31A-29-106 - Powers of board.
31A-29-106. Powers of board.
(1) The board shall have the general powers and authority granted under the laws of thisstate to insurance companies licensed to transact health care insurance business. In addition, theboard shall have the specific authority to:
(a) enter into contracts to carry out the provisions and purposes of this chapter, including,with the approval of the commissioner, contracts with:
(i) similar pools of other states for the joint performance of common administrativefunctions; or
(ii) persons or other organizations for the performance of administrative functions;
(b) sue or be sued, including taking such legal action necessary to avoid the payment ofimproper claims against the pool or the coverage provided through the pool;
(c) establish appropriate rates, rate schedules, rate adjustments, expense allowances,agents' referral fees, claim reserve formulas, and any other actuarial function appropriate to theoperation of the pool;
(d) issue policies of insurance in accordance with the requirements of this chapter;
(e) retain an executive director and appropriate legal, actuarial, and other personnel asnecessary to 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 forMedicare and Medicaid Services, or other appropriate office or agency of government, allappropriate waivers, authority, and permission needed to coordinate the coverage available fromthe pool with coverage available under Medicaid, either before or after Medicaid coverage, or asa conversion option upon completion of Medicaid eligibility, without the necessity forrequalification by the enrollee;
(i) provide for and employ cost containment measures and requirements includingpreadmission certification, concurrent inpatient review, and individual case management for thepurpose 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 whilemaintaining quality care;
(k) establish annual limits on benefits payable under the pool to or on behalf of anyenrollee;
(l) exclude from coverage under the pool specific benefits, medical conditions, andprocedures 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 AdministrativeRulemaking Act, to implement this chapter; and
(o) adopt, trademark, and copyright a trade name for the pool for use in marketing andpublicizing the pool and its products.
(2) (a) The board shall prepare and submit an annual report to the Legislature which shallinclude:
(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 shallcomply with the requirements of Title 63J, Chapter 1, Budgetary Procedures Act, and is subjectto review and approval by the Legislature.
(3) (a) The board shall on or before September 1, 2004, require the plan administrator oran independent actuarial consultant retained by the plan administrator to redetermine thereasonable equivalent of the criteria for uninsurability required under Subsection31A-30-106(1)(j) 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 everyfive years thereafter.
Amended by Chapter 382, 2008 General Session