State of Washington | 62nd Legislature | 2011 Regular Session |
READ FIRST TIME 02/08/11.
AN ACT Relating to guaranteed issue health insurance for persons under age nineteen; amending RCW 48.43.012 and 48.41.100; reenacting and amending RCW 48.43.005 and 48.41.110; adding a new section to chapter 48.43 RCW; creating a new section; and declaring an emergency.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
NEW SECTION. Sec. 1 The federal patient protection and
affordable care act (P.L. 111-148) prohibits insurance carriers from
applying preexisting condition limitations for persons under age
nineteen, beginning on or after September 23, 2010. The guidance from
the United States department of health and human services provides some
direction for the implementation of the new policy requirement, and the
office of the insurance commissioner further clarified open enrollment
requirements to help prevent disruption in the individual health
insurance marketplace. It is the intent of this act to:
(1) Maintain access to individual plan options for persons under
age nineteen; and
(2) Provide clarity for the establishment of open enrollment and
special open enrollment periods that balance access to guaranteed issue
coverage with efforts that protect market stability.
Sec. 2 RCW 48.43.005 and 2010 c 292 s 1 are each reenacted and
amended to read as follows:
Unless otherwise specifically provided, the definitions in this
section apply throughout this chapter.
(1) "Adjusted community rate" means the rating method used to
establish the premium for health plans adjusted to reflect actuarially
demonstrated differences in utilization or cost attributable to
geographic region, age, family size, and use of wellness activities.
(2) "Applicant" means a person who applies for enrollment in an
individual health plan as the subscriber or an enrollee, or the
dependent or spouse of a subscriber or enrollee.
(3) "Basic health plan" means the plan described under chapter
70.47 RCW, as revised from time to time.
(((3))) (4) "Basic health plan model plan" means a health plan as
required in RCW 70.47.060(2)(e).
(((4))) (5) "Basic health plan services" means that schedule of
covered health services, including the description of how those
benefits are to be administered, that are required to be delivered to
an enrollee under the basic health plan, as revised from time to time.
(((5))) (6) "Catastrophic health plan" means:
(a) In the case of a contract, agreement, or policy covering a
single enrollee, a health benefit plan requiring a calendar year
deductible of, at a minimum, one thousand seven hundred fifty dollars
and an annual out-of-pocket expense required to be paid under the plan
(other than for premiums) for covered benefits of at least three
thousand five hundred dollars, both amounts to be adjusted annually by
the insurance commissioner; and
(b) In the case of a contract, agreement, or policy covering more
than one enrollee, a health benefit plan requiring a calendar year
deductible of, at a minimum, three thousand five hundred dollars and an
annual out-of-pocket expense required to be paid under the plan (other
than for premiums) for covered benefits of at least six thousand
dollars, both amounts to be adjusted annually by the insurance
commissioner; or
(c) Any health benefit plan that provides benefits for hospital
inpatient and outpatient services, professional and prescription drugs
provided in conjunction with such hospital inpatient and outpatient
services, and excludes or substantially limits outpatient physician
services and those services usually provided in an office setting.
In July 2008, and in each July thereafter, the insurance
commissioner shall adjust the minimum deductible and out-of-pocket
expense required for a plan to qualify as a catastrophic plan to
reflect the percentage change in the consumer price index for medical
care for a preceding twelve months, as determined by the United States
department of labor. The adjusted amount shall apply on the following
January 1st.
(((6))) (7) "Certification" means a determination by a review
organization that an admission, extension of stay, or other health care
service or procedure has been reviewed and, based on the information
provided, meets the clinical requirements for medical necessity,
appropriateness, level of care, or effectiveness under the auspices of
the applicable health benefit plan.
(((7))) (8) "Concurrent review" means utilization review conducted
during a patient's hospital stay or course of treatment.
(((8))) (9) "Covered person" or "enrollee" means a person covered
by a health plan including an enrollee, subscriber, policyholder,
beneficiary of a group plan, or individual covered by any other health
plan.
(((9))) (10) "Dependent" means, at a minimum, the enrollee's legal
spouse and unmarried dependent children who qualify for coverage under
the enrollee's health benefit plan.
(((10))) (11) "Emergency medical condition" means the emergent and
acute onset of a symptom or symptoms, including severe pain, that would
lead a prudent layperson acting reasonably to believe that a health
condition exists that requires immediate medical attention, if failure
to provide medical attention would result in serious impairment to
bodily functions or serious dysfunction of a bodily organ or part, or
would place the person's health in serious jeopardy.
