                                 CODE OF VIRGINIA

DUTIES OF EXCHANGE (§ 38.2-6505)

The Exchange shall:

1. Implement procedures for the certification, recertification, and
decertification of qualified health plans and qualified dental plans consistent
with guidelines developed by the Secretary under &#xA7; 1311(c) of the Federal
Act and &#xA7; 38.2-6506;

2. Provide for enrollment periods under &#xA7; 1311(c)(6) of the Federal Act;

3. Provide for the operation of a toll-free telephone hotline to respond to
requests for assistance;

4. Utilize a website on which enrollees and prospective enrollees of qualified
health plans and qualified dental plans may obtain standardized comparative
information. Information on qualified health plans shall include, at a minimum,
(i) premium and cost-sharing information; (ii) the summary of benefits and
coverage offered; (iii) identification of a qualified health plan as a
bronze-level, silver-level, gold-level, or platinum-level plan as defined by
&#xA7; 1302(d) of the Federal Act or a catastrophic plan as defined by &#xA7;
1302(e) of the Federal Act; (iv) the results of enrollee satisfaction surveys,
described in &#xA7; 1311(c)(4) of the Federal Act; (v) quality ratings assigned
pursuant to &#xA7; 1311(c)(3) of the Federal Act; (vi) medical loss ratio
information as reported to the Secretary in accordance with 45 C.F.R. Part 158;
(vii) transparency of coverage measures reported to the Exchange during
certification processes; and (viii) the provider directory made available to the
Exchange. The website shall be accessible to persons with disabilities, shall
provide meaningful access for persons with limited English proficiency, and
shall contain the information described in clauses (i) through (viii) without
diversion to a website of a carrier;

5. Assign a rating to each qualified health plan offered through the Exchange in
accordance with the criteria developed by the Secretary under &#xA7; 1311(c)(3)
of the Federal Act;

6. Determine each qualified health plan&#8217;s level of coverage in accordance
with regulations issued by the Secretary under &#xA7; 1302(d)(2)(A) of the
Federal Act;

7. Use a standardized format for presenting health benefit options in the
Exchange, including the use of the uniform outline of coverage as established
under &#xA7; 2715 of the PHSA, 42 U.S.C. &#xA7; 300gg-15;

8. Inform individuals, in accordance with &#xA7; 1413 of the Federal Act, of
eligibility requirements for (i) the State Medicaid Program; (ii) the
Children&#8217;s Health Insurance Program (CHIP) under Title XXI of the Social
Security Act, including FAMIS, as amended from time to time; or (iii) any
applicable state or local public health subsidy program, and enroll an
individual in such program if it is determined, through screening of the
application, that such individual is eligible for any such program;

9. Make available by electronic means through the website described in
subdivision 4 a calculator to determine the actual cost of coverage after
application of any premium assistance tax credit under 26 U.S.C. &#xA7; 36B and
any cost-sharing reduction under &#xA7; 1402 of the Federal Act;

10. Establish an American Health Benefit Exchange through which qualified
individuals may enroll in any qualified health plan or qualified dental plan
offered through the American Health Benefit Exchange for which they are eligible
and establish a SHOP exchange through which qualified employers may make their
eligible employees eligible for one or more qualified health plans or qualified
dental plans offered through the SHOP exchange or specify a level of coverage so
that any of their eligible employees may enroll in any qualified health plan or
qualified dental plan offered through the SHOP exchange at the specified level
of coverage;

11. Subject to &#xA7; 1411 of the Federal Act, grant a certification attesting
that, for purposes of the individual responsibility penalty under &#xA7; 5000A
of the Internal Revenue Code of 1986, an individual is exempt from the
individual responsibility requirement or from the penalty imposed by that
section because there is no affordable qualified health plan available through
the Exchange, or the individual&#8217;s employer, covering the individual or the
individual meets the requirements for any other such exemption from the
individual responsibility requirement or penalty;

