Source: https://development.code.dccouncil.us/dc/council/code/titles/31/chapters/31D/
Timestamp: 2019-04-23 12:27:07+00:00

Document:
D.C. Law Library - Chapter 31D. Health Benefit Exchange.
§ 31–3171.02. Establishment and purpose.
§ 31–3171.06. Powers and duties of executive board.
§ 31–3171.08. Executive director and Authority staff.
§ 31–3171.09. Health benefit plan certification.
§ 31–3171.09a. Distribution of individual and small group health benefit plans.
§ 31–3171.09b. Sale, solicitation, and negotiation by insurance producers.
§ 31–3171.10. Conflicts of interest.
§ 31–3171.12. Limitation of liability.
§ 31–3171.13. Relation to other laws.
§ 31–3171.14. Powers of the Mayor.
§ 31–3171.15. Dissolution of the Authority.
§ 31–3171.16. Implementation and reports.
(1) “American Health Benefit Exchange” means an entity established pursuant to § 31-3171.04, and section 1311(b) of the Federal Act.
(2) “Authority” means the District of Columbia Health Benefit Exchange Authority established by § 31-3171.02.
(3) “Commissioner” means the Commissioner of the Department of Insurance, Securities and Banking, as established by § 31-102.
(3A) “Direct gross receipts” means all policy and membership fees and net premium receipts or consideration received in a calendar year on all health insurance carrier risks originating in or from the District of Columbia.
(4) “Federal Act” means the Patient Protection and Affordable Care Act, approved March 23, 2010 (124 Stat. 119; 42 U.S.C. § 18001, note), as amended by the Health Care and Education Reconciliation Act of 2010 approved March 30, 2010 (124 Stat. 1029; 42 U.S.C. § 1305, note), and any amendments, regulations, or guidance issued pursuant to the Federal Act.
(5)(A) “Health benefit plan” means a policy, contract, certificate, or agreement offered or issued by a health carrier to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services.
(viii) Other similar insurance coverage, specified in federal regulations issued pursuant to the Health Insurance Portability and Accountability Act of 1996, approved August 21, 1996 (110 Stat. 1936; 42 U.S.C. § 201, note) (“HIPAA”), under which benefits for health care services are secondary or incidental to other insurance benefits.
(iii) Other similar, limited benefits specified in federal regulations issued pursuant to HIPAA.
(ii) Hospital indemnity or other fixed indemnity insurance.
(iii) Similar supplemental coverage provided to coverage under a group health plan.
(D) Any other entity providing a health benefit plan.
(7) “Health professional” shall have the same meaning as provided in § 3-1201.01(8).
(8) “Internal Revenue Code of 1986” means the Internal Revenue Code of 1986, approved August 16, 1954 (100 Stat. 2095; 26 U.S.C. § 1 et seq.).
(8A) “Metal level” means the bronze, silver, gold, and platinum levels of coverage as defined in section 1302(d)(1) of the Federal Act.
(8B) “Navigator” refers to the entities described in section 1311(i) of the Federal Act.
(8C) “Net premium receipts or consideration received” means gross premiums or consideration received less the sum of premiums received for reinsurance assumed and premiums or consideration returned on policies or contracts canceled or not taken.
(9) “PHSA” means the Public Health Service Act, approved July 1, 1944 (58 Stat. 682; 42 U.S.C. § 201 et seq.).
(10) “Qualified dental plan” means a limited-scope dental plan that has been certified in accordance with § 31-3171.09.
(B) Elects to provide coverage through the SHOP Exchange to all of its eligible employees who are principally employed in the District.
(12) “Qualified health plan” means a health benefit plan that has a certification validating that the plan meets the criteria for certification described in section 1311(c) of the Federal Act and § 31-3171.09.
(D) Is, and is reasonably expected to be, for the entire period for which enrollment is sought, a citizen or national of the United States or an alien lawfully present in the United States.
(14) “Secretary” means the Secretary of the United States Department of Health and Human Services.
(15) “SHOP Exchange” means a Small Business Health Options Program Exchange established pursuant to § 31-3171.04, and section 1311(b) of the Federal Act.
(16)(A) “Small employer” means a single employer that employed an average of not more than 50 employees during the preceding calendar year.
