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  • Acts
  • 2006
  • Chapter 324 AN ACT RELATIVE TO HEALTH CARE ACCESS.

Whereas, The deferred operation of this act would tend to defeat its purpose, which is to implement forthwith improved access to health care, therefore it is hereby declared to be an emergency law, necessary for the immediate preservation of the public convenience.

Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same as follows:

SECTION 1. Section 16K of chapter 6A, as appearing in section 3 of chapter 58 of the acts of 2006, is hereby amended by striking out the sixth sentence and inserting in place thereof the following sentence:-

The representatives of nongovernmental organizations shall serve staggered 3-year terms; but another representative shall be appointed to complete an unexpired term if a vacancy exists.

SECTION 2. The first sentence of the first paragraph of section l6N of chapter 6A of the General Laws, as so appearing, is hereby amended by adding the following words:- or any successor fund.

SECTION 3. The fourth sentence of the first paragraph of section 16O of said chapter 6A, as so appearing, is hereby amended by inserting after the word “increase” the following words:- diversity in.

SECTION 4. The first sentence of the second paragraph of said section 16O of said chapter 6A, as so appearing, is hereby amended by striking out the words “New England Division" and inserting in place thereof the following words:- , Northeast Affiliate.

SECTION 5. Section 7A of chapter 26 of the General Laws, inserted by section 6 of said chapter 58, is hereby amended by adding the following paragraph:-
The commissioner may make and collect an assessment against the carriers licensed under chapters 175, 176A, 176B and 176G to pay for the expenses of the bureau. The assessment shall be at a rate sufficient to produce $600,000 annually. In addition to that amount, the assessment shall include an amount to be credited to the General Fund which shall be equal to the total amount of funds estimated by the secretary for administration and finance to be expended from the General Fund for indirect and fringe benefit costs attributable to the personnel costs of the bureau. If the commissioner fails to expend for the costs and expenses of the bureau in a fiscal year the total amount of $600,000 for the purposes set forth in this section, any amount unexpended in that fiscal year shall be credited against the assessment to be made in the following fiscal year, and the assessment in the following fiscal year shall be reduced by that unexpended amount. The assessment shall be allocated on a fair and reasonable basis among all carriers licensed under said chapters 175, 176A, 176B and 176G. The funds produced by the assessments shall be expended by the division, in addition to any other funds which may be appropriated, to assist in defraying the general operating expenses of the bureau, and may be used to compensate consultants retained by the bureau. A carrier licensed under said chapters 175, 176A, 176B and 176G shall pay the amount assessed against it within 30 days after the date of the notice of assessment from the commissioner.

SECTION 6. Said chapter 26 is hereby further amended by striking out section 7B, inserted by section 6A of said chapter 58, and inserting in place thereof the following section:-

Section 7B. (a) For the purposes of implementing chapter 111M and section 8B of chapter 62C, the commissioner may consult with the department of revenue and may enter into an interdepartmental service agreement with the department that may include the transfer of information from statements and reports provided under said section 8B.

(b) Upon request, carriers licensed under chapters 175, 176A, 176B and 176G and the office of Medicaid shall make information available to the bureau, but such information shall be limited to the minimum amount of personal information necessary for the purposes of said chapter 111M and shall not include social security numbers or information about previous or current diagnoses or treatments. The information acquired under this section shall be confidential and shall not constitute a public record.
(c) The division may consider violations of this section and said section 8B when licensing or authorizing entities to provide health coverage.

SECTION 7. The second sentence of section 2OOO of chapter 29 of the General Laws, as appearing in section 8 of said chapter 58, is hereby amended by striking out clauses (d) and (e) and inserting in place thereof the following clause:-

(d) revenue deposited from penalties collected under chapter 111M.

SECTION 8. Said chapter 29 is hereby further amended by striking out section 2QQQ, as so appearing, and inserting in place thereof the following section:-

Section 2QQQ. There shall be established on the books of the commonwealth the Medical Assistance Trust Fund, which shall be administered by the secretary of health and human services. Funds from the trust fund may be expended for supplemental Medicaid payments to qualifying providers under an approved state plan or federal waiver. Amounts credited to the trust fund shall not be subject to further appropriation.

SECTION 9. Section 2 of chapter 32A of the General Laws is hereby amended by inserting after the word “Authority”, in line 11, as appearing in the 2004 Official Edition, the following words:- , the commonwealth health insurance connector authority.

SECTION 10. Said section 2 of said chapter 32A is hereby further amended by striking out, in lines 46 and 47, as so appearing, the words “under nineteen years of age” and inserting in place thereof the following words:- under 26 years of age or for 2 years following loss of dependent status under the Internal Revenue Code, whichever occurs first.

