Under current law, the Health Insurance Risk-Sharing Plan (HIRSP)
Authority administers HIRSP, which provides health insurance coverage for persons
who are covered under Medicare because they are disabled, persons who have tested
positive for human immunodeficiency virus (HIV), persons who have been refused
coverage, or coverage at an affordable price, in the private health insurance market
because of their mental or physical health condition, and persons who do not
currently have health insurance coverage, but who were covered under certain types
of health insurance coverage (creditable coverage) for at least 18 months in the past.
HIRSP is funded by premiums paid by covered persons, insurer assessments, and
provider payment discounts.

This bill makes the following changes to HIRSP and the HIRSP Authority:

1. Currently, for payment under HIRSP, all providers of services and articles
must be certified to provide those services and articles under the Medical Assistance

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(MA) program. The bill allows prescription drugs to be provided by a network of
pharmacists and pharmacies that are approved by the HIRSP Authority Board of
Directors, regardless of whether the pharmacists and pharmacies in the network are
certified to provide prescription drugs under MA. In addition, the bill authorizes the
HIRSP Authority to certify providers on a temporary basis to provide services or
articles to HIRSP enrollees. These providers would not be certified to provide
services and articles under MA; they would have to be licensed to provide the services
or articles that they are providing to HIRSP enrollees but not necessarily licensed
in this state; and the certification could be done retroactively after the services or
articles were provided.

2. Currently, payments to providers must consist of the allowable charges for
services and articles under MA with an enhancement determined by the HIRSP
Authority. The adjustments must take into account provider discounts. The bill
requires payments to providers to consist of usual and customary payment rates,
determined by the HIRSP Authority, with adjustments that take into account
provider discounts.

3. Under current law, HIRSP enrollees with incomes below a specified level who
are covered under certain HIRSP coverage options are eligible for premium and
deductible subsidies. The bill makes all persons with coverage under HIRSP with
incomes below that specified level eligible for the premium and deductible subsidies.

4. For HIRSP enrollees who receive premium subsidies, current law describes
the amount of the reduction in an enrollee's premium in terms of requiring an
enrollee's regular HIRSP premium to be reduced to a specified percentage of the rate
that a standard risk would be charged under an individual policy providing
substantially the same coverage and deductibles as HIRSP. The bill changes the way
the premium reduction is described by establishing discounts, so that an enrollee's
regular premium is reduced by a specified percentage of the premium, such as 30
percent or 20 percent.

5. Under current law, the HIRSP Authority is required to design and
administer a Health Care Tax Credit Program that satisfies requirements under
federal law enabling persons covered under this health care program to receive an
income tax credit for a portion of premiums paid for the coverage. The HIRSP
Authority has determined that such a health care program would not be
economically feasible as a stand-alone program. The bill repeals the requirement
for the HIRSP Authority to design and administer the program.

6. Under current law, with certain exceptions, anyone who is eligible for certain
types of health care coverage provided by an employer is ineligible for coverage under
HIRSP. The bill authorizes the HIRSP Authority Board to specify other exceptions.