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First Substitute H.B. 459

This document includes House Committee Amendments incorporated into the bill on Thu, Mar 4, 2010 at 8:33 AM by jeyring. --> This document includes House Floor Amendments incorporated into the bill on Fri, Mar 5, 2010 at 3:14 PM by jeyring. --> This document includes Senate 3rd Reading Floor Amendments incorporated into the bill on Tue, Mar 9, 2010 at 12:26 PM by cmillar. -->

Representative David Clark proposes the following substitute bill:


             1     
HEALTH AMENDMENTS

             2     
2010 GENERAL SESSION

             3     
STATE OF UTAH

             4     
Chief Sponsor: David Clark

             5     
Senate Sponsor: Wayne L. Niederhauser

             6     
             7      LONG TITLE
             8      General Description:
             9          This bill amends provisions related to transparency and health benefits in the Insurance
             10      Code and the Medicaid program.
             11      Highlighted Provisions:
             12          This bill:
             13          .    requires accountability and transparency from the state Medicaid program;
             14          .    requires an insurer to provide information to consumers regarding health insurance
             15      policies; and
             16          .    requires greater choice of benefit plans for employers in the defined contribution
             17      market of the health insurance exchange.
             18      Monies Appropriated in this Bill:
             19          None
             20      Other Special Clauses:
             21          This bill provides an effective date.
             22          This bill coordinates with H.B. 294, Health System Reform Amendments, by
             23      substantively superseding a provision.
             24          This bill coordinates with H.B. 39, Insurance Related Amendments, by providing
             25      substantive changes.


             26      Utah Code Sections Affected:
             27      AMENDS:
             28          26-18-2.3, as last amended by Laws of Utah 2006, Chapter 46
             29          26-18-3, as last amended by Laws of Utah 2008, Chapters 62 and 382
             30          31A-22-613.5, as last amended by Laws of Utah 2009, Chapter 12
             31          31A-22-722.5, as enacted by Laws of Utah 2009, Chapter 274
             32          31A-30-205, as enacted by Laws of Utah 2009, Chapter 12
             33      Utah Code Sections Affected by Coordination Clause:
             33a      H. 31A-22-613.5, as last amended by Laws of Utah 2009, Chapter 12 .H
             34          31A-22-722.5, as enacted by Laws of Utah 2009, Chapter 274
             34a      H. 31A-30-205, as enacted by Laws of Utah 2009, Chapter 12 .H
             35     
             36      Be it enacted by the Legislature of the state of Utah:
             37          Section 1. Section 26-18-2.3 is amended to read:
             38           26-18-2.3. Division responsibilities -- Emphasis -- Periodic assessment.
             39          (1) In accordance with the requirements of Title XIX of the Social Security Act and
             40      applicable federal regulations, the division is responsible for the effective and impartial
             41      administration of this chapter in an efficient, economical manner. The division shall:
             42          (a) establish, on a statewide basis, a program to safeguard against unnecessary or
             43      inappropriate use of Medicaid services, excessive payments, and unnecessary or inappropriate
             44      hospital admissions or lengths of stay;
             45          (b) deny any provider claim for services that fail to meet criteria established by the
             46      division concerning medical necessity or appropriateness; and
             47          (c) place its emphasis on high quality care to recipients in the most economical and
             48      cost-effective manner possible, with regard to both publicly and privately provided services.
             49          (2) The division shall implement and utilize cost-containment methods, where
             50      possible, which may include[, but are not limited to]:
             51          (a) prepayment and postpayment review systems to determine if utilization is
             52      reasonable and necessary;
             53          (b) preadmission certification of nonemergency admissions;
             54          (c) mandatory outpatient, rather than inpatient, surgery in appropriate cases;
             55          (d) second surgical opinions;
             56          (e) procedures for encouraging the use of outpatient services;


