (5) health care policy;

h r i s (6) the enrollment of underserved residents in h , t, health care coverage;

e u g e b l e e h (7) administration of a private or public n d d i = = o h health care delivery system;

l ] b ,d i a º e (8) information technology;

r i = r t e w d (9) starting a small business with fifty or mfewer aemployees; n o d m :

b e d s º o t n = .217021.1AIC February 17, 2020 (4:55pm) s k m e - 10 - e a n e d r e l u [ A d HJC/HB 100 fewer employees;

[K.J.

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[L.K.

]Except K.for the secretary of human services, the HJC/HB 100/a Page 9 non-health insurance issuer directors appointed by the governor shall be appointed for initial terms of three years or less, staggered so that the term of at least one director expires on June 30 of each year.

Except for the secretary of human services, the non-health insurance issuer directors appointed by the governor shall be appointed for initial terms of three years or less, staggered so that the term of at least one director expires on June 30 of each year.

The health insurance issuers appointed to the board shall, upon appointment, select one of them by lot to have an initial term ending on June 30 following one year of service and one to have an initial term ending on June 30 following two h years of service.

Following the initial terms, health g o insurance issuer directors shall be appointed for terms of two t hr g e years.

A director whose term has expired shall continue to i k h r i s serve until a successor is appointed by the respective h , t, appointing authority.

Health insurance issuer directors shall e u g e b l not serve two consecutive terms.

eL. e h n d d i [M.

]The L.exchange, members of the board and employees of the exchange shall operate consistent with provisions of the Governmental Conduct Act, the Inspection of Public Records Act, the Financial Disclosure Act, the Gift Act, the Whistleblower Protection Act, the Open Meetings Act and the Procurement Code and shall not be subject to the Personnel Act.

TheM. exchange, members of the board and = = o h l ] b ,d i a º e employees of the exchange shall operate consistent with r i = r t e w d provisions of the Governmental Conduct Act, the Inspection of m a n o d m :

bThe eboard dand sthe ºexchange oshall timplement n = .217021.1AIC February 17, 2020 (4:55pm) s k m e - 11 - e a n e d r e l u [ A d HJC/HB 100100/a PublicPage Records10 Act,performance-based thebudgeting Financialand Disclosuresubmit Act,annual thebudgets Giftfor Act, the Whistleblowerexchange Protectionto Act, the Opensecretary Meetingsof Actfinance and theadministration Procurement Code and shall not be subject to the Personnellegislative Act.finance committee.

[N.N.

] M.

The board and the exchange shall implement performance-based budgeting and submit annual budgets for the exchange to the secretary of finance and administration and the legislative finance committee.

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]Within P.thirty days of the effective date of the New Mexico Health Insurance Exchange Act, the board shall be fully appointed and the superintendent shall convene an organizational meeting of the board, during which the board shall elect a chair and vice chair from among the directors.

WithinThereafter, thirtyevery daysthree ofyears, the effective date of g o the New Mexico Health Insurance Exchange Act, the board shall telect hrin gopen e i k be fully appointed and the superintendent shall convene an h r i s organizational meeting of the board, during which the board h , t, shall elect a chair and vice chair from among the directors.

eThe uchair gand evice bchair l e e h Thereafter, every three years, the board shall electserve inno openmore nthan dtwo dconsecutive ithree-year =terms =as o h meeting a chair and vice chairchair. from among the directors.

TheQ. l ] b ,d i a º e chair and vice chair shall serve no more than two consecutive r i = r t e w d three-year terms as chair and vice chair.

m a n o d m :

b e d s º o t n = .217021.1AIC February 17, 2020 (4:55pm) s k m e - 12 - e a n e d r e l u [ A d HJC/HB 100 [R.

] Q.

[S.R.

]A R.director may be removed from the board by a HJC/HB 100/a Page 11 two-thirds majority vote of the directors.

A director may be removed from the board by a two-thirds majority vote of the directors.

[T.S.

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hT. [U.