(((11))) (12) "Emergency services" means otherwise covered health
care services medically necessary to evaluate and treat an emergency
medical condition, provided in a hospital emergency department.
(((12))) (13) "Employee" has the same meaning given to the term, as
of January 1, 2008, under section 3(6) of the federal employee
retirement income security act of 1974.
(((13))) (14) "Enrollee point-of-service cost-sharing" means
amounts paid to health carriers directly providing services, health
care providers, or health care facilities by enrollees and may include
copayments, coinsurance, or deductibles.
(((14))) (15) "Grievance" means a written complaint submitted by or
on behalf of a covered person regarding: (a) Denial of payment for
medical services or nonprovision of medical services included in the
covered person's health benefit plan, or (b) service delivery issues
other than denial of payment for medical services or nonprovision of
medical services, including dissatisfaction with medical care, waiting
time for medical services, provider or staff attitude or demeanor, or
dissatisfaction with service provided by the health carrier.
(((15))) (16) "Health care facility" or "facility" means hospices
licensed under chapter 70.127 RCW, hospitals licensed under chapter
70.41 RCW, rural health care facilities as defined in RCW 70.175.020,
psychiatric hospitals licensed under chapter 71.12 RCW, nursing homes
licensed under chapter 18.51 RCW, community mental health centers
licensed under chapter 71.05 or 71.24 RCW, kidney disease treatment
centers licensed under chapter 70.41 RCW, ambulatory diagnostic,
treatment, or surgical facilities licensed under chapter 70.41 RCW,
drug and alcohol treatment facilities licensed under chapter 70.96A
RCW, and home health agencies licensed under chapter 70.127 RCW, and
includes such facilities if owned and operated by a political
subdivision or instrumentality of the state and such other facilities
as required by federal law and implementing regulations.
(((16))) (17) "Health care provider" or "provider" means:
(a) A person regulated under Title 18 or chapter 70.127 RCW, to
practice health or health-related services or otherwise practicing
health care services in this state consistent with state law; or
(b) An employee or agent of a person described in (a) of this
subsection, acting in the course and scope of his or her employment.
(((17))) (18) "Health care service" means that service offered or
provided by health care facilities and health care providers relating
to the prevention, cure, or treatment of illness, injury, or disease.
(((18))) (19) "Health carrier" or "carrier" means a disability
insurer regulated under chapter 48.20 or 48.21 RCW, a health care
service contractor as defined in RCW 48.44.010, or a health maintenance
organization as defined in RCW 48.46.020, and includes "issuers" as
that term is used in the patient protection and affordable care act
(P.L. 111-148).
(((19))) (20) "Health plan" or "health benefit plan" means any
policy, contract, or agreement offered by a health carrier to provide,
arrange, reimburse, or pay for health care services except the
following:
(a) Long-term care insurance governed by chapter 48.84 or 48.83
RCW;
(b) Medicare supplemental health insurance governed by chapter
48.66 RCW;
(c) Coverage supplemental to the coverage provided under chapter
55, Title 10, United States Code;
(d) Limited health care services offered by limited health care
service contractors in accordance with RCW 48.44.035;
(e) Disability income;
(f) Coverage incidental to a property/casualty liability insurance
policy such as automobile personal injury protection coverage and
homeowner guest medical;
(g) Workers' compensation coverage;
(h) Accident only coverage;
(i) Specified disease or illness-triggered fixed payment insurance,
hospital confinement fixed payment insurance, or other fixed payment
insurance offered as an independent, noncoordinated benefit;
(j) Employer-sponsored self-funded health plans;
(k) Dental only and vision only coverage; and
(l) Plans deemed by the insurance commissioner to have a short-term
limited purpose or duration, or to be a student-only plan that is
guaranteed renewable while the covered person is enrolled as a regular
full-time undergraduate or graduate student at an accredited higher
education institution, after a written request for such classification
by the carrier and subsequent written approval by the insurance
commissioner.
(((20))) (21) "Material modification" means a change in the
actuarial value of the health plan as modified of more than five
percent but less than fifteen percent.
(((21))) (22) "Open enrollment" means a period of time as defined
in rule to be held at the same time each year, during which applicants
may enroll in a carrier's individual health benefit plan without being
subject to health screening or otherwise required to provide evidence
of insurability as a condition for enrollment.