SECTION 11. Chapter 62C of the General Laws, as so appearing, is hereby amended by inserting after section 8A the following section:-

Section 8B. (a) An employer or other sponsor of an employment-sponsored health plan shall (i) provide, or contract with service providers or insurance carriers to provide, a written statement, annually on or before January 31 of each year, to each subscriber or covered individual residing in the commonwealth to whom it provided creditable coverage, as defined in chapter 111M, in the previous calendar year and (ii) provide a separate report verifying the statement to the commissioner.
(b) If a resident is not covered under a Massachusetts-based employment-sponsored health plan, the office of Medicaid and carriers licensed or otherwise authorized to offer health coverage under chapters 175, 176A, 176B, and 176G shall (i) provide, or contract with service providers to provide, a written statement annually on or before January 31 of each year, to each subscriber or covered individual residing in the commonwealth to whom it provided creditable coverage, as defined in said chapter 111M, in the previous calendar year and (ii) provide a separate report verifying the statement to the commissioner.
(c) The statements and reports shall identify the carrier or employer, the covered individual and covered dependents, the insurance policy or similar numbers and the dates of coverage during the year, and shall provide other information as required by the commissioner of revenue; but shall be limited to the minimum amount of personal information necessary for the purposes of said chapter 111M and shall not include social security numbers or information about previous or current diagnoses or treatments. The commissioner of revenue, in consultation with the commissioner of insurance, may specify the content and format of the statements and reports. The commissioner of revenue may disclose the information in the statements and reports to the division of insurance, the division of health care finance and policy and the commonwealth health insurance connector. The information in the statements and reports shall be confidential and shall not constitute a public record.
(d) The commissioner of revenue, in consultation with the commissioner of insurance pursuant to section 7B of chapter 26, shall promulgate regulations or other written guidance to implement this section, which may include an allowance for reporting alternatives for family or other joint coverage.
(e) Carriers, employers or other sponsors of employment-sponsored health plans that fail to provide written statements to covered individuals or to report to the commissioner in violation of this section shall be punishable by a penalty of $50 per individual to which the failure relates, not to exceed $50,000 per year per violator. The commissioner shall assess such penalties as a tax subject to chapter 62C but, in his discretion, may waive all or any portion of such penalties for reasonable cause shown.

SECTION 12. Subsection (b) of section 21 of said chapter 62C, as so appearing, is hereby amended by adding the following clause:-

(22) the disclosure of any non-financial information contained on a return filed pursuant to section 10 to the division of unemployment assistance, the division of insurance and the division of health care finance and policy under an interagency agreement for the enforcement or administration of chapter 118G.

SECTION 13. Section 1 of chapter 62D of the General Laws, as so appearing, is hereby amended by inserting after the figure “118G”, in line 53, the following words:- ; or any individual owing the Health Safety Net Trust Fund for the cost of reimbursable health services or emergency bad debt paid in whole or in part by the fund, under paragraph (c) of section 60 of chapter 118E.

SECTION 14. Said section 12 of said chapter 62E, as so appearing, is hereby further amended by striking out the last paragraph and inserting in place thereof the following paragraph:-

Notwithstanding any general or special law to the contrary, the commissioner may disclose any information referred to in this chapter to the division of unemployment assistance, the division of insurance and the division of health care finance and policy under an interagency agreement for purposes of the administration and enforcement of sections 6B, 6C and 18B of chapter 118G and for the administration of the fair share employer contribution requirement under section 188 of chapter 149.

SECTION 15. Said section 12 of said chapter 62E is hereby further amended by striking out the last paragraph, inserted by section 14 of this act, and inserting in place thereof the following paragraph:-

Notwithstanding any general or special law to the contrary, the commissioner may disclose any information referred to in this chapter to the division of unemployment assistance, the division of insurance and the division of health care finance and policy under an interagency agreement for purposes of the administration and enforcement of sections 55 to 60, inclusive of chapter 118E and sections 6B, 6C and 18B of chapter 118G and for the administration of the fair share employer contribution requirement under section 188 of chapter 149.

SECTION 16.
Section 1 of chapter 111M of the General Laws, as appearing in section 12 of chapter 58 of the acts of 2006, is hereby amended by striking out the definition of “Creditable coverage” and inserting in place thereof the following definition:-

“Creditable coverage”, coverage of an individual under any of the following health plans or as a named beneficiary receiving coverage on another’s plan with no lapse of coverage for more than 63 days: (a) an individual or group health plan which meets the definition of “minimum creditable coverage” as established by the board of the connector; (b) a health plan including, but not limited to, a health plan issued, renewed or delivered within or without the commonwealth to an individual who is enrolled in a qualifying student health insurance program under section 18 of chapter 15A or a qualifying student health program of another state; (c) Part A or Part B of Title XVIII of the Social Security Act; (d) Title XIX of the Social Security Act, other than coverage consisting solely of benefits under section 1928; (e) 10 U.S.C. 55; (f) a medical care program of the Indian Health Service or of a tribal organization; (g) a state health benefits risk pool; (h) a health plan offered under 5 U.S.C. 89; (i) a public health plan as defined in federal regulations authorized by the Public Health Service Act, section 2701(c)(1)(I), as amended by Public Law 104-191; (j) a health benefit plan under the Peace Corps Act, 22 U.S.C. 2504(e); (k) coverage for young adults under section 10 of chapter 176J; and (l) any other qualifying coverage required by the Health Insurance Portability and Accountability Act of 1996, as amended, or by regulations promulgated under that act; provided, however, that the following shall not qualify as creditable coverage: a plan issued as a supplemental health insurance policy including, but not limited to, accident only, credit only, or limited scope vision or dental benefits if offered separately; hospital indemnity insurance policies if offered as independent, non-coordinated benefits which, for the purposes of this chapter, shall mean policies issued under chapter 175 which provide a benefit not to exceed $500 per day, as adjusted on an annual basis by the amount of increase in the average weekly wages in the commonwealth as defined in section 1 of chapter 152, to be paid to an insured or a dependent, including the spouse of an insured, on the basis of a hospitalization of the insured or a dependent; disability income insurance; coverage issued as a supplement to liability insurance; specified disease insurance that is purchased as a supplement and not as a substitute for a health plan and that meets any requirements the commissioner, by regulation, may set; insurance arising out of a workers’ compensation law or similar law; automobile medical payment insurance; insurance under which benefits are payable with or without regard to fault and which is statutorily required to be contained in a liability insurance policy or equivalent self insurance; long-term care if offered separately; coverage supplemental to the coverage provided under 10 U.S.C. 55 if offered as a separate insurance policy; or any policy subject to chapter 176K or any similar policies issued on a group basis, including Medicare Prescription drug plans.

