Healthy DC Act of 2008
Language to be included in the FY09 Budget Support Act of 2008
Add new subtitles to Title V to read as follows:
TITLE V. HUMAN SUPPORT SERVICE.
SUBTITLE X. HEALTHY DC.
Sec. 50XX. Short title.
This subtitle may be cited as “Healthy DC Act of 2008”.
Sec. 50XX. Definitions.
For purposes of this subtitle, the term “health insurer” means any
person that provides one or more health benefit plans or insurance in the
District of Columbia, including an insurer, a hospital and medical
services corporation, a fraternal benefit society, a health maintenance
organization, a multiple employer welfare arrangement, or any other person
providing a plan of health insurance subject to the authority of the
Commissioner of the Department of Insurance, Securities and Banking.
Sec. 50XX. Establishment of Healthy DC Program; administration.
(a) There is established the Healthy DC Program (“Program”) which
shall provide affordable health benefits to eligible individuals.
(b) The Program shall be administered by the Department of Health Care
Finance, established by the Department of Health Care Finance
Establishment Act of 2007, effective February 27, 2008 (D.C. Law 17-109;
55 DCR 216).
(c) The Program shall be funded through the Healthy DC Fund as
established by section 15b of the Hospital and Medical Services
Corporation Regulatory Act of 1996, effective March 2, 2007 (D.C. Law
16-19; D.C. Code § 31-3514.02).
(d) The Program shall be subject to the availability of funding.
Nothing in this subtitle shall be construed to create or constitute an
entitlement to health insurance or health or medical benefits.
Sec. 50XX. Program eligibility.
(a) An individual shall be eligible for the Program if the individual:
(1) Has resided in the District for at least 6 months at the time of
application to the Program;(2) Resides in a household having a gross household income between
200% and 400% of the Federal Poverty Guidelines as updated periodically
in the Federal Register by the U.S. Department of Health and Human
Services under the authority of 42 U.S.C. 9902(2);(3) Does not qualify for the D.C. HealthCare Alliance or for
Medicare, Medicaid, or other federal health benefits programs; and(4)(A) Has not had health insurance during the 6-month period prior
to application to the Program;(B) Has had health insurance during the 6-month period prior to
application to the Program but the insurance was terminated due to:(i) The loss of employment;
(ii) A death of a spouse, domestic partner, or family member who
maintained the individual as a beneficiary on a health insurance
plan;(iii) Changes in student status, including graduation, a leave of
absence, or reduction to part-time study;(iv) A change of employment to a new employer who does not
provide group health insurance;(v) A legal annulment, separation, divorce, or the dissolution of
a domestic partnership;(vi) The loss of financial eligibility under Medicaid or the
District of Columbia HealthCare Alliance;(vii) The cancellation or discontinuation of a group health
insurance contract by a health insurer; or(viii) Any other reason as determined by the Mayor; or
(C) Has employer-based health insurance but the annual premium cost
to the individual is deemed unaffordable as determined by the Mayor.
(b) Eligibility for the Program shall not be subject to any
pre-existing condition exclusions.
Sec. 50XX. Program benefits; affordability.
(a) The Program shall provide, at minimum, health and medical benefits
that are equal to those provided to individuals enrolled in the D.C.
HealthCare Alliance.
(b) The Program shall limit annual premium costs to 3% or less of a
Program participant’s gross income.
Sec. 50XX. Program implementation.
(a) The Mayor shall make the Program available to eligible individuals
by July 1, 2009.
(b) To meet the deadline set forth in subsection (a) of this section,
the Mayor is authorized to enter into a contract with one or more health
insurers to administer the Program.
(c) Any contract entered into pursuant to this section shall require
annual reporting of clinical quality measurements and utilization data to
the Mayor.
Sec. 50XX. Prohibitions.
It shall be unlawful for a health insurer to eliminate or restrict the
availability of a health insurance plan offered in the District with the
intent of shifting beneficiaries to the Program. An entity found to be in
violation of this section shall be subject to a fine of not less than
$10,000.
Sec. 50XX. Disposition of fines and penalties.
Fines and penalties collected pursuant to this act shall be deposited
in the Healthy DC Fund.
Sec. 50XX. Rulemaking.
The Mayor, pursuant to Title I of the District of Columbia
Administrative Procedure Act, approved October 21, 1968 (82 Stat. 1204;
D.C. Official Code § 2-501 et seq.), shall issue rules to
implement the provisions of this act.
SUBTITLE X. HEALTHY DC FUND.
Sec. 50XX. Short title.