             57          (f) consistent with Sections 26-18-2.4 and 58-17b-606 , a Medicaid drug program;
             58          (g) coordination of benefits; and
             59          (h) review and exclusion of providers who are not cost effective or who have abused
             60      the Medicaid program, in accordance with the procedures and provisions of federal law and
             61      regulation.
             62          (3) The director of the division shall periodically assess the cost effectiveness and
             63      health implications of the existing Medicaid program, and consider alternative approaches to
             64      the provision of covered health and medical services through the Medicaid program, in order to
             65      reduce unnecessary or unreasonable utilization.
             66          (4) The department shall ensure Medicaid program integrity by conducting internal
             67      audits of the Medicaid program for efficiencies, best practices, fraud, waste, abuse, and cost
             68      recovery, at least in proportion to the percent of funding for the program that comes from state
             69      funds.
             70          (5) The department shall, by December 31 of each year, report to the Health and
             71      Human Services Appropriations Subcommittee regarding:
             72          (a) measures taken under this section to increase:
             73          (i) efficiencies within the program; and
             74          (ii) cost avoidance and cost recovery efforts in the program; and
             75          (b) results of program integrity efforts under Subsection (4).
             76          Section 2. Section 26-18-3 is amended to read:
             77           26-18-3. Administration of Medicaid program by department -- Reporting to the
             78      Legislature -- Disciplinary measures and sanctions -- Funds collected -- Eligibility
             79      standards.
             80          (1) The department shall be the single state agency responsible for the administration
             81      of the Medicaid program in connection with the United States Department of Health and
             82      Human Services pursuant to Title XIX of the Social Security Act.
             83          (2) (a) The department shall implement the Medicaid program through administrative
             84      rules in conformity with this chapter, Title 63G, Chapter 3, Utah Administrative Rulemaking
             85      Act, the requirements of Title XIX, and applicable federal regulations.
             86          (b) The rules adopted under Subsection (2)(a) shall include, in addition to other rules
             87      necessary to implement the program:


             88          (i) the standards used by the department for determining eligibility for Medicaid
             89      services;
             90          (ii) the services and benefits to be covered by the Medicaid program; and
             91          (iii) reimbursement methodologies for providers under the Medicaid program.
             92          (3) (a) The department shall, in accordance with Subsection (3)(b), report to either the
             93      Legislative Executive Appropriations Committee or the Legislative Health and Human
             94      Services Appropriations Subcommittee when the department:
             95          (i) implements a change in the Medicaid State Plan;
             96          (ii) initiates a new Medicaid waiver;
             97          (iii) initiates an amendment to an existing Medicaid waiver; [or]
             98          (iv) applies for an extension of an application for a waiver or an existing Medicaid
             99      waiver; or
             100          [(iv)] (v) initiates a rate change that requires public notice under state or federal law.
             101          (b) The report required by Subsection (3)(a) shall:
             102          (i) be submitted to the Legislature's Executive Appropriations Committee or the
             103      legislative Health and Human Services Appropriations Subcommittee prior to the department
             104      implementing the proposed change; and
             105          (ii) [shall] include:
             106          (A) a description of the department's current practice or policy that the department is
             107      proposing to change;
             108          (B) an explanation of why the department is proposing the change;
             109          (C) the proposed change in services or reimbursement, including a description of the
             110      effect of the change;
             111          (D) the effect of an increase or decrease in services or benefits on individuals and
             112      families;
             113          (E) the degree to which any proposed cut may result in cost-shifting to more expensive
             114      services in health or human service programs; and
             115          (F) the fiscal impact of the proposed change, including:
             116          (I) the effect of the proposed change on current or future appropriations from the
             117      Legislature to the department;
             118          (II) the effect the proposed change may have on federal matching dollars received by