12. Transfer to the U.S. Secretary of the Treasury the following:
			a. A list of the individuals who are issued a certification under subdivision
11, including the name and taxpayer identification number of each individual;
			b. The name and taxpayer identification number of each individual who was an
employee of an employer but who was determined to be eligible for the premium
assistance tax credit under 26 U.S.C. &#xA7; 36B because (i) the employer did
not provide minimum essential coverage or (ii) the employer provided minimum
essential coverage but a determination under 26 U.S.C. &#xA7; 36B(c)(2)(C) found
that either the coverage was unaffordable for the employee or did not provide
the required minimum actuarial value; and
			c. The name and taxpayer identification number of (i) each individual who
notifies the Exchange under 42 U.S.C. &#xA7; 18081 that the individual has
changed employers and (ii) each individual who ceases coverage under a qualified
health plan and the effective date of the cessation;

13. Provide to each employer the name of each of the employer&#8217;s employees
described in subdivision 12 b who ceases coverage under a qualified health plan
during a plan year and the effective date of the cessation;

14. Perform duties required of the Exchange by the Secretary or the U.S.
Secretary of the Treasury related to determining eligibility for premium
assistance tax credits, reduced cost-sharing, or individual responsibility
requirement exemptions;

15. Certify entities qualified to serve as Navigators in accordance with &#xA7;
1311(i) of the Federal Act and &#xA7; 38.2-6513;

16. Consult with stakeholders relevant to carrying out the activities required
under this chapter, including:
			a. Health care consumers who are enrollees in qualified health plans and
qualified dental plans;
			b. Individuals and entities with experience in facilitating enrollment in
qualified health plans and qualified dental plans;
			c. Advocates for enrolling hard-to-reach populations, which include
individuals with mental health or substance use disorders;
			d. Representatives of small businesses and self-employed individuals;
			e. The Department of Medical Assistance Services;
			f. Federally recognized tribes, as defined in the Federally Recognized Indian
Tribe List Act of 1994 (25 U.S.C. &#xA7; 479a), that are located within the
Exchange&#8217;s geographic area;
			g. Public health experts;
			h. Health care providers;
			i. Large employers;
			j. Health carriers; and
			k. Insurance agents;

17. Meet the following financial integrity requirements:
			a. Keep an accurate accounting of all activities, receipts, and expenditures
and annually submit to the Secretary, the Governor, and the Commission a report
concerning such accountings;
			b. Fully cooperate with any investigation conducted by the Secretary pursuant
to the Secretary&#8217;s authority under the Federal Act and allow the
Secretary, in coordination with the Inspector General of the U.S. Department of
Health and Human Services, to:

   1. Investigate the affairs of the Exchange;

   2. Examine the properties and records of the Exchange; and

   3. Require periodic reports in relation to the activities undertaken by the
   Exchange; and
   				c. Not use any funds in carrying out its activities under this chapter
   that are intended for the administrative and operational expenses of the
   Exchange for staff retreats, promotional giveaways, excessive executive
   compensation, or promotion of federal or state legislative and regulatory
   modifications;

18. In collaboration with the Department of Medical Assistance Services,
coordinate the operations of the Exchange with the operations of the state plan
for medical assistance to determine initial and ongoing eligibility for those
programs in a streamlined fashion;

19. Identify systems, policies, and practices to achieve the requirements of
subdivisions 8 and 18 and in doing so, consult with stakeholders, including the
Department of Taxation, the Department of Medical Assistance Services, the
Department of Social Services, consumer groups, insurers, health care providers,
navigators or other consumer assisters, insurance brokers or agents, and other
relevant stakeholders selected by the Exchange;

20. Prepare an annual marketing plan that includes consumer outreach, licensed
health insurance agents, and navigator programs; and

21. Take any other actions necessary and appropriate to ensure that the Exchange
complies with the requirements of the Federal Act.

HISTORY: 2020, cc. 916, 917; 2021, Sp. Sess. I, c. 162; 2022, cc. 250, 251.