SB-0693, As Passed Senate, November 10, 2011

SUBSTITUTE FOR

SENATE BILL NO. 693

A bill to provide for the establishment of the MIHealth

marketplace as a nonprofit corporation; to create the board of the

MIHealth marketplace and prescribe its powers and duties; to

provide for assessments and user fees; and to provide for the

powers and duties of certain state and local governmental officers

and agencies.

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

PART 1

GENERAL PROVISIONS

Sec. 101. (1) This act shall be known and may be cited as the

"MIHealth marketplace act". The marketplace under this act is a

nonexclusive health insurance clearinghouse. The marketplace shall

foster a competitive market for health insurance in this state and

serve as a market facilitator to promote the purchase and sale of

qualified health plans and to disseminate health insurance

information regarding qualified health plans to health benefit plan

consumers.

(2) A reference in this act to the federal act includes other

provisions of the laws of the United States relating to health care

coverage. Nothing in this act shall be construed or implied to

recognize the constitutionality of the federal act.

(3) The senate majority leader and the speaker of the house of

representatives shall establish a joint committee to review the

federal law, if any provisions remain, and the implications with

regard to this act. The joint committee shall report to the

legislature its findings under this subsection by January 1, 2014

or within 30 days after all or any part of the federal act is

declared unconstitutional, repealed, or otherwise altered in a

manner that affects the implementation or administration of this

act, whichever date is earlier. The joint committee shall include

in the report its recommendations regarding amendments to this act

or other state law.

(4) If the part of the federal act that requires the

establishment of a small business health options program is

declared unconstitutional or repealed, the commissioner shall issue

an order requiring the marketplace to suspend the operation of the

SHOP. Upon issuance of the commissioner's order under this

subsection, the marketplace shall immediately suspend the operation

of the SHOP. Upon suspension of the SHOP under this subsection,

federally recognized Indian tribes shall be allowed to pay premiums

for qualified health plans on behalf of tribal members as allowed

under section 211(1)(u).

(5) For purposes of this act, the words and phrases defined in

sections 103 to 109 have the meanings ascribed to them in those

sections.

Sec. 103. (1) "Board" means the MIHealth marketplace board

created under section 201.

(2) "Commissioner" means the commissioner of the office of

financial and insurance regulation.

(3) "Educated health care consumer" means an individual who is

knowledgeable about the health care system and has background or

experience in making informed decisions regarding health, medical,

and scientific matters.

(4) "Executive director" means the executive director

appointed by the board under section 207.

(5) "Federal act" means the federal patient protection and

affordable care act, Public Law 111-148, as amended by the federal

health care and education reconciliation act of 2010, Public Law

111-152, and any regulations promulgated under those acts.

(6) "Federally recognized Indian tribe" means any of the

following:

(a) An Indian tribe as that term is defined in the federally

recognized Indian tribe list act of 1994, 25 USC 479a.

(b) An Indian tribe as that term is defined in the Indian

health care improvement act, 25 USC 1603.

consortium, as those terms are defined and used in the Indian self-

determination and education assistance act of 1975, 25 USC 450 to

458dd-2.

Sec. 105. (1) "Health benefit plan" means a policy, contract,

certificate, or agreement offered or issued by a health carrier to

provide, deliver, arrange for, pay for, or reimburse any of the

costs of health care services. Health benefit plan does not include

any of the following:

(a) Coverage only for accident or disability income insurance,

or any combination of those coverages.

(b) Coverage issued as a supplement to liability insurance.

and automobile liability insurance.

(d) Worker's compensation or similar insurance.

(e) Automobile medical payment insurance.

(f) Credit-only insurance.

(g) Coverage for on-site medical clinics.

(h) Other similar insurance coverage, specified in federal

regulations issued pursuant to the health insurance portability and

accountability act of 1996, Public Law 104-191, under which

benefits for health care services are secondary or incidental to

other insurance benefits.

(i) A plan that provides the following benefits if those

benefits are provided under a separate policy, certificate, or

contract of insurance or are otherwise not an integral part of the

plan:

(i) Limited scope dental or vision benefits.

(ii) Benefits for long-term care, nursing home care, home

health care, community-based care, or any combination of those

benefits.

(iii) Other similar, limited benefits specified in federal

regulations issued pursuant to the health insurance portability and

accountability act of 1996, Public Law 104-191.

