Source: http://dcwatch.com/council17/17-700.htm
Timestamp: 2020-02-28 04:50:39
Document Index: 68851506

Matched Legal Cases: ['§ 31', '§ 31', '§ 31', '§ 31', '§ 31', '§ 31', '§ 31', '§ 31', '§ 1']

Healthy DC Act of 2008, Bill 17-700
Healthy DC Act of 2008
Bill 17-700
Healthy DctC Program and Legislation Preview, April 1, 2008
Healthy DC Act of 2008, revised version, May 6, 2008
To establish the Healthy DC Program; to require that District residents maintain health insurance coverage; to increase Medicaid fee-for-service reimbursement rates; to amend the Healthy DC Fund to allow for additional revenue to be deposited; to require health maintenance organizations to pay a premium tax; to increase the cigarette tax and to raise the premium tax imposed on health insurers in the District; and, to require that all products on the individual health insurance market be guaranteed issue and community rated.
BE IT ENACTED BY THE COUNCIL OF THE DISTRICT OF COLUMBIA, That this act may be cited as the “Healthy DC Act of 2008”.
TITLE I - Healthy DC Program
(1) “Employer” means any individual, firm, association, or corporation, any receiver or trustee of any individual firm, association, or corporation, or the legal representative of a deceased employer who uses the services of another individual for pay in the District.
(2) “Employee” means any individual who has been employed by the same employer for 1 year and has worked at least 1000 hours without a break in service, except for regular holiday, sick, or personal leave granted by the employer.
(3) “Health insurer” means any person that provides one or more health benefit plans or insurance in the District of Columbia, including an insurer, a hospital and medical services corporation, a fraternal benefit society, a health maintenance organization, a multiple employer welfare arrangement, or any other person providing a plan of health insurance subject to the authority of the Commissioner of the Department of Insurance, Securities and Banking.
Sec. 102. Establishment of Healthy DC Program; administration.
(a) There is established the Healthy DC Program (“Program”) which shall provide affordable health insurance benefits to eligible individuals.
(b) The Program shall be administered by the Department of Health Care Finance, established by the Department of Health Care Finance Establishment Act of 2007, effective February 27, 2008 (D.C. Law 17-109; 55 DCR 216).
Sec. 103. Program eligibility.
An individual shall be eligible for the Program if the individual:
(2) Resides in a household having a gross household income greater than 200% of the Federal Poverty Guidelines as updated periodically in the Federal Register by the U.S. Department of Health and Human Services under the authority of 42 U.S.C. 9902(2);
(3) Does not qualify for the District of Columbia HealthCare Alliance, Medicare, Medicaid, or other federal health benefits programs; and
(ii) A death of a spouse, domestic partner, or family member who maintained the individual as a beneficiary on a health insurance plan;
(vi) The loss of financial eligibility under Medicaid or the District of Columbia HealthCare Alliance;
(viii) Any other reason as determined by the Mayor;
(C) Has employer-based health insurance but the annual premium cost to the individual is deemed unaffordable as determined by the Mayor; or
(D) Has insurance coverage as an individual through a health insurer, including participation in the Open Enrollment Program as established by section 15 of the Hospital and Medical Services Corporation Regulatory Act of 1996, effective April 9, 1997 (D.C. Law 11-245; D.C. Code § 31-3514).
Sec. 104. Program benefits; affordability.
(a) The Program shall provide, at minimum, the following health benefits:
(1) Hospitalization, both in-patient and out-patient;
(3) Mental health services;
(4) Substance abuse treatment;
(5) Maternity; and
(6) Prescription pharmaceuticals.
(b) The Program shall maintain the following affordability criteria for individual participants:
(1) Annual premium costs shall not exceed 3% of the individual’s gross income; and
(2) All other annual costs, excluding annual premium costs, shall not exceed 6% of the individual’s gross income.
Sec. 105. Program implementation; funding.
(a) The Mayor shall make the Program available to eligible individuals by July 1, 2009.
