2022 -- S 2944 | |
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LC005870 | |
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STATE OF RHODE ISLAND | |
IN GENERAL ASSEMBLY | |
JANUARY SESSION, A.D. 2022 | |
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A N A C T | |
RELATING TO INSURANCE -- PSYCHIATRY RESOURCE NETWORK FUNDING ACT | |
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Introduced By: Senator Maryellen Goodwin | |
Date Introduced: May 18, 2022 | |
Referred To: Senate Health & Human Services | |
It is enacted by the General Assembly as follows: | |
1 | SECTION 1. Title 27 of the General Laws entitled "INSURANCE" is hereby amended by |
2 | adding thereto the following chapter: |
3 | CHAPTER 82 |
4 | PSYCHIATRY RESOURCE NETWORK FUNDING ACT |
5 | 27-82-1. Short title. |
6 | This chapter shall be known and may be cited as the "Psychiatry Resource Network |
7 | Funding Act." |
8 | 27-82-2. Definitions. |
9 | As used in this chapter: |
10 | (1) "Adult" means: |
11 | (i) All residents who are over age eighteen (18) and under age sixty-five (65); and |
12 | (ii) All other persons over age eighteen (18) and under age sixty-five (65) who receive |
13 | health care services. |
14 | (2) "Assessed entity" means any health carrier or other entity that contracts or offers to |
15 | insure, provide, deliver, arrange, pay for, administer any claims for or reimburse or facilitate the |
16 | sharing of any of the costs of health care services for any person residing in or receiving health care |
17 | services in the state, including, without limitation, the following: |
18 | (i) Any writer of individual, group, or stop loss insurance; |
19 | (ii) Health maintenance organizations; |
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1 | (iii) Third-party administrator; |
2 | (iv) Preferred provider agreement; |
3 | (v) Fraternal benefit society; |
4 | (vi) Administrative services organization and any other organization managing claims on |
5 | behalf of a self-insured entity; |
6 | (vii) Any self-insurer or other entity that provides an employee or group benefit plan and |
7 | does not utilize an external claims managing service; |
8 | (viii) Any governmental entity that provides an employee or group benefit plan and does |
9 | not utilize external claims management services; or |
10 | (viv) Any entity, administrator or sponsor of any health care costs sharing program. |
11 | (3) "Assessment" means the association member liability with respect to costs determined |
12 | in accordance with this chapter. |
13 | (4) "Association" means the health care information line association created by this |
14 | chapter. |
15 | (5) "Association director" means the director of a health care information line association. |
16 | (6) "Board" means the board of directors of the association. |
17 | (7) "Child" or "children" means: |
18 | (i) All residents who are under age nineteen (19); and |
19 | (ii) All other persons under age nineteen (19) who receive health care services in the state. |
20 | (8) "Covered lives" means all individuals who are: |
21 | (i) Covered under an individual health insurance policy issued or delivered in the state; |
22 | (ii) Covered under a group health insurance policy that is issued or delivered in the state; |
23 | (iii) Covered under a group health insurance policy evidenced by a certificate of insurance |
24 | that is issued or delivered to an individual who resides in the state; |
25 | (iv) Protected, in part, by a group excess loss insurance policy where the policy or |
26 | certificate of coverage has been issued or delivered in the state; or |
27 | (v) Protected, in part, by an employee benefit plan of a self-insured entity or a government |
28 | plan for any employer or government entity which: |
29 | (A) Has an office or other worksite located in the state; or |
30 | (B) Has fifty (50) or more employees who are participants or beneficiaries of a health cost |
31 | sharing program. |
32 | (9) "Director" means the director of the department of health. |
33 | (10) "Health carrier" or "carrier" means an entity subject to the insurance laws and rules of |
34 | the state, or subject to the jurisdiction of the commissioner of insurance, that contracts or offers to |
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1 | contract to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care |
2 | services, including an insurance company, a health maintenance organization, a health service |
3 | corporation, or any other entity providing a plan of health insurance, health benefits, or health |
4 | services. |
5 | (11) "Health cost sharing program" means any cost sharing or similar program which seeks |
6 | to share the costs of health care services and which in the preceding twelve (12) months either has: |
7 | (i) Coordinated payment for or reimbursed over ten thousand dollars ($10,000) of costs for |
8 | health services delivered in this state; or |
9 | (ii) Communicated by mail or electronic media to residents of this state concerning their |
10 | potential participation. |
11 | (12) "Insurance commissioner" means the health insurance commissioner of the |
12 | department of business regulation. |
13 | (13) "Psychiatry resource network" or "PRN" means any information lines, referral service, |
14 | including PediPRN and MomsPRN which is available to providers in the state, and which is funded |
15 | pursuant to the association's plan of operation. |
16 | (14) "Provider" means a person licensed by the state to provide health care services or a |
17 | partnership or corporation or other entity made up of those persons. |
18 | (15) "Senior" means: |