SECTION 17. Section 9A of chapter 118E of the General Laws is hereby further amended by striking out subsection (15), added by said section 18 of said chapter 58, and inserting in place thereof the following subsection:-
(15) Pursuant to section 8B of chapter 62C, the office of Medicaid shall provide written statements to residents of the commonwealth for whom creditable coverage is provided and shall provide a separate report verifying those statements to the commissioner of revenue.

SECTION 18. The definition of “Eligible employee” in section 9C of said chapter 118E, as amended by section 19 of said chapter 58, is hereby further amended by striking out the words “; provided further that clause (iv) shall not apply to employees participating in the program established under this chapter as of June 30, 2006”.

SECTION 19. Section 55 of said chapter 118E, as appearing in section 30 of said chapter 58, is hereby amended by striking out the definition of “Allowable reimbursement” and inserting in place thereof the following definition:-
“Allowable reimbursement”, payment to acute hospitals and community health centers for health services provided to uninsured or underinsured patients of the commonwealth under section 60 and any further regulations promulgated by the health safety net office.

SECTION 20. Said section 55 of said chapter 118E, as so appearing, is hereby further amended by striking out the definition of “Financial requirements” and inserting in place thereof the following definition:-
“Financial requirements”, a hospital’s requirement for revenue which shall include, but not be limited to, reasonable operating, capital and working capital costs, the reasonable costs of depreciation of plant and equipment and the reasonable costs associated with changes in medical practice and technology.

SECTION 21. Subsection (c) of section 60 of said chapter 118E, as so appearing, is hereby amended by striking out the second and third sentences and inserting in place thereof the following 2 sentences:- The division shall promulgate regulations requiring acute hospitals to submit data that will enable the department of revenue to pursue recoveries from individuals who are ineligible for reimbursable health services and on whose behalf the fund has made payments to acute hospitals for such services or for emergency bad debt. Any amounts recovered, including amounts received under chapter 62D, shall be deposited in the Health Safety Net Trust Fund, established in section 57.

SECTION 22. The definition of “Non-providing employer” in section 1 of chapter 118G of the General Laws, inserted by section 32 of said chapter 58, is hereby amended by striking out clause (i) and inserting in place thereof the following clause:-

(i) an employer who complies with chapter 151F for such employee;.

SECTION 23. Said section 1 of said chapter 118G is hereby further amended by striking out the definition of “Payments from non-providing employers”, inserted by section 33 of said chapter 58, and inserting in place thereof the following definition:-

“Payments from non-providing employers”, all amounts paid to the Uncompensated Care Trust Fund or the General Fund or any successor fund by non-providing employers.

SECTION 24. Section 6 of said chapter 118G is hereby amended by striking out the second paragraph, inserted by section 41 of said chapter 58, and inserting in place thereof the following paragraph:-

In addition, such uniform reporting shall provide the name and address and such other identifying information as may be needed relative to the employer of any patient for whom health care services were rendered under this chapter and for whom reimbursement from the uncompensated care pool or the Health Safety Net Trust Fund has been requested.

SECTION 25. Said chapter 118G is hereby further amended by striking out sections 6A and 6B and inserting in place thereof the following two sections:-
Section 6B. Notwithstanding any general or special law to the contrary, an applicant for uncompensated care pool assistance, if eligible, shall be enrolled in MassHealth, established by section 9A of chapter 118E, the insurance reimbursement program, established by section 9C of said chapter 118E, or the commonwealth care health insurance program, established by chapter 118H. An applicant deemed ineligible for these programs and who is unable to make all or part of the payment for health services shall provide the name and address of his employer, if any, and his name, address and date of birth. The division shall collaborate with the division of insurance and the department of revenue to implement this section and sections 6C and 18.

Section 6C. (a) The division shall prepare a form, to be called the employer health insurance responsibility disclosure, on which an employer shall report whether it is in compliance with chapter 151F and any other information required by the division relative to sections 6B and 18B. The form shall be completed, signed and returned to the division by every employer with more than 10 employees.