(j) A plan that provides the following benefits if the

benefits are provided under a separate policy, certificate, or

contract of insurance, there is no coordination between the

provision of the benefits and any exclusion of benefits under any

group health benefit plan maintained by the same plan sponsor, and

the benefits are paid with respect to an event without regard to

whether benefits are provided with respect to such an event under

any group health benefit plan maintained by the same plan sponsor:

(i) Coverage only for a specified disease or illness.

(ii) Hospital indemnity or other fixed indemnity insurance.

(k) Any of the following if offered as a separate policy,

certificate, or contract of insurance:

(i) A medicare supplemental policy as defined in section

1882(g)(1) of the social security act, 42 USC 1395ss.

(ii) Coverage supplemental to the coverage provided by the

TRICARE program under 10 USC 1071 to 1110b.

(iii) Similar coverage supplemental to coverage provided under a

group health plan.

(2) "Health carrier" or "carrier" means any of the following

entities that are subject to the insurance laws and regulations of

this state or otherwise subject to the jurisdiction of the

commissioner:

(a) A health insurer operating pursuant to the insurance code

of 1956, 1956 PA 218, MCL 500.100 to 500.8302.

(b) A health maintenance organization operating pursuant to

the insurance code of 1956, 1956 PA 218, MCL 500.100 to 500.8302.

nonprofit health care corporation reform act of 1980, 1980 PA 350,

MCL 550.1101 to 550.1704.

(d) A nonprofit dental care corporation operating under 1963

PA 125, MCL 550.351 to 550.373.

(e) Any other entity providing a plan of health insurance,

health benefits, or health services.

(3) "Marketplace" or "MIHealth marketplace" means the

nonprofit corporation organized under section 203.

Sec. 107. (1) "Producer" means insurance producer as defined

in section 1201 of the insurance code of 1956, 1956 PA 218, MCL

500.1201.

(2) "Qualified dental plan" means a limited scope dental plan

that has been certified under section 215.

(3) "Qualified employer" means a small employer that elects to

make its full-time employees eligible for 1 or more qualified

health plans offered through the SHOP and, at the option of the

employer, some or all of its part-time employees, provided that the

employer meets any of the following:

(a) Has its principal place of business in this state and

elects to provide coverage through the SHOP to all of its eligible

employees, wherever employed.

(b) Elects to provide coverage through the SHOP to all of its

eligible employees who are principally employed in this state.

(4) "Qualified health plan" means a health benefit plan that

has been certified under section 215.

(5) "Qualified individual" means an individual, including a

minor, who meets all of the following requirements:

(a) Is seeking to enroll in a qualified health plan offered to

individuals through the marketplace.

(b) Resides in this state.

incarceration pending the disposition of charges.

(d) Is, and is reasonably expected to be, for the entire

period for which enrollment is sought, a citizen or national of the

United States or an alien lawfully present in the United States.

Sec. 109. (1) "SHOP" means the small business health options

program established by the marketplace under section 211.

(2) "Small employer", until January 1, 2016, means both a sole

proprietor and small employer as those terms are defined in section

3701 of the insurance code of 1956, 1956 PA 218, MCL 500.3701.

Effective January 1, 2016, "small employer" means an employer that

employed an average of not more than 100 employees during the

preceding calendar year. Effective January 1, 2016, all of the

following apply to an employer to determine if it is a small

employer under this act:

(a) All persons treated as a single employer under section

414(b), (c), (m), or (o) of the internal revenue code of 1986, 26

USC 414, shall be treated as a single employer.

(b) An employer and any predecessor employer shall be treated

as a single employer.

employees and employees who are not eligible for coverage through

the employer.

(d) If an employer was not in existence for the entire

preceding calendar year, the determination of whether that employer

is a small employer shall be based on the average number of

employees that it is reasonably expected the employer will employ

on business days in the current calendar year.

(e) An employer that makes enrollment in qualified health

plans available to its employees through the SHOP, and would cease

to be a small employer because of an increase in the number of its

employees, shall continue to be treated as a small employer for

purposes of this act as long as it continuously makes enrollment

through the SHOP available to its employees.

(3) "State medical assistance program" means a program

established in this state under title XIX of the social security

act, 42 USC 1396 to 1396w-5, or under title XXI of the social

security act, 42 USC 1397aa to 1397mm.