(23) "Preexisting condition" means any medical condition, illness,
or injury that existed any time prior to the effective date of
coverage.
(((22))) (24) "Premium" means all sums charged, received, or
deposited by a health carrier as consideration for a health plan or the
continuance of a health plan. Any assessment or any "membership,"
"policy," "contract," "service," or similar fee or charge made by a
health carrier in consideration for a health plan is deemed part of the
premium. "Premium" shall not include amounts paid as enrollee point-of-service cost-sharing.
(((23))) (25) "Review organization" means a disability insurer
regulated under chapter 48.20 or 48.21 RCW, health care service
contractor as defined in RCW 48.44.010, or health maintenance
organization as defined in RCW 48.46.020, and entities affiliated with,
under contract with, or acting on behalf of a health carrier to perform
a utilization review.
(((24))) (26) "Small employer" or "small group" means any person,
firm, corporation, partnership, association, political subdivision,
sole proprietor, or self-employed individual that is actively engaged
in business that employed an average of at least one but no more than
fifty employees, during the previous calendar year and employed at
least one employee on the first day of the plan year, is not formed
primarily for purposes of buying health insurance, and in which a bona
fide employer-employee relationship exists. In determining the number
of employees, companies that are affiliated companies, or that are
eligible to file a combined tax return for purposes of taxation by this
state, shall be considered an employer. Subsequent to the issuance of
a health plan to a small employer and for the purpose of determining
eligibility, the size of a small employer shall be determined annually.
Except as otherwise specifically provided, a small employer shall
continue to be considered a small employer until the plan anniversary
following the date the small employer no longer meets the requirements
of this definition. A self-employed individual or sole proprietor who
is covered as a group of one must also: (a) Have been employed by the
same small employer or small group for at least twelve months prior to
application for small group coverage, and (b) verify that he or she
derived at least seventy-five percent of his or her income from a trade
or business through which the individual or sole proprietor has
attempted to earn taxable income and for which he or she has filed the
appropriate internal revenue service form 1040, schedule C or F, for
the previous taxable year, except a self-employed individual or sole
proprietor in an agricultural trade or business, must have derived at
least fifty-one percent of his or her income from the trade or business
through which the individual or sole proprietor has attempted to earn
taxable income and for which he or she has filed the appropriate
internal revenue service form 1040, for the previous taxable year.
(((25))) (27) "Special enrollment" means a defined period of time
of not less than thirty-one days, triggered by a specific qualifying
event experienced by the applicant, during which applicants may enroll
in the carrier's individual health benefit plan without being subject
to health screening or otherwise required to provide evidence of
insurability as a condition for enrollment.
(28) "Standard health questionnaire" means the standard health
questionnaire designated under chapter 48.41 RCW.
(29) "Utilization review" means the prospective, concurrent, or
retrospective assessment of the necessity and appropriateness of the
allocation of health care resources and services of a provider or
facility, given or proposed to be given to an enrollee or group of
enrollees.
(((26))) (30) "Wellness activity" means an explicit program of an
activity consistent with department of health guidelines, such as,
smoking cessation, injury and accident prevention, reduction of alcohol
misuse, appropriate weight reduction, exercise, automobile and
motorcycle safety, blood cholesterol reduction, and nutrition education
for the purpose of improving enrollee health status and reducing health
service costs.
Sec. 3 RCW 48.43.012 and 2001 c 196 s 6 are each amended to read
as follows:
(1) No carrier may reject an individual for an individual health
benefit plan based upon preexisting conditions of the individual except
as provided in RCW 48.43.018.
(2) No carrier may deny, exclude, or otherwise limit coverage for
an individual's preexisting health conditions except as provided in
this section.
(3) For an individual health benefit plan originally issued on or
after March 23, 2000, preexisting condition waiting periods imposed
upon a person enrolling in an individual health benefit plan shall be
no more than nine months for a preexisting condition for which medical
advice was given, for which a health care provider recommended or
provided treatment, or for which a prudent layperson would have sought
advice or treatment, within six months prior to the effective date of
the plan. No carrier may impose a preexisting condition waiting period
on an individual health benefit plan issued to an eligible individual
as defined in section 2741(b) of the federal health insurance
portability and accountability act of 1996 (42 U.S.C. 300gg-41(b)).
(4) Individual health benefit plan preexisting condition waiting
periods shall not apply to prenatal care services.