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g o (1) meet at the call of the chair and no less t hr g e often than once per calendar quarter.

There shall be at least i k h r i s seven days' notice given to directors prior to any meeting.

h , t, There shall be sufficient notice provided to the public prior e u g e b l to meetings pursuant to the Open Meetings Act;

e e h n d d i (2) create, make appointments to and duly =consider =recommendations oof han ladvisory ]committee bor ,dcommittees imade aup ºof estakeholders, considerincluding recommendationshealth ofinsurance anissuers, advisoryhealth committeecare orconsumers, committeeshealth rcare iproviders, =health rcare tpractitioners, einsurance wproducers, dqualified madeemployer uprepresentatives ofand stakeholders,advocates includingfor healthlow- insuranceHJC/HB issuers,100/a mPage a12 nincome oor dunderserved mresidents; :

b e d s º o t n = .217021.1AIC February 17, 2020 (4:55pm) s k m e - 13 - e a n e d r e l u [ A d HJC/HB 100 health care consumers, health care providers, health care practitioners, SFCº brokers»SFC SFCºinsurance producers»SFC, qualified employer representatives and advocates for low-income or underserved residents;

h (5) designate a Native American liaison, who g o shall assist the board in developing and ensuring t hr g e i k implementation of communication and collaboration between the h r i s exchange and Native Americans in the state.

The Native h , t, American liaison shall serve as a contact person between the e u g e b l e e h exchange and New Mexico Indian nations, tribes and pueblos and n d d i = = o h shall ensure that training is provided to the staff of the l ] b ,d i a º e exchange, which may include training in:

r i = r t e w d m a n o (a) cultural competency;

d(b) mstate :and federal law relating to Indian health;

band e(c) dother smatters ºrelating oto tthe nHJC/HB =100/a .217021.1AICPage February13 17,functions 2020of (4:55pm)the sexchange kwith mrespect eto -Native 14Americans -in ethe astate; n e d r e l u [ A d HJC/HB 100 (b) state and federal law relating to Indian health;

and (c) other matters relating to the functions of the exchange with respect to Native Americans in the state;

[WithinNo sixtylater daysthan ofSeptember 1, 2020, the effectiveboard, datein ofcoordination thewith Newinsurance Mexicoproducers Healthappointed Insuranceand Exchangecompensated Act,by the boardinsurance industry, shall createreview aits preliminary plan of operation containingand provisionsapprove amendments to it as appropriate to ensure that the fair,exchange reasonableis andoperated equitableusing administrationbest ofpractices thefor exchange.state-based exchanges in business administration, consumer engagement and public outreach and marketing.

Within six months of the effective date of the New h Mexico Health Insurance Exchange Act, the board shall create g o and implement a final plan of operation containing provisions t hr g e to ensure that the exchange is administered using best i k h r i s practices in business administration] No later than September h , t, 1, 2020, the board, SFCºin coordination with insurance e u g e b l producers appointed and compensated by the insurance e e h n d d i industry»SFC, shall review its plan of operation and approve = = o h l ] b ,d i a º e amendments to it as appropriate to ensure that the exchange is r i = r t e w d operated using best practices for state-based exchanges in m a n o d m :

b e d s º o t n = .217021.1AIC February 17, 2020 (4:55pm) s k m e - 15 - e a n e d r e l u [ A d HJC/HB 100 business administration, consumer engagement and public outreach and marketing.

The [preliminary] plan of operation shall contain:

(1) [establish ] procedures to implement the provisions of the New Mexico Health Insurance Exchange Act, consistent with state and federal law;

(2) [establish ] procedures for handling and accounting for the exchange's assets and money;

[and ] (3) [establish ] regular times and meeting places for HJC/HB 100/a Page 14 meetings of the board;

[D.(4) a statewide consumer assistance program, including a navigator program;

The(5) finalprocedures planfor ofconsumer operationcomplaints shall:and grievances for issues relating to the exchange;