(i) All persons treated as a single employer under section 414(b), (c), (m), or (o) of the Internal Revenue Code of 1986 (26 U.S.C. § 414(b), (c), (m), or (o)) shall be treated as a single employer.
(ii) An employer and any predecessor employer shall be treated as a single employer.
(iii) All employees shall be counted, including part-time employees and employees who are not eligible for health benefit coverage through the employer.
(iv) If an employer was not in existence throughout the preceding calendar year, the determination of whether that employer is a small employer shall be based on the average number of employees that employer is reasonably expected to employ in the current calendar year.
(v) An employer that makes enrollment in qualified health plans available to its employees through the SHOP Exchange and would cease to be a small employer by reason of an increase in the number of its employees shall continue to be treated as a small employer for purposes of this chapter as long as it continuously makes enrollment through the SHOP Exchange available to its employees.
(17) “Social Security Act” means the Social Security Act, approved August 14, 1935 (49 Stat. 620; 42 U.S.C. § 301 et seq.), as amended.
(18) “Standardized plan” means a plan with defined benefits and cost sharing as determined by the executive board for the Authority.
The 2014 amendment by D.C. Law 20-123 added (8A), (8B), and (18).
The 2015 amendment by D.C. Law 21-13 added (3A) and (8C).
For temporary (90 days) amendment of this section, see § 2(a) of the Better Prices, Better Quality, Better Choices for Health Coverage Emergency Act of 2013 (D.C. Act 20-87, June 19, 2013, 60 DCR 9542, 20 DCSTAT 1446).
For temporary (90 days) amendment of this section, see §§ 2(a) and 3 of the Better Prices, Better Quality, Better Choices for Health Coverage Congressional Review Emergency Amendment Act of 2013 (D.C. Act 20-170, September 26, 2013, 60 DCR 14742).
For temporary (90 days) amendment of this section, see § 2(a) of the Health Benefit Exchange Authority Financial Sustainability Emergency Amendment Act of 2014, (D.C. Act 20-329, May 22, 2014, 61 DCR 5363).
For temporary (90 days) amendment of this section, see § 2(a) of the Better Prices, Better Quality, Better Choices for Health Coverage Emergency Amendment Act of 2014, (D.C. Act 20-335, May 22, 2014, 61 DCR 5375).
For temporary (90 days) amendment of this section, see § 2(a) of the Health Benefit Exchange Authority Financial Sustainability Congressional Review Emergency Amendment Act of 2014 (D.C. Act 20-395, July 29, 2014, 61 DCR 8078).
For temporary (90 days) amendment of this section, see § 2(a) of the Health Benefit Exchange Authority Financial Sustainability Emergency Amendment Act of 2015 (D.C. Act 21-17, Mar. 26, 2015, 62 DCR 3853, 21 DCSTAT 849).
For temporary (225 days) amendment of this section, see § 2(a) of the Better Prices, Better Quality, Better Choices for Health Coverage Temporary Amendment Act of 2013 (D.C. Law 20-22, October 3, 2013, 60 DCR 10880).
For temporary (225 days) amendment of this section, see § 2(a) of the Health Benefit Exchange Authority Financial Sustainability Temporary Amendment Act of 2014 (D.C. Law 20-133, Aug. 8, 2014, 61 DCR 6340).
For temporary (225 days) amendment of this section, see § 2(a) of the Health Benefit Exchange Authority Financial Sustainability Temporary Amendment Act of 2015 (D.C. Law 21-5, June 4, 2015, 62 DCR 4560).
(a) There is established, as an independent authority of the District government, the District of Columbia Health Benefit Exchange Authority. The Authority shall be an instrumentality, created to effectuate the purposes stated in this chapter, that shall have a legal existence separate from the District government.
(7) Assist individuals and groups to access programs, premium assistance tax credits, and cost-sharing reductions.
This section is referenced in § 31-3171.01.
(a) There is established as a nonlapsing fund the District of Columbia Health Benefit Exchange Authority Fund (“Fund”), which shall be administered by the Authority in accordance with generally accepted accounting principles and which shall be used solely for the purposes set forth in this chapter and the costs of administering this chapter.
(8) Any other money from any other source accepted for the benefit of the Fund.