(b) The division shall prepare a form, to be called the employee health insurance responsibility disclosure, on which an employee of employers with more than 10 employees who declines an employer-sponsored health plan shall report whether he has an alternative source of health insurance coverage. The form shall be completed and signed by the employee and shall be retained by the employer for 3 years. The division may request a copy of the signed employee form.

(c) Information that identifies individual employees by name or health insurance status shall not be a public record, but that information may be exchanged with the department of revenue and the health care access bureau in the division of insurance under an interagency service agreement for the purposes of enforcing this section and sections 6B and 18B. Nothing in this section shall prevent the implementation of section 304 of chapter 149 of the acts of 2004. An employer who knowingly falsifies or fails to file with the division any information required by this section or by any regulation promulgated by the division shall be punished by a fine of not less than $1,000 nor more than $5,000.

SECTION 26. Subsection (k) of section 18B of said chapter 118G, as appearing in section 44 of said chapter 58, is hereby amended by striking out the first sentence and inserting in place thereof the following sentence:- A hospital, surgical center, health center or other entity that provides uncompensated care pool services shall provide an uninsured patient with written notice of the criminal penalties for committing fraud in connection with the receipt of uncompensated care pool services.

SECTION 27. Subsection (b) of section 3 of chapter 118H of the General Laws, as appearing in section 45 of said chapter 58, is hereby amended by striking out the first sentence and inserting in place thereof the following sentence:- The board may waive clause (4) of subsection (a) if the individual’s employer complies with section 110 of chapter 175, section 8 ½ of chapter 176A, section 3B of chapter 176B or section 6A of chapter 176G. The employer’s health insurance premium contribution for the applying individual, which shall be the cash equivalent of the premium contribution that would otherwise be made by an employer on behalf of the applying individual for the plan and rate basis type for which the individual would be eligible or, in cases where the individual is eligible to participate in more than 1 plan, the cash equivalent of the premium contribution for the most popular plan and rate basis type for which the individual is eligible, shall be paid to the connector.

SECTION 28. Subsection (a) of section 188 of chapter 149, as appearing in section 47 of said chapter 58, is hereby amended by striking out the definitions of “Department” and “Director” and inserting in place thereof the following definition:-
“Department”, the department of workforce development.

SECTION 29. Subsection (b) of said section 188 of said chapter 149, as so appearing, is hereby amended by striking out the first sentence and inserting in place thereof the following sentence:— For the purpose of more equitably distributing the costs of health care provided to uninsured residents of the commonwealth, each employer that (i) employs 11 or more full-time equivalent employees in the commonwealth and (ii) is not a contributing employer shall pay a per-employee contribution at a time and in a manner prescribed by the director of workforce development, in consultation with the director of unemployment assistance, in this section called the fair share employer contribution.

SECTION 30. Subsection (c) of said section 188 of said chapter 149, as so appearing, is hereby amended by striking out the introductory paragraph and inserting in place thereof the following introductory paragraph:-
The commissioner of health care finance and policy shall, in consultation with the director of workforce development, annually determine the fair share employer contribution rate based on the best available data and under the following provisions:.

SECTION 31. Said subsection (c) of said section 188 of said chapter 149, as so appearing, is hereby further amended by striking out clause (10) and inserting in place thereof the following clause:-
(10) Notwithstanding this section, the total annual fair share employer contribution shall not exceed $295 per employee which may be made in a single payment, or in equal amounts semi-annually or quarterly, at the employer’s discretion.

SECTION 32. Said section 188 of said chapter 149, as so appearing, is hereby amended by striking out subsection (d) and inserting in place thereof the following subsection:-

(d) The director of unemployment assistance shall collect the contribution required under subsections (b) and (c) and shall implement penalties for employers who fail to make contributions as required by this section. In order to reduce the administrative costs of collection of contributions, the director shall, to the extent possible, use any existing procedures that have been implemented by the division of unemployment assistance to make similar collections. Amounts collected pursuant to this section shall be deposited in the Commonwealth Care Trust Fund, established by section 2000 of chapter 29.

SECTION 33. Paragraph (a) of subdivision (2) of section 108 of chapter 175 of the General Laws is hereby amended by striking out clause (3), as amended by section 49 of chapter 58 of the acts of 2006, and inserting in place thereof the following clause:-
(3) It purports to insure only 1 person, except that a policy must insure, originally or by subsequent amendment, upon the application of an adult member of a family who shall be deemed the policyholder, 2 or more eligible members of that family, including the policyholder, spouse, dependent children and other dependent persons, children during pendency of adoption procedures under chapter 210, children under 26 years of age or for 2 years following loss of dependent status under the Internal Revenue Code, whichever occurs first, and children who are mentally or physically incapable of earning their own living, if due proof of such incapacity is received by the insurer within 31 days of the date upon which the coverage would otherwise be terminated; and.