             119      the state Medicaid program;
             120          (III) any cost shifting or cost savings within the department's budget that may result
             121      from the proposed change; and
             122          (IV) identification of the funds that will be used for the proposed change, including any
             123      transfer of funds within the department's budget.
             124          (4) Any rules adopted by the department under Subsection (2) are subject to review and
             125      reauthorization by the Legislature in accordance with Section 63G-3-502 .
             126          (5) The department may, in its discretion, contract with the Department of Human
             127      Services or other qualified agencies for services in connection with the administration of the
             128      Medicaid program, including:
             129          (a) the determination of the eligibility of individuals for the program;
             130          (b) recovery of overpayments; and
             131          (c) consistent with Section 26-20-13 , and to the extent permitted by law and quality
             132      control services, enforcement of fraud and abuse laws.
             133          (6) The department shall provide, by rule, disciplinary measures and sanctions for
             134      Medicaid providers who fail to comply with the rules and procedures of the program, provided
             135      that sanctions imposed administratively may not extend beyond:
             136          (a) termination from the program;
             137          (b) recovery of claim reimbursements incorrectly paid; and
             138          (c) those specified in Section 1919 of Title XIX of the federal Social Security Act.
             139          (7) Funds collected as a result of a sanction imposed under Section 1919 of Title XIX
             140      of the federal Social Security Act shall be deposited in the General Fund as nonlapsing
             141      dedicated credits to be used by the division in accordance with the requirements of Section
             142      1919 of Title XIX of the federal Social Security Act.
             143          (8) (a) In determining whether an applicant or recipient is eligible for a service or
             144      benefit under this part or Chapter 40, Utah Children's Health Insurance Act, the department
             145      shall, if Subsection (8)(b) is satisfied, exclude from consideration one passenger vehicle
             146      designated by the applicant or recipient.
             147          (b) Before Subsection (8)(a) may be applied:
             148          (i) the federal government must:
             149          (A) determine that Subsection (8)(a) may be implemented within the state's existing


             150      public assistance-related waivers as of January 1, 1999;
             151          (B) extend a waiver to the state permitting the implementation of Subsection (8)(a); or
             152          (C) determine that the state's waivers that permit dual eligibility determinations for
             153      cash assistance and Medicaid are no longer valid; and
             154          (ii) the department must determine that Subsection (8)(a) can be implemented within
             155      existing funding.
             156          (9) (a) For purposes of this Subsection (9):
             157          (i) "aged, blind, or disabled" shall be defined by administrative rule; and
             158          (ii) "spend down" means an amount of income in excess of the allowable income
             159      standard that must be paid in cash to the department or incurred through the medical services
             160      not paid by Medicaid.
             161          (b) In determining whether an applicant or recipient who is aged, blind, or disabled is
             162      eligible for a service or benefit under this chapter, the department shall use 100% of the federal
             163      poverty level as:
             164          (i) the allowable income standard for eligibility for services or benefits; and
             165          (ii) the allowable income standard for eligibility as a result of spend down.
             166          Section 3. Section 31A-22-613.5 is amended to read:
             167           31A-22-613.5. Price and value comparisons of health insurance -- Basic Health
             168      Care Plan.
             169          (1) (a) [Except as provided in Subsection (1)(b), this] This section applies to all health
             170      [insurance policies and health maintenance organization contracts] benefit plans.
             171          (b) Subsection (2) applies to:
             172          (i) all [health insurance policies and health maintenance organization contracts] health
             173      benefit plans; and
             174          (ii) coverage offered to state employees under Subsection 49-20-202 (1)(a).
             175          (2) (a) The commissioner shall promote informed consumer behavior and responsible
             176      [health insurance and] health benefit plans by requiring an insurer issuing [health insurance
             177      policies or health maintenance organization contracts] a health benefit plan to:
             178          (i) provide to all enrollees, prior to enrollment in the health benefit plan [or health
             179      insurance policy,] written disclosure of:
             180          [(i)] (A) restrictions or limitations on prescription drugs and biologics including:


