Commonwealth Care Health Benefits Program; association health plans for individual market.

JLARC; association health plans for the individual market;review. Directs the Joint Legislative Audit and Review Commission (JLARC),as part of its review and evaluation of the agencies and programs under theSecretary of Health and Human Services, to examine and review the implicationsof the establishment, implementation, and administration of a program, to beknown as the Commonwealth Care Health Benefits Program (the Program), underwhich a division of the State Corporation Commission (the Commission), ornonprofit corporation established by the Commission, will be the sponsor ofassociation health plans through which it will sell individual health insurancecoverage in the Commonwealth. The bill provides that JLARC shall request andconsider information and input from the Commission's Bureau of Insurance andthe Secretary of Health and Human Resources. The bill provides that elements ofthe Program to be reviewed and examined by JLARC shall include the following:(i) implementation of the Program would be contingent on the approval of theU.S. Secretary of Health and Human Services of a state innovation waiver under§ 1332 of the Affordable Care Act (ACA); (ii) the Commission will retain staffsufficient to establish and implement the Program; (iii) the Program willarrange for a number of third-party administrators, sufficient to ensurecompetition but in no event fewer than two; (iv) the Program will design andimplement health plans that are comparable those currently sold through thefederal exchange; (v) the covered benefits provided under a plan offeredthrough the Program would provide coverage that a large group plan orassociation health plan subject to the federal Employee Retirement IncomeSecurity Act of 1974 (ERISA) is required to provide so long as one or morehealth plans provide additional benefits as may be required to provide coveragethat is at least as comprehensive and affordable as plans currently offered onthe exchange pursuant to the ACA or otherwise to comply with the Guardrailrequirements of the ACA; (vi) the Program will address the establishment of areinsurance program; (vii) health plan premiums for individuals with ahousehold income between 100 percent and 400 percent of the federal povertylevel would be subsidized; (viii) the Program will offer a cost-sharingreduction feature that removes disincentives to Program participation bylow-income individuals who are enrolled in the Medicaid program; (ix)individuals will still be able to purchase individual health insurance coverageoutside of the Program; (x) premiums for the plans offered through the Programwill be set by the third-party administrators, subject to approval by theCommission with assistance of qualified actuaries; (xi) the Program would bedesigned and operated in order to ensure that any shortfall in revenues isaddressed by the reinsurance program and by self-funding a reserve that isdetermined by the Corporation's actuary to be adequate, and (xii) the Programwill include premium incentives for compliance with wellness or chronic diseasemanagement benefit programs. The bill requires JLARC to report its findings andconclusions to the Joint Committee for Health and Human Resources Oversight.