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S.B. 208 Enrolled

             1     

HEALTHCARE COMPACT

             2     
2012 GENERAL SESSION

             3     
STATE OF UTAH

             4     
Chief Sponsor: J. Stuart Adams

             5     
House Sponsor: Bradley M. Daw

             6     
             7      LONG TITLE
             8      General Description:
             9          This bill enacts a Health Care Compact.
             10      Highlighted Provisions:
             11          This bill:
             12          .    adopts the Health Care Compact;
             13          .    defines terms;
             14          .    joins an interstate Advisory Health Care Commission;
             15          .    pledges to take joint and separate action to secure the consent of the United States
             16      Congress to the compact in order to return the authority to regulate health care to the
             17      member states, consistent with the goals and principles articulated in the compact;
             18          .    sunsets the compact on July 1, 2014; and
             19          .    requires the study of certain issues before reauthorizing the Health Care Compact.
             20      Money Appropriated in this Bill:
             21          None
             22      Other Special Clauses:
             23          None
             24      Utah Code Sections Affected:
             25      AMENDS:
             26          63I-1-263, as last amended by Laws of Utah 2011, Chapters 199, 370, 408, and 411
             27      ENACTS:
             28          63M-1-2507, Utah Code Annotated 1953
             29     


             30      Be it enacted by the Legislature of the state of Utah:
             31          Section 1. Section 63I-1-263 is amended to read:
             32           63I-1-263. Repeal dates, Titles 63A to 63M.
             33          (1) Section 63A-4-204 , authorizing the Risk Management Fund to provide coverage to
             34      any public school district which chooses to participate, is repealed July 1, 2016.
             35          (2) Section 63A-5-603 , State Facility Energy Efficiency Fund, is repealed July 1, 2016.
             36          (3) Section 63C-8-106 , rural residency training program, is repealed July 1, 2015.
             37          (4) Title 63C, Chapter 13, Prison Relocation and Development Authority Act, is
             38      repealed July 1, 2014.
             39          (5) Subsection 63G-6-502 (5)(b)(ii) authorizing certain transportation agencies to award
             40      a contract for a design-build transportation project in certain circumstances, is repealed July 1,
             41      2015.
             42          (6) Title 63H, Chapter 4, Heber Valley Historic Railroad Authority, is repealed July 1,
             43      2020.
             44          (7) The Resource Development Coordinating Committee, created in Section
             45      63J-4-501 , is repealed July 1, 2015.
             46          (8) Title 63M, Chapter 1, Part 4, Enterprise Zone Act, is repealed July 1, 2018.
             47          (9) (a) Title 63M, Chapter 1, Part 11, Recycling Market Development Zone Act, is
             48      repealed January 1, 2021.
             49          (b) Subject to Subsection (9)(c), Sections 59-7-610 and 59-10-1007 regarding tax
             50      credits for certain persons in recycling market development zones, are repealed for taxable
             51      years beginning on or after January 1, 2012.
             52          (c) A person may not claim a tax credit under Section 59-7-610 or 59-10-1007 :
             53          (i) for the purchase price of machinery or equipment described in Section 59-7-610 or
             54      59-10-1007 , if the machinery or equipment is purchased on or after January 1, 2012; or
             55          (ii) for an expenditure described in Subsection 59-7-610 (1)(b) or 59-10-1007 (1)(b), if
             56      the expenditure is made on or after January 1, 2012.
             57          (d) Notwithstanding Subsections (9)(b) and (c), a person may carry forward a tax credit


