Source: https://code.dccouncil.us/dc/council/code/titles/31/chapters/31D/
Timestamp: 2018-07-22 23:55:11
Document Index: 309458656

Matched Legal Cases: ['§ 31', '§ 31', '§ 31', '§ 31', '§ 31', '§ 31', '§ 31', '§ 31', '§ 31', '§ 3', '§ 31', '§ 1', '§ 158', '§ 31', '§ 4', '§ 5083', '§ 2', '§ 2', '§\u20092', '§ 5083', '§ 5083', '§ 5083', '§ 2', '§ 2', '§ 2', '§ 5', '§ 3', '§\u20022', '§ 1', '§ 6', '§ 7', '§ 3', '§ 3', '§ 8', '§ 9', '§\u200931', '§ 10', '§ 2', '§ 2', '§ 2', '§ 2', '§\u20022', '§ 31', '§ 10', '§ 2', '§ 2', '§ 2', '§ 2', '§\u20022', '§ 2', '§ 12', '§ 13', '§ 14', '§ 15', '§ 16', '§ 17', '§ 2', '§ 18', '§ 19', '§ 7015', '§ 7005', '§ 7005', '§ 7005', '§ 7015', '§ 7015', '§\u20027015']

DC Code - Chapter 31D. Health Benefit Exchange.
§ 31–3171.06. Powers and duties of executive board.
§ 31–3171.07. Advisory board.
§ 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.
§ 31–3171.17. Rules.
§ 31–3171.18. Applicability. [Repealed]
(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.
(b) The purposes of the Authority shall be to:
(1) Enable individuals and small employers to find affordable and easier-to-understand health insurance;
(2) Facilitate the purchase and sale of qualified health plans;
(3) Assist small employers in facilitating the enrollment of their employees in qualified health plans;
(4) Reduce the number of uninsured;
(5) Provide a transparent marketplace for health benefit plans;
(6) Educate consumers; and
(7) Assist individuals and groups to access programs, premium assistance tax credits, and cost-sharing reductions.
(Mar. 2, 2012, D.C. Law 19-94, § 3, 59 DCR 213.)
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.
(1) Any user fees, licensing fees, or other assessments collected by the Authority;
(2) Income from investments made on behalf of the Fund;
(3) Interest on money in the Fund;
(4) Money collected by the executive board as a result of a legal or other action;
(5) Donations;
(6) Grants;
(7) All general revenue funds appropriated by a line item in the budget submitted pursuant to § 1-204.46, and authorized by Congress for the purposes of the Authority; and
(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.
(e)(1) The Authority is authorized to charge, through rulemaking:
(A) User fees;
(B) Licensing fees; and
(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.
(Mar. 2, 2012, D.C. Law 19-94, § 4, 59 DCR 213; Feb. 26, 2015, D.C. Law 20-155, § 5083, 61 DCR 9990; June 23, 2015, D.C. Law 21-13, § 2(b), 62 DCR 5946.)
The 2015 amendment by D.C. Law 20-155 added (e)(3).
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).
(iv) Promotion of federal or District legislative and regulatory modifications not contemplated under the Federal Act.
(Mar. 2, 2012, D.C. Law 19-94, § 5, 59 DCR 213; Mar. 14, 2014, D.C. Law 20-94, § 3(a), 61 DCR 963.)
Expiration of Law 20-94
The second section designated as Section 3 of D.C. Law 20-94 provided that §§ 2(a)(2), 2(a)(3), 2(a)(4) and 3(a) of the act shall expire at the end of fiscal year 2018.
(a) There is established an executive board to govern the Authority consisting of:
(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).
(2) Four nonvoting, ex-officio members, or their designees, who shall be the:
(A) Director of the Department of Health Care Finance;
(B) Commissioner of the Department of Insurance, Securities and Banking;
(C) Director of the Department of Health; and
(D) Director of the Department of Human Services.
(b)(1) Members of the executive board, other than an ex-officio member, shall be appointed for a term of 4 years, except that for the initial appointments:
(A) Two shall be for a term of 2 years;
(B) One shall be for a term of 3 years;
(C) Two shall be for a term of 4 years; and
(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.
(c)(1) Each person appointed to the executive board as a voting member shall have demonstrated and acknowledged expertise in at least 2 of the following areas:
(A) Individual or small employer health care coverage;
(B) Health benefits plan administration;
(C) Health care finance;
(D) Administering a public or private health care delivery system;
(E) Purchasing health plan coverage;
(F) Prior experience in commercial insurance management;
(H) Health care economics;
(I) Human services administration;
(J) Health care consumer interest advocacy;
(K) Public health programs; or
(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.