(c) All revenues, income from investments, proceeds, and other monies, from whatever source derived, that are collected or received by the Authority shall be deposited into the Fund. All funds deposited into the Fund, and any interest earned on those funds, shall not revert to the unrestricted fund balance of the General Fund of the District of Columbia at the end of a fiscal year, or at any other time, but shall be continually available for the uses and purposes set forth in this chapter without regard to fiscal year limitation, subject to authorization by Congress.
(d) The Chief Financial Officer shall invest the money of the Fund in the same manner as other District money may be invested.
(C) Other assessments on health carriers selling qualified dental plans or qualified health plans in the District, including qualified health plans and qualified dental plans sold outside the exchanges.
(2) User fees, licensing fees, or other assessments authorized shall not exceed reasonable projections regarding the amount necessary to support the operations of the Authority.
(3) The assessment on health carriers pursuant to subsection (f) of this section shall be a tax and licensing and regulatory fee for purposes of 45 CFR §§ 158.221(c) and 158.161(b).
(f)(1) The Authority shall annually assess, through a Notice of Assessment, each health carrier doing business in the District with direct gross receipts of $50,000 or greater in the preceding calendar year an amount based on a percentage of its direct gross receipts for the preceding calendar year. These assessments shall be deposited in the Fund.
(2) The Authority shall adjust the assessment rate in each assessable year. The amount assessed shall not exceed reasonable projections regarding the amount necessary to support the operations of the Authority.
(3) Each health carrier shall pay to the Authority the amount stated in the Notice of Assessment within 30 business days after the date of the Notice of Assessment.
(4) Failure to pay the assessment in accordance with paragraph (3) of this subsection shall subject the health carrier to § 31-1204.
The 2015 amendment by D.C. Law 21-13 added (f).
For temporary (90 days) amendment of this section, see § 2(b) of the Health Benefit Exchange Authority Financial Sustainability Emergency Amendment Act of 2014, (D.C. Act 20-329, May 22, 2014, 61 DCR 5363).
For temporary (90 days) amendment of this section, see § 2(b) of the Health Benefit Exchange Authority Financial Sustainability Congressional Review Emergency Amendment Act of 2014 (D.C. Act 20-395, July 29, 2014, 61 DCR 8078).
For temporary (90 days) amendment of this section, see § 5083 of the Fiscal Year 2015 Budget Support Emergency Act of 2014 (D.C. Act 20-377, July 14, 2014, 61 DCR 7598, 20 STAT 3696).
For temporary (90 days) amendment of this section, see § 5083 of the Fiscal Year 2015 Budget Support Congressional Review Emergency Act of 2014 (D.C. Act 20-449, October 10, 2014, 61 DCR 10915, 20 STAT 4188).
For temporary (90 days) amendment of this section, see § 5083 of the Fiscal Year 2015 Budget Support Second Congressional Review Emergency Act of 2014 (D.C. Act 20-566, January 9, 2015, 62 DCR 884, 21 STAT 541).
For temporary (90 days) amendment of this section, see § 2(b) of the Health Benefit Exchange Authority Financial Sustainability Emergency Amendment Act of 2015 (D.C. Act 21-17, Mar. 26, 2015, 62 DCR 3853, 21 DCSTAT 849).
For temporary (225 days) amendment of this section, see § 2(b) of the Health Benefit Exchange Authority Financial Sustainability Temporary Amendment Act of 2014 (D.C. Law 20-133, Aug. 8, 2014, 61 DCR 6340).
For temporary (225 days) amendment of this section, see § 2(b) of the Health Benefit Exchange Authority Financial Sustainability Temporary Amendment Act of 2015 (D.C. Law 21-5, June 4, 2015, 62 DCR 4560).
(1) Seven voting members, who shall be residents of the District of Columbia, appointed by the Mayor, with the advice and consent of the Council pursuant to § 1-523.01(f).
(D) Director of the Department of Human Services.
(D) Two shall be for a term of 5 years.
(2)(A) A member of the executive board may continue to serve until his or her successor has been approved by the Council and appointed by the Mayor.
(B) Vacancies shall be filled by Mayoral appointment for the unexpired term in the same manner of the original appointment.