             181          (I) the use of a formulary [and];
             182          (II) co-payments and deductibles for prescription drugs; and
             183          (III) requirements for generic substitution;
             184          [(ii)] (B) coverage limits under the plan; and
             185          [(iii)] (C) any limitation or exclusion of coverage including:
             186          [(A)] (I) a limitation or exclusion for a secondary medical condition related to a
             187      limitation or exclusion from coverage; and
             188          [(B)] (II) [beginning July 1, 2009,] easily understood examples of a limitation or
             189      exclusion of coverage for a secondary medical condition[.]; and
             190          (ii) provide the commissioner with:
             191          (A) the information described in Subsections 63M-1-2506 (3) through (6) in the
             192      standardized electronic format required by Subsection 63M-1-2506 (1); and
             193          (B) information regarding insurer transparency in accordance with Subsection (5).
             194          (b) [In addition to the requirements of Subsections (2)(a), (d), and (e) an insurer
             195      described in Subsection (2)(a) shall file the written] An insurer shall provide the disclosure
             196      required by [this] Subsection (2)(a)(i) [to the commissioner:] in writing to the commissioner:
             197          (i) upon commencement of operations in the state; and
             198          (ii) anytime the insurer amends any of the following described in Subsection (2)(a)(i):
             199          (A) treatment policies;
             200          (B) practice standards;
             201          (C) restrictions;
             202          (D) coverage limits of the insurer's health benefit plan or health insurance policy; or
             203          (E) limitations or exclusions of coverage including a limitation or exclusion for a
             204      secondary medical condition related to a limitation or exclusion of the insurer's health
             205      insurance plan.
             206          [(c) The commissioner may adopt rules to implement the disclosure requirements of
             207      this Subsection (2), taking into account:]
             208          [(i) business confidentiality of the insurer;]
             209          [(ii) definitions of terms;]
             210          [(iii) the method of disclosure to enrollees; and]
             211          [(iv) limitations and exclusions.]


             212          (c) An insurer shall provide the enrollee with notice of an increase in costs for
             213      prescription drug coverage due to a change in benefit design under Subsection (2)(a)(i)(A):
             214          (i) either:
             215          (A) in writing; or
             216          (B) on the insurer's website; and
             217          (ii) at least 30 days prior to the date of the implementation of the increase in cost, or as
             218      soon as reasonably possible.
             219          (d) If under Subsection (2)(a)(i)(A) a formulary is used, the insurer shall make
             220      available to prospective enrollees and maintain evidence of the fact of the disclosure of:
             221          (i) the drugs included;
             222          (ii) the patented drugs not included;
             223          (iii) any conditions that exist as a precedent to coverage; and
             224          (iv) any exclusion from coverage for secondary medical conditions that may result
             225      from the use of an excluded drug.
             226          (e) (i) The department shall develop examples of limitations or exclusions of a
             227      secondary medical condition that an insurer may use under Subsection (2)(a)[(iii)](i)(C).
             228          (ii) Examples of a limitation or exclusion of coverage provided under Subsection
             229      (2)(a)[(iii)](i)(C) or otherwise are for illustrative purposes only, and the failure of a particular
             230      fact situation to fall within the description of an example does not, by itself, support a finding
             231      of coverage.
             232          (3) An insurer who offers a health [care] benefit plan under Chapter 30, Individual,
             233      Small Employer, and Group Health Insurance Act, shall[: (a) until January 1, 2010, offer the
             234      basic health care plan described in Subsection (4) subject to the open enrollment provisions of
             235      Chapter 30, Individual, Small Employer, and Group Health Insurance Act; and (b) beginning
             236      January 1, 2010,] offer a basic health care plan subject to the open enrollment provisions of
             237      Chapter 30, Individual, Small Employer, and Group Health Insurance Act, that:
             238          [(i)] (a) is a federally qualified high deductible health plan;
             239          [(ii)] (b) has [the lowest] a deductible that is within $250 of the lowest deductible that
             240      qualifies under a federally qualified high deductible health plan, as adjusted by federal law; and
             241          [(iii)] (c) does not exceed an annual out of pocket maximum equal to three times the
             242      amount of the annual deductible.