(b) To meet the deadline set forth in subsection (a) of this section, the Mayor is authorized to enter into a contract with CareFirst, Inc. to implement and carry out the Program.
(c) Any contract entered into pursuant to this section shall require annual reporting of clinical quality measurements and utilization data to the Mayor.
(d) The Program shall be funded through the Healthy DC Fund as established by section 15b of the Hospital and Medical Services Corporation Regulatory Act of 1996, effective March 2, 2007 (D.C. Law 16-19; D.C. Code § 31-3514.02) (“Fund”).
Sec. 106. Notice of change in insurance requirement.
(a) Prior to eliminating or restricting the availability of any health insurance plans offered in the District, a health insurer shall submit a notice of change to the Commissioner of the Department of Insurance, Securities and Banking explaining the proposed change. The notice of change shall be submitted in a manner and form determined by the Mayor.
(b) The failure or refusal to submit a notice of change required by this section shall be subject to a civil penalty not to exceed $10,000 for each such failure or refusal.
Sec. 107. Employer reporting requirement.
(a) Beginning in 2010, employers shall submit an annual report, in a manner and form determined by the Mayor, attached to their tax return that includes the following information for the prior calendar year:
(1) The number of its employees who were located in the District of Columbia;
(2) The total cost to the employer of providing health insurance benefits on an expense reimbursed or prepaid basis to those employees who were located in the District of Columbia;
(3) The average per employee cost to the employer of providing health insurance benefits on an expense reimbursed or prepaid basis to those employees who were located in the District of Columbia; and
(4) Any other information as required by the Mayor.
(b) Any employer that refuses or otherwise fails to submit the report required by this section shall be subject to a civil penalty not to exceed $10,000 for each such refusal or failure.
Sec. 108. Employer maintenance of effort.
(a) Beginning in 2009, an employer shall be required to maintain the same level of per employee health care expenditure as it did during the prior calendar year, unless granted a waiver of compliance with this requirement by the Mayor. For purposes of this subsection, the per employee health care expenditure shall be the average per employee cost to the employer of providing health insurance benefits on an expense reimbursed or prepaid basis to those employees located in the District of Columbia.
(b) An employer found by the Mayor to be in violation of this section shall be subject to a fine of not less than double the difference between the employer’s total required expenditure to provide health insurance benefits on an expense reimbursed or prepaid basis to its employees located in the District and the employer’s actual expenditure.
Sec. 109. Prohibitions.
(a) It shall be unlawful for a health insurer to eliminate or restrict the availability of a health insurance plan offered in the District with the intent of shifting beneficiaries to the Program. A health insurer found to be in violation of this subsection shall be subject to a fine of not less than $10,000.
(b) It shall be unlawful for an employer that provides or contributes toward the cost of group health insurance benefits on an expense reimbursed or prepaid basis for its employees to eliminate such benefits or to change the terms of an employee’s employment with the intent of shifting responsibility for employee health insurance to the Program. An employer found by the Mayor to be in violation of this section shall be subject to a fine of not less than double the difference between the employer’s required health expenditure and the employer’s actual health expenditure for the calendar year in which the violation was found.
Sec. 110. Disposition of fines and penalties.
Fines and penalties collected pursuant to this title shall be deposited in the Fund.
Sec. 111. Rulemaking.
TITLE II - Individual insurance mandate
For purposes of this title, the term “continuous health coverage” means the ongoing participation by an individual in a health insurance plan, either as an individual or as a named beneficiary on another individual’s coverage, with no lapse in coverage exceeding 63 days in any calendar year.
Sec. 202. Individual mandate.
By July 1, 2009, each District resident who is 18 years of age or older shall obtain and maintain continuous health coverage.
Sec. 203. Compliance; penalties.
(a) Beginning January 1, 2011, each individual required to maintain continuous health coverage pursuant to section 202 shall certify under penalty of perjury in his or her income tax return for the prior calendar year that for that prior calendar year, the individual either:
(1) maintained continuous health coverage; or
(2) was exempt pursuant to section 204.