19 | (i) All residents who are over age sixty-four (64); and |
20 | (ii) All other persons over age sixty-four (64) who receive health care services in Rhode |
21 | Island. |
22 | (16) "State" means the State of Rhode Island. |
23 | 27-82-3. Association and PRN fund created. |
24 | (a) There is hereby created the Rhode Island psychiatry resource network or "RIPRN" for |
25 | the primary purpose of equitably determining and collecting assessments for the cost of PRNs in |
26 | the state which are not covered by other federal or state funding. |
27 | (b) The association shall be comprised of all assessed entities, as defined in this chapter. |
28 | (c) A PRN fund shall be maintained in the custody of the general treasurer. Receipts from |
29 | public and private sources for funding PRNs may be deposited into the account in the manner and |
30 | method specified in the association's plan of operation. Expenditures from the account shall be used |
31 | exclusively for the costs of operating any PRNs funded by the association, at no cost to providers. |
32 | Only the director of health, or designee may authorize expenditures from the account. |
33 | 27-82-4. Powers and duties. |
34 | (a) The association shall be a not-for-profit, voluntary corporation and shall possess all |
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1 | general powers as derive from that status under state law and such additional powers and duties as |
2 | are specified in this section. |
3 | (b) The directors' terms and method of appointments shall be specified in the plan of |
4 | operation. The board of directors shall include: |
5 | (1) The director of the department of health, or designee; |
6 | (2) The health insurance commissioner, or designee; |
7 | (3) Three (3) health carrier representatives; |
8 | (4) Two (2) provider representatives, one of whom serves primarily children and one of |
9 | whom serves primarily adults; |
10 | (5) One representative from a third-party administrator which is not a health carrier; and |
11 | (6) May include up to three (3) additional members as specified in the association's plan of |
12 | operation. |
13 | (c) Any director may designate a personal representative to act for the director at a meeting |
14 | or on a committee. A personal representative shall notify the meeting's presiding officer of such |
15 | designation. A director may revoke any such designation at any time. |
16 | (d) The board shall have the following duties: |
17 | (1) Prepare and adopt articles of association and bylaws; |
18 | (2) Prepare and adopt a plan of operation; |
19 | (3) Submit the plan of operation to the director of health for approval following opportunity |
20 | for comment by the health insurance commissioner; |
21 | (4) Conduct all activities in accordance with the approved plan of operation; |
22 | (5) Undertake reasonable steps to minimize: |
23 | (i) Duplicate counting of child or adult covered lives; or |
24 | (ii) Duplicate assessments; |
25 | (6) Pay the association's operating costs; |
26 | (7) Remit collected assessments, after costs and reserves, to the general treasurer for credit |
27 | to the PRN fund; |
28 | (8) Submit to the director of health, no later than one hundred twenty (120) days after the |
29 | close of the association's fiscal year, a financial report in a form acceptable to the director; and |
30 | (9) Submit a periodic noncompliance report to the director and the health insurance |
31 | commissioner listing any assessed entities that failed to either: |
32 | (i) Remit assessments in accordance with the plan of operation; or |
33 | (ii) After notice from the association, comply with any reporting or auditing requirement |
34 | of this chapter or the plan of operation. |
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1 | (e) The board shall have the following powers: |
2 | (1) Enter into contracts, including one or more contracts for executive director and |
3 | administrative services to administer the association. |
4 | (2) Sue or be sued, including taking any legal action for the recovery of any assessment or |
5 | interest or other cost reimbursement due to the association. Reasonable legal fees and costs for any |
6 | amounts determined to be due to the association shall also be awarded to the association. |
7 | (3) Appoint, from among its directors, committees to provide technical assistance and to |
8 | supplement those committees with non-board members. |
9 | (4) Engage professionals including auditors, attorneys, and independent consultants. |
10 | (5) Borrow and repay working capital, reserve, or other funds and grant security interests |
11 | in assets and future assessments as may be helpful or necessary for such purposes. |
12 | (6) Maintain one or more bank accounts for collection of assessments, refund |
13 | overpayments, and pay the association's costs of operation. |
14 | (7) Invest reserves as the board determines to be appropriate from time to time. |
15 | (8) Provide member and public information about its operations. |
16 | (9) Enter into one or more agreements with other state or federal authorities, including |
17 | similar funding associations in other states, to ensure equitable allocation of funding responsibility |
18 | with respect to individuals who may reside in one state, but receive health care services in another. |
19 | Any amounts owed under any such agreements shall be included in the estimated costs for |
20 | assessment rate setting purposes. |
21 | (10) Enter into one or more agreements with assessed entities for one or more alternative |
22 | payment methodologies for the respective assessed entity's covered lives. |
