Medicaid Innovation and Reform Commission and Marketplace Virginia (language only)

Item 4-14 #1s

Language
Page 504, after line 36, insert:
"3. That § 30-347 of the Code of Virginia is amended and reenacted as follows:
§ 30-347. Medicaid Innovation and Reform Commission; membership; terms; compensation and expenses; definition.
A. The Medicaid Innovation and Reform Commission (the Commission) is established as a commission in the legislative branch of state government. The purpose of the Commission shall be to review, recommend and approve and monitor such innovation and reform proposals affecting the implementation of Title XIX and Title XXI of the Social Security Act, including eligibility and financing for proposals set out in Item 307 of this as set forth in the general appropriation act. Specifically, the Commission shall review and monitor
(i) the development of such reform proposals; (ii) progress in obtaining federal approval for such reforms such as benefit design, service delivery, payment reform, and quality and cost containment outcomes; and (iii) implementation of such reform measures.
B. The Commission shall consist of 12 members as follows: the chair of the House Committee on Appropriations, or his designee, and four members of the House Committee on Appropriations appointed by the chair and the chair of the Senate Finance Committee, or his designee, and four members of the Senate Finance Committee appointed by the chair. In addition, the Secretaries of Finance and Health and Human Resources shall serve as ex officio, nonvoting members of the Commission.
C. Members shall serve terms coincident with their terms of office. Vacancies for unexpired terms shall be filled in the same manner as the original appointments. Members may be reappointed for successive terms.
D.1. The members of the Commission shall elect a chairman and vice chairman annually. A majority of the voting members of the Commission shall constitute a quorum. The meetings of the Commission shall be held at the call of the chairman or whenever the majority of the members so request. The Commission shall meet bimonthly beginning in June 2013, or as soon as possible thereafter.
2. An affirmative vote by three of the five members of the Commission from the House of Delegates and three of the five members of the Commission from the Senate shall be required to endorse any reform proposal to amend the State Plan for Medical Assistance under Title XIX of the Social Security Act, and any waivers thereof, to implement coverage for newly eligible individuals pursuant to 42 U.S.C. § 1396d(y)(1)[2010] of the Patient Protection and Affordable Care Act.
E. Legislative members of the Commission shall receive such compensation as provided in§ 30-19.12, and nonlegislative members shall receive such compensation as provided in § 2.2-2813.
4. That the Secretary of Health and Human Resources shall develop and implement a program to allow individuals described in 42 U.S.C. § 1396a(a)(10)(A)(i)(VIII) to purchase health care coverage through a private insurance network, which shall be designed to promote efficiency, accountability, personal responsibility, and competitive, value-based purchasing of health care and ensure a model of health coverage for participants that is fiscally sustainable and cost effective.  Such program shall include: (i) requirements for a health benefit package based on the Anthem KeyCare 30 Plan; (ii) requirements to include traditional and community-based behavioral health services; (iii) systems for determining eligibility for participation in the program; (iv) provisions for payment of premium assistance for participants; (v) requirements for cost-sharing of up to 5 percent of total household income for health care expenses, as appropriate; (vi) requirements for personal responsibility and accountability related to the delivery of health care such as appropriate use of health care services to avoid overutilization of emergency care and to promote healthy behaviors; (vii) provisions for participation in work search activities for participants not currently employed, receiving unemployment compensation benefits, enrolled as full-time students, or caring for dependent family members under 12 months of age or disabled family members of any age; (viii) provisions for monitoring and oversight of the use of health care services to ensure appropriate utilization; (ix) establishment of a Health Reform and Innovation Fund to consist of projected general fund savings, identified in consultation with the Secretary of Finance, that are attributable to coverage for program participants related to behavioral health services, inmate health care and indigent care and used to provide grants of up to $3.5 million annually to reduce the rate of growth of health care spending; (x) establishment of a Taxpayer Recovery Fund to consist of taxes and other payments paid by residents of the Commonwealth to the federal government and recovered by the Commonwealth and used to support the program; and (xi) a provision for termination of the program if revenues received by the Taxpayer Recovery Fund are less than the commitments set forth in 42 C.F.R. § 433.10(c)(6). The Secretary shall seek all federal approvals necessary to implement the provisions of this enactment clause.
5.  That the Secretary of Health and Human Resources shall apply for available federal funding for the purpose of establishing and operating marketplace Virginia to include but not be limited to eligibility, enrollment, consumer assistance, plan management and financial management.
6.  That the second enactment of Chapter 679 of the Acts of Assembly of 2013 is repealed."

Explanation
(This amendment adds four enactment clauses to the appropriation act. Enactment clause 3 removes the requirement that the Medicaid Innovation and Reform Commission (MIRC) recommend and approve Medicaid reform proposals and deletes a requirement that the Commission must approve by an affirmative vote an expansion of Medicaid to newly eligible individuals.Enactment clause 4 requires the Secretary of Health and Human Resources to develop and implement a program to allow low-income uninsured Virginians to purchase health care coverage through a private insurance network. The program must include: (i) requirements for a health benefit package based on the Anthem KeyCare 30 Plan; (ii) requirements to include traditional and community-based behavioral health services; (iii) systems for determining eligibility for participation in the program; (iv) provisions for payment of premium assistance for participants; (v) requirements for cost-sharing of up to 5 percent of total household income for health care expenses, as appropriate; (vi) requirements for personal responsibility and accountability related to the delivery of health care such as appropriate use of health care services to avoid overutilization of emergency care and to promote healthy behaviors; (vii) provisions for participation in work search activities for participants not currently employed, receiving unemployment compensation benefits, enrolled as full-time students, or caring for dependent family members under 12 months of age or disabled family members of any age; (viii) provisions for monitoring and oversight of the use of health care services to ensure appropriate utilization; (ix) establishment of a Health Reform and Innovation Fund to consist of projected general fund savings, identified in consultation with the Secretary of Finance, attributable to coverage for program participants related to behavioral health services, inmate health care and indigent care and used to provide grants of up to $3.5 million annually to reduce the rate of growth of health care spending; (x) establishment of a Taxpayer Recovery Fund to consist of taxes and other payments paid by residents of the Commonwealth to the federal government and recovered by the Commonwealth and used to support the program; and (xi) a provision for termination of the program if revenues received by the Taxpayer Recovery Fund are less than the commitments set forth in 42 C.F.R. § 433.10(c)(6). The Secretary shall seek all federal approvals necessary to implement the provisions of this enactment clause. Enactment clause 5 requires the Secretary of Health and Human Resources to apply for available federal funding for the purpose of establishing and operating marketplace Virginia to include but not be limited to eligibility, enrollment, consumer assistance, plan management and financial management. Enactment clause 6 repeals the second enactment of Chapter 679 of the Acts of Assembly of 2013 related to the creation of a health benefit exchange.)