,i #aadth ,,congress #ast ,session ,h4 ,r4 #bhfi ,,in ,,the ,,house ,,of ,,representatives ,june #bd1 #bjae ,mr4 ,marchant 7for himself1 ,mr4 ,thornberry1 and ,mr4 ,olson7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce ,a ,,bill ,to amend title ,,xxvii of the ,public ,health ,service ,act to permit cooperative governing of public entity health benefits through local governments in secondary ,states4 #a4 ,short title ,this ,act may be cited as the ,local and ,municipal ,health ,care ,choice ,act of #bjae4 #b4 ,cooperative governing of public entity group health coverage ,title ,,xxvii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg et seq47 is amended-- 7#a7 by redesignating the section #bgid 7#db ,u4,s4,c4 #cjj;gg-#ie7 relating to uniform fraud and abuse referral format as section #bgie2 and 7#b7 by adding at the end the following new section3 #bgif4 ,authority to offer public entity group health coverage to local governments in a secondary ,state 7a7 ,in general ,a local government in a secondary ,state 7as defined in subsection 7i77#g77 may provide group health coverage to its officers1 employees1 or retirees 7and their dependents7 through a local government employee health benefits pool or program authorized under the laws of a primary ,state1 subject to the provisions of this section4 7b7 ,eligibility for multistate activity ,a local government employee health benefits pool or program shall be eligible to offer group health coverage to officials1 employees1 and retirees 7and their dependents7 of a local government located in a secondary ,state through an interlocal agreement with such local government1 or as approved by an applicable ,state authority in such secondary ,state1 unless-- 7#a7 in the case of a pool or program that primarily serves municipal officers1 employees1 or retirees 7and their dependents71 an objection is made to the offering of such coverage by the municipal league or association located in the secondary ,state within #ij days of the date on which the authority is granted or an interlocal agreement is executed2 or 7#b7 in the case of a pool or program that primarily serves county officers1 employees1 retirees 7and their dependents71 an objection is made to the offering of such coverage by the county association located in the secondary ,state within #ij days of the date on which the authority is granted or an interlocal agreement is executed4 7c7 ,application of covered laws of primary ,state ,the covered laws 7as defined in subsection 7i77#b77 of the primary ,state shall apply to group health coverage offered by a local government employee health benefits pool or program in the primary ,state and in any secondary ,state1 but only if the coverage and the pool or program comply with the conditions of this section with respect to the offering of coverage in any secondary ,state4 7d7 ,limited application of secondary ,state laws 7#a7 ,in general ,except as provided in this section1 a local government employee health benefits pool or program that offers group health coverage in a secondary ,state to the officers1 employees1 or retirees 7and their dependents7 of a local government located in such secondary ,state1 is exempt from any covered laws of the secondary ,state 7and any rules1 regulations1 agreements1 or orders sought or issued by such ,state under or related to such covered laws74 7#b7 ,secondary ,state authority ,a secondary ,state may require a local government employee health benefits pool or program to do any or all of the following3 7,a7 ,registration ,to register with an applicable ,state authority in such ,state with jurisdiction over local government employee health benefits pools or programs and designate such authority as its agent solely for the purpose of receiving service of legal documents or process4 7,b7 ,documentation ,to file with an applicable state authority in such ,state-- 7i7 a written intent to do business in that ,state2 7ii7 copies of the membership or interlocal agreements entered into between the local government employee health benefits pool or program and a local government of that ,state2 and 7iii7 copies of annual audited financial statements of the local government employee health benefits pool or program filed with the primary ,state4 7,c7 ,compliance with injunctions ,to comply with an injunction issued by a court of competent jurisdiction1 upon a petition by an applicable ,state authority in such ,state alleging that the pool or program is in hazardous financial condition4 7,d7 ,compliance with ,state fraud and abuse laws ,to comply with any ,state law regarding fraud and abuse1 except that if the ,state seeks an injunction regarding the conduct described in this subparagraph1 such injunction must be obtained from a court of competent jurisdiction4 7,e7 ,compliance with ,state unfair claims settlement practices laws ,to comply with any ,state law regarding unfair claims settlement practices4 7#c7 ,limitations on secondary ,state authority ,if a local government employee health benefits pool or program offers group health insurance coverage to officials1 employees1 and retirees 7and their dependents7 of a local government located in a secondary ,state pursuant to subsection 7b71 such secondary ,state may not do any of the following3 7,a7 ,countersigned by local agent or broker ,require any group health coverage issued by the pool or program to be countersigned by an insurance agent or broker residing in that secondary ,state4 7,b7 ,submit to duplicative financial examinations ,require the pool or program to submit to an examination of its financial condition by an applicable ,state