Local and Municipal Health Care Choice Act of 2015
Amends the Public Health Service Act to authorize a local government in a secondary state to provide group health coverage to its officers, employees, or retirees (and their dependents) through a local government employee health benefits pool or program authorized under the laws of a primary state.
Defines: (1) "primary state" to mean the state designated by a local government employee health benefits pool or program as the state whose covered laws shall govern the pool or program in the issuance of group health coverage, and (2) "secondary state" to mean any state that is not the primary state.
Makes a local government employee health benefits pool or program eligible to offer group health coverage to officials, employees, and retirees (and their dependents) of a local government located in a secondary state through an interlocal agreement with such local government, or as approved by an applicable state authority in such secondary state, unless objections are made within a specified time frame by the municipal league or association or county association located in the secondary state.
Requires the covered laws of the primary state to apply to group health coverage offered by a local government employee health benefits pool or program in the primary state and in any secondary state, but only if the coverage and the pool or program comply with conditions set forth in this Act with respect to the offering of coverage in any secondary state.
Defines "covered laws" as the laws, rules, regulations, agreements, and orders pertaining to:
Excludes from such term any law, rule, regulation, agreement, or order governing the use of care or cost management techniques.
Exempts a local government pool or program that offers group health coverage in a secondary state to the officers, employees, or retirees of a local government located in such secondary state from any covered laws of the secondary state. Permits a secondary state to require such a pool or program to register with an applicable authority in such state and to comply with any state law regarding fraud and abuse or unfair claims settlement practices.
[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2869 Introduced in House (IH)]
114th CONGRESS
1st Session
H. R. 2869
To amend title XXVII of the Public Health Service Act to permit
cooperative governing of public entity health benefits through local
governments in secondary States.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
June 24, 2015
Mr. Marchant (for himself, Mr. Thornberry, and Mr. Olson) introduced
the following bill; which was referred to the Committee on Energy and
Commerce
_______________________________________________________________________
A BILL
To amend title XXVII of the Public Health Service Act to permit
cooperative governing of public entity health benefits through local
governments in secondary States.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Local and Municipal Health Care
Choice Act of 2015''.
SEC. 2. COOPERATIVE GOVERNING OF PUBLIC ENTITY GROUP HEALTH COVERAGE.
Title XXVII of the Public Health Service Act (42 U.S.C. 300gg et
seq.) is amended--
(1) by redesignating the section 2794 (42 U.S.C. 300gg-95)
relating to uniform fraud and abuse referral format as section
2795; and
(2) by adding at the end the following new section:
``SEC. 2796. AUTHORITY TO OFFER PUBLIC ENTITY GROUP HEALTH COVERAGE TO
LOCAL GOVERNMENTS IN A SECONDARY STATE.
``(a) In General.--A local government in a secondary State (as
defined in subsection (i)(7)) may provide group health coverage to its
officers, employees, or retirees (and their dependents) through a local
government employee health benefits pool or program authorized under
the laws of a primary State, subject to the provisions of this section.
``(b) Eligibility for Multistate Activity.--A local government
employee health benefits pool or program shall be eligible to offer
group health coverage to officials, employees, and retirees (and their
dependents) of a local government located in a secondary State through
an interlocal agreement with such local government, or as approved by
an applicable State authority in such secondary State, unless--
``(1) in the case of a pool or program that primarily
serves municipal officers, employees, or retirees (and their
dependents), an objection is made to the offering of such
coverage by the municipal league or association located in the
secondary State within 90 days of the date on which the
authority is granted or an interlocal agreement is executed; or
``(2) in the case of a pool or program that primarily
serves county officers, employees, retirees (and their
dependents), an objection is made to the offering of such
coverage by the county association located in the secondary
State within 90 days of the date on which the authority is
granted or an interlocal agreement is executed.
``(c) Application of Covered Laws of Primary State.--The covered
laws (as defined in subsection (i)(2)) of the primary State shall apply
to group health coverage offered by a local government employee health
benefits pool or program in the primary State and in any secondary
State, but only if the coverage and the pool or program comply with the
conditions of this section with respect to the offering of coverage in
any secondary State.
``(d) Limited Application of Secondary State Laws.--
``(1) In general.--Except as provided in this section, a
local government employee health benefits pool or program that
offers group health coverage in a secondary State to the
officers, employees, or retirees (and their dependents) of a
local government located in such secondary State, is exempt
from any covered laws of the secondary State (and any rules,
regulations, agreements, or orders sought or issued by such
State under or related to such covered laws).
``(2) Secondary state authority.--A secondary State may
require a local government employee health benefits pool or
program to do any or all of the following:
``(A) Registration.--To register with an applicable
State authority in such State with jurisdiction over
local government employee health benefits pools or
programs and designate such authority as its agent
solely for the purpose of receiving service of legal
documents or process.
``(B) Documentation.--To file with an applicable
state authority in such State--
``(i) a written intent to do business in
that State;
``(ii) copies of the membership or
interlocal agreements entered into between the
local government employee health benefits pool
or program and a local government of that
State; and
``(iii) copies of annual audited financial
statements of the local government employee
health benefits pool or program filed with the
primary State.
``(C) Compliance with injunctions.--To comply with
an injunction issued by a court of competent
jurisdiction, upon a petition by an applicable State
authority in such State alleging that the pool or
program is in hazardous financial condition.