This subtitle may be cited as “Hospital and Medical Services
Corporation Regulatory Act Amendment Act of 2008”.
Sec. 50XX. Section 15b of the Hospital and Medical Services Corporation
Regulatory Act of 1996, effective March 2, 2007 (D.C. Law 16-192; D.C.
Official Code § 31-3514.02.), is amended to read as follows:
“Section 15b. Establishment of Healthy DC Fund.
“(a) There is established a segregated, nonlapsing fund
designated as the Healthy DC Fund ("Fund"). Funds deposited
into the Fund shall not revert to the General Fund of the District of
Columbia at the end of any fiscal year, or at any other time, but
shall be continually available to support the Healthy DC Program (“Program”),
established by the Healthy DC Act of 2008, [as included in the FY09
Budget Support Act of 2008])(“Healthy DC Act”).“(b) There shall be deposited into the Fund:
“(1) All tax revenue generated pursuant to section 15a;
“(2) Any other local funds, including any fees, penalties and
other tax revenue required by District law, including any premium
tax imposed health maintenance organizations set forth in the Health
Maintenance Organization Act of 1996, effective April 9, 1997 (D.C.
Law 11-235; D.C. Official Code § 31-3401 et seq.);“(3) Annual appropriations, if any;
“(4) Federal grant funds;
“(5) All fines and penalties collected pursuant to the Healthy
DC Act; and“(6) Grants, gifts, or subsidies from public or private
sources.”
SUBTITLE X. MEDICAID STATE PLAN AMENDMENT
Sec. 50XX. Short title.
This subtitle may be cited as “Medicaid Fee-For-Service State Plan
Amendment Act of 2008”.
Sec. X. Medicaid fee-for-service rate increases.
By October 1, 2008, the Mayor shall submit to the Council a Medicaid
state plan amendment that will increase the
specialty physician and primary care physician reimbursement rates under
the District Medicaid fee-for-service program to match the specialty
physician and primary care physician reimbursement rates under the federal
Medicare program.
Add a new subtitle to read as follows:
SUBTITLE X. HEALTHY DC REVENUE.
Sec. X. Short title.
This subtitle may be cited as “Healthy DC Revenue Act of 2008”.
Sec. X. The Health Maintenance Organization Act of 1996, effective
April 9, 1997 (D.C. Law 11-235; D.C. Official Code § 31-3401 et seq.)
is amended by adding a new section 4a to read as follows:
“(4a) Premium tax.
“(a) Effective January 1, 2009, all health maintenance
organizations shall pay to the District of Columbia, for each calendar
year, a sum of money as taxes equal to 2.0% of their policy and
membership fees and net premium receipts or consideration received in
such calendar year, excluding those fees, receipts or consideration
received pursuant to District Medicaid program, the District of
Columbia HealthCare Alliance, any federal employee health benefit
program or Medicare, on all policies or contracts in the District of
Columbia. Such tax shall be in lieu of all other taxes except:“(1) Taxes upon real estate; and
“(2) Fees and charges provided for pursuant to the Health
Maintenance Organization Act of 1996, effective April 9, 1997 (D.C.
Law 11-235; D.C. Code § 31-3401 et seq.).“(b) The certificate of authority of any health maintenance
organization may be revoked for failure to pay the required premium
tax.“(c) All revenues generated pursuant to this section shall be
collected in a manner prescribed by the Mayor and shall be deposited
in the Healthy DC Fund as established by section 15b of the Hospital
and Medical Services Corporation Regulatory Act of 1996, effective
March 2, 2007 (D.C. Law 16-192; D.C. Code § 31-3514.02).”
Sec. X. Title 47 of the District of Columbia Official Code is amended
as follows:
(a) Section 47-2402(a) is amended by striking the phrase “$.05 for
each cigarette.” and inserting the phrase “$.10 for each cigarette.”
in its place.
(b) Section 47-2608(a) is amended as follows:
(1) Paragraph (1) is amending by striking the phrase “All such
companies” and inserting “Except as provided in paragraph (1A), all
such companies” in its place.(2) A new paragraph (1A) is added to read as follows:
“(1A) All companies which issue contracts of insurance against
accident and loss of health shall pay to the District of Columbia, for
each calendar year, a sum of money as taxes equal to 2.0% of their
policy and membership fees and net premium receipts or consideration
received in such calendar year on all policies or contracts in the
District of Columbia. Such tax shall be in lieu of all other taxes
except:“(i) Taxes upon real estate; and
“(ii) Fees and charges provided for by the insurance laws of
the District including amendment made to such laws by this chapter.”