56-7-2903. Creation of Access Tennessee health insurance pool Board of directors Advisory committee Funding plan and plan of operation Promulgation of rules Errors and omissions by commissioner or board members. [Effective until June 30, 2010. See the Compiler's Notes.]
(a) There is created a nonprofit entity known as Access Tennessee to operate an insurance pool to provide health insurance coverage pursuant to this part. The pool shall be known as the Access Tennessee health insurance pool.
(b) Access Tennessee shall operate the pool subject to the supervision and control of a board of directors composed of thirteen (13) members. The commissioner shall, within ninety (90) days after July 1, 2006, give notice to all insurers of the time and place for the initial organizational meeting of the board. The board shall consist of the following members:
(1) The commissioner of finance and administration or the commissioner's designee;
(2) The commissioner of health or the commissioner's designee;
(3) The commissioner of mental health and developmental disabilities or the commissioner's designee;
(4) One (1) representative of the Tennessee Hospital Association, selected by the commissioner;
(5) One (1) representative of the Tennessee Medical Association, selected by the commissioner;
(6) One (1) member involved primarily as a producer in the business of health insurance, selected by the commissioner;
(7) One (1) member of the general public, selected by the commissioner;
(8) One (1) member selected by the speaker of the house of representatives;
(9) One (1) member selected by the speaker of the senate;
(10) One (1) representative of an employer of greater than or equal to five hundred (500) employees that is self-insured, selected by the commissioner;
(11) One (1) representative of an employer of less than five hundred (500) employees that is commercially insured, selected by the commissioner;
(12) One (1) representative of a hospital medical service corporation, selected by the commissioner, unless, pursuant to subsection (d), no such representative is able to serve, in which case this position shall be filled by a representative of another insurer; and
(13) One (1) representative of an insurer other than a hospital medical service corporation, selected by the commissioner, unless, pursuant to subsection (d), no such representative is able to serve, in which case this position shall be filled by a representative of another insurer.
(c) The commissioner and the speakers of the senate and the house of representatives, in making appointments to the board, shall strive to ensure that the membership of the board is representative of the state's geographic and demographic composition, with appropriate attention to the representation of women and minorities.
(d) No individual representing an entity selected to administer the pool, pursuant to § 56-7-2909, or its affiliates shall serve on the board. Any appointed board member who represents an entity or affiliate that has the intention of serving as administrator of the pool shall be prohibited from serving as the administrator, unless the board member provides written notice to the board of the entity's or affiliate's intent to bid on the contract for administrator. The notice shall be delivered to the board at least six (6) months prior to the release of any request for proposal (RFP) seeking to select or renew an administrator. In the event the notice is delivered, the board member shall simultaneously resign the board member's membership on the board.
(e) The commissioner shall, on an annual basis, designate one (1) member of the board to serve as chair and one (1) member of the board to serve as vice chair.
(f) The board members selected pursuant to subdivisions (b)(4), (5) and (6) shall serve for an original term of one (1) year. The board members selected pursuant to subdivisions (b)(8), (9), (12) and (13) shall serve for an original term of two (2) years. The board members selected pursuant to subdivisions (b)(7), (10) and (11) shall serve for an original term of three (3) years. Thereafter, all board members selected pursuant to subdivisions (b)(4) - (11) shall serve for a term of three (3) years. Board members appointed pursuant to subdivisions (b)(12) and (13) shall not be appointed to the board until after Access Tennessee awards an initial contract to an administrator of the pool.
(g) Board members shall receive no compensation, but shall be reimbursed for all travel expenses in accordance with state travel regulations.
(h) Vacancies in the board shall be filled by the appropriate appointing authority. Board members may be removed by their respective appointing authority for cause.
(i) In order to assist the board, there shall be an advisory committee consisting of five (5) representatives of insurers that offer health insurance coverage in the state of Tennessee who shall be selected by the commissioner. The advisory committee may provide advice on insurance related issues, including, but not limited to, benefit design and market impact of the plans created and offered by Access Tennessee.
(j) The board, on an annual basis, shall submit to the commissioner and the comptroller of the treasury a funding plan and a plan for operation of the pool and any amendments necessary or suitable to assure the fair, reasonable and efficient administration of the pool and its financial solvency, based upon timely and accurate actuarial assumptions. The plan of operation shall become effective upon approval, in writing, by the commissioner and the comptroller of the treasury.
(k) The commissioner and the comptroller of the treasury shall approve the funding plan and the plan of operation, if they determine that the plans assure the financial solvency of the pool, the efficient administration of the pool, and otherwise are in compliance with this part.