SECTION 34. Section 110 of said chapter 175 is hereby amended by adding the following subdivision:-
(P) A blanket or general policy of insurance described in subdivision (A), (C) or (D), except policies or certificates which provide coverage to Medicare or other governmental programs which shall be delivered, issued or renewed in the commonwealth, shall provide, as benefits to all group members having a place of employment in the commonwealth, coverage to persons under 26 years of age or for 2 years after the loss of dependent status under the Internal Revenue Code, whichever occurs first.

SECTION 35. Said chapter 175 is hereby further amended by striking out section 110M, inserted by section 51 of chapter 58 of the acts of 2006, and inserting in place thereof the following section:-

Section 110M. Pursuant to section 8B of chapter 62C, carriers shall provide written statements to residents of the commonwealth for whom creditable coverage is provided and shall provide a separate report verifying those statements to the commissioner of revenue.

SECTION 36. Chapter 176A of the General Laws is hereby amended by striking out section 8Z, inserted by section 53 of said chapter 58, and inserting in place thereof the following section:-

Section 8Z. Any subscription certificate under a group nonprofit hospital service agreement, except certificates which provide stand alone dental services, supplemental coverage to Medicare or other governmental programs, which shall be delivered, issued or renewed in the commonwealth, shall provide, as benefits to all group members having a principal place of employment within the commonwealth, coverage to persons under 26 years of age or for 2 years following loss of dependent status under the Internal Revenue Code, whichever occurs first.

SECTION 37. Said chapter 176A is hereby further amended by striking out section 34, added by section 54 of said chapter 58, and inserting in place thereof the following section:-

Section 34. Pursuant to section 8B of chapter 62C, any corporation subject to this chapter shall provide written statements to residents of the commonwealth for whom creditable coverage is provided and shall provide a separate report verifying those statements to the commissioner of revenue.

SECTION 38. Chapter 176B of the General Laws is hereby amended by striking out section 4Z, inserted by section 56 of said chapter 58, and inserting in place thereof the following section:-

Section 4Z. Any subscription certificate under an individual or group medical service agreement, except certificates that provide stand alone dental services, which shall be delivered or issued or renewed in this commonwealth, shall provide, as benefits to all individual subscribers and members within the commonwealth and to all group members having a principal place of employment within the commonwealth, coverage to persons under 26 years of age or for 2 years following loss of dependent status under the Internal Revenue Code, whichever occurs first.

SECTION 39. Said chapter 176B is hereby further amended by striking out section 22, added by section 57 of said chapter 58 and inserting in place thereof the following section:-

Section 22. Pursuant to section 8B of chapter 62C, any corporation subject to this chapter shall provide written statements to residents of the commonwealth for whom creditable coverage is provided and shall provide a separate report verifying those statements to the commissioner of revenue.

SECTION 40. Chapter 176G of the General Laws is hereby amended by striking out section 4R, inserted by section 58 of said chapter 58, and inserting in place thereof the following section:-

Section 4R. A health maintenance contract, excluding contracts for stand alone dental services, shall provide coverage to persons under 26 years of age or for 2 years following loss of dependent status under the Internal Revenue Code, whichever occurs first.

SECTION 41. Said chapter 176G is hereby further amended by striking out section 16A, inserted by section 60 of said chapter 58, and inserting in place thereof the following section:-

Section 16A. The commissioner shall not disapprove a health maintenance contract on the basis that it includes a deductible that is consistent with the requirements for a high deductible plan as defined in section 223 of the Internal Revenue Code and implementing regulations or guidelines; provided, however, that the maximum deductible shall not be greater than the maximum annual contribution to a health savings account permitted under section 223 of the Internal Revenue Code. A deductible equal to the maximum annual contribution to a health savings account shall only be approved for products which include a health savings account permitted under said section 223 of the Internal Revenue Code.

SECTION 42. Chapter 176G of the General Laws is hereby amended by striking out section 30, added by section 61 of said chapter 58, and inserting in place thereof the following section:-

Section 30. Pursuant to section 8B of chapter 62C, carriers shall provide written statements to residents of the commonwealth for whom creditable coverage is provided and shall provide a separate report verifying those statements to the commissioner of revenue.

SECTION 43. Section 1 of chapter 176J of the General Laws is hereby amended by inserting after the definition of “Creditable coverage”, inserted by section 67 of said chapter 58, the following definition:-

“Date of enrollment”, with respect to an individual covered under a group health plan or health insurance coverage, the date of enrollment of the individual in the plan or coverage or, if earlier, the first day of the waiting period for such enrollment.

SECTION 44. Said section 1 of said chapter 176J is hereby further amended by striking out, in line 75, as appearing in the 2004 Official Edition, the words “group size”.

SECTION 45. The definition of “Pre-existing conditions provision” in said section 1 of said chapter 176J, as amended by section 77 of chapter 58 of the acts of 2006, is hereby amended by adding the following sentence:- Pregnancy shall not be a preexisting condition.