authority in such ,state1 unless-- 7i7 an applicable ,state authority of the primary ,state has not done an examination within the period recommended by the ,national ,association of ,insurance ,commissioners2 and 7ii7 any such examination by the secondary ,state is conducted in accordance with the examiners' handbook of the ,national ,association of ,insurance ,commissioners and is coordinated to avoid unjustified duplication and unjustified repetition4 7,c7 ,discriminate against pool or program ,otherwise discriminate against the pool or program issuing group health coverage in both the primary ,state and in any secondary ,state4 7e7 ,benefit requirements ,group health coverage offered by a local government employee health benefits pool or program shall be at least as comprehensive as the coverage of the essential health benefits under section #acjb7;b7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjbb7;b774 7f7 ,disclosure requirement ,prior to providing group health coverage to the officers1 employees1 or retirees 7and their dependents7 of a local government located in a secondary ,state1 a local government employee health benefits pool or program shall provide notice to such individuals that the health coverage is governed by the covered laws and regulations of the primary ,state1 as well as by any applicable ,federal laws and regulations4 7g7 ,status of group health coverage in secondary ,state ,a local government employee health benefits pool or program that is not regulated as an insurer in its primary ,state1 and whose group health plans are not regulated as insurance in its primary ,state1 shall not be subject to the jurisdiction of a ,state insurance regulatory agency in any secondary ,state4 7h7 ,designation of primary ,state 7#a7 ,designation of a single ,state ,a local government employee health benefits pool or program may only designate one ,state as its primary ,state with respect to all such coverage it offers under this section4 7#b7 ,initial operations in primary ,state ,such pool or program may not offer group health coverage in a secondary ,state until it is deemed to be doing business in the primary ,state4 7i7 ,definitions ,in this section3 7#a7 ,applicable ,state authority ,the term applicable ,state authority means1 with respect to a local government employee health benefits pool or program in a ,state1 any official or officials designated by the ,state to administer the requirements of this section for the ,state with respect to such pool or program1 including the official or officials with authority to approve interlocal agreements under applicable ,state law1 but shall not include any ,state insurance regulatory agency4 7#b7 ,covered laws 7,a7 ,in general ,the term covered laws means the laws1 rules1 regulations1 agreements1 and orders pertaining to any of the following3 7i7 ,group health coverage issued by a local government employee health benefits pool or program4 7ii7 ,the offer1 sale1 rating 7including medical underwriting71 renewal1 and issuance of group health coverage to local government officials1 employees1 and retirees or their dependents4 7iii7 ,the management1 operations1 and investment activities of a local government employee health benefits pool or program4 7iv7 ,loss control and claims administration for a local government employee health benefits pool or program with respect to liability for which the pool or program provides coverage4 7v7 ,the payment1 on a nondiscriminatory basis1 of applicable premium and other taxes 7including high risk pool assessments7 which are levied on health insurance issuers1 brokers1 or policyholders under the laws of the ,state4 7,b7 ,exception ,such term does not include any law1 rule1 regulation1 agreement1 or order governing the use of care or cost management techniques1 including any requirement related to provider contracting1 network access or adequacy1 health care data collection1 or quality assurance4 7#c7 ,group health coverage ,the term group health coverage means medical care expense reimbursement provided under a group health plan4 7#d7 ,local government ,the term local government means a county1 municipality1 special district1 school district1 junior college district1 housing authority1 or other political subdivision or public entity defined under ,state law4 7#e7 ,local government employee health benefits pool or program ,the term local government employee health benefits pool or program means a risk pool authorized or permitted by ,state statute or otherwise regulated by a ,state agency under which-- 7,a7 a local government or group of local governments1 directly or through a pool1 provide health care benefits primarily for local government officials1 employees1 and retirees and their dependents2 and 7,b7 such pool may provide health care benefits from the assets of the pool or its member local governments through any combination of self-funded arrangements or fully insured products2 and includes any other ,state authorized program designed to provide health benefits to local government officials1 employees1 and retirees and their dependents4 7#f7 ,primary ,state ,the term primary ,state means1 with respect to group health coverage offered by a local government employee health benefits pool or program1 the ,state designated by the pool or program as the ,state whose covered laws shall govern the pool or program in the issuance of such coverage under this part4 7#g7 ,secondary ,state ,the term secondary ,state means1 with respect to group health coverage offered by a local government employee health benefits pool or program1 any ,state that is not the primary ,state4 4