(1) (a) (I) Starting in the 2021 calendar year, the enterprise shall assess and collect from carriers, by July 15 each year, a health insurance affordability fee. The fee amount is based on the following percentages of premiums collected by the following carriers in the immediately preceding calendar year on health benefit plans issued in the state:
(A) One and fifteen hundredths percent of premiums collected by nonprofit carriers; and (B) Two and one-tenth percent of premiums collected by for-profit carriers.
(II) For the 2022 and 2023 calendar years, the enterprise shall assess and collect from hospitals a special assessment of twenty million dollars per year, subject to subsection (5) of this section. The enterprise shall not collect the special assessment for the 2022 calendar year before October 1, 2022.
The enterprise shall use the fee, the special assessment on hospitals, and any othermoney available in the fund as follows, allocated in accordance with subsection (2) of this section:
To provide funding for the reinsurance program;
To provide payments to carriers to increase the affordability of health insurance onthe individual market for Coloradans who receive the premium tax credit;
To provide subsidies for state-subsidized individual health coverage plans purchased by qualified individuals;
To pay the actual administrative costs of the enterprise for implementing and administering this part 12, limited to three percent of the enterprise's revenues. Actual administrative costs include the following:
The administrative costs of the enterprise, including the costs to implement and administer the programs established pursuant to this part 12;
The enterprise's actual costs related to implementing and maintaining the fee andspecial assessment on hospitals, including personal services and operating expenses; and
The costs for conducting analyses necessary to determine the payments to be madeto carriers for the purposes described in subsection (1)(b)(II) of this section and the requirements for state-subsidized individual health coverage plans offered by carriers; and
(V) To pay the costs for consumer enrollment, outreach, and education activities regarding health care coverage, including:
(A) Increasing grants to the exchange's certified assistance network; (B) Marketing for the exchange;
Grants to community-based organizations that are able to assist with outreach andenrollment, particularly in communities that face the greatest barriers to enrolling in health care coverage; and
Improving the connection between unemployment services and enrollment in healthcare coverage.
This subsection (1) does not apply to plans or benefits provided under medicaid,medicare, or the children's basic health plan.
(2) (a) The enterprise shall transmit the fees and special assessments collected pursuant to this section to the state treasurer for deposit in the health insurance affordability cash fund created in section 10-16-1206 and, except as provided in subsection (4) of this section, shall allocate the money in the fund in accordance with this subsection (2).
(b) The enterprise shall allocate the revenues collected in 2021, and any other money deposited in the fund in 2021, as follows:
Up to three percent for actual administrative costs as set forth in subsection (1)(b)(IV) of this section;
To the reinsurance program cash fund, an amount necessary to fund the paymentparameters of the reinsurance program, as determined pursuant to section 10-16-1105 (2), not to exceed ninety million dollars or, if the revenues collected pursuant to subsection (1)(a) of this section are less than ninety million dollars, the amount collected; and
Of any remaining balance in the fund after deducting the allocations specified insubsections (2)(b)(I) and (2)(b)(II) of this section:
Up to one percent of the total amount of revenues collected or deposited into thefund in 2021, but not more than one million five hundred thousand dollars, for implementation costs and consumer enrollment, outreach, and education activities regarding health care coverage as described in subsection (1)(b)(V) of this section; and
The remaining balance to carriers to reduce the costs of individual health plans forindividuals who purchase an individual health benefit plan on the exchange and receive the premium tax credit.
(c) The enterprise shall allocate the revenues collected in 2022, and any other money deposited in the fund in 2022, as follows:
Up to three percent for actual administrative costs as set forth in subsection (1)(b)(IV) of this section;
To the reinsurance program cash fund, eighty-eight million dollars; and
Of the remaining balance in the fund after deducting the allocations specified insubsections (2)(c)(I) and (2)(c)(II) of this section:
Thirty percent to carriers to reduce the costs of individual health plans for individuals who purchase an individual health benefit plan on the exchange and receive the premium tax credit; and
Seventy percent for subsidies for state-subsidized individual health coverage planspurchased by qualified individuals.
(I) The enterprise shall allocate the revenues collected in 2023 and each year thereafter, and any other money deposited in the fund in 2023 and each year thereafter, in the following amounts and order of priority:
First, up to three percent for actual administrative costs as set forth in subsection
(1)(b)(IV) of this section;
Second, eighteen million dollars for subsidies for state-subsidized individual healthcoverage plans purchased by qualified individuals;
Third, the amount remaining in the fund, up to seventy-three percent of the totalamount of revenues collected or deposited into the fund in the applicable year, but not to exceed ninety million dollars, to the reinsurance program cash fund; and
Fourth, ten percent of the total amount of revenues collected or deposited into thefund in the applicable year or the amount remaining in the fund, whichever is less, to carriers to reduce the costs of individual health plans for individuals who purchase an individual health benefit plan on the exchange and receive the premium tax credit.
(II) If, after making the allocations specified in subsection (2)(d)(I) of this section, there is money remaining in the fund in the applicable year, the enterprise shall allocate the remaining money for subsidies for state-subsidized individual health coverage plans purchased by qualified individuals.
The enterprise shall distribute the allocations specified in subsection (2) of this section in accordance with the requirements determined by the board pursuant to section 10-161207 (4).
If the commissioner, pursuant to section 10-16-1107 (4), notifies the board that thereinsurance program will receive federal funding pursuant to a federal reinsurance program or other federal financial assistance for the reinsurance program that is in excess of federal passthrough funding received pursuant to section 10-16-1107 (1)(a)(I), the enterprise may eliminate or reduce the amount of enterprise revenues allocated to the reinsurance program pursuant to subsection (2) of this section based on the amount of federal funding the reinsurance program receives, as indicated in the commissioner's notice, and shall reallocate the portion of the enterprise revenues no longer allocated to the reinsurance program to the other purposes specified in subsection (2) of this section in accordance with that subsection (2).
(a) The special assessments on hospitals under subsection (1)(a)(II) of this section must comply with and not violate 42 CFR 433.68. If the federal centers for medicare and medicaid services in the United States department of health and human services informs the state that the state will not be in compliance with 42 CFR 433.68 as a result of the special assessment on hospitals pursuant to subsection (1)(a)(II) of this section, the enterprise shall reduce the amount of the special assessment as necessary to avoid any reduction in the healthcare affordability and sustainability fee collected pursuant to section 25.5-4-402.4.
(b) A hospital shall pay the special assessment imposed pursuant to subsection (1)(a)(II) of this section from its general revenues and is prohibited from:
Collecting an assessment from consumers as any type of surcharge on its fees;
Passing the special assessment on to consumers as any type of increase to fees orcharges for services; or
Otherwise passing the special assessment on to consumers in any manner.
Source: L. 2020: Entire part added, (SB 20-215), ch. 201, p. 990, § 1, effective June 30.