             58      in accordance with Section 59-7-610 or 59-10-1007 if:
             59          (i) the person is entitled to a tax credit under Section 59-7-610 or 59-10-1007 ; and
             60          (ii) (A) for the purchase price of machinery or equipment described in Section
             61      59-7-610 or 59-10-1007 , the machinery or equipment is purchased on or before December 31,
             62      2011; or
             63          (B) for an expenditure described in Subsection 59-7-610 (1)(b) or 59-10-1007 (1)(b), the
             64      expenditure is made on or before December 31, 2011.
             65          (10) (a) Section 63M-1-2507 , Health Care Compact is repealed on July 1, 2014.
             66          (b) (i) The Legislature shall, before reauthorizing the Health Care Compact:
             67          (A) direct the Health System Reform Task Force to evaluate the issues listed in
             68      Subsection (10)(b)(ii), and by January 1, 2013 develop and recommend criteria for the
             69      Legislature to use to negotiate the terms of the Health Care Compact; and
             70          (B) prior to July 1, 2014, seek amendments to the Health Care Compact among the
             71      member states that the Legislature determines are appropriate after considering the
             72      recommendations of the Health System Reform Task Force.
             73          (ii) The Health System Reform Task Force shall evaluate and develop criteria for the
             74      Legislature regarding:
             75          (A) the impact of the Supreme Court ruling on the Affordable Care Act;
             76          (B) whether Utah is likely to be required to implement any part of the Affordable Care
             77      Act prior to negotiating the compact with the federal government, such as Medicaid expansion
             78      in 2014;
             79          (C) whether the compact's current funding formula, based on adjusted 2010 state
             80      expenditures, is the best formula for Utah and other state compact members to use for
             81      establishing the block grants from the federal government;
             82          (D) whether the compact's calculation of current year inflation adjustment factor,
             83      without consideration of the regional medical inflation rate in the current year, is adequate to
             84      protect the state from increased costs associated with administering a state based Medicaid and
             85      a state based Medicare program;


             86          (E) whether the state has the flexibility it needs under the compact to implement and
             87      fund state based initiatives, or whether the compact requires uniformity across member states
             88      that does not benefit Utah;
             89          (F) whether the state has the option under the compact to refuse to take over the federal
             90      Medicare program;
             91          (G) whether a state based Medicare program would provide better benefits to the
             92      elderly and disabled citizens of the state than a federally run Medicare program;
             93          (H) whether the state has the infrastructure necessary to implement and administer a
             94      better state based Medicare program;
             95          (I) whether the compact appropriately delegates policy decisions between the
             96      legislative and executive branches of government regarding the development and
             97      implementation of the compact with other states and the federal government; and
             98          (J) the impact on public health activities, including communicable disease surveillance
             99      and epidemiology.
             100          [(10)] (11) The Crime Victim Reparations Board, created in Section 63M-7-504 , is
             101      repealed July 1, 2017.
             102          [(11)] (12) Title 63M, Chapter 8, Utah Commission for Women and Families Act, is
             103      repealed July 1, 2011.
             104          [(12)] (13) Title 63M, Chapter 9, Families, Agencies, and Communities Together for
             105      Children and Youth At Risk Act, is repealed July 1, 2016.
             106          [(13)] (14) Title 63M, Chapter 11, Utah Commission on Aging, is repealed July 1,
             107      2012.
             108          Section 2. Section 63M-1-2507 is enacted to read:
             109          63M-1-2507. The Health Care Compact.
             110          The Health Care Compact is hereby enacted and entered into with all other jurisdictions
             111      that legally join in the compact, which is, in form, substantially as follows:
             112     
Health Care Compact