(5) No carrier may avoid the requirements of this section through
the creation of a new rate classification or the modification of an
existing rate classification. A new or changed rate classification
will be deemed an attempt to avoid the provisions of this section if
the new or changed classification would substantially discourage
applications for coverage from individuals who are higher than average
health risks. These provisions apply only to individuals who are
Washington residents.
(6) For any person under age nineteen applying for coverage as
allowed by section 4(1) of this act or enrolled in a health benefit
plan subject to sections 1201 and 10103 of the patient protection and
affordable care act (P.L. 111-148) that is not a grandfathered health
plan in the individual market, a carrier must not impose a preexisting
condition exclusion or waiting period or other limitations on benefits
or enrollment due to a preexisting condition.
NEW SECTION. Sec. 4 A new section is added to chapter 48.43 RCW
to read as follows:
(1) The commissioner shall adopt rules establishing and
implementing requirements for the open enrollment periods and special
enrollment periods that carriers must follow for individual health
benefit plans and enrollment of persons under age nineteen.
(2) The commissioner shall monitor the sale of individual health
benefit plans and if a carrier refuses to sell guaranteed issue
policies to persons under age nineteen in compliance with rules adopted
by the commissioner pursuant to subsection (1) of this section, the
commissioner may levy fines or suspend or revoke a certificate of
authority as provided in chapter 48.05 RCW.
Sec. 5 RCW 48.41.100 and 2009 c 555 s 3 are each amended to read
as follows:
(1)(a) The following persons who are residents of this state are
eligible for pool coverage:
(i) Any person who provides evidence of a carrier's decision not to
accept him or her for enrollment in an individual health benefit plan
as defined in RCW 48.43.005 based upon, and within ninety days of the
receipt of, the results of the standard health questionnaire designated
by the board and administered by health carriers under RCW 48.43.018;
(ii) Any person who continues to be eligible for pool coverage
based upon the results of the standard health questionnaire designated
by the board and administered by the pool administrator pursuant to
subsection (3) of this section;
(iii) Any person who resides in a county of the state where no
carrier or insurer eligible under chapter 48.15 RCW offers to the
public an individual health benefit plan other than a catastrophic
health plan as defined in RCW 48.43.005 at the time of application to
the pool, and who makes direct application to the pool;
(iv) Any person becoming eligible for medicare before August 1,
2009, who provides evidence of (A) a rejection for medical reasons, (B)
a requirement of restrictive riders, (C) an up-rated premium, (D) a
preexisting conditions limitation, or (E) lack of access to or for a
comprehensive medicare supplemental insurance policy under chapter
48.66 RCW, the effect of any of which is to substantially reduce
coverage from that received by a person considered a standard risk by
at least one member within six months of the date of application;
((and))
(v) Any person becoming eligible for medicare on or after August 1,
2009, who does not have access to a reasonable choice of comprehensive
medicare part C plans, as defined in (b) of this subsection, and who
provides evidence of (A) a rejection for medical reasons, (B) a
requirement of restrictive riders, (C) an up-rated premium, (D) a
preexisting conditions limitation, or (E) lack of access to or for a
comprehensive medicare supplemental insurance policy under chapter
48.66 RCW, the effect of any of which is to substantially reduce
coverage from that received by a person considered a standard risk by
at least one member within six months of the date of application; and
(vi) Any person under the age of nineteen who does not have access
to individual plan open enrollment or special enrollment, as defined in
RCW 48.43.005, or the federal preexisting condition insurance pool, at
the time of application to the pool is eligible for the pool coverage.
(b) For purposes of (a)(v) of this subsection (1), a person does
not have access to a reasonable choice of plans unless the person has
a choice of health maintenance organization or preferred provider
organization medicare part C plans offered by at least three different
carriers that have had provider networks in the person's county of
residence for at least five years. The plan options must include
coverage at least as comprehensive as a plan F medicare supplement plan
combined with medicare parts A and B. The plan options must also
provide access to adequate and stable provider networks that make up-to-date provider directories easily accessible on the carrier web site,
and will provide them in hard copy, if requested. In addition, if no
health maintenance organization or preferred provider organization plan
includes the health care provider with whom the person has an
established care relationship and from whom he or she has received
treatment within the past twelve months, the person does not have
reasonable access.