PART 2

MIHEALTH MARKETPLACE

Sec. 201. (1) The MIHealth marketplace board consisting of 7

voting members is created to organize and govern the MIHealth

marketplace. The MIHealth marketplace board is created to support

health care consumers, including employers, in this state, and a

majority of the voting members of the board appointed under

subsection (2) shall represent the interests of those health care

consumers. The board is the incorporator of the marketplace for the

purposes of the nonprofit corporation act, 1982 PA 162, MCL

450.2101 to 450.3192. The commissioner shall serve as a nonvoting

ex officio member of the board.

(2) The governor shall appoint 5 of the initial voting members

of the board with the advice and consent of the senate. The senate

majority leader and the speaker of the house of representatives

shall each appoint 1 of the initial voting members of the board.

Except as otherwise provided in this subsection, a vacancy in the

board after the initial appointment under this subsection shall be

filled in the manner specified in the marketplace's articles of

incorporation or bylaws. The appointment of a member to the board

after the initial appointment under this subsection shall be with

the advice and consent of the senate. The articles of incorporation

and bylaws shall include provisions that ensure that the majority

of the voting members of the board at all times represent the

interests of health care consumers as prescribed in subsection (1).

A board member shall not serve more than 2 consecutive terms of

office.

(3) A board member shall not currently or within the

immediately preceding 12-month period of time be employed by a

carrier, producer, health care provider, or third party

administrator or by an affiliate or subsidiary of a carrier,

producer, health care provider, or third party administrator or be

otherwise engaged by an entity that receives more than 50% of its

revenues from a carrier, producer, health care provider, or third

party administrator.

(4) The members first appointed to the board shall be

appointed within 30 days after the effective date of this act.

Except as otherwise provided in this subsection, an appointed board

member shall serve for a term of 4 years or until a successor is

appointed, whichever is later. The following apply to the members

first appointed under subsection (2):

(a) For the members appointed by the governor, 1 member shall

serve for 1 year, 1 member shall serve for 2 years, 2 members shall

serve for 3 years, and 1 member shall serve for 4 years.

(b) For the member appointed by the senate majority leader,

the member shall serve for 4 years.

representatives, the member shall serve for 2 years.

(5) The first meeting of the board shall be called by the

commissioner. A chairperson shall be elected at the first meeting

of the board. After the first meeting, the board shall meet at

least quarterly, or more frequently at the call of the chairperson

or if requested by 4 or more members.

(6) Four members of the board constitute a quorum for the

transaction of business at a meeting of the board. An affirmative

vote of 4 board members is necessary for official action of the

board.

(7) The business that the board may perform shall be conducted

at a meeting of the board that is held in this state, is open to

the public, and is held in a place that is available to the general

public. However, the board may establish reasonable rules and

regulations to minimize disruption of a meeting of the board. At

least 10 days or more before but not more than 60 days before a

meeting, the board shall provide public notice of its meeting at

its principal office and on its internet website. The board shall

include in the public notice of its meeting the address where board

minutes required under subsection (8) may be inspected by the

public. The board may meet in a closed session for any of the

following purposes:

(a) To consider the hiring, dismissal, suspension, or

disciplining of board members or its employees or agents.

(b) To consult with its attorney.

regarding privacy or confidentiality.

(8) The board shall keep minutes of each meeting. Board

minutes shall be open to public inspection, and the board shall

make the minutes available at the address designated on the public

notice of its meeting under subsection (7). The board shall make

copies of the minutes available to the public at the reasonable

estimated cost for printing and copying. The board shall include

all of the following in its board minutes:

(a) The date, time, and place of the meeting.

(b) Board members who are present and absent.

(d) All roll call votes taken at the meeting.

(9) Board members shall serve without compensation. However,

board members may be reimbursed for their actual and necessary

expenses incurred in the performance of their official duties as

board members.

(10) The board shall adopt a code of ethics for its members,

employees, and agents and for the directors, officers, and

employees of the marketplace pursuant to federal law, state law,

and the standard of practice applicable to nonprofit corporations.

The board shall include in the code of ethics policies and

procedures requiring the disclosure of relationships that may give

rise to a conflict of interest.

(11) In addition to complying with the code of ethics under

subsection (10), a board member shall declare any conflicts of

interest. The board shall require that any board member with a

direct or indirect interest in any matter before the marketplace

disclose the member's interest to the board before the board takes

any action on the matter. If a board member or a member of his or

her immediate family, organizationally or individually, would

derive direct and specific benefit from a decision of the board,

that member shall recuse himself or herself from the discussion and

vote on the issue.