(C) A member of the executive board, upon findings by the Mayor, may be removed for incompetence, misconduct, or failure to perform the duties of the position.
(L) Enrolling individuals into health benefit plans.
(2) The Mayor shall consider the expertise of each of the members of the executive board and attempt to make appointments so that the executive board’s composition reflects a diversity of expertise.
(3) At least one voting member of the executive board shall have demonstrated knowledge in health care consumer interest advocacy.
(d) Each member of the executive board shall have the responsibility and duty to meet the requirements of this chapter, the Federal Act, and all applicable District and federal laws and regulations, to serve the public interest of the individuals and small businesses seeking health care coverage through the exchanges, and to ensure the operational effectiveness and fiscal solvency of the Authority.
(e) The executive board shall elect a chairperson on an annual basis.
(f) Executive board members shall receive no compensation for their services but shall receive actual and necessary expenses incurred in the performance of their official duties.
(g) The Mayor shall nominate a majority of the executive board members within 90 days of March 2, 2012.
(a) Subject to any limitations under this chapter, or other applicable law, the executive board shall have all the powers necessary to carry out the functions authorized by the Federal Act and consistent with the purposes of the Authority.
(b) The enumeration of specific powers in this chapter is not intended to restrict the executive board’s power to take any lawful action that it determines is necessary to carry out the functions authorized by the Federal Act and is consistent with the purposes of the Authority.
(7) Do all things necessary in conformity with the law to exercise the powers granted by this chapter.
(E) Any other entities that have experience in individual and small group public and private health insurance plans or in facilitating enrollment in those plans.
(2) The executive board shall ensure that any entity under a contract with the Authority complies with the provisions of this chapter when performing services on behalf of the Authority that are subject to this chapter.
(e)(1) The executive board may enter into information-sharing agreements with federal agencies, District agencies, agencies of one or more states, and other state health insurance exchanges to carry out the provisions of this chapter.
(B) Comply with all District and federal laws and regulations.
(f) The executive board shall adopt written policies and procedures, which shall be made publicly accessible on the Authority’s website and published in the District of Columbia Register, governing all procurements of the Authority.
(g) The executive board may limit the number of plans offered in the exchanges using selective criteria or contracting; provided, that individuals and employers have an adequate number and selection of choices.
(h) The executive board may merge the exchanges for individual coverage within the American Health Benefits Exchange and the SHOP Exchange if a merger is considered by the Authority to be in the best interest of the District.
The 2014 amendment by D.C. Law 20-94 substituted “policies and procedures, which shall be made publicly accessible on the Authority’s website and published in the District of Columbia Register” for “policies and procedures” in (f).
For temporary (90 days) amendment of this section, see § 3(b) of the Procurement Practices Reform Exemption Emergency Amendment Act of 2014 (D.C. Act 20-282, February 20, 2014, 61 DCR 1576).
(a) In addition to the executive board, there shall be a standing advisory board consisting of 9 members, who shall be residents of the District.
(b) The executive board may create additional advisory boards as it considers appropriate.
(6) Any other policy or operational issues, within the executive board’s discretion.
(6) Appoint the chair of any additional advisory boards created.
(e)(1) An advisory board member may continue to serve until the appointment of his or her successor.
(2) Vacancies shall be filled by appointment by the executive board for the unexpired term of the appointee’s predecessor.
(10) Such other interests considered necessary.
(a) The executive board shall hire an executive director within 60 days of a majority of executive board members being confirmed to organize, administer, and manage the operations of the Authority.
(1) The executive director shall not be an employee in the career service and shall serve at the pleasure of the executive board.
(2) The executive director shall become a resident of the District within 180 days of the date of hire.
(b) The executive board shall determine the appropriate compensation for the executive director; provided, that the executive director’s compensation shall not exceed the maximum allowable salary in the District of Columbia Excepted Service salary schedule.
(3) Perform all duties necessary to comply with and carry out the provisions of this chapter, other District laws and regulations, and the Federal Act.
(d)(1) The executive director may employ and retain staff for the Authority.
(C) Other professionals or consultants necessary to carry out the planning, development, and operations of the Authority and the provisions of this chapter.
(3) Employee compensation shall not exceed the maximum allowable salary in the District of Columbia Excepted Service salary schedule.