(2) The following persons are not eligible for coverage by the
pool:
(a) Any person having terminated coverage in the pool unless (i)
twelve months have lapsed since termination, or (ii) that person can
show continuous other coverage which has been involuntarily terminated
for any reason other than nonpayment of premiums. However, these
exclusions do not apply to eligible individuals as defined in section
2741(b) of the federal health insurance portability and accountability
act of 1996 (42 U.S.C. Sec. 300gg-41(b));
(b) Any person on whose behalf the pool has paid out two million
dollars in benefits;
(c) Inmates of public institutions and those persons who become
eligible for medical assistance after June 30, 2008, as defined in RCW
74.09.010. However, these exclusions do not apply to eligible
individuals as defined in section 2741(b) of the federal health
insurance portability and accountability act of 1996 (42 U.S.C. Sec.
300gg-41(b));
(d) Any person who resides in a county of the state where any
carrier or insurer regulated under chapter 48.15 RCW offers to the
public an individual health benefit plan other than a catastrophic
health plan as defined in RCW 48.43.005 at the time of application to
the pool and who does not qualify for pool coverage based upon the
results of the standard health questionnaire, or pursuant to subsection
(1)(a)(iv) of this section.
(3) When a carrier or insurer regulated under chapter 48.15 RCW
begins to offer an individual health benefit plan in a county where no
carrier had been offering an individual health benefit plan:
(a) If the health benefit plan offered is other than a catastrophic
health plan as defined in RCW 48.43.005, any person enrolled in a pool
plan pursuant to subsection (1)(a)(iii) of this section in that county
shall no longer be eligible for coverage under that plan pursuant to
subsection (1)(a)(iii) of this section, but may continue to be eligible
for pool coverage based upon the results of the standard health
questionnaire designated by the board and administered by the pool
administrator. The pool administrator shall offer to administer the
questionnaire to each person no longer eligible for coverage under
subsection (1)(a)(iii) of this section within thirty days of
determining that he or she is no longer eligible;
(b) Losing eligibility for pool coverage under this subsection (3)
does not affect a person's eligibility for pool coverage under
subsection (1)(a)(i), (ii), or (iv) of this section; and
(c) The pool administrator shall provide written notice to any
person who is no longer eligible for coverage under a pool plan under
this subsection (3) within thirty days of the administrator's
determination that the person is no longer eligible. The notice shall:
(i) Indicate that coverage under the plan will cease ninety days from
the date that the notice is dated; (ii) describe any other coverage
options, either in or outside of the pool, available to the person;
(iii) describe the procedures for the administration of the standard
health questionnaire to determine the person's continued eligibility
for coverage under subsection (1)(a)(ii) of this section; and (iv)
describe the enrollment process for the available options outside of
the pool.
(4) The board shall ensure that an independent analysis of the
eligibility standards for the pool coverage is conducted, including
examining the eight percent eligibility threshold, eligibility for
medicaid enrollees and other publicly sponsored enrollees, and the
impacts on the pool and the state budget. The board shall report the
findings to the legislature by December 1, 2007.
Sec. 6 RCW 48.41.110 and 2007 c 259 s 26 and 2007 c 8 s 5 are
each reenacted and amended to read as follows:
(1) The pool shall offer one or more care management plans of
coverage. Such plans may, but are not required to, include point of
service features that permit participants to receive in-network
benefits or out-of-network benefits subject to differential cost
shares. The pool may incorporate managed care features into existing
plans.
(2) The administrator shall prepare a brochure outlining the
benefits and exclusions of pool policies in plain language. After
approval by the board, such brochure shall be made reasonably available
to participants or potential participants.
(3) The health insurance policies issued by the pool shall pay only
reasonable amounts for medically necessary eligible health care
services rendered or furnished for the diagnosis or treatment of
covered illnesses, injuries, and conditions. Eligible expenses are the
reasonable amounts for the health care services and items for which
benefits are extended under a pool policy.
