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DC Health Benefit Exchange Authority Financial Sustainability Plan

Consistent with the Patient Protection and Affordable Care Act and District of Columbia law, the DC Health Benefit Exchange Authority will assess health carriers annually to support its annual budget beginning with FY 2015.  Below is information regarding the assessment.

HBX Health Carrier Assessment Appeal Process

The annual Notice of Assessments were sent out July 25, 2016 and are due September 6, 2016. A health carrier seeking to contest the assessment in the Notice of Assessment issued pursuant to DC Code Section 31-3171.03 can submit a request for reconsideration by September 8, 2016, consistent with the HBX Health Carrier Assessment Final Rule (2016). A health carrier can file a request for reconsideration by submitting a written request to the DC Health Benefit Exchange Authority at [email protected], specifying the basis for the request as specified in this rule.

HBX Health Carrier Assessment Final Rule

The DC Health Benefit Exchange Authority (HBX) Assessment Final Rule, issued pursuant to the Health Benefit Exchange Authority Financial Sustainability Amendment Act of 2015 (D.C Law 21-0013), was published in the D.C Register on July 22, 2016.

HBX Health Carrier Assessment Proposed Rule

The DC Health Benefit Exchange Authority (HBX) Assessment Proposed Rule, issued pursuant to the Health Benefit Exchange Authority Financial Sustainability Amendment Act of 2015 (D.C Law 21-0013), was published in the D.C. Register on December 18, 2015. The DC Office of Attorney General provided technical and conforming changes for legal sufficiency, changes that can be found below. The proposed rule has been submitted for Council review.

HBX Health Carrier Assessment Draft Proposed Rule - Comments Requested

The DC Health Benefit Exchange Authority (HBX) is seeking informal comment from stakeholders, including consumer advocates and the public, on a proposed regulation that establishes a process for the health carrier assessment pursuant to the Health Benefit Exchange Authority Financial Sustainability Amendment Act of 2015 (L21-0013).

HBX is specifically seeking comments on how to identify lines of business that are not subject to the assessment where not identified in carrier insurance filings, such as stop-loss insurance. HBX also seeks comments on how any such process might be implemented.

Comments are due to [email protected] by close of business November 20, 2015.

Emergency Health Carrier Assessment Rule

The DC Health Benefit Exchange Authority Executive Board voted to adopt the “Emergency Health Carrier Assessment” rule at its July 21, 2015 meeting.

Under the Health Benefit Exchange Authority Financial Sustainability Amendment Act of 2015 (L21-0013) the DC Health Benefit Exchange Authority will annually assess health carriers to support its budget. The emergency rule sets forth the process by which an assessed entity may contest an assessment levied pursuant to DC Code Section 31-3171.03(f).

The DC Health Benefit Exchange Authority must have its initial assessment of health carriers in the summer of 2015 to support its FY 2016 Authority budget. Emergency action is necessary to ensure there is due process available to assessed entities to contest the assessment levied pursuant to §31-3171.03(f).

A health carrier seeking to contest the assessment in the Notice of Assessment issued pursuant to DC Code Section 31-3171.03 can submit a request for reconsideration consistent with the Emergency Health Carrier Assessment rule (2015). A health carrier can file a request for reconsideration by submitting a written request to the DC Health Benefit Exchange Authority at [email protected], specifying the basis for the request as specified in this rule.

Comments Received: HBX Health Carrier Assessment Due Process Draft Proposed Rule

The DC Health Benefit Exchange Authority sought informal comment from stakeholders on an emergency regulation that establishes a process for the health carrier assessment pursuant to the Health Benefit Exchange Authority Financial Sustainability Emergency Amendment Act of 2015 (A21-0017).Comments were due to [email protected] by close of business July 10, 2014 and are posted here:

HBX Health Carrier Assessment Draft Emergency Rule - Comments Requested

The DC Health Benefit Exchange Authority is seeking informal comment from stakeholders, including consumer advocates and the public, on an emergency regulation that establishes a process for the health carrier assessment pursuant to the Health Benefit Exchange Authority Financial Sustainability Emergency Amendment Act of 2015 (A21-0017).

Comments were due to [email protected] by close of business July 10, 2015.

Health Benefit Exchange Authority Financial Sustainability Amendment Act

The Health Benefit Exchange Authority Establishment Act of 2011 requires the Health Benefit Exchange Authority (“Authority”) to “prepare a plan that identifies how the Authority will be financially self-sustaining by January 1, 2015.” DC Official Code § 31-3171.16(b)(1).  After considering options for achieving financial self-sustainability, the Authority Executive Board adopted a broad-based assessment of all health insurance carriers, similar to an existing approach used by the Ombudsman Program.  The Council adopted this approach amending DC Official Code § 31-3171.03 on an emergency basis to authorize the Authority to annually assess all health carriers doing business in the District.

The Department of Insurance, Securities and Banking (DISB) will administer the assessment on behalf of the Authority. In 2014 annual Notice of Assessment was sent on August 18, 2014 and assessments were due on September 30, 2014.

2014 Administrative Appeal Rights Regarding the Health Carrier Assessment

In 2014, a health carrier seeking to contest the assessment in the Notice of Assessment issued pursuant to DC Code Section 31-3171.03 was able to submit a request for reconsideration consistent with 26-D DCMR §110 (2014).  A health carrier could file a request for reconsideration by submitting a written request to the DC Health Benefit Exchange Authority at [email protected], specifying the basis for the request as specified in 26-D DCMR §110.1.

The DC Health Benefit Exchange Authority Executive Board voted to adopt the “Emergency Health Carrier Assessment Administrative Appeal” rule at its June 11, 2014 meeting.

Comments Received: HBX Health Carrier Assessment Due Process Draft Proposed Rule

The DC Health Benefit Exchange Authority sought informal comment from the public on a proposed regulation for “Health Carrier Assessment Administrative Appeal” prior to formal rulemaking.  Comments were due to [email protected] by close of business July 11, 2014 and are posted here:

Under the Health Benefit Exchange Authority Financial Sustainability Emergency Amendment Act of 2014 (DC Code Section 31-3171.01(f)), the DC Health Benefit Exchange Authority will annually assess health carriers to support its budget.  The proposed rule sets forth the process by which an assessed entity may contest an assessment levied pursuant to DC Code Section 31-3171.01(f).

Emergency Health Carrier Assessment Administrative Appeal

The DC Health Benefit Exchange Authority Executive Board voted to adopt the “Emergency Health Carrier Assessment Administrative Appeal” rule at its June 11, 2014 meeting.

Under the Health Benefit Exchange Authority Financial Sustainability Emergency Amendment Act of 2014 (DC Code Section 31-3171.01(f)), the DC Health Benefit Exchange Authority will annually assess health carriers to support its budget.  The emergency rule sets forth the process by which an assessed entity may contest an assessment levied pursuant to DC Code Section 31-3171.01(f).

The DC Health Benefit Exchange Authority must have its initial assessment of health carriers in the summer of 2014 to support its FY 2015 Authority budget.  Emergency action is necessary to ensure there is due process available to assessed entities to contest the initial assessment levied pursuant to §31-3171.03(f).  

Other Financial Sustainability Documents