(e) Except as otherwise provided in this chapter, an employee or independent contractor of the Authority shall not be subject to any law, regulation or Mayor’s Order governing District government compensation, including furloughs, pay cuts, or any other general fund cost-saving measure.
(10) Provide benefits identical to the essential health benefits benchmark plan, as defined in federal regulations promulgated pursuant to section 1302(a) of the Federal Act, as defined by the District without benefit substitution.
(4) On the basis of the number of qualified health plans being offered.
(ix) Other information as determined appropriate by the Secretary.
(4) Promptly notify affected individuals of price and benefit changes, or other changes in circumstances that could materially impact enrollment or coverage.
(d) The Authority shall not exempt any health carrier seeking certification as a qualified health plan, regardless of the type or size of the health carrier, from District licensure or solvency requirements, and shall apply the criteria of this section in a manner that assures a level playing field between or among health carriers participating in the exchanges.
(e)(1) The provisions of this chapter that are applicable to qualified health plans shall also apply, to the extent relevant, to qualified dental plans except as modified in accordance with the provisions of paragraphs (2), (3) and (4) of this subsection or by regulations adopted by the Authority.
(2) The health carrier shall be licensed to offer dental coverage, but need not be licensed to offer other health benefits.
(3) The plan shall be limited to dental and oral health benefits, without substantially duplicating the benefits typically offered by health benefit plans without dental coverage and shall include, at a minimum, the essential pediatric dental benefits prescribed by the Secretary pursuant to section 1302(b)(1)(J) of the Federal Act, and such other dental benefits as the Authority or the Secretary may specify by regulation.
(4) Health carriers may jointly offer a comprehensive plan through the exchanges in which the dental benefits are provided by a health carrier through a qualified dental plan and the other benefits are provided by a health carrier through a qualified health plan; provided, that the plans are priced separately and are also made available for purchase separately at the same price.
(f) The Authority shall take the information required by subsection (c)(1) of this section, along with the information and the recommendations provided to the Authority by the Commissioner under section 2794(b) of the PHSA, into consideration when determining whether to allow the health carrier to make plans available through the exchanges.
(g) A qualified health plan may provide additional services that are not in the essential health benefits package required in subsection (a)(1) of this section, if the services are eligible for claims submission and reimbursement.
(h) For the purposes of the essential health benefits benchmark plan, as defined in federal regulations promulgated pursuant to section 1302(a) of the Federal Act, the term “habilitative services” includes health care services that help a person keep, learn, or improve skills and functioning for daily living, including applied behavioral analysis for the treatment of autism spectrum disorder.
This section is referenced in § 31-3171.01 and § 31-3171.04.
The 2014 amendment by D.C. Law 20-123 added “at least one qualified health plan at the bronze level,” in (a)(5)(B)(i); deleted “and” at the end of (a)(5)(D); added (a)(5)(F), (a)(5)(G), and (a)(5)(H); made minor stylistic changes in (a)(6) and (a)(7); added (a)(8), (a)(9), and (a)(10); made minor stylistic changes in (b)(2) and (b)(3); and added (b)(4), (g), and (h).
For temporary (90 days) amendment of this section, see § 2(b) of the Better Prices, Better Quality, Better Choices for Health Coverage Emergency Act of 2013 (D.C. Act 20-87, June 19, 2013, 60 DCR 9542, 20 DCSTAT 1446).
For temporary (90 days) addition of D.C. Law 19-94, § 10a, see §§ 2(c) and 3 of the Better Prices, Better Quality, Better Choices for Health Coverage Congressional Review Emergency Amendment Act of 2013 (D.C. Act 20-170, September 26, 2013, 60 DCR 14742).
For temporary (90 days) amendment of section, see § 2(b) of the Better Prices, Better Quality, Better Choices for Health Coverage Emergency Amendment Act of 2014, (D.C. Act 20-335, May 22, 2014, 61 DCR 5375).
For temporary (225 days) addition of D.C. Law 19-94, § 10a, concerning distribution of individual and small group health benefit plans, see § 2(c) of the Better Prices, Better Quality, Better Choices for Health Coverage Temporary Amendment Act of 2013 (D.C. Law 20-22, October 3, 2013, 60 DCR 10880).