23 | (11) Assist the director in qualification for grant and other resources from the federal |
24 | government and adjust its procedures as may be needed from time to time in order that appropriate |
25 | adjustments are made to any assessment liability with respect to any person who is eligible for |
26 | federally funded services. |
27 | (12) Perform any other functions the board determines to be helpful or necessary to carry |
28 | out the plan of operation or the purposes of this chapter. |
29 | 27-82-5. Assessments. |
30 | (a) Assessment rates shall be determined as follows: |
31 | (1) The director shall provide estimated PRN operation costs, not covered by any other |
32 | state or federal funds, for the succeeding year no later than one hundred twenty (120) days prior to |
33 | the commencement of each year and shall update such estimate at such times as reasonably may be |
34 | requested by the association. |
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1 | (2) Add estimates to cover the association's operating costs, including any interest payable, |
2 | for the upcoming year. |
3 | (3) Add a reserve of up to ten percent (10%) of the sum of subsections (a)(1) and (a)(2) of |
4 | this section for unanticipated costs. |
5 | (4) Add a working capital reserve in such amount as may be reasonably determined by the |
6 | board from time to time. |
7 | (5) Subtract the amount of any unexpended fund balance, including any net investment |
8 | income earned, as of the end of the preceding year. |
9 | (6) Calculate a per child covered life per month and per adult covered life per month and a |
10 | per senior covered life per month amount to be self-reported and paid by all assessed entities by |
11 | dividing the annual amount determined in accordance with subsections (a)(1) through (a)(5) of this |
12 | section by the number of covered lives in each age band, respectively, projected to be covered by |
13 | the assessed entities during the succeeding program year, divided by twelve (12). At the option of |
14 | the association, the assessment may, instead, be calculated as a single per covered life assessment, |
15 | not segregated for child and adult and senior covered lives. |
16 | (b) Within forty-five (45) days of the close of each calendar quarter, an assessed entity |
17 | shall pay a quarterly assessment equal to assessment rates multiplied by the applicable number of |
18 | covered life months covered by the assessed entity in the preceding calendar quarter. Unless |
19 | otherwise determined by the board, the assessed entity which would have been responsible for |
20 | payment or coordination of payment or reimbursement of any provider's primary care provider |
21 | health care services for any individual shall be the entity responsible for reporting the respective |
22 | child covered lives and for payment of the corresponding assessment. |
23 | (c) At any time after one full year of operation under subsections (a) and (b) of this section, |
24 | the association, upon two-thirds (2/3) vote of its board and the approval of the director may: |
25 | (1) Make changes to the assessment collection mechanism outlined in subsections (a) and |
26 | (b); and |
27 | (2) Add any health care information line or other services for which the board determines |
28 | funding pursuant to this health care funding act is desirable to those services funded by this chapter. |
29 | Any such changes shall be reflected in an updated plan of operation available to the public. |
30 | (d) If an assessed entity has not paid in accordance with this section, interest accrues at one |
31 | percent (1%) per month, compounded monthly on or after the due date. |
32 | (e) The board may determine an interim assessment for new programs covered or to cover |
33 | any unanticipated funding shortfall. The board shall calculate a supplemental interim assessment |
34 | using the methodology for regular assessments, but payable over the remaining fiscal year, and |
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1 | such interim assessment shall be payable together with the regular assessment commencing the |
2 | calendar quarter that begins no less than thirty (30) days following the establishment of the interim |
3 | assessment. The board may not impose more than one interim assessment per year, except in the |
4 | case of a public health emergency declared in accordance with state or federal law. |
5 | (f) For purposes of rate setting, medical loss ratio calculations, and reimbursement by plan |
6 | sponsors, all association assessments are considered medical benefit costs and not regulatory or |
7 | administrative costs. |
8 | (g) In the event of any insolvency or similar proceedings affecting any payer, assessments |
9 | shall be included in the highest priority of obligations to be paid by or on behalf of such payer. |
10 | (h) Annual accounting. The general treasurer shall supply funds as are needed for PRN |
11 | operations throughout the state's fiscal year. No later than forty-five (45) days following the close |
12 | of the state's fiscal year, the treasurer shall provide an accounting of PRN operating costs not |
13 | covered by any other state or federal program and advise the association of the final amount needed |
14 | to cover the prior fiscal year. The association shall reimburse such amount within forty-five (45) |
15 | days of receiving the accounting; provided, however, that with respect to all or any part of any |
16 | amount due which exceeds one hundred five percent (105%) of the amount which had been |