(12) The board shall establish committees to obtain

recommendations concerning the operation and implementation of the

marketplace in this state. Committees established by the board

under this subsection shall be given a specific charge and may

include individuals who are not board members, including, but not

limited to, representatives of health care consumers, carriers, and

health care providers and other health industry representatives.

(13) There is no liability on the part of, and no cause of

action shall arise against, any member of the board for any lawful

action taken by him or her in the performance of his or her powers

and duties under this act.

Sec. 203. (1) The initial board appointed under section 201

shall organize a nonprofit corporation, on a nonstock, directorship

basis, under the nonprofit corporation act, 1982 PA 162, MCL

450.2101 to 450.3192. The nonprofit corporation shall be known as

the MIHealth marketplace and is organized to provide both an

individual and SHOP marketplace for qualified health plans in this

state.

(2) Subject to subsection (3), the marketplace has only the

following powers and duties as a nonprofit corporation:

(a) To contract with others, public or private, for the

provision of all or a portion of services necessary for the

management and operation of the marketplace.

(b) To make contracts, give guarantees, incur liabilities,

borrow money at rates of interest as the marketplace may determine,

issue its notes, bonds, and other obligations, and secure any of

its obligations by mortgage or pledge of any of its property or an

interest in the property, wherever situated.

actions and proceedings judicial, administrative, arbitrative, or

otherwise, in the same manner as a natural person.

(d) To have a corporate seal, and to alter the seal, and to

use it by causing it or a facsimile to be affixed, impressed, or

reproduced in any other manner.

(e) To adopt, amend, or repeal bylaws, including emergency

bylaws, relating to the purposes of the marketplace, the conduct of

its affairs, its rights and powers, and the rights and powers of

its board members, directors, or officers.

(f) To elect or appoint officers, employees, and other agents

of the marketplace, to prescribe their duties, to fix their

compensation and the compensation of directors, and to indemnify

corporate directors, officers, employees, and agents.

(g) To purchase, receive, take by grant, gift, devise,

bequest, or otherwise, lease, or otherwise acquire, own, hold,

improve, employ, use, and otherwise deal in and with, real or

personal property, or an interest in real or personal property,

wherever situated, either absolutely or in trust and without

limitation as to amount or value.

(h) To sell, convey, lease, exchange, transfer, or otherwise

dispose of, or mortgage or pledge, or create a security interest

in, any of its property, or an interest in the property, wherever

situated.

(i) To purchase, take, receive, subscribe for, or otherwise

acquire, own, hold, vote, employ, sell, lend, lease, exchange,

transfer, or otherwise dispose of, mortgage, pledge, use, and

otherwise deal in and with, bonds and other obligations, shares or

other securities or interests or memberships issued by others,

whether engaged in similar or different business, governmental, or

other activities, including banking corporations or trust

companies. The marketplace shall not guarantee or become surety

upon a bond or other undertaking securing the deposit of public

money.

(j) To invest and reinvest its funds, and take and hold real

and personal property as security for the payment of funds loaned

or invested.

(k) To establish and carry out savings, thrift, and other

incentive, and benefit plans, trusts, and provisions for any of its

directors, officers, and employees. The marketplace shall not

establish and carry out pension plans.

(l) To purchase, receive, take, otherwise acquire, own, hold,

sell, lend, exchange, transfer, otherwise dispose of, pledge, use,

and otherwise deal in and with its bonds and other securities.

(m) To cease its corporate activities and dissolve pursuant to

this subdivision, the nonprofit corporation act, 1982 PA 162, MCL

450.2101 to 450.3192, and the federal act. The marketplace shall

submit its plan to cease its corporate activities and dissolve to

the commissioner and the senate and house of representatives

standing committees on health policy 60 or more business days,

which business days also include at least 7 legislative session

days, before it plans to dissolve. Upon dissolution, the assets of

the marketplace shall be distributed as follows:

(i) All liabilities shall be paid and discharged.

(ii) Assets remaining after subparagraph (i) is fulfilled shall

be distributed as provided in a plan of action developed and

adopted by the board and approved by the commissioner.