For temporary (225 days) addition of D.C. Law 19-94, § 10b, concerning sale, solicitation, and negotiation by insurance producers, see §2(c) of the Better Prices, Better Quality, Better Choices for Health Coverage Temporary Amendment Act of 2013 (D.C. Law 20-22, October 3, 2013, 60 DCR 10880).
For temporary (225 days) amendment of this section, see § 2(b) of the Better Prices, Better Quality, Better Choices for Health Coverage Temporary Amendment Act of 2013 (D.C. Law 20-22, October 3, 2013, 60 DCR 10880).
(4) Unless the Council acts by October 1, 2014 to change the date that all small group health plans shall be offered, issued, or renewed through the American Health Benefit Exchange, on or after January 1, 2015, all small group health benefit plans shall be offered and issued or renewed solely through the American Health Benefit Exchange.
(b) The requirements of this section shall not apply to grandfathered health plans as defined in section 1251 of the Federal Act.
For temporary (90 days) addition of this section, see § 2(c) of the Better Prices, Better Quality, Better Choices for Health Coverage Emergency Amendment Act of 2013 (D.C. Act 20-87, June 19, 2013, 60 DCR 9542, 20 DCSTAT 1446).
For temporary (90 days) addition of this section, see §§ 2(c) and 3 of the Better Prices, Better Quality, Better Choices for Health Coverage Congressional Review Emergency Amendment Act of 2013 (D.C. Act 20-170, September 26, 2013, 60 DCR 14742).
For temporary (90 days) addition of this section, see § 2(c) of the Better Prices, Better Quality, Better Choices for Health Coverage Emergency Amendment Act of 2014 (D.C. Act 20-335, May 22, 2014, 61 DCR 5375).
For temporary (225 days) addition of this section, see § 2(c) of the Better Prices, Better Quality, Better Choices for Health Coverage Temporary Amendment Act of 2013 (D.C. Law 20-22, October 3, 2013, 60 DCR 10880).
(a) An insurance producer that is licensed in the District and authorized by the Commissioner to sell, solicit, or negotiate health insurance pursuant to Chapter 11A of Title 31 [§ 31-1131.02 et seq.], may sell any qualified health plan offered in the American Health Benefit Exchange, after satisfactorily completing training developed and provided by the Authority.
(b) An insurance producer shall be compensated directly by a health carrier for the sale of a qualified health plan offered in the American Health Benefit Exchange.
For temporary (90 days) addition of section, see § 2(c) of the Better Prices, Better Quality, Better Choices for Health Coverage Emergency Amendment Act of 2013 (D.C. Act 20-87, June 19, 2013, 60 DCR 9542, 20 DCSTAT 1446).
For temporary (90 days) addition of section, see §§ 2(a) and 3 of the Better Prices, Better Quality, Better Choices for Health Coverage Congressional Review Emergency Amendment Act of 2013 (D.C. Act 20-170, September 26, 2013, 60 DCR 14742).
For temporary (90 days) addition of section, see § 2(c) of the Better Prices, Better Quality, Better Choices for Health Coverage Emergency Amendment Act of 2014, (D.C. Act 20-335, May 22, 2014, 61 DCR 5375).
For temporary (225 days) addition of section, see § 2(c) of the Better Prices, Better Quality, Better Choices for Health Coverage Temporary Amendment Act of 2013 (D.C. Law 20-22, October 3, 2013, 60 DCR 10880).
(a)(1) A member of the executive board or of the staff of the Authority shall not be employed by, a consultant to, a member of the board of directors of, affiliated with, or otherwise a representative of, a health carrier or other insurer, an agent or broker, a health professional, or a health care facility or health clinic while serving on the board or on the staff of the Authority.
(2) A member of the executive board or of the staff of the Authority shall not be a member, a board member, or an employee of a trade association of health carriers, health facilities, health clinics, or health professionals while serving on the board or on the staff of the Authority.
(3) A member of the executive board or of the staff of the Authority shall not be a health professional unless he or she receives no compensation for rendering services as a health professional and does not have an ownership interest in a professional health care practice.
(b) No member of the executive board or of the staff of the Authority shall, for one year after the end of the member’s service on the board or employment by the Authority, accept employment with any health carrier that offers a qualified health benefit plan through the exchanges.