SECTION 46. Subsection (a) of section 3 of said chapter 176J, as appearing in section 82 of said chapter 58, is hereby amended by striking out clause (1) and inserting in place thereof the following clause:-

(1) For every health benefit plan issued or renewed to eligible small groups on or after April 1, 1992 and to eligible individuals on or after July 1, 2007, including a certificate issued to an eligible small group or eligible individual that evidences coverage under a policy or contract issued or renewed to a trust, association or other entity that is not a group health plan, a carrier shall develop a base premium rate for a class of business. The group base premium rates charged by a carrier to each eligible group or eligible individual during a rating period shall not exceed 2 times the group base premium rate which could be charged by that carrier to the eligible group or eligible individual with the lowest group base premium rate for that rate basis type within that class of business in that group’s or individual’s geographic area. In calculating the premium to be charged to each eligible small group or eligible individual, a carrier shall develop a base premium rate for each rate basis type and may develop and use any of the rate adjustment factors identified in clauses (2) to (6), inclusive, provided that after multiplying any of the used rate adjustment factors by the base premium rate, the resulting product for all adjusted group base premium rate combinations fall within rate bands ranging between 0.66 and 1.32 that is required of all products offered to eligible small groups and eligible individuals. In addition, carriers may apply additional factors, identified in subsection (b) that would apply outside the 0.66 to 1.32 rate band. All other rating adjustments are prohibited. Carriers may offer any rate basis types, but rate basis types that are offered to any eligible small employer or eligible individual shall be offered to every eligible small employer or eligible individual for all coverage issued or renewed on or after July 1, 2007. If an eligible small employer does not meet a carrier’s minimum or participation contribution requirements, the carrier may separately rate each employee as an eligible individual.

SECTION 47. Paragraph (3) of subsection (b) of said section 3 of said chapter 176J, as so appearing, is hereby amended by striking out the first sentence and inserting in place thereof the following sentence:- A carrier shall establish a rate basis type adjustment factor for eligible individuals and eligible small groups which shall be expressed as a number.

SECTION 48. Paragraph (3) of subsection (a) of section 4 of said chapter 176J, as appearing in section 83 of said chapter 58, is hereby amended by striking out the first sentence and inserting in place thereof the following sentence:- A carrier shall enroll an eligible individual who does not meet the requirements of paragraph (2) into a health benefit plan, but a carrier may only impose a preexisting condition exclusion for not more than 6 months or a waiting period, which shall be applied uniformly without regard to any health status-related factors, of not more than 4 months following the individual’s effective date of coverage.

SECTION 49. Said chapter 176J is hereby further amended by striking out section 5, as amended by section 84 of said chapter 58, and inserting in place thereof the following section:-

Section 5. (a) No policy shall exclude an eligible individual, eligible employee or eligible dependent on the basis of age, occupation, actual or expected health condition, claims experience, duration of coverage or medical condition.

(b) Preexisting conditions provisions shall not exclude coverage for a period beyond 6 months after the individual’s date of enrollment and shall only relate to conditions which had, during the 6 months before an eligible individual’s, eligible employee’s or eligible dependent’s date of enrollment and shall only relate to a limitation or exclusion of benefits relating to a condition based on the fact that the condition was present before the date of enrollment for such coverage and for which any medical advice, diagnosis, care or treatment was recommended or received before that date. Preexisting conditions provisions shall not apply to a pregnancy existing on the date of enrollment. A carrier shall not impose a preexisting conditions exclusion or waiting period for Trade Act/Health Coverage Tax Credit Eligible Persons.

(c) No policy shall provide for a waiting period of more than 4 months after the insured’s date of enrollment under the health benefit plan, but an eligible individual who has not had creditable coverage for the 18 months before the date of enrollment shall not be subject to a waiting period and a carrier shall not impose any waiting period upon a new employee who had creditable coverage under a previous qualifying health plan immediately before, or until, employment by the eligible small business. If a policy includes a waiting period, emergency services shall be covered during the waiting period. In determining whether a waiting period applies to an eligible individual, eligible employee or dependent, all health benefit plans shall credit the time the person was covered under a previous qualifying health plan if the insured experiences only a temporary interruption in coverage and if the previous qualifying coverage was reasonably actuarially equivalent to the new coverage, both as determined by the commissioner. The waiting period shall only apply to services which the new plan covers, but which were not covered under the previous plan.

(d) The commissioner shall adopt regulations to enforce this section.

SECTION 50. Section 10 of said chapter 176J, as appearing in section 90 of said chapter 58, is hereby amended by striking out the last paragraph and inserting in place thereof the following paragraph:-

Such plans shall only be offered by a carrier that, as of the close of any preceding calendar year, has a combined total of 5,000 or more eligible individuals, eligible employees and eligible dependents, who are enrolled in health plans sold, issued, delivered, made effective or renewed to qualified small businesses or eligible individuals pursuant to its license under chapter 175, chapter 176A, chapter 176B or chapter 176G. Further, such plans shall only be offered through the commonwealth health insurance connector as defined in chapter 176Q. Premium rates for young adult plans shall be consistent with section 3.

SECTION 51. Section 3 of chapter 176M of the General Laws is hereby amended by striking out the words “through June 31, 2007”, inserted by section 93 of said chapter 58, and inserting in place thereof the following words:-through June 30, 2007. A carrier shall not impose a preexisting condition exclusion or waiting period for Trade Act/HCTC-Eligible Persons.