(b)(1) The failure to meet the requirement set forth in section 202 for a calendar year shall result in a penalty. The amount of the penalty shall be determined by the Mayor; provided, that it shall be no less than $250.
(2) The failure to meet the requirement set forth in section 202 for any two consecutive calendar years shall result in a penalty. The amount of the penalty shall be determined by the Mayor; provided, that it shall be no less than $500.
(c) Any penalties collected pursuant to this section shall be deposited in the Healthy DC Fund as established by section 15b of the Hospital and Medical Services Corporation Regulatory Act of 1996, effective March 2, 2007 (D.C. Law 16-19; D.C. Code § 31-3514.02).
Sec. 204. Exemptions; waiver.
(a) An individual for whom the requirement set forth in section 202 would violate the established tenets and practices of his or her religion shall be exempt from the requirements of this title.
(b)(1) The Mayor may grant an economic hardship waiver from the requirement set forth in section 202 to an individual whose annual premium costs would exceed 6% of gross income.
(2) The Mayor may grant a hardship waiver from the penalties set forth in section 203(b).
(3) Any waiver granted pursuant to this subsection shall be based on regulations issued in accordance with this title.
Sec. 205. Rulemaking.
TITLE III - Medicaid reimbursement rates
Sec. 301. Reimbursement rates.
The Department of Health Care Finance, established by the Department of Health Care Finance Establishment Act of 2007, effective February 27, 2008 (D.C. Law 17-109; 55 DCR 216), shall increase the specialty physician and primary care physician reimbursement rates under the District Medicaid fee-for-service program to match the specialty physician and primary care physician reimbursement rates under the federal Medicare program.
Sec. 302. Funding.
Implementation of this title shall be subject to appropriations.
TITLE IV - Healthy DC Fund amendment
Sec. 401. Section 15b of the Hospital and Medical Services Corporation Regulatory Act of 1996, effective March 2, 2007 (D.C. Law 16-192; D.C. Official Code § 31-3514.02.), is amended to read as follows:
“Section 15b. Establishment of Healthy DC Fund.
“(a) There is established a segregated, nonlapsing fund designated as the Healthy DC Fund ("Fund"). Funds deposited into the Fund shall not revert to the General Fund of the District of Columbia at the end of any fiscal year, or at any other time, but shall be continually available to support the Healthy DC Program (“Program”), established by the Healthy DC Act of 2008, as introduced on April 1, 2008 (D.C. Bill 17-__), and, if funds remain in the Fund in any given fiscal year after the Program has been fully funded, to support other publicly financed health care programs, including the District’s Medicaid program and the DC HealthCare Alliance; provided, that the Fund shall at all times maintain a minimum balance as determined by the Mayor so as to secure funding for the Program for a minimum of 12 months.
“(b) There shall be deposited into the Fund:
“(1) All tax revenue derived pursuant to section 15a;
“(2) Any other local funds, including any fees, penalties and other tax revenue required by District law;
“(3) Annual appropriations, if any;
“(4) Federal grant funds;
“(5) All fines and penalties collected pursuant to Titles I and II of the Healthy DC Act of 2008, as introduced on April 1, 2008 (D.C. Bill 17-__); and “(6) Grants, gifts, or subsidies from public or private sources.”
TITLE V - Tax amendments.
Sec. 501. The Health Maintenance Organization Act of 1996, effective April 9, 1997 (D.C. Law 11-235; D.C. Official Code § 31-3401 et seq.) is amended by adding a new section 4a to read as follows:
“(4a) Premium tax.