(n) To conduct its affairs, carry on its operations, and have

offices and exercise the powers granted by this act in any

jurisdiction within this state, and, for the transaction of

business, the receipt and payment of money, the care and custody of

property, and other incidental business matters, to transact

business, receive, collect, and disburse money, and to engage in

other incidental business matters as are naturally or properly

within the scope of its articles.

(3) Other than a power or duty under section 261 of the

nonprofit corporation act, 1982 PA 162, MCL 450.2261, the

marketplace has the powers and duties of a nonprofit corporation

under the nonprofit corporation act, 1982 PA 162, MCL 450.2101 to

450.3192. Subsection (2) controls regarding the powers and duties

of the marketplace in lieu of section 261 of the nonprofit

corporation act, 1982 PA 162, MCL 450.2261. If a conflict between a

power or duty of the marketplace under this act conflicts with a

power or duty under other state law, this act controls.

Sec. 204. Beginning on the effective date of this act, an

entity shall not incorporate, file, register, or otherwise form in

this state using a name that is the same as or deceptively or

confusingly similar to the name "MIHealth marketplace".

Sec. 205. The board shall develop criteria for rating each

qualified health plan offered through the marketplace based on

relative value and quality. The criteria developed by the board

shall be in compliance with federal law, state law, and the

purposes of this act. The board shall consult with the commissioner

and the medical services administration for the department of

community health on the development of the rating criteria. The

board shall ensure that the methods used to develop the criteria

are included in minutes open to the public as prescribed in section

201(8) and that the criteria are applied uniformly to all qualified

health plans.

Sec. 207. (1) The board shall appoint an executive director to

manage the marketplace. The executive director shall be independent

and have no material relationship with the marketplace. The

executive director may appoint staff as necessary.

(2) The executive director may contract with others, public or

private, to provide the services necessary to operate the

marketplace.

(3) To ensure efficient operation of the marketplace, the

executive director may seek assistance and support as may be

required in the performance of his or her duties from appropriate

state departments, agencies, and offices. Upon request of the

executive director, the state department, agency, or office may

provide assistance and support to the executive director.

(4) The executive director shall display on the marketplace

internet website information relevant to the public, as defined by

the board, concerning the marketplace's operations and

efficiencies, as well as the board's assessments of those

activities.

Sec. 209. (1) The marketplace shall make qualified health

plans available through its internet website and its toll-free

telephone hotline for review, purchase, and enrollment by qualified

individuals and qualified employers beginning on or before January

1, 2014 or as otherwise provided for by federal law, rule, or

regulation.

(2) The marketplace shall not make available any health

benefit plan that is not a qualified health plan. However, the

marketplace shall allow a health carrier to offer a plan that

provides limited scope dental benefits meeting the requirements of

section 9832(c)(2)(A) of the internal revenue code of 1986, 26 USC

9832, through the marketplace, either separately or in conjunction

with a qualified health plan, if the plan provides pediatric dental

benefits meeting the requirements of section 1302(b)(1)(J) of the

federal act.

(3) The marketplace or a carrier offering health benefit plans

through the marketplace shall not charge an individual a fee or

penalty for termination of coverage if the individual enrolls in

another type of minimum essential coverage because the individual

has become newly eligible for that coverage or because the

individual's employer-sponsored coverage has become affordable

under the standards of section 36B(c)(2)(C) of the internal revenue

code of 1986, 26 USC 36B.

Sec. 211. (1) The marketplace shall do all of the following:

(a) Perform all duties and obligations of an exchange required

by federal law, state law, and the purposes of this act. Consistent

with its role as a market facilitator, the marketplace shall not,

with respect to the establishment of premium rates, negotiate

rates, require competitive bidding, or engage in other purchaser-

related activities.

(b) Implement procedures consistent with section 215 for the

certification, recertification, and decertification of health

benefit plans as qualified health plans. The marketplace shall

contract with the office of financial and insurance regulation to

certify health benefit plans as qualified health plans consistent

with section 215.

plans and all qualified dental plans consistent with section 215.

(d) Provide for the operation of a toll-free telephone hotline

to respond to requests for assistance in a manner that is

linguistically appropriate to the needs of the population being

served by the hotline.

(e) Provide at the least an annual enrollment period beginning

on October 15 and ending on December 7. If enrollment periods are

provided on a more frequent basis, the marketplace shall provide

enrollment periods in a manner than reduces the likelihood of

adverse selection.

