§5-16B-6d Modified benefit plan implementation.
§5-16B-6d. Modified benefit plan implementation.
(a) Upon approval by the Centers for Medicare and Medicaid Services, the board shall implement a program for uninsured children of families with income between two hundred and three hundred percent of the federal poverty level.
(b) The benefit plans offered pursuant to this section shall include services determined to be appropriate for children, but may vary from those currently offered by the board.
(c) The board shall structure the benefit plans for this expansion to include premiums, coinsurance or copays and deductibles. The board shall develop the cost sharing features in such a manner as to keep the program fiscally stable without creating a barrier to enrollment. Such features may include different cost-sharing features within this group based upon the percentage of the federal poverty level.
(d) Children covered by an employer sponsored health insurance plan during the previous twelve month period are not eligible for coverage under this expansion, unless that coverage is lost due to the parent's loss of employment.
(e) Provider reimbursement schedules shall be no lower than the reimbursement provided for the same services under the plans offered in article sixteen of this chapter.
(f) All provisions of this article are applicable to this expansion unless expressly addressed in this section.
(g) Nothing in this section may be construed to require any appropriation of state general revenue funds for the payment of any benefit provided pursuant to this section, except for the state appropriation used to match the federal financial participation funds. In the event that federal funds are no longer authorized for participation by individuals eligible at income levels above two hundred percent, the board shall take immediate steps to terminate the expansion provided for in this section and notify all enrollees of such termination. In the event federal appropriations decrease for the programs created pursuant to Title XXI of the Social Security Act of 1997, the board is directed to make those decreases in this expansion program before making changes to the programs created for those children whose family income is less than two hundred percent of the federal poverty level.
(h) The board is directed to report no less than quarterly to the Legislative Oversight Commission on Health and Human Resources Accountability on the development, implementation and progress of the expansion authorized in this section.