17 | projected by the director to be needed for such fiscal year, the association may defer such payment |
18 | and the treasurer shall include such deferral in the subsequent year's accounting. In the event of |
19 | such deferral, any such remaining unreimbursed amount shall be included in the assessment |
20 | calculation by the association for the funds to be raised by the association in the subsequent year. |
21 | (i) If the association discontinues operation for any reason, any unexpended assessments, |
22 | including unexpended funds from prior assessments in the PRN fund, after the association's wind |
23 | down expenses, shall be refunded to payees in proportion to the respective assessment payments |
24 | by payees over the most recent eight (8) quarters prior to discontinuation of association operations. |
25 | 27-82-6. Reports and audits. |
26 | (a) Each assessed entity is required to report its respective numbers of covered lives in a |
27 | timely fashion as prescribed in this chapter and respond to any audit requests by the association |
28 | related to covered lives or assessments due to the association. Upon failure of any assessed entity |
29 | to respond to an audit request within ten (10) days of the receipt of notification of said audit request |
30 | by the association, the assessed entity shall be responsible for prompt payment of the fees of any |
31 | outside auditor engaged by the association to determine such information and shall make all books |
32 | and records requested by said auditors available for inspection and copying at such location within |
33 | the state as may be specified by such auditor. |
34 | (b) Failure to cure non-compliance with any reporting, auditing, or assessment obligation |
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1 | to the association within thirty (30) days from the postmarked date of written notice of |
2 | noncompliance shall subject the assessed entity to all the fines and penalties, including suspension |
3 | or loss of license, allowable under any provision of any other state statute. Any monetary fine or |
4 | penalty shall be remitted to the PRN fund and, thereby, reduce future obligations of the association |
5 | for PRN funding. The assessed entity also shall pay for reasonable attorneys' fees and any other |
6 | costs of enforcement under this section. |
7 | 27-82-7. Immunity. |
8 | Apart from liabilities of assessed entities expressly stated in this chapter or the plan of |
9 | operation, there shall be no liability on the part of and no cause of action of any nature shall arise |
10 | against: |
11 | (1) Any association member or a member's agents, independent contractors, or employees; |
12 | (2) The association or its agents, contractors, or employees; |
13 | (3) Members of the board of directors; |
14 | (4) The director or the representatives thereof; or |
15 | (5) The health insurance commissioner or the representatives thereof, for any action or |
16 | omission by any of them related to activities under this chapter. |
17 | 27-82-8. Tax exempt status. |
18 | The association is expressly granted exemption from all taxes levied either by the state or |
19 | any governmental entity located therein. |
20 | 27-82-9. Severability. |
21 | If any provision of this chapter or the application thereof to any person or circumstance is |
22 | held invalid, the invalidity does not affect other provisions or applications of the chapter which can |
23 | be given effect without the invalid provision or application, and to this end the provisions of this |
24 | chapter are severable. |
25 | 27-82-10. Rulemaking. |
26 | The director and the health insurance commissioner may adopt rules and regulations to |
27 | carry out the purposes of this chapter. |
28 | 27-82-11. Administrative allowance to department of health. |
29 | Within forty-five (45) days following the close of each calendar quarter, the association |
30 | shall transfer from assessments raised a sum equal to five percent (5%) of the costs funded by the |
31 | association to the department of health's account in recognition of the support from the department |
32 | and its staff in enabling association members to meet their obligations for funding health care |
33 | services at lower cost. |
34 | 27-82-12. Transitional matters. |
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1 | To generate sufficient start-up funding, the association may accept prepayment from |
2 | member assessed entities, subject to offset of future amounts otherwise owing or other repayment |
3 | method as determined by the board. |
4 | SECTION 2. This act shall take effect upon passage. |
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LC005870 | |
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EXPLANATION | |
BY THE LEGISLATIVE COUNCIL | |
OF | |
A N A C T | |
RELATING TO INSURANCE -- PSYCHIATRY RESOURCE NETWORK FUNDING ACT | |
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1 | This act would create the Rhode Island psychiatry resource network for the primary |
2 | purpose of equitably determining and collecting assessments for the cost of psychiatry resource |
3 | networks in the state which are not covered by other federal or state funding. Assessed entities |
4 | would include HMO's, governmental entities providing group benefits, third-party administrators, |
5 | fraternal benefit societies, administrative service organizations for self insured, self insured |
6 | providing group benefits and health care cost sharing programs. |
7 | This act would take effect upon passage. |
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LC005870 | |
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