SECTION 52. Section 2 of chapter 176N of the General Laws, as amended by section 100 of said chapter 58, is hereby further amended by striking out clauses (b) and (c) and inserting in place thereof the following 2 clauses:-

(b) contain a preexisting conditions provision that excludes coverage for a period beyond 6 months after the individual’s date of enrollment. A preexisting conditions provision may only relate to: (1) conditions which had, during the 6 months immediately before the date of enrollment, manifested themselves in such a manner as would cause an ordinarily prudent person to seek medical advice, diagnosis, care or treatment or for which medical advice, diagnosis, care or treatment was recommended or received. In determining whether a preexisting conditions provision applies to an eligible insured, a health plan shall credit the time a person was under a previous qualifying health plan if the previous coverage was continuous to a date not more than 63 days before the effective date of the new coverage, exclusive of any applicable service waiting period under the new coverage and if the previous qualifying health plan coverage was reasonably actuarially equivalent to the new coverage;

(c) provide for a waiting period of more than 4 months beyond the eligible insured’s date of enrollment under the health plan, but an eligible individual who has not had creditable coverage for the 18 months before the date of enrollment shall not be subject to a waiting period. If a health plan includes a waiting period, emergency services shall be covered during the waiting period. The waiting period shall only apply to services which the new plan covers, but which were not covered under the old plan. In applying a waiting period to an eligible insured, a health plan shall credit the time the person was covered under a previous qualifying health plan if the person experiences only a temporary interruption in coverage;.

SECTION 53. The second sentence of subsection (b) of section 2 of chapter 176Q of the General Laws, as appearing in section 101 of said chapter 58, is hereby amended by striking out the figure “11” and inserting in place thereof the following figure:- 10.

SECTION 54. Said section 2 of said chapter 176Q, as so appearing, is hereby further amended by striking out subsection (f).

SECTION 55.
Clause (p) of section 3 of said chapter 176Q, as so appearing, is hereby amended by inserting after the second sentence the following sentence:- For the purpose of determining the schedule, the board shall consider deductibles when determining the affordability of a health benefit plan.

SECTION 56. Said section 3 of said chapter 176Q, as so appearing, is hereby further amended by striking out clause (q) and inserting in place thereof the following clause:-

(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.

SECTION 57. Section 6 of said chapter 176Q, as so appearing, is hereby amended by striking out clause (c) and inserting in place thereof the following clause:-

(c) that the employers shall participate in a payroll deduction program to facilitate the payment of health benefit plan premium payments by employees to benefit from exclusions from gross income under 26 U.S.C. 104, 105, 106 and 125; and.

SECTION 58. The first paragraph of section 110 of chapter 58 of the acts of 2006 is hereby amended by striking out the third sentence and inserting in place thereof the following sentence:- The advisory council shall be chaired by the commissioner of public health or his designee and shall include 14 additional members, including the chief executives or their designees of the following agencies or organizations: office of Medicaid, department of workforce development, Massachusetts Community Health Workers Network, Outreach Worker Training Institute of Central Massachusetts Area Health Education Center, Community Partners’ Health Access Network, the Massachusetts Public Health Association, Massachusetts Center for Nursing, Boston Public Health Commission, Massachusetts Association of Health Plans, Blue Cross Blue Shield of Massachusetts, Massachusetts Medical Society, Massachusetts Hospital Association, the Massachusetts League of Community Health Centers and the MassHealth Technical Forum.

SECTION 59. Section 115 of said chapter 58 is hereby amended by striking out the second sentence and inserting in place thereof the following sentence:-The open enrollment period shall begin on May 1, 2007 and end on July 31, 2007.

SECTION 60. Section 123 of said chapter 58 is hereby amended by striking out the first sentence and inserting in place thereof the following sentence:-Notwithstanding any general or special law to the contrary, from July 1, 2006 to June 30, 2009, inclusive, the executive director of the commonwealth health insurance connector shall collaborate with the secretary of health and human services and the commissioner of insurance to ensure that only Medicaid managed care organizations that have contracted with the commonwealth as of July 1, 2006 to deliver managed care services shall receive premium assistance payments from the commonwealth care health insurance program, under chapter 118H of the General Laws, for the purposes of enrolling low-income individuals, but any organization referenced in section 28 of chapter 47 of the acts of 1997 may offer health benefit plans through the commonwealth care health insurance program, through the connector.

SECTION 61. Subparagraph (a) of the seventh paragraph of section 124 of said chapter 58 is hereby amended by striking out clause (1) and inserting in place thereof the following clause:-

(1) calculate the projected allowable uncompensated care charges for each hospital using the best and latest available data on allowable uncompensated care reported by the hospital times its ratio of costs to charges calculated using the most recent available data.

SECTION 62. The first sentence of section 128 of said chapter 58 is hereby amended by inserting after the words “Notwithstanding any general or special law to the contrary,” the following words:- , and in accordance with section 13B of chapter 118E of the General Laws,.

SECTION 63. The first sentence of section 134 of said chapter 58 is hereby amended striking out, in line 1, the words “department of labor” and inserting in place thereof the following words:- division of unemployment assistance.

