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  • PART I ADMINISTRATION OF THE GOVERNMENT
  • TITLE XXII CORPORATIONS
  • CHAPTER 176Q COMMONWEALTH HEALTH INSURANCE CONNECTOR
  • Section 3 Powers and duties of board

Section 3. The purpose of the board of the connector shall be to implement the commonwealth health insurance connector. The goal of the board is to facilitate the purchase of health care insurance products through the connector at an affordable price by eligible individuals, groups and commonwealth care health insurance plan enrollees. For these purposes, the board is authorized and empowered as follows:—

(a) to develop a plan of operation for the connector, this shall include, but not be limited to, the following:—

(1) establish procedures for operations of the connector;

(2) establish procedures for communications with the executive director;

(3) establish procedures for the selection of and the seal of approval certification for health benefit plans and stand-alone vision or stand-alone dental plans to be offered through the connector;

(4) establish procedures for the enrollment of eligible individuals, groups and commonwealth care health insurance program enrollees;

(5) establish procedures for granting an annual certification upon request of a resident who has sought health insurance coverage through the connector, attesting that, for the purposes of enforcing section 2 of chapter 111M, no health benefit plan which meets the definition of creditable coverage was deemed affordable by the connector for said individual. The connector shall maintain a list of individuals for whom such certificates have been granted;

(6) establish procedures for appeals of eligibility decisions for the commonwealth care health insurance program, established by chapter 118H;

(7) establish appeals procedures for enforcement actions taken by the department of revenue under said chapter 111M, including standards to govern appeals based on the assertion that imposition of the penalty under said chapter 111M would create extreme hardship;

(8) establish a plan for operating a health insurance service center to provide eligible individuals, groups and commonwealth care health insurance program enrollees, with information on the connector and manage connector enrollment;

(9) establish and manage a system of collecting all premium payments made by, or on behalf of, individuals obtaining health insurance coverage or stand-alone vision or stand-alone dental insurance coverage through the connector, including any premium payments made by enrollees, employees, unions or other organizations;

(10) establish and manage a system of remitting premium assistance payments to the carriers;

(11) establish a plan for publicizing the existence of the connector and the connector’s eligibility requirements and enrollment procedures;

(12) develop criteria for determining that certain health benefit plans and stand-alone vision or stand-alone dental plans shall no longer be made available through the connector, and to develop a plan to decertify and remove the seal of approval from certain health benefit plans and stand-alone vision or stand-alone dental plans;

(13) develop a standard application form for eligible individuals, groups seeking to purchase health insurance through the connector, and commonwealth care health insurance program enrollees, seeking a premium assistance payment which shall include information necessary to determine an applicant’s eligibility, previous health insurance coverage history and payment method; and

(14) develop criteria for plans sold through the connector that are eligible for premium assistance payments or cost sharing.

(b) to determine each applicant’s eligibility for purchasing insurance offered by the connector, including eligibility for premium assistance payments or cost-sharing subsidies for applicants at or below 300 per cent of the federal poverty guidelines.

(c) to seek and receive any grant funding from the federal government, departments or agencies of the commonwealth, and private foundations.

(d) to contract with professional service firms as may be necessary in its judgment, and to fix their compensation.

(e) to contract with companies which provide third-party administrative and billing services for insurance products.

(f) to charge and equitably apportion among participating institutions its administrative costs and expenses incurred in the exercise of the powers and duties granted by this chapter.

(g) to adopt by-laws for the regulation of its affairs and the conduct of its business.

(h) to adopt an official seal and alter the same.

(i) to maintain an office at such place or places in the commonwealth as it may designate.

(j) to sue and be sued in its own name, plead and be impleaded.

(k) to establish lines of credit, and establish one or more cash and investment accounts to receive payments for services rendered, appropriations from the commonwealth and for all other business activity granted by this chapter except to the extent otherwise limited by any applicable provision of the Employee Retirement Income Security Act of 1974.