(f) Maintain an internet website through which enrollees and

prospective enrollees of qualified health plans may obtain

standardized comparative information on the plans. At the direction

of the board, the marketplace shall also include on the internet

website information relative to individual health and wellness.

(g) Assign a rating to each qualified health plan offered

through the marketplace pursuant to the rating criteria developed

by the board under section 205.

(h) Use a standardized format for presenting health benefit

options in the marketplace, including the use of the uniform

outline of coverage established under section 2715 of the public

health service act, 42 USC 300gg-15.

(i) Inform individuals of eligibility requirements for a state

medical assistance program or any applicable health subsidy program

pursuant to the federal act. If through screening of an application

by the marketplace the marketplace determines an individual is

potentially eligible for a state medical assistance program or

other applicable health subsidy program, the marketplace shall

provide the individual with information about the program and, if

applicable, the ability to enroll in that program through the

marketplace. If requested by the individual, the marketplace shall

enroll the individual in the program, if applicable, or direct that

individual to the appropriate authority for final eligibility

determination and enrollment.

(j) Establish and make available by electronic means a

calculator to determine the actual cost of coverage after

application of any premium tax credit under section 36B of the

internal revenue code of 1986, 26 USC 36B, and any cost-sharing

reduction under section 1402 of the federal act.

(k) Subject to section 101(4), establish a small business

health options program through which qualified employers may access

coverage for their employees and federally recognized Indian tribes

may access coverage for their tribal members. The SHOP shall be

established to do all of the following:

(i) Enable any qualified employer or federally recognized

Indian tribe to specify a level of coverage so that any of its

employees or tribal members may enroll in any qualified health plan

offered through the SHOP at the specified level of coverage.

(ii) Provide a qualified employer or federally recognized

Indian tribe with the opportunity to establish a defined

contribution arrangement for its employees or tribal members to

purchase a health benefit plan.

(l) Notify employees using the SHOP of potential eligibility

for a state medical assistance program.

(m) Grant a certification attesting that, for purposes of the

individual responsibility penalty under section 5000A of the

internal revenue code of 1986, 26 USC 5000A, an individual is

exempt from the individual responsibility requirement or from the

penalty imposed by that section because of any of the following:

(i) There is no affordable qualified health plan available

through the marketplace, or the individual's employer, covering the

individual.

(ii) The individual meets the requirements for any other

exemption from the individual responsibility requirement or

penalty.

(n) Adopt an annual operating revenue and expense budget

before the start of each fiscal year and make the budget available

on its internet website.

(o) Transfer all data and information required to be

transferred in compliance with federal law, state law, and the

purposes of this act.

(p) Provide to each employer defined in this subdivision the

name of each employee of the employer who ceases coverage under a

qualified health plan during a plan year and the effective date of

the cessation. As used in this subdivision, "employer" includes all

of the following:

(i) An employer that did not provide minimum essential

coverage.

(ii) An employer that provided the minimum essential coverage,

but the coverage was determined under section 36B(c)(2)(C) of the

internal revenue code of 1986, 26 USC 36B, to either be

unaffordable to the employee or not provide the required minimum

actuarial value.

(q) Perform duties required of the marketplace in compliance

with federal law, state law, and the purposes of this act related

to determining eligibility for premium tax credits, reduced cost-

sharing, or individual responsibility requirement exemptions.

(r) Select entities qualified to serve as navigators in

compliance with federal law, state law, and the purposes of this

act, and award grants to enable navigators to do all of the

following:

(i) Conduct public education activities to raise awareness of

the availability of qualified health plans.

(ii) Distribute fair, accurate, and impartial information

concerning qualified health plans and acknowledge other health

plans.

(iii) Provide referrals to any applicable office of health

insurance consumer assistance or health insurance ombudsman program

established under section 2793 of the public health service act, 42

USC 300gg-93, or any other appropriate state agency or agencies,

for any enrollee with a grievance, complaint, or question regarding

his or her health benefit plan or coverage or a determination under

that plan or coverage.

(iv) Provide information in a manner that is culturally and

linguistically appropriate to the needs of the population being

served by the marketplace.

(v) Facilitate enrollment in qualified health plans. As used

in this subparagraph, "facilitate enrollment" means to perform an

act that is only indirectly related to the sale, solicitation, or

negotiation of a health benefit plan and is to inform an individual

of his or her eligibility for public assistance or to inform an

individual that he or she can purchase a health benefit plan

through a producer, the MIHealth marketplace, a carrier offering a

qualified health plan, or other source, which act is in compliance

with federal law, state law, and the purposes of this act.