(4) The pool shall offer at least two policies, one of which will
be a comprehensive policy that must comply with RCW 48.41.120 and must
at a minimum include the following services or related items:
(a) Hospital services, including charges for the most common
semiprivate room, for the most common private room if semiprivate rooms
do not exist in the health care facility, or for the private room if
medically necessary, including no less than a total of one hundred
eighty inpatient days in a calendar year, and no less than thirty days
inpatient care for alcohol, drug, or chemical dependency or abuse per
calendar year;
(b) Professional services including surgery for the treatment of
injuries, illnesses, or conditions, other than dental, which are
rendered by a health care provider, or at the direction of a health
care provider, by a staff of registered or licensed practical nurses,
or other health care providers;
(c) No less than twenty outpatient professional visits for the
diagnosis or treatment of alcohol, drug, or chemical dependency or
abuse rendered during a calendar year by a state-certified chemical
dependency program approved under chapter 70.96A RCW, or by one or more
physicians, psychologists, or community mental health professionals,
or, at the direction of a physician, by other qualified licensed health
care practitioners;
(d) Drugs and contraceptive devices requiring a prescription;
(e) Services of a skilled nursing facility, excluding custodial and
convalescent care, for not less than one hundred days in a calendar
year as prescribed by a physician;
(f) Services of a home health agency;
(g) Chemotherapy, radioisotope, radiation, and nuclear medicine
therapy;
(h) Oxygen;
(i) Anesthesia services;
(j) Prostheses, other than dental;
(k) Durable medical equipment which has no personal use in the
absence of the condition for which prescribed;
(l) Diagnostic x-rays and laboratory tests;
(m) Oral surgery including at least the following: Fractures of
facial bones; excisions of mandibular joints, lesions of the mouth,
lip, or tongue, tumors, or cysts excluding treatment for
temporomandibular joints; incision of accessory sinuses, mouth salivary
glands or ducts; dislocations of the jaw; plastic reconstruction or
repair of traumatic injuries occurring while covered under the pool;
and excision of impacted wisdom teeth;
(n) Maternity care services;
(o) Services of a physical therapist and services of a speech
therapist;
(p) Hospice services;
(q) Professional ambulance service to the nearest health care
facility qualified to treat the illness or injury;
(r) Mental health services pursuant to RCW 48.41.220; and
(s) Other medical equipment, services, or supplies required by
physician's orders and medically necessary and consistent with the
diagnosis, treatment, and condition.
(5) The board shall design and employ cost containment measures and
requirements such as, but not limited to, care coordination, provider
network limitations, preadmission certification, and concurrent
inpatient review which may make the pool more cost-effective.
(6) The pool benefit policy may contain benefit limitations,
exceptions, and cost shares such as copayments, coinsurance, and
deductibles that are consistent with managed care products, except that
differential cost shares may be adopted by the board for nonnetwork
providers under point of service plans. No limitation, exception, or
reduction may be used that would exclude coverage for any disease,
illness, or injury.
(7)(a) The pool may not reject an individual for health plan
coverage based upon preexisting conditions of the individual or deny,
exclude, or otherwise limit coverage for an individual's preexisting
health conditions; except that it shall impose a six-month benefit
waiting period for preexisting conditions for which medical advice was
given, for which a health care provider recommended or provided
treatment, or for which a prudent layperson would have sought advice or
treatment, within six months before the effective date of coverage.
The preexisting condition waiting period shall not apply to prenatal
care services. The pool may not avoid the requirements of this section
through the creation of a new rate classification or the modification
of an existing rate classification. Credit against the waiting period
shall be as provided in subsection (8) of this section.
(b) The pool shall not impose any preexisting condition waiting
period for any person under the age of nineteen.
(8)(a) Except as provided in (b) of this subsection, the pool shall
credit any preexisting condition waiting period in its plans for a
person who was enrolled at any time during the sixty-three day period
immediately preceding the date of application for the new pool plan.
For the person previously enrolled in a group health benefit plan, the
pool must credit the aggregate of all periods of preceding coverage not
separated by more than sixty-three days toward the waiting period of
the new health plan. For the person previously enrolled in an
individual health benefit plan other than a catastrophic health plan,
the pool must credit the period of coverage the person was continuously
covered under the immediately preceding health plan toward the waiting
period of the new health plan. For the purposes of this subsection, a
preceding health plan includes an employer-provided self-funded health
plan.
(b) The pool shall waive any preexisting condition waiting period
for a person who is an eligible individual as defined in section
2741(b) of the federal health insurance portability and accountability
act of 1996 (42 U.S.C. 300gg-41(b)).
(9) If an application is made for the pool policy as a result of
rejection by a carrier, then the date of application to the carrier,
rather than to the pool, should govern for purposes of determining
preexisting condition credit.
(10) The pool shall contract with organizations that provide care
management that has been demonstrated to be effective and shall
encourage enrollees who are eligible for care management services to
participate. The pool may encourage the use of shared decision making
and certified decision aids for preference-sensitive care areas.
NEW SECTION. Sec. 7 This act is necessary for the immediate
preservation of the public peace, health, or safety, or support of the
state government and its existing public institutions, and takes effect
immediately.