(Mar. 2, 2012, D.C. Law 19-94, § 6, 59 DCR 213.)
(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.
(c) In addition to the powers set forth elsewhere in this chapter, the executive board may:
(2) Sue, be sued, plead, and be impleaded;
(3) Adopt bylaws, rules, and policies;
(4) Maintain an office in the District at a place designated by the executive board;
(5) Enter into any agreements or contracts and execute the instruments necessary to manage its affairs and to carry out the purposes of this chapter;
(6) Apply for and receive grants, contracts, or other public or private funding; and
(7) Do all things necessary in conformity with the law to exercise the powers granted by this chapter.
(d)(1) To carry out the purposes of this chapter or perform any of its functions under this chapter, the executive board may contract or enter into memoranda of understanding with eligible entities, including the:
(A) Department of Health Care Finance;
(C) Department of Insurance, Securities and Banking;
(D) Insurance producers and third-party administrators registered in the District; and
(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.
(2) An information-sharing agreement entered into under paragraph (1) of this subsection shall:
(A) Include adequate protections with respect to the confidentiality of information; and
(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.
(Mar. 2, 2012, D.C. Law 19-94, § 7, 59 DCR 213; Mar. 14, 2014, D.C. Law 20-94, § 3(b), 61 DCR 963.)
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.
(c) The executive board shall solicit the recommendations of, and consult with, the advisory boards on:
(1) Insurance standards;
(2) Covered benefits;
(3) Premiums;
(4) Plan certification;
(5) Internet technology system development; and
(6) Any other policy or operational issues, within the executive board’s discretion.
(d) The executive board shall:
(1) Select the members of the advisory boards;
(2) Establish the terms of the members;
(3) Ensure that at least one member of the standing advisory board demonstrates expertise as a health insurance broker or agent;
(4) Appoint the chair of the standing advisory board;
(5) Determine the residency requirement of any additional advisory board created; and
(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.
(f) Each person appointed to an advisory board shall have demonstrated and acknowledged expertise on issues related to at least one of the following groups:
(1) Health professionals;
(2) Health insurance consumers;
(3) Disease and demographic-specific advocacy groups;
(4) Commercial sector health plans;
(5) Public sector health plans;
(6) Health insurance brokers;
(7) Health care consumer interest advocacy;
(8) Health care foundations;
(9) Exchange consumers; or
(10) Such other interests considered necessary.
(Mar. 2, 2012, D.C. Law 19-94, § 8, 59 DCR 213.)
(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.
(c) Under the direction of the executive board, the executive director shall;
(1) Be the chief administrative officer of the Authority;
(2) Direct, administer, and manage the operations of the Authority; and
(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.
(2) The executive director may retain as independent contractors or employees, and set compensation for:
(B) Financial consultants; and
(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.
(Mar. 2, 2012, D.C. Law 19-94, § 9, 59 DCR 213.)
(a) A carrier that offers individual or small group health benefit plans shall offer such plans solely through the American Health Benefit Exchange, as established pursuant to § 31–3171.04(a), subject to the following transition provisions:
(1) Individual health benefit plans with plan years beginning on or after January 1, 2014, shall be offered solely through the American Health Benefit Exchange;
(2) On or after January 1, 2014, small group health benefit plans offered to any small business that was not insured as of December 31, 2013, shall be offered and issued solely through the American Health Benefit Exchange;
(3) Small group health benefit plans offered to or renewed by any small business that was insured as of December 31, 2013, may be issued or renewed during calendar year 2014 through existing distribution channels with the same carrier or a new carrier, except that such plans shall meet the qualifications for certification of a qualified health plan as provided in section 10; and
(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.
(Mar. 2, 2012, D.C. Law 19-94, § 10a; as added July 16, 2014, D.C. Law 20-123, § 2(c), 61 DCR 5379.)
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.
(Mar. 2, 2012, D.C. Law 19-94, § 10b; as added July 16, 2014, D.C. Law 20-123, § 2(c), 61 DCR 5379.)
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).
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.
(Mar. 2, 2012, D.C. Law 19-94, § 12, 59 DCR 213.)
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.
(Mar. 2, 2012, D.C. Law 19-94, § 13, 59 DCR 213.)
(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.
(Mar. 2, 2012, D.C. Law 19-94, § 14, 59 DCR 213.)
Notwithstanding any other provision of this chapter, all powers and authority vested by this chapter in the Authority shall remain with the Mayor until:
(1) A majority of members of the executive board have been confirmed by the Council; and
(2) The executive board has hired an executive director.
(Mar. 2, 2012, D.C. Law 19-94, § 15, 59 DCR 213.)
