H.B.
47
INSURANCE LAW AMENDMENTS
House Floor
Amendments
provide technical assistance in the operations of the pool;
(f) establish rules, conditions, and procedures for reinsuring risks under this chapter;
(g) cause the pool to have an annual audit of its operations by the state auditor;
(h) coordinate with the Department of Health in seeking to obtain from the Centers for Medicare and
Medicaid Services, or other appropriate office or agency of government, all appropriate waivers, authority, and
permission needed to coordinate the coverage available from the pool with coverage available under Medicaid,
either before or after Medicaid coverage, or as a conversion option upon completion of Medicaid eligibility,
without the necessity for requalification by the enrollee;
(i) provide for and employ cost containment measures and requirements including preadmission
certification, concurrent inpatient review, and individual case management for the purpose of making the pool
more cost-effective;
(j) offer pool coverage through contracts with health maintenance organizations, preferred provider
organizations, and other managed care systems that will manage costs while maintaining quality care;
(k) establish annual limits on benefits payable under the pool to or on behalf of any enrollee;
(l) exclude from coverage under the pool specific benefits, medical conditions, and procedures for the
purpose of protecting the financial viability of the pool;
(m) administer the Pool Fund;
(n) make rules in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, to
implement this chapter;
and
}
(o) adopt, trademark, and copyright a trade name for the pool for use in marketing and publicizing the
pool and its products
.
}
; and
(p) transition health care coverage for all individuals covered under the pool as part of the
conversion to health insurance coverage, regardless of pre-existing conditions, under PPACA.
(2) (a) The board shall prepare and submit an annual report to the Legislature which shall include:
(i) the net premiums anticipated;
(ii) actuarial projections of payments required of the pool;
(iii) the expenses of administration; and
(iv) the anticipated reserves or losses of the pool.
(b) The budget for operation of the pool is subject to the approval of the board.
(c) The administrative budget of the board and the commissioner under this chapter shall comply with
the requirements of Title 63J, Chapter 1, Budgetary Procedures Act, and is subject to review and approval by
the Legislature.
(3) (a) The board shall on or before September 1, 2004, require the plan administrator or an independent
actuarial consultant retained by the plan administrator to redetermine the reasonable equivalent of the criteria
for uninsurability required under Subsection
31A-30-106
(1)(h) that is used by the board to determine
eligibility for coverage in the pool.
(b) The board shall redetermine the criteria established in Subsection (3)(a) at least every five years
thereafter.
5. Page
68, Lines 2093 through 2099
:
2093
(1) There is created a restricted special revenue fund known as the "Insurance Fraud
2094
Victim Restitution Fund."
2095
(2) The Insurance Fraud Victim Restitution Fund shall consist of money ordered paid
2096
under Subsections
31A-31-109
(1)(a)(i) and (2)(a).
2097
(3) Interest on fund money shall be deposited into the General Fund.
}
2098
(4)
}
(3)
The commissioner shall administer the Insurance Fraud Victim Restitution Fund for
2099
the sole benefit of insurance fraud victims.
Renumber remaining sections accordingly.
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LRGC
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