(1) Any source of income, other than gifts and other than loans by a commercial lending institution in the regular course of business on terms available to the public without regard to official status, aggregating $250 or more in value provided to, received by, or promised to the member within 12 months prior to the time when the decision is made.
(2) Any business entity in which the member is a director, officer, partner, trustee, or employee, or holds any position of management.
The executive and advisory boards shall be subject to subchapter IV of Chapter 5 of Title 2 [§ 2-571 et seq.]; except, that the executive board may hold closed sessions when considering matters related to litigation, personnel, contracting, or rates.
There shall not be any liability, in a private capacity, on the part of the executive or advisory board members, or any officer, or employee of the executive or advisory board, for or on account of any act performed or obligation entered into in an official capacity when done in good faith, without intent to defraud, and in connection with the administration, management, or conduct of this chapter or affairs related to this chapter.
(a) Nothing in this chapter, and no action taken by the Authority pursuant to this chapter, shall be construed to preempt or supersede the authority of the Commissioner to regulate the business of insurance within the District. Except as expressly provided to the contrary in this chapter, all health carriers offering qualified health plans and qualified dental plans in the District shall comply fully with all applicable health insurance laws of the District and regulations adopted and orders issued by the Commissioner.
(b) Nothing in this chapter, and no action taken by the Authority pursuant to this chapter, shall be construed to preempt or supersede the authority of the Department of Health Care Finance, as the single state agency, to establish policy and enforce the rules and regulations governing Titles XIX and XXI of the Social Security Act and other health-care programs under its jurisdiction.
(2) The executive board has hired an executive director.
(3) The expenditure of any net earnings shall be restricted to costs related to the direct delivery of health care to residents of the District.
(2) Report its findings under paragraph (1) of this subsection to the Mayor, Council, and public within 180 days of March 2, 2012.
(b)(1) The executive board shall prepare a plan that identifies how the Authority will be financially self-sustaining by January 1, 2015.
(2) The plan, which shall be certified by an independent actuary as actuarially sound, shall be submitted to the Mayor and Council not later than December 15, 2013.
(a) The Authority, pursuant to subchapter I of Chapter 5 of Title 2 [§ 2-501 et seq.], shall issue rules to implement the provisions of this chapter and as authorized by § 47-5109.
(b) The Authority shall submit all proposed rules adopted by the Authority to the Council for a 30-day period of review, excluding Saturdays, Sundays, legal holidays, and days of Council recess. If the Council does not approve or disapprove the proposed rules, in whole or in part, by resolution, within this 30-day review period, the proposed rules shall be deemed approved.
(c) Regulations promulgated under this section shall not conflict with or prevent the application of regulations promulgated by the Secretary under the Federal Act.
For temporary (90 days) amendment of this section, see § 5003(b) of Fiscal Year 2019 Budget Support Congressional Review Emergency Act of 2018 (D.C. Act 22-458, Oct. 3, 2018, 65 DCR 11212).
For temporary (90 days) amendment of this section, see § 5003(b) of Fiscal Year 2019 Budget Support Emergency Act of 2018 (D.C. Act 22-434, July 30, 2018, 65 DCR 8200).
The 2012 amendment by D.C. Law 19-168 rewrote the section.
For temporary (90 days) repeal of this section, see § 7005 of Fiscal Year 2018 Budget Support Congressional Review Emergency Act of 2017 (D.C. Act 22-167, Oct. 24, 2017, 64 DCR 10802).
For temporary (90 days) repeal of this section, see § 7005 of Fiscal Year 2018 Budget Support Emergency Act of 2017 (D.C. Act 22-104, July 20, 2017, 64 DCR 7032).
For temporary (90 day) amendment of section, see § 7015 of Fiscal Year 2013 Budget Support Emergency Act of 2012 (D.C. Act 19-383, June 19, 2012, 59 DCR 7764).
For temporary (90 day) amendment of section, see § 7015 of Fiscal Year 2013 Budget Support Congressional Review Emergency Act of 2012 (D.C. Act 19-413, July 25, 2012, 59 DCR 9290).
Section 7016 of D.C. Law 19-168 provided that § 7015 of the act shall apply as of June 19, 2012.

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