“(a) Effective January 1, 2009, all health maintenance organizations shall pay to the District of Columbia, for each calendar year, a sum of money as taxes equal to 2.0% of their policy and membership fees and net premium receipts or consideration received in such calendar year, excluding those fees, receipts or consideration received pursuant to District Medicaid program, the District of Columbia HealthCare Alliance, any federal employee health benefit program or Medicare, on all policies or contracts in the District of Columbia. Such tax shall be in lieu of all other taxes except:
“(1) Taxes upon real estate; and
“(2) Fees and charges provided for pursuant to the Health Maintenance Organization Act of 1996, effective April 9, 1997 (D.C. Law 11-235; D.C. Code § 31-3401 et seq.).
“(b)(1) Except as provided in paragraph (2) of this subsection, the tax imposed for calendar year 2009, and for each calendar year thereafter, shall be paid on or before the first day of June of the calendar year in which the income to be taxed is received and before the first day of March following the close of each calendar year. The June payment shall be an amount equal to 1/2 of the total premium tax liability determined for the preceding calendar year. In accordance with rules prescribed by the Mayor, each company shall determine its total tax liability for each calendar year and pay the remainder, if any, on or before the first day of March following the close of each calendar year. Overpayments of tax may be refunded to the company or credited to the company's next installment payment, at the election of the company.
“(2) The installment payment provision of subsection (b)(1) of this section shall not apply in the case of any company having a tax liability for the preceding calendar year less than $1,000. In such cases the tax shall be paid on or before the first day of March following the close of the calendar year.
“(c) The certificate of authority of any health maintenance organization may be revoked for failure to pay the required premium tax.
“(d) All revenues collected pursuant to this paragraph shall be deposited in the Healthy DC Fund as established by section 15b of the Hospital and Medical Services Corporation Regulatory Act of 1996, effective March 2, 2007 (D.C. Law 16-192; D.C. Code § 31-3514.02).”
Sec. 502. Title 47 of the District of Columbia Official Code is amended as follows:
(a) Section 47-2402(a) is amended by striking the phrase “$.05 for each cigarette.” and inserting the phrase “$.10 for each cigarette.” in its place.
(b) Section 47-2608(a) is amended as follows:
(1) Paragraph (1) is amending by striking the phrase “All such companies” and inserting “Except as provided in paragraph (1A), all such companies” in its place.
“(1A)(A) All companies which issue contracts of insurance against accident and loss of health shall pay to the District of Columbia, for each calendar year, a sum of money as taxes equal to 2.0% of their policy and membership fees and net premium receipts or consideration received in such calendar year on all policies or contracts in the District of Columbia. Such tax shall be in lieu of all other taxes except:
“(i) Taxes upon real estate; and
“(ii) Fees and charges provided for by the insurance laws of the District including amendment made to such laws by this chapter.
“(B) All funds collected pursuant to this paragraph shall be deposited in the Healthy DC Fund as established by section 15b of the Hospital and Medical Services Corporation Regulatory Act of 1996, effective March 2, 2007 (D.C. Law 16-192; D.C. Code § 31-3514.02).”
TITLE VI - Insurance market regulation
(1) “Community rated” means an insurance premium that is calculated based on the costs for all covered individuals divided by the number of covered persons so as to produce a single per person rate that reflects the average total costs of all members in an individual coverage plan.
(2) “Guaranteed issue” shall mean that no carrier shall decline coverage for an individual.
Sec. 602. Individual insurance market.
Beginning July 1, 2009, all health insurance policies issued to individual subscribers, including any policies issued pursuant to the Healthy DC Program established by the Healthy DC Act of 2008, as introduced on April 1, 2008 (D.C. Bill 17-__), shall be guaranteed issue and community rated.
Sec. 603. Policy maintenance.
All individual health insurance policies issued prior to July 1, 2009, shall continue in force until renewal. Upon renewal, the policy shall comply with section 602.
This act shall take effect following approval by the Mayor (or in the event of veto by the Mayor, action by the Council to override the veto), a 60-day period of Congressional review, as provided in section 602(c)(1) of the District of Columbia Home Rule Act, approved December 24, 1973 (87 Stat. 813; D.C. Official Code § 1-206.02(c)(1)), and publication in the District of Columbia Register.