(1)(6) establish]procedures (4)for aalternative statewidedispute consumerresolution assistancebetween program,the includingexchange aand navigatorcontractors program;or health insurance issuers;

h(7) [(2)policies establishthat: ] (5) procedures for consumer g o [complaint ] complaints and [grievance procedures] grievances t hr g e i k for issues relating to the exchange;

h(a) rpromote ieffective scommunication [(3)and establishcollaboration ]between (6)the proceduresexchange forand hIndian ,nations, t,tribes alternativeand disputepueblos, resolutionincluding betweencommunicating the exchange and ecollaborating uon gthose enations', btribes' land epueblos' eplans hfor contractorscreating or participating in health insurance issuers;exchanges;

n d d i = = o h [(4) develop and implement ] (7) policies l ] b ,d i a º e that:

r i = r t e w d (a) promote effective communication and m a n o d m :

b e d s º o t n = .217021.1AIC February 17, 2020 (4:55pm) s k m e - 16 - e a n e d r e l u [ A d HJC/HB 100 collaboration between the exchange and Indian nations, tribes and pueblos, including communicating and collaborating on those nations', tribes' and pueblos' plans for creating or participating in health insurance exchanges;

[(5) establish ] (8) conflict-of-interest policies and procedures;

[and ] (9) details on the contents of the reports required pursuant to the New Mexico Health Insurance Exchange Act;

and [(6) contain additional] (10) provisions necessary and proper for the execution of the powers and duties of the board and exchangeexchange." ." SECTION 5.

Section 59A-23F-7 NMSA 1978 (being Laws HJC/HB 100/a Page 15 2013, Chapter 54, Section 7) is amended to read:

h "59A-23F-7.

SUPERINTENDENT OF INSURANCE--RULEMAKING.--TheINSURANCE--RULEMAKING.-- gThe o superintendent shall coordinate with the board to promulgate t hr g e rules necessary to implement and carry out the provisions of i k h r i s the New Mexico Health Insurance Exchange Act, including rules h , t, to establish the criteria for certification of qualified health e u g e b l plans." e e h n d d i SECTION 6.

A new section of the New Mexico Health = = o h l ] b ,d i a º e Insurance Exchange Act is enacted to read:

r"BOARD--ADDITIONAL iDUTIES =AND rPOWERS.--In taddition eto wother dduties "[NEWand MATERIAL]powers BOARD--ADDITIONALin DUTIESthe ANDNew POWERS.--InMexico mHealth aInsurance nExchange oAct, dthe mboard :shall:

b e d s º o t n = .217021.1AIC February 17, 2020 (4:55pm) s k m e - 17 - e a n e d r e l u [ A d HJC/HB 100 addition to other duties and powers in the New Mexico Health Insurance Exchange Act, the board shall:

establish policies and procedures that allow HJC/HB 100/a Page 16 city, county and state governments, Indian nations, tribes and h pueblos, tribal organizations, urban Native American g o organizations, private foundations and other entities to pay t hr g e i k premiums and cost-sharing on behalf of qualified individuals h r i s consistent with federal requirements;

h , t, C.

provide for the operation of a toll-free hotline e u g e b l e e h to respond to requests for assistance, using staff that is n d d i = = o h trained to provide assistance in a culturally and l ] b ,d i a º e linguistically appropriate manner;

r i = r t e w d D.

provide for an annual regular enrollment period mand aspecial nenrollment operiods din mthe :best interest of qualified individuals and qualified small employers;

b e d s º o t n = .217021.1AIC February 17, 2020 (4:55pm) s k m e - 18 - e a n e d r e l u [ A d HJC/HB 100 and special enrollment periods in the best interest of qualified individuals and qualified small employers;

inform individuals of eligibility requirements HJC/HB 100/a Page 17 for medicaid, the children's health insurance program or other applicable state or local public programs.