SECTION 64. Said chapter 58 is hereby further amended by striking out section 138 and inserting in place thereof the following section:-
Section 138. Notwithstanding any special or general law to the contrary, the initial terms of the appointed members of the board of the commonwealth health insurance connector, established by section 2 of chapter 176Q, shall commence on July 1, 2006 and shall be as follows: the governor shall designate 1 of his initial appointees to serve for a term of 1 year, 1 of his initial appointees to serve for a term of 2 years and 1 of his initial appointees to serve for a term of 3 years and the attorney general shall designate 1 of his initial appointees to serve for a term of 1 year, 1 of his initial appointees to serve for a term of 2 years and 1 of his initial appointees to serve for a term of 3 years, such that the terms of 2 appointees shall thereafter, expire every year.

SECTION 65. Said chapter 58 is hereby further amended by striking out section 141 and inserting in place thereof the following section:-
Section 141. Sections 19, 20, 21, 45 and 47 shall take effect on October 1, 2006.

SECTION 66. Said chapter 58 is hereby further amended by striking out section 142 and inserting in place thereof the following section:-
Section 142. Sections 33, 35, 41, 42, 44, 46, 49, 50, 52, 53, 55, 56, 58, 59, 62, 63, 64, 65, 66, 67, 69, 70, 73, 76, 77, 78, 79, 80, 83, 84 and 87 shall take effect on January 1, 2007.

SECTION 67. Section 144 of said chapter 58 is hereby repealed.

SECTION 68. Said chapter 58 is hereby further amended by striking out section 145 and inserting in place thereof the following section:-

Section 145. Sections 12, 22, 23, 48, 60A, 68, 72, 74, 82, 85, 86, 89 and 90 shall take effect on July 1, 2007.

SECTION 69. Said chapter 58 is hereby further amended by striking out section 146 and inserting in place thereof the following section:-

Section 146. Sections 25, 28, 30, 31, 34, 36, 37, 38, 39, 40, 43, and 126 shall take effect on October 1, 2007.

SECTION 70. Nothing in section 16A of chapter 176G of the General Laws shall prohibit a health maintenance contract from being issued with deductible limits consistent with those approved by the commissioner before April 1, 2006 nor require such a contract to include a health savings account.

SECTION 71. Clause (iv) of the definition of “Eligible employee” in section 9C of chapter 118E of the General Laws shall not apply to employees participating, prior to September 30, 2006, in the insurance reimbursement program established under said section 9C.

SECTION 72. The commonwealth health insurance connector shall begin offering health benefit plans under section 5 of chapter 176Q of the General Laws on May 1, 2007, with coverage to be effective on July 1, 2007.

SECTION 73. The first annual report required to be published pursuant to clause (q) of section 3 of chapter 176Q of the General Laws shall be due on June 1, 2007.

SECTION 74. Notwithstanding any general or special law to the contrary, the terms of the initial 7 representatives of nongovernmental organizations on the health care quality and cost council, established by section 16K of chapter 6A of the General Laws, shall be as follows: the governor shall designate 2 members for a term of 1 year, 3 members for a term of 2 years and 2 members for a term of 3 years.

SECTION 75. Notwithstanding any contrary provisions in section 10 of chapter 176J of the General Laws, young adult plans offered under said section 10 may also be offered by a carrier or a wholly-owned or wholly-controlled subsidiary of a carrier that, as of the close of any preceding calendar year, have a combined total of 5,000 or more eligible individuals, eligible employees and eligible dependents, who are enrolled in health plans sold, issued, delivered, made effective or renewed to qualified small businesses or eligible individuals pursuant to their license under chapter 175, chapter 176A, chapter 176B and chapter 176G of the General Laws. A carrier or a wholly-owned or wholly-controlled subsidiary of a carrier that, as of the close of any preceding calendar year, has less than 5,000 eligible individuals, eligible employees and eligible dependents who are enrolled in health plans sold, issued, delivered, made effective or renewed to qualified small businesses or eligible individuals shall develop rates for young adult products that are consistent with section 3 of chapter 176J of the General Laws when considered together with the rates for products offered to qualified small businesses or eligible individuals by the entity in combination with which it meets the requirement of having a combined total of 5,000 or more eligible individuals, eligible employees and eligible dependents who are enrolled in health plans sold, issued, delivered, made effective or renewed to qualified small businesses or eligible individuals. Enrollees in young adult products shall not be counted toward the requirement of 5,000 or more.

SECTION 76.
Section 75 of this act is hereby repealed.

SECTION 77. Sections 66 to 69, inclusive, shall take effect as of April 12, 2006.

SECTION 78. Sections 10, 22, 23, 24, 25, 26, 33, 34, 43, 46, 47 and 49 shall take effect on January 1, 2007.

SECTION 79. Sections 16 and 50 shall take effect on July 1, 2007.

SECTION 80. Sections 13, 15, 19, 20, 21 and 62 shall take effect on October 1, 2007.

SECTION 81. Sections 6, 11, 12, 17, 35, 37, 39 and 42 shall take effect on January 1, 2008.

SECTION 82. Section 76 shall take effect on July 1, 2009.

Approved October 26, 2006.