Upon dissolution, liquidation, or other termination of the Authority:
(1) All rights and properties of the Authority shall pass to and be vested in the District, subject to the rights of lien holders and other creditors;
(2) Any net earnings of the Authority, beyond that necessary for retirement of any indebtedness or to implement a public purpose or program of the District authorized under this chapter, shall not inure to the benefit of any person other than the District;
(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.
(Mar. 2, 2012, D.C. Law 19-94, § 16, 59 DCR 213.)
(a) The executive board shall:
(1) Study, in consultation with the advisory boards established under this chapter and with other stakeholders:
(A) The feasibility and desirability of the Authority engaging in:
(i) Selective contracting, either through competitive bidding or a negotiation process similar to that used by large employers, to reduce health care costs and improve quality-of-care by certifying only those health benefit plans that meet certain requirements, such as:
(I) Promoting patient-centered medical homes;
(II) Adopting electronic health records;
(III) Meeting minimum outcome standards;
(IV) Implementing payment reforms to reduce medical errors and preventable hospitalizations;
(V) Reducing disparities;
(VI) Ensuring adequate reimbursements;
(VII) Enrolling high-risk members and underserved populations;
(VIII) Managing chronic conditions and promoting healthy consumer lifestyles;
(IX) Value-based insurance design;
(X) Adhering to transparency guidelines; and
(XI) Uniform price and quality reporting;
(ii) Multistate contracting; and
(iii) Entering into a regional exchange;
(B) The rules under which health benefit plans should be offered inside and outside the exchanges in order to mitigate adverse selection and encourage enrollment in the exchanges, including:
(i) Whether any benefits should be required of qualified health plans beyond those mandated by the Federal Act, and whether any such additional benefits should be required of health benefit plans offered outside the exchanges;
(ii) Whether health carriers offering health benefit plans outside the exchanges should be required to offer either all the same health benefit plans inside the exchanges or, alternatively, at least one health benefit plan inside the exchanges;
(iii) Whether managed care organizations with Health Choice contracts should be required to offer products inside the exchanges;
(iv) Whether health carriers offering health benefit plans inside the exchanges should be required to also participate in the District medical assistance program; and
(v) Which provisions applicable to qualified health plans should be made applicable to qualified dental plans;
(C) The design and operation of the Authority’s Navigator program and any other appropriate consumer-assistance mechanisms, including:
(i) How the Navigator program could utilize, interact with, or complement private-sector resources, including insurance producers;
(ii) The infrastructure of the existing private sector health insurance distribution system in the District to determine whether private sector resources may be available and suitable for use by the Authority;
(iii) The effect the exchanges may have on private sector employment in the health insurance distribution system in the District;
(iv) What functions, in addition to those required by the Federal Act, should be performed by Navigators;
(v) What training and expertise should be required of Navigators, and whether different markets and populations require Navigators with different qualifications;
(vi) How Navigators should be retained and compensated, and how disparities between Navigator compensation and the compensation of insurance producers outside the exchanges can be minimized or avoided;
(vii) How to ensure that Navigators provide information in a manner culturally, linguistically, and otherwise appropriate to the needs of the diverse populations served by the Authority, and that Navigators have the capacity to meet these needs; and
(viii) What other means of consumer assistance may be appropriate and feasible, and how they should be designed and implemented;
(D) The design and function of the SHOP Exchange beyond the requirements of the Federal Act, to promote quality, affordability, and portability, including:
(i) Whether it should be a defined contribution/employee choice model or whether employers should choose the qualified health plan to offer their employees;
(ii) Whether the current individual and small group markets should be merged; and
(iii) Whether the SHOP Exchange should be made available to employers with 50 to 100 employees prior to 2016, as authorized by the Federal Act;
(E) How the Authority will ensure financial integrity in compliance with the Federal Act, including:
(i) A recommended plan for the budget of the Authority;
(ii) The user fees, licensing fees, or other assessments that should be imposed by the Authority to fund its operations, including what type of user fee cap or other methodology would be appropriate to ensure that the income of the Authority comports with the expenditures of the Authority; and
(iii) A recommended plan for how to prevent fraud, waste, and abuse; and
(F) How the Authority should conduct its public relations and advertising campaign, including what type of solicitation, if any, of individual consumers or employers, would be desirable and appropriate; and
(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.
(Mar. 2, 2012, D.C. Law 19-94, § 17, 59 DCR 213.)
(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.
(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.
(Mar. 2, 2012, D.C. Law 19-94, § 18, 59 DCR 213.)
(Mar. 2, 2012, D.C. Law 19-94, § 19, 59 DCR 213; Sept. 20, 2012, D.C. Law 19-168, § 7015, 59 DCR 8025; Dec. 13, 2017, D.C. Law 22-33, § 7005, 64 DCR 7652.)
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.