             113          Whereas, the separation of powers, both between the branches of the federal


             114      government and between federal and state authority, is essential to the preservation of
             115      individual liberty;
             116          Whereas, the Constitution creates a federal government of limited and enumerated
             117      powers, and reserves to the states or to the people those powers not granted to the federal
             118      government;
             119          Whereas, the federal government has enacted many laws that have preempted state laws
             120      with respect to health care, and placed increasing strain on state budgets, impairing other
             121      responsibilities such as education, infrastructure, and public safety;
             122          Whereas, the member states seek to protect individual liberty and personal control over
             123      health care decisions, and believe the best method to achieve these ends is by vesting
             124      regulatory authority over health care in the states;
             125          Whereas, by acting in concert, the member states may express and inspire confidence in
             126      the ability of each member state to govern health care effectively; and
             127          Whereas, the member states recognize that consent of Congress may be more easily
             128      secured if the member states collectively seek consent through an interstate compact;
             129          NOW THEREFORE, the member states hereto resolve, and by the adoption into law
             130      under their respective state constitutions of this health care compact, agree, as follows:
             131           Sec. 1. Definitions.
             132          As used in this compact, unless the context clearly indicates otherwise:
             133          (1) "Commission" means the Interstate Advisory Health Care Commission.
             134          (2) "Effective date" means the date upon which this compact shall become effective for
             135      purposes of the operation of state and federal law in a member state, which shall be the later of:
             136          (a) the date upon which this compact shall be adopted under the laws of the member
             137      state, and
             138          (b) the date upon which this compact receives the consent of Congress pursuant to
             139      Article I, Section 10, of the United States Constitution, after at least two member states adopt
             140      this compact.
             141          (3) "Health care" means care, services, supplies, or plans related to the health of an


             142      individual and includes but is not limited to:
             143          (a) preventive, diagnostic, therapeutic, rehabilitative, maintenance, or palliative care
             144      and counseling, service, assessment, or procedure with respect to the physical or mental
             145      condition or functional status of an individual or that affects the structure or function of the
             146      body, and
             147          (b) sale or dispensing of a drug, device, equipment, or other item in accordance with a
             148      prescription, and
             149          (c) an individual or group plan that provides, or pays the cost of, care, services, or
             150      supplies related to the health of an individual, except any care, services, supplies, or plans
             151      provided by the United States Department of Defense and United States Department of Veteran
             152      Affairs, or provided to Native Americans.
             153          (4) "Member state" means a state that is signatory to this compact and has adopted it
             154      under the laws of that state.
             155          (5) "Member state base funding level" means a number equal to the total federal
             156      spending on health care in the member state during federal fiscal year 2010. On or before the
             157      effective date, each member state shall determine the member state base funding level for its
             158      state, and that number shall be binding upon that member state. The preliminary estimate of
             159      member state base funding level for the state of Utah is $4,102,000,000.
             160          (6) "Member state current year funding level" means the member state base funding
             161      level multiplied by the member state current year population adjustment factor multiplied by
             162      the current year inflation adjustment factor.
             163          (7) "Member state current year population adjustment factor" means the average
             164      population of the member state in the current year less the average population of the member
             165      state in federal fiscal year 2010, divided by the average population of the member state in
             166      federal fiscal year 2010, plus 1. Average population in a member state shall be determined by
             167      the United States Census Bureau.
             168          (8) "Current year inflation adjustment factor" means the total gross domestic product
             169      deflator in the current year divided by the total gross domestic product deflator in federal fiscal


             170      year 2010. Total gross domestic product deflator shall be determined by the Bureau of
             171      Economic Analysis of the United States Department of Commerce.
             172           Sec. 2. Pledge.
             173          The member states shall take joint and separate action to secure the consent of the
             174      United States Congress to this compact in order to return the authority to regulate health care to
             175      the member states consistent with the goals and principles articulated in this compact. The
             176      member states shall improve health care policy within their respective jurisdictions and
             177      according to the judgment and discretion of each member state.
             178           Sec. 3. Legislative Power.
             179          The legislatures of the member states have the primary responsibility to regulate health
             180      care in their respective states.
             181           Sec. 4. State Control.
             182          Each member state, within its state, may suspend by legislation the operation of all
             183      federal laws, rules, regulations, and orders regarding health care that are inconsistent with the
             184      laws and regulations adopted by the member state pursuant to this compact. Federal and state
             185      laws, rules, regulations, and orders regarding health care will remain in effect unless a member
             186      state expressly suspends them pursuant to its authority under this compact. For any federal
             187      law, rule, regulation, or order that remains in effect in a member state after the effective date,
             188      that member state shall be responsible for the associated funding obligations in its state.
             189           Sec. 5. Funding.
             190          (a) Each federal fiscal year, each member state shall have the right to federal monies up
             191      to an amount equal to its member state current year funding level for that federal fiscal year,
             192      funded by Congress as mandatory spending and not subject to annual appropriation, to support
             193      the exercise of member state authority under this compact. This funding shall not be
             194      conditional on any action of or regulation, policy, law, or rule being adopted by the member
             195      state.
             196          (b) By the start of each federal fiscal year, Congress shall establish an initial member
             197      state current year funding level for each member state, based upon reasonable estimates. The