(s) Review the rate of premium growth within the marketplace

and outside the marketplace and consider the information in

developing recommendations on whether to continue limiting

qualified employer status to small employers.

(t) Subject to subsection (2), permit producers to do all of

the following:

(i) Receive commissions or other remuneration from a carrier

for enrolling consumers in a qualified health plan.

(ii) Enroll qualified individuals, qualified employers, and

qualified employees in any qualified health plan. Upon enrollment

by a producer under this subparagraph, the marketplace shall verify

that enrollment with the individual or employer enrolled.

(iii) Assist individuals in applying for advance payments of

premium tax credits under section 36B of the internal revenue code

of 1986, 26 USC 36B, and cost-sharing reductions under section 1402

of the federal act.

(u) Subject to terms and conditions determined by the

marketplace, allow a federally recognized Indian tribe to pay

premiums for qualified health plans on behalf of tribal members who

are qualified individuals enrolled in a qualified health plan.

(v) Consult with stakeholders relevant to carrying out the

activities required under this act. Stakeholders include, but are

not limited to, the following:

(i) Educated health care consumers who are enrollees in

qualified health plans.

(ii) Individuals and entities with experience in facilitating

enrollment in qualified health plans.

(iii) Representatives of small businesses and self-employed

individuals.

(iv) The medical services administration of the department of

community health.

(v) Advocates for enrolling hard-to-reach populations.

(vi) Federally recognized Indian tribes.

(w) At least monthly, provide to carriers in an electronic

format all enrollment and disenrollment information.

(x) At least monthly, remit to carriers any premiums received

from qualified employees.

(2) Subsection (1)(t) does not require a qualified individual,

qualified employer, or qualified employee to utilize a producer for

any of the services described in subsection (1)(t). However, a

qualified individual, qualified employer, or qualified employee

shall not be penalized, either by premium cost or coverage under a

health benefit plan, for choosing to use the services of a

producer.

Sec. 213. (1) The board shall appoint an audit committee. The

audit committee shall contract with an external auditor for the

preparation of at least 1 audit of the financial statements of the

marketplace in every fiscal year. The audit committee shall not

have contractual relationships with the marketplace or the external

auditor other than for the marketplace audit.

(2) The executive director shall do all of the following:

(a) Review and certify the reports of the external auditor.

(b) Make the external auditor reports available to the board

and the general public.

(3) The marketplace shall meet all of the following financial

integrity requirements:

(a) Keep an accurate accounting of all activities, receipts,

and expenditures and annually submit to the governor, the

commissioner, and the senate and house of representatives

appropriations committees and standing committees on health policy

a report concerning those accountings.

(b) Fully cooperate with any investigation conducted by this

state or a federal agency pursuant to authority under federal or

state law, to do any of the following:

(i) Investigate the affairs of the marketplace.

(ii) Examine the properties and records of the marketplace.

(iii) Require periodic reports in relation to the activities

undertaken by the marketplace.

money intended for the administrative and operational expenses of

the marketplace for staff retreats, promotional giveaways,

excessive executive compensation, or promotion of federal or state

legislative and regulatory modifications.

Sec. 215. (1) As provided in section 211, the marketplace

shall contract with the office of financial and insurance

regulation to certify health benefit plans under this section. The

certification criteria used by the commissioner under this section

shall not, to the extent possible under the federal act, duplicate

existing requirements of state law. Subject to subsection (2), the

commissioner shall certify a health benefit plan as a qualified

health plan if either of the following requirements is met:

(a) The health benefit plan meets the requirements of federal

law, state law, and the purposes of this act.

(b) If, as determined by the commissioner, the requirements of

the federal act have changed substantially after the effective date

of this act, and the health benefit plan is offered by a carrier

that is licensed or has a certificate of authority under the laws

of this state and is in good standing to offer the health benefit

plan to all residents of this state.

(2) The commissioner shall not certify a health benefit plan

as a qualified health plan unless the premium rates and contract

language have been approved by the commissioner.

(3) The commissioner shall not exclude a health benefit plan

as a qualified health plan as follows:

(a) On the basis that the plan is a fee-for-service plan.

(b) Through the imposition of premium price controls in the

marketplace.

treatments necessary to prevent patients' deaths in circumstances

the commissioner determines are inappropriate or too costly.