``(D) Compliance with state fraud and abuse laws.--
To comply with any State law regarding fraud and abuse,
except that if the State seeks an injunction regarding
the conduct described in this subparagraph, such
injunction must be obtained from a court of competent
jurisdiction.
``(E) Compliance with state unfair claims
settlement practices laws.--To comply with any State
law regarding unfair claims settlement practices.
``(3) Limitations on secondary state authority.--If a local
government employee health benefits pool or program offers
group health insurance coverage to officials, employees, and
retirees (and their dependents) of a local government located
in a secondary State pursuant to subsection (b), such secondary
State may not do any of the following:
``(A) Countersigned by local agent or broker.--
Require any group health coverage issued by the pool or
program to be countersigned by an insurance agent or
broker residing in that secondary State.
``(B) Submit to duplicative financial
examinations.--Require the pool or program to submit to
an examination of its financial condition by an
applicable State authority in such State, unless--
``(i) an applicable State authority of the
primary State has not done an examination
within the period recommended by the National
Association of Insurance Commissioners; and
``(ii) any such examination by the
secondary State is conducted in accordance with
the examiners' handbook of the National
Association of Insurance Commissioners and is
coordinated to avoid unjustified duplication
and unjustified repetition.
``(C) Discriminate against pool or program.--
Otherwise discriminate against the pool or program
issuing group health coverage in both the primary State
and in any secondary State.
``(e) Benefit Requirements.--Group health coverage offered by a
local government employee health benefits pool or program shall be at
least as comprehensive as the coverage of the essential health benefits
under section 1302(b) of the Patient Protection and Affordable Care Act
(42 U.S.C. 18022(b)).
``(f) Disclosure Requirement.--Prior to providing group health
coverage to the officers, employees, or retirees (and their dependents)
of a local government located in a secondary State, a local government
employee health benefits pool or program shall provide notice to such
individuals that the health coverage is governed by the covered laws
and regulations of the primary State, as well as by any applicable
Federal laws and regulations.
``(g) Status of Group Health Coverage in Secondary State.--A local
government employee health benefits pool or program that is not
regulated as an insurer in its primary State, and whose group health
plans are not regulated as insurance in its primary State, shall not be
subject to the jurisdiction of a State insurance regulatory agency in
any secondary State.
``(h) Designation of Primary State.--
``(1) Designation of a single state.--A local government
employee health benefits pool or program may only designate one
State as its primary State with respect to all such coverage it
offers under this section.
``(2) Initial operations in primary state.--Such pool or
program may not offer group health coverage in a secondary
State until it is deemed to be doing business in the primary
State.
``(i) Definitions.--In this section:
``(1) Applicable state authority.--The term `applicable
State authority' means, with respect to a local government
employee health benefits pool or program in a State, any
official or officials designated by the State to administer the
requirements of this section for the State with respect to such
pool or program, including the official or officials with
authority to approve interlocal agreements under applicable
State law, but shall not include any State insurance regulatory
agency.
``(2) Covered laws.--
``(A) In general.--The term `covered laws' means
the laws, rules, regulations, agreements, and orders
pertaining to any of the following:
``(i) Group health coverage issued by a
local government employee health benefits pool
or program.
``(ii) The offer, sale, rating (including
medical underwriting), renewal, and issuance of
group health coverage to local government
officials, employees, and retirees or their
dependents.
``(iii) The management, operations, and
investment activities of a local government
employee health benefits pool or program.
``(iv) Loss control and claims
administration for a local government employee
health benefits pool or program with respect to
liability for which the pool or program
provides coverage.
``(v) The payment, on a nondiscriminatory
basis, of applicable premium and other taxes
(including high risk pool assessments) which
are levied on health insurance issuers,
brokers, or policyholders under the laws of the
State.
``(B) Exception.--Such term does not include any
law, rule, regulation, agreement, or order governing
the use of care or cost management techniques,
including any requirement related to provider
contracting, network access or adequacy, health care
data collection, or quality assurance.
``(3) Group health coverage.--The term `group health
coverage' means medical care expense reimbursement provided
under a group health plan.
``(4) Local government.--The term `local government' means
a county, municipality, special district, school district,
junior college district, housing authority, or other political
subdivision or public entity defined under State law.
``(5) Local government employee health benefits pool or
program.--The term `local government employee health benefits
pool or program' means a risk pool authorized or permitted by
State statute or otherwise regulated by a State agency under
which--
``(A) a local government or group of local
governments, directly or through a pool, provide health
care benefits primarily for local government officials,
employees, and retirees and their dependents; and
``(B) such pool may provide health care benefits
from the assets of the pool or its member local
governments through any combination of self-funded
arrangements or fully insured products;
and includes any other State authorized program designed to
provide health benefits to local government officials,
employees, and retirees and their dependents.
``(6) Primary state.--The term `primary State' means, with
respect to group health coverage offered by a local government
employee health benefits pool or program, the State designated
by the pool or program as the State whose covered laws shall
govern the pool or program in the issuance of such coverage
under this part.
``(7) Secondary state.--The term `secondary State' means,
with respect to group health coverage offered by a local
government employee health benefits pool or program, any State
that is not the primary State.''.
<all>
Introduced in House
Introduced in House
Referred to the House Committee on Energy and Commerce.
Referred to the Subcommittee on Health.
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