             243          [(4) Until January 1, 2010, the Basic Health Care Plan under this section shall provide
             244      for:]
             245          [(a) a lifetime maximum benefit per person not less than $1,000,000;]
             246          [(b) an annual maximum benefit per person not less than $250,000;]
             247          [(c) an out-of-pocket maximum of cost-sharing features:]
             248          [(i) including:]
             249          [(A) a deductible;]
             250          [(B) a copayment; and]
             251          [(C) coinsurance;]
             252          [(ii) not to exceed $5,000 per person; and]
             253          [(iii) for family coverage, not to exceed three times the per person out-of-pocket
             254      maximum provided in Subsection (4)(c)(ii);]
             255          [(d) in relation to its cost-sharing features:]
             256          [(i) a deductible of:]
             257          [(A) not less than $1,000 per person for major medical expenses; and]
             258          [(B) for family coverage, not to exceed three times the per person deductible for major
             259      medical expenses under Subsection (4)(d)(i)(A); and]
             260          [(ii) (A) a copayment of not less than:]
             261          [(I) $25 per visit for office services; and]
             262          [(II) $150 per visit to an emergency room; or]
             263          [(B) coinsurance of not less than:]
             264          [(I) 20% per visit for office services; and]
             265          [(II) 20% per visit for an emergency room; and]
             266          [(e) in relation to cost-sharing features for prescription drugs:]
             267          [(i) (A) a deductible not to exceed $1,000 per person; and]
             268          [(B) for family coverage, not to exceed three times the per person deductible provided
             269      in Subsection (4)(e)(i)(A); and]
             270          [(ii) (A) a copayment of not less than:]
             271          [(I) the lesser of the cost of the prescription drug or $15 for the lowest level of cost for
             272      prescription drugs;]
             273          [(II) the lesser of the cost of the prescription drug or $25 for the second level of cost for


             274      prescription drugs; and]
             275          [(III) the lesser of the cost of the prescription drug or $35 for the highest level of cost
             276      for prescription drugs; or]
             277          [(B) coinsurance of not less than:]
             278          [(I) the lesser of the cost of the prescription drug or 25% for the lowest level of cost for
             279      prescription drugs;]
             280          [(II) the lesser of the cost of the prescription drug or 40% for the second level of cost
             281      for prescription drugs; and]
             282          [(III) the lesser of the cost of the prescription drug or 60% for the highest level of cost
             283      for prescription drugs.]
             284          [(5) The department shall include in its yearly insurance market report information
             285      about:]
             286          [(a) the types of health benefit plans sold on the Internet portal created in Section
             287      63M-1-2504 ;]
             288          [(b) the number of insurers participating in the defined contribution market on the
             289      Internet portal;]
             290          [(c) the number of employers and covered lives in the defined contribution market;
             291      and]
             292          [(d) the number of lives covered by health benefit plans that do not include state
             293      mandates as permitted by Subsection 31A-30-109 (2).]
             294          [(6)] (4) The commissioner:
             295          (a) shall forward the information submitted by an insurer under Subsection (2)(a)(ii) to
             296      the Health Insurance Exchange created under Section 63M-1-2504 ; and
             297          (b) may request information from an insurer to verify the information submitted by the
             298      insurer [to the Internet portal under Subsection 63M-1-2506 (4)] under this section.
             299          (5) The commissioner shall:
             300          (a) convene a group of insurers, a member representing the Public Employees' Benefit
             301      and Insurance Program, consumers, and an organization described in Subsection
             302      31A-22-614.6 (3)(b), to develop information for consumers to compare health insurers and
             303      health benefit plans on the Health Insurance Exchange, which shall include consideration of:
             304          (i) the number and cost of an insurer's denied health claims;