(4) The commissioner shall require each carrier seeking

certification of a health benefit plan as a qualified health plan

to do all of the following:

(a) Submit a justification for any premium increase before

implementation of that increase. The carrier shall prominently post

the information on its internet website. The commissioner shall

take this information into consideration when determining whether

to allow the carrier to make plans available through the

marketplace.

(b) Make available to the public, in plain language, as that

term is defined in section 1311(e)(3)(B) of the federal act, and

submit to the marketplace and the commissioner accurate and timely

disclosure of all of the following:

(i) Claims payment policies and practices.

(ii) Periodic financial disclosures.

(iii) Data on enrollment.

(iv) Data on disenrollment.

(v) Data on the number of claims that are denied.

(vi) Data on rating practices.

(vii) Information on cost-sharing and payments with respect to

any out-of-network coverage.

(viii) Information on enrollee and participant rights under

title I of the federal act.

(ix) Other information as required to be in compliance with

federal law, state law, and the purposes of this act.

the request of the individual, the level of cost-sharing, including

deductibles, copayments, and coinsurance, under the individual's

plan or coverage that the individual would be responsible for

paying with respect to the furnishing of a specific item or service

by a participating provider. At a minimum, this information shall

be made available to the individual through an internet website and

through other means for individuals without access to the internet.

(5) The provisions of this act that are applicable to

qualified health plans apply to the extent relevant to qualified

dental plans except as modified in this subsection or by the board

as permitted by the federal act. A carrier offering a qualified

dental plan shall be licensed to offer dental coverage, but need

not be licensed to offer other health benefits. The qualified

dental plan shall be limited to dental and oral health benefits,

without substantially duplicating the benefits typically offered by

health benefit plans without dental coverage, and shall include, at

a minimum, the essential pediatric dental benefits prescribed under

section 1302(b)(1)(J) of the federal act, and any other dental

benefits specified in compliance with federal law, state law, and

the purposes of this act. Carriers may jointly offer a

comprehensive plan through the marketplace in which the dental

benefits are provided by a carrier through a qualified dental plan

and the other benefits are provided by a carrier through a

qualified health plan, if the plans are priced separately and are

also made available for purchase separately at the same price.

Sec. 217. (1) This act does not authorize the expending of any

state money by the marketplace.

(2) Subject to section 221, the marketplace may charge

assessments or user fees to health carriers eligible to offer

qualified health plans in the marketplace or otherwise may generate

funding necessary to support its operations under this act. The

marketplace shall only charge an assessment or user fee to a

carrier based upon that carrier's participation in the marketplace.

An assessment or user fee charged to carriers under this section is

considered a licensing or regulatory fee for the purpose of

determining compliance with the medical loss ratio requirements of

the federal act.

(3) The marketplace shall publish the average costs of fees

and any other payments required by the marketplace, and the

administrative costs of the marketplace, on its internet website.

The marketplace shall include information on money lost to waste,

fraud, and abuse.

(4) The marketplace may generate revenue in compliance with

federal law, state law, and the purposes of this act, including,

but not limited to, raising revenue through advertising on its

internet website. The marketplace shall comply with all conflict of

interest safeguards established by the board in advertising under

this subsection.

Sec. 219. (1) This act does not preempt or supersede the

authority of the commissioner to regulate the business of insurance

within this state or of the single state agency to administer a

state medical assistance program.

(2) Except as expressly provided to the contrary in this act,

all carriers offering qualified health plans in this state shall

comply fully with all applicable health insurance laws of this

state and rules promulgated and orders issued by the commissioner.

(3) Any standard or requirement adopted by the marketplace

pursuant to the federal act or this act shall be applied uniformly

to all carriers and health benefit plans in each insurance market

to which the standard or requirement applies.

Sec. 221. Before implementing or increasing an assessment or

user fee under section 217, the marketplace shall submit its

proposal and its justification for that proposal to the

commissioner and the senate and house of representatives standing

committees on health policy. The justification for that proposal

shall include the reason for the implementation or increase of the

assessment or user fee, the amount of assessments or user fees to

be collected, and the potential impact on consumers and carriers.

On or before the expiration of 60 days after a proposal is

submitted under this subsection, the commissioner may reject the

proposal as unreasonable or unnecessary. An assessment or user fee

proposal that is rejected under this section shall not take effect.