             198      final member state current year funding level shall be calculated, and funding shall be
             199      reconciled by the United States Congress based upon information provided by each member
             200      state and audited by the United States Government Accountability Office.
             201           Sec. 6. Interstate Advisory Health Care Commission.
             202          (a) The Interstate Advisory Health Care Commission is established. The commission
             203      consists of members appointed by each member state through a process to be determined by
             204      each member state. A member state may not appoint more than two members to the
             205      commission and may withdraw membership from the commission at any time. Each
             206      commission member is entitled to one vote. The commission shall not act unless a majority of
             207      the members are present, and no action shall be binding unless approved by a majority of the
             208      commission's total membership.
             209          (b) The commission may elect from among its membership a chairperson. The
             210      commission may adopt and publish bylaws and policies that are not inconsistent with this
             211      compact. The commission shall meet at least once a year, and may meet more frequently.
             212          (c) The commission may study issues of health care regulation that are of particular
             213      concern to the member states. The commission may make non-binding recommendations to
             214      the member states. The legislatures of the member states may consider these recommendations
             215      in determining the appropriate health care policies in their respective states.
             216          (d) The commission shall collect information and data to assist the member states in
             217      their regulation of health care, including assessing the performance of various state health care
             218      programs and compiling information on the prices of health care. The commission shall make
             219      this information and data available to the legislatures of the member states. Notwithstanding
             220      any other provision in this compact, no member state shall disclose to the commission the
             221      health information of any individual, nor shall the commission disclose the health information
             222      of any individual.
             223          (e) The commission shall be funded by the member states as agreed to by the member
             224      states. The commission shall have the responsibilities and duties as may be conferred upon it
             225      by subsequent action of the respective legislatures of the member states in accordance with the


             226      terms of this compact.
             227          (f) The commission shall not take any action within a member state that contravenes
             228      any state law of that member state.
             229           Sec. 7. Congressional Consent.
             230          This compact shall be effective on its adoption by at least two member states and
             231      consent of the United States Congress. This compact shall be effective unless the United States
             232      Congress, in consenting to this compact, alters the fundamental purposes of this compact,
             233      which are:
             234          (a) to secure the right of the member states to regulate health care in their respective
             235      states pursuant to this compact and to suspend the operation of any conflicting federal laws,
             236      rules, regulations, and orders within their states; and
             237          (b) to secure federal funding for member states that choose to invoke their authority
             238      under this compact, as prescribed by Section 5 of this compact.
             239           Sec. 8. Amendments.
             240          The member states, by unanimous agreement, may amend this compact from time to
             241      time without the prior consent or approval of Congress and any amendment shall be effective
             242      unless, within one year, the Congress disapproves that amendment. Any state may join this
             243      compact after the date on which Congress consents to the compact by adoption into law under
             244      its state constitution.
             245           Sec. 9. Withdrawal; Dissolution.
             246          Any member state may withdraw from this compact by adopting a law to that effect, but
             247      no such withdrawal shall take effect until six months after the governor of the withdrawing
             248      member state has given notice of the withdrawal to the other member states. A withdrawing
             249      state shall be liable for any obligations that it may have incurred prior to the date on which its
             250      withdrawal becomes effective. This compact shall be dissolved upon the withdrawal of all but
             251      one of the member states.
             252           Sec. 10. Sunset.
             253          This compact sunsets on July 1, 2014.


             254     


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