             305          (ii) the cost of denied claims that is transferred to providers;
             306          (iii) the average out-of-pocket expenses incurred by participants in each health benefit
             307      plan that is offered by an insurer in the Health Insurance Exchange;
             308          (iv) the relative efficiency and quality of claims administration and other administrative
             309      processes for each insurer offering plans in the Health Insurance Exchange; and
             310          (v) consumer assessment of each insurer or health benefit plan;
             311          (b) adopt an administrative rule that establishes:
             312          (i) definition of terms;
             313          (ii) the methodology for determining and comparing the insurer transparency
             314      information;
             315          (iii) the data, and format of the data, that an insurer must submit to the department in
             316      order to facilitate the consumer comparison on the Health Insurance Exchange in accordance
             317      with Section 63M-1-2506 ; and
             318          (iv) the dates on which the insurer must submit the data to the department in order for
             319      the department to transmit the data to the Health Insurance Exchange in accordance with
             320      Section 63M-1-2506 ; and
             321          (c) implement the rules adopted under Subsection (5)(b) in a manner that protects the
             322      business confidentiality of the insurer.
             323          Section 4. Section 31A-22-722.5 is amended to read:
             324           31A-22-722.5. Mini-COBRA election -- American Recovery and Reinvestment
             325      Act.
             326          (1) [An] (a) If the provisions of Subsection (1)(b) are met, an individual has a right[,
             327      until April 18, 2009,] to contact the individual's employer or the insurer for the employer to
             328      participate in a [second election] transition period for mini-COBRA benefits under Section
             329      31A-22-722 in accordance with Section 3001 of the American Recovery and Reinvestment Act
             330      of 2009 (Pub. S. 111-5) [if the individual:], as amended.
             331          [(a) was] (b) An individual has the right under Subsection (1)(a) if the individual:
             332          (i) was involuntarily terminated from employment [between September 1, 2008 and
             333      February 17, 2009, as defined] during the period of time identified in Section 3001 of the
             334      American Recovery and Reinvestment Act of 2009 (Pub. S. 111-5), as amended;
             335          [(b)] (ii) is eligible for COBRA premium assistance under Section 3001 of the


             336      American Recovery and Reinvestment Act of 2009 (Pub. S. 111-5), as amended; [and]
             337          [(c)] (iii) was eligible for Utah mini-COBRA as provided in Section 31A-22-722 at the
             338      time of termination[.];
             339          (iv) elected Utah mini-Cobra; and
             340          (v) voluntarily dropped coverage, which includes dropping coverage through
             341      non-payment of premiums, between December 1, 2009 and February 1, 2010.
             342          (2) (a) An individual or the employer of the individual shall contact the insurer and
             343      inform the insurer that the individual wants to [take advantage of the second election] maintain
             344      coverage and pay retroactive premiums under a transition period for mini-COBRA coverage
             345      [under] in accordance with the provisions of Section 3001 of the American Recovery and
             346      Reinvestment Act of 2009 (Pub. S. 111-5), as amended.
             347          (b) An individual or an employer on behalf of an eligible individual must submit the
             348      [enrollment forms] applicable forms and premiums for coverage under Subsection (1) to the
             349      insurer [prior to May 1, 2009] in accordance with the provisions of Section 3001 of the
             350      American Recovery and Reinvestment Act of 2009 (Pub. S. 11-5), as amended..
             351          (3) [The provision regarding the application of pre-existing condition waivers to the
             352      extended second election period for federal COBRA under Section 3001 of the American
             353      Recovery and Reinvestment Act of 2009 (Pub. S. 111-5) shall apply to the extended second
             354      election for state mini-COBRA under this section.] An insured has the right to extend the
             355      employee's coverage under mini-cobra with the current employer's group policy beyond the 12
             356      months to the period of time the insured is eligible to receive assistance in accordance with
             357      Section 3001 of the American Recovery and Reinvestment Act of 2009 (Pub. S. 111-5) as
             358      amended.
             359          (4) An insurer that violates this section is subject to penalties in accordance with
             360      Section 31A-2-308 .
             361          Section 5. Section 31A-30-205 is amended to read:
             362           31A-30-205. Health benefit plans offered in the defined contribution market.
             363          (1) An insurer who [chooses to offer a health benefit plan in the] offers a defined
             364      contribution [market must] arrangement health benefit plan shall offer the following health
             365      benefit plans as defined contribution arrangements:
             366          [(a) one health benefit plan that:]