(l) to approve the use of its trademarks, brand names, seals, logos and similar instruments by participating carriers, employers or organizations.

(m) to enter into interdepartmental agreements with the department of revenue, the executive office of health and human services, the division of insurance, the division of unemployment assistance and any other state agencies, departments, commissions, authorities or political subdivisions the board considers necessary or appropriate to implement chapters 111M, 118E, 118G 118H and this chapter.

(n) to create and deliver to the department of revenue a form for the department to distribute to every person to whom it distributes information regarding personal income tax liability, including, without limitation, every person who filed a personal income tax return in the most recent calendar year, informing the recipient of the requirements to establish and maintain health care coverage.

(o) to create for publication, by September 30 of each year, the commonwealth care health insurance program consumer price schedule.

(p) to create for publication by December 1 of each year, a premium schedule, which, accounting for maximum pricing in all rating factors with an exception for age, shall include the lowest premium on the market for which an individual would be eligible for “creditable coverage” as defined in chapter 111M. The schedule shall publish premiums allowing variance for age and rate basis type. For the purpose of determining the schedule, the board shall consider deductibles when determining the affordability of a health benefit plan. The premium schedule shall be delivered to the department of revenue for use in establishing compliance with section 2 of chapter 111M.

(q) to review annually the publication of income levels for the federal poverty guidelines and other pertinent measures of individual and family income and devise and report annually a schedule that describes the percentage of income which an individual could be expected to contribute towards the purchase of health insurance coverage. The director shall consider contribution schedules, such as those set for government benefit programs. Before each report is published, the schedule shall be reported to the house and senate committee on ways and means and the joint committee on health care financing.

(r) to establish criteria, accept applications, and approve or reject licenses for certain sub-connectors which shall be authorized to offer health benefit plans offered by the connector. The board shall establish and maintain a procedure for coordination with said sub-connectors.

(s) to define and set by regulation minimum requirements for health plans meeting the requirement of “creditable coverage” as used in section 1 of chapter 111M; provided, however, that notwithstanding subsection (d) of section 2, no changes to the regulations defining minimum creditable coverage shall take effect until 90 days after the connector gives notice of the changes to the joint committee on health care finance, the joint committee on public health, the senate and house of representatives committees on ways and means and the clerks of the senate and house of representatives.

(t) to establish and evaluate requirements for plans issued under section 5 with regard to health care delivery network design.

(u) to perform all the duties and responsibilities required of an American Health Benefit Exchange, as that term is defined by the Patient Protection and Affordable Care Act, Pub. L. 111-148, amended from time to time, including, but not limited to, the following: (1) the certification of qualified health plans for sale in the Exchange; (2) the determination of eligibility of individuals for shopping, receiving federal premium tax credits and qualifying for reduced cost sharing through the Exchange, as provided by federal law; and (3) the certification of individuals as exempt from the requirements of section 36B of the Internal Revenue Code of 1986.

[Clause (v) as added by 2012, 118, Sec. 44. See also clause (v) as added by 2012, 139, Sec. 133, below.]

(v) to define and establish by regulation a risk adjustment program as required by 42 U.S.C. § 18063; provided, however, that not later than 30 days before a risk adjustment program is established, the board shall provide a report of the program to the clerks of the senate and house of representatives, the senate and house committee on ways and means and the joint committee on health care financing.

[Clause (v) as added by 2012, 139, Sec. 133. See also clause (v) as added by 2012, 118, Sec. 44, above.]

(v) to enter into contracts or agreements, at the board’s discretion, with state departments, agencies, commissions, authorities or political subdivisions or with any individuals, groups, nonprofit or not-for-profit corporations, organizations or associations seeking affordable health insurance; provided, however, that the connector shall serve as an agent or advisor to assist with or procure health insurance for such entities or persons. The board shall give preference to assisting nonprofit or not-for-profit corporations or individuals, groups, organizations or associations seeking the connector’s assistance for populations that have been historically uninsured or underinsured.