53-2-216. Health insurance premium assistance -- legislative intent -- application for section 1115 waiver -- duties of board of directors of small business health insurance pool, commissioner of insurance, and department of public health and human services. (1) It is the intent of the legislature that the small business health insurance pool board of directors, established in 33-22-2003, consider the option of funding a portion of the premium incentive payments on behalf of eligible small employers or premium assistance payments on behalf of eligible employees under Title 33, chapter 22, part 20, to the extent possible through a section 1115 waiver demonstration project of medicaid coverage as authorized by section 1115 of Title XI of the Social Security Act, 42 U.S.C. 1315.
     (2) The department shall prepare an analysis of the section 1115 waiver for the board for its consideration in deciding whether to request that the department seek the section 1115 waiver as provided in 33-22-2004.
     (3) (a) The department, as the designated single state agency for the receipt of medicaid, may seek, if requested by the board, approval from the U.S. department of health and human services for inclusion in a section 1115 waiver for the premium incentive payments and premium assistance payments to be provided on behalf of employees eligible under Title 33, chapter 22, part 20, who meet the applicable income standard established through the section 1115 waiver.
     (b) The commissioner of insurance and the board shall cooperate with the department in obtaining approval for the inclusion of the premium assistance payment coverage group in a section 1115 waiver.
     (4) Upon approval of a premium assistance payment coverage group through a section 1115 waiver:
     (a) the eligibility of program participants for the section 1115 demonstration premium assistance coverage group must be determined by the department. The commissioner of insurance shall provide employee and other information to the department as necessary for section 1115 waiver eligibility determinations.
     (b) the department may access confidential employee and employer information necessary for administration of the premium assistance payment coverage group. The commissioner shall provide employee, employer, and other information to the department as necessary for the administration of the section 1115 waiver.
     (c) the commissioner of insurance and the board shall provide to the department the funds or certification necessary to provide the state match for the medicaid money to be expended on behalf of the section 1115 waiver premium incentive payment or premium assistance payment coverage groups and for the administration of the coverage groups by the department;
     (d) the commissioner of insurance, the board, and the department shall cooperate in the adoption of administrative rules necessary for the implementation of the premium incentive payments and premium assistance payments. The department shall adopt rules for the implementation of medicaid coverage for employees participating in the program as provided in the conditions for the waiver.
     (e) the commissioner and the board shall cooperate with the department to ensure that expenditures of medicaid money are made in accordance with the requirements of federal law and the approval for the section 1115 waiver.
     (5) The department may coordinate or include the authorization to seek the waiver granted by this section with any other authority granted to the department in this part to seek section 1115 waivers.

     History: En. Sec. 10, Ch. 595, L. 2005.