             367          [(i) is a federally qualified high deductible health plan;]
             368          [(ii) has the lowest deductible permitted for a federally qualified high deductible health
             369      plan as adjusted by federal law; and]
             370          [(iii) does not exceed annual out-of-pocket maximum equal to three times the amount
             371      of the annual deductible; and]
             372          (a) the basic benefit plan;
             373          (b) one health benefit plan with [benefits that have] an aggregate actuarial value at least
             374      15% greater [that] than the [plan described in Subsection (1)(a).] actuarial value of the basic
             375      benefit plan;
             376          (c) on or before January 1, 2011, one health benefit plan that is a federally qualified
             377      high deductible health plan that has an individual deductible of $2,500 and a deductible of
             378      $5,000 for coverage including two or more individuals, and does not exceed an annual
             379      out-of-pocket maximum equal to three times the amount of the annual deductible;
             380          (d) on or before January 1, 2011, one health benefit plan that is a federally qualified
             381      high deductible health plan that has S. a deductible that is within $250 of .S the highest deductible
             381a      that qualifies as a federally qualified
             382      high deductible health plan as adjusted by federal law, and does not exceed an annual
             383      out-of-pocket maximum equal to three times the amount of the annual deductible; and
             384          (e) the insurer's five most commonly selected health benefit plans that:
             385          (i) include:
             386          (A) the provider panel;
             387          (B) the deductible;
             388          (C) co-payments;
             389          (D) co-insurance; and
             390          (E) pharmacy benefits; and
             391          (ii) are currently being marketed by the carrier to new groups for enrollment.
             392          (2) (a) The provisions of Subsection (1) do not limit the number of defined
             393      contribution arrangement health benefit plans an insurer may offer in the defined contribution
             394      arrangement market.
             395          (b) An insurer who offers the health benefit plans required by Subsection (1) may also
             396      offer any other health benefit plan [in the] as a defined contribution [market] arrangement if:
             397          (i) the health benefit plan provides benefits that are [actuarially richer] of greater


             398      actuarial value than the benefits required in [Subsection (1)(a).] the basic benefit plan; or
             399          (ii) the health benefit plan provides benefits with an aggregate actuarial value that is no
             400      lower than the actuarial value of the plan required in Subsection (1)(c).
             401          Section 6. Coordinating H.B. 459 with H.B. 294 -- Superseding amendments.
             402          If this H.B. 459 and H.B. 294, Health System Reform Amendments, both pass, it is the
             403      intent of the Legislature that the amendments to Sections 31A-22-613.5 and 31A-30-205 in this
             404      bill supersede the amendments to Sections 31A-22-613.5 and 31A-30-205 in H.B. 294, when
             405      the Office of Legislative Research and General Counsel prepares the Utah Code database for
             406      publication.
             407          Section 7. Effective date.
             408          If approved by two-thirds of all the members elected to each house, H. [ Section
             409      31A-22-722.5
] this bill .H
takes effect upon approval by the governor, or the day following the
             410      constitutional time limit of Utah Constitution Article VII, Section 8, without the governor's
             411      signature, or in the case of a veto, the date of veto override.
             412          Section 8. Coordinating H.B. 459 with H.B. 39 -- Substantive changes.
             413          If this H.B. 459 and H.B. 39, Insurance Related Amendments, both pass, it is the intent
             414      of the Legislature that the amendments to Section 31A-22-722.5 in this bill supersede the
             415      amendments to Section 31A-22-722.5 in H.B. 39, and has retrospective operation to the date
             416      the governor signed H.B. 39, when the Office of Legislative Research and General Counsel
             417      prepares the Utah Code database for publication.


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