If the exchange h assesses that an individual may be eligible for a program, the g o board shall share information with that program to facilitate t hr g e the eligibility determination and enrollment of the individual;

i k h r i s I.

establish and make available by electronic means h , t, a calculator to determine the actual cost of coverage after the e u g e b l application of any premium tax credits and cost-sharing e e h n d d i reductions under applicable federal or state law;

= = o h l ] b ,d i a º e J.

perform duties required of, or delegated to, the rexchange iby =the rsecretary tof ethe wUnited dStates exchangedepartment byof thehealth secretaryand ofhuman services or the United States departmentsecretary of mthe atreasury nrelated oto ddetermining meligibility :for premium tax credits or reduced cost sharing;

b e d s º o t n = .217021.1AIC February 17, 2020 (4:55pm) s k m e - 19 - e a n e d r e l u [ A d HJC/HB 100 health and human services or the United States secretary of the treasury related to determining eligibility for premium tax credits or reduced cost sharing;

(1) enable a qualified employer to specify a level of coverage so that its employees may enroll in a HJC/HB 100/a Page 18 qualified health plan offered through the small business health options program exchange at the specified level of coverage;

or (2) enable a qualified employer to provide a specific amount or other payment formulated in accordance with h federal law to be used as part of an employee's choice of g o plan." t hr g e i k SECTION 7.

A new section of the New Mexico Health h r i s Insurance Exchange Act is enacted to read:

h"STANDARDIZED , t, "[NEW MATERIAL ] STANDARDIZED HEALTH PLANS.-- e u g e b l e e h A.

The board may establish no more than three n d d i = = o h standardized health plans for each of three levels of coverage l ] b ,d i a º e with increasing benefits, designated bronze, silver and gold r i = r t e w d m a n o plans.

dB. m :

b e d s º o t n = .217021.1AIC February 17, 2020 (4:55pm) s k m e - 20 - e a n e d r e l u [ A d HJC/HB 100 B.

HJC/HB 100/a Page 19 (7) reduce barriers to maintaining and improving health;

h D.

The board shall provide for notice and public g o comment before finalizing each year's standardized health t hr g e plans.

i k h r i s E.

The board shall establish a procedure and time h , t, line for providing written notice of the standardized health e u g e b l plans to health insurance issuers before the year in which the e e h n d d i health plans are to be offered on the exchange.

= = o h l ] b ,d i a º e F.

Beginning on January 1, 2022, the board may r i = r t e w d require a health insurance issuer offering a qualified health mplan athrough nthe oexchange dto moffer :one silver standardized health plan and one gold standardized health plan on the exchange.

b e d s º o t n = .217021.1AIC February 17, 2020 (4:55pm) s k m e - 21 - e a n e d r e l u [ A d HJC/HB 100 plan through the exchange to offer one silver standardized health plan and one gold standardized health plan on the exchange.

The actuarial value of nonstandardized silver health plans offered through the exchange shall not be less HJC/HB 100/a Page 20 than the actuarial value of the standardized silver health plan with the lowest actuarial value." SECTION 8.

"[NEW"REPORTING.--The MATERIAL] REPORTING.--The board shall make reports h publicly available as follows:

g o A.

during all exchange open enrollment periods t hr g e i k beginning on or after October 1, 2021, the board shall produce h r i s weekly reports that include information on:

h , t, (1) applications;

e u g e b l e e h (2) plan selections;

n d d i = = o h (3) new enrollees;

l ] b ,d i a º e (4) enrollees renewing coverage;

r i = r t e w d m a n o (5) call center volume;

and d(6) mwebsite :traffic;

b e d s º o t n = .217021.1AIC February 17, 2020 (4:55pm) s k m e - 22 - e a n e d r e l u [ A d HJC/HB 100 (6) website traffic;

HJC/HB 100/a Page 21 (2) on- and off-exchange enrollment and demographics;

and h u » r (7) the remaining uninsured in New Mexico and t h g e strategies to reach them." lHJC/HB i100/a hPage r22 -25 23 - i s h , e h t u g e b l e e , gh n d d i = = o h l ] b ,d i a º r e r = t e w d m a n o d m :

b r e t º o t n = .217021.1AIC February 17, 2020 (4:55pm) s k m e e a n e d r e l u [ A d