(l) If the board fails to submit a suitable plan of operation within one hundred eighty (180) days after the appointment of the board or at any time thereafter fails to submit suitable amendments to the plan of operation, the commissioner may initiate actions necessary or advisable to effectuate this part. The actions shall continue in effect until modified by the commissioner or superseded by a plan of operation submitted by the board and approved by the commissioner and the comptroller. To the extent that the actions include the promulgation of rules to effectuate this part, the rules shall be promulgated as public necessity rules pursuant to § 4-5-209.
(m) The plan of operation shall:
(1) Establish procedures for operation of the pool;
(2) Establish procedures for selecting an administrator, in accordance with § 56-7-2909;
(3) Establish procedures to create a fund, under management of the board, for administrative expenses;
(4) Establish procedures for the handling, accounting, and auditing of assets, moneys and claims of the pool and the pool administrator;
(5) Develop and implement a program to publicize the existence of the pool, the eligibility requirements, and procedures for enrollment, and to maintain public awareness of the pool;
(6) Establish procedures under which applicants and participants may have grievances reviewed by a grievance committee appointed by the board. The grievances shall be reported to the board after completion of the review. The board shall retain all written complaints regarding the plan for at least three (3) years;
(7) Establish procedures to implement the requirements of § 56-7-2909(g); and
(8) Provide for other matters as may be necessary and proper for the execution of the board's powers, duties and obligations under this part.
(n) The funding plan shall:
(1) Establish premium rates for the upcoming year, pursuant to § 56-7-2911(a);
(2) Establish an assessment rate for insurers and insurance arrangements, pursuant to § 56-7-2911(a)(2); provided, however, that the total amount of the assessments authorized under § 56-7-2911(a)(2) for a fiscal year shall not exceed the amount appropriated by the state to the pool for that same fiscal year; and
(3) Identify other available funds for the pool, including any legislative appropriations and federal funding.
(o) There shall be no liability on the part of, and no cause of action of any nature shall arise against, the commissioner or the board members, or any of their employees or agents, for any omission or any action taken by them within the scope of their duties arising from this part, except for willful, malicious or criminal acts or omissions done for personal gain.
56-7-2903. Creation of Access Tennessee health insurance pool Board of directors Advisory committee Funding plan and plan of operation Promulgation of rules Errors and omissions by commissioner or board members. [Effective until June 30, 2010. See the Compiler's Notes.]
(a) There is created a nonprofit entity known as Access Tennessee to operate an insurance pool to provide health insurance coverage pursuant to this part. The pool shall be known as the Access Tennessee health insurance pool.
(b) Access Tennessee shall operate the pool subject to the supervision and control of a board of directors composed of thirteen (13) members. The commissioner shall, within ninety (90) days after July 1, 2006, give notice to all insurers of the time and place for the initial organizational meeting of the board. The board shall consist of the following members:
(1) The commissioner of finance and administration or the commissioner's designee;
(2) The commissioner of health or the commissioner's designee;
(3) The commissioner of mental health and developmental disabilities or the commissioner's designee;
(4) One (1) representative of the Tennessee Hospital Association, selected by the commissioner;
(5) One (1) representative of the Tennessee Medical Association, selected by the commissioner;
(6) One (1) member involved primarily as a producer in the business of health insurance, selected by the commissioner;
(7) One (1) member of the general public, selected by the commissioner;
(8) One (1) member selected by the speaker of the house of representatives;
(9) One (1) member selected by the speaker of the senate;
(10) One (1) representative of an employer of greater than or equal to five hundred (500) employees that is self-insured, selected by the commissioner;
(11) One (1) representative of an employer of less than five hundred (500) employees that is commercially insured, selected by the commissioner;
(12) One (1) representative of a hospital medical service corporation, selected by the commissioner, unless, pursuant to subsection (d), no such representative is able to serve, in which case this position shall be filled by a representative of another insurer; and
(13) One (1) representative of an insurer other than a hospital medical service corporation, selected by the commissioner, unless, pursuant to subsection (d), no such representative is able to serve, in which case this position shall be filled by a representative of another insurer.
(c) The commissioner and the speakers of the senate and the house of representatives, in making appointments to the board, shall strive to ensure that the membership of the board is representative of the state's geographic and demographic composition, with appropriate attention to the representation of women and minorities.
(d) No individual representing an entity selected to administer the pool, pursuant to § 56-7-2909, or its affiliates shall serve on the board. Any appointed board member who represents an entity or affiliate that has the intention of serving as administrator of the pool shall be prohibited from serving as the administrator, unless the board member provides written notice to the board of the entity's or affiliate's intent to bid on the contract for administrator. The notice shall be delivered to the board at least six (6) months prior to the release of any request for proposal (RFP) seeking to select or renew an administrator. In the event the notice is delivered, the board member shall simultaneously resign the board member's membership on the board.
(e) The commissioner shall, on an annual basis, designate one (1) member of the board to serve as chair and one (1) member of the board to serve as vice chair.
(f) The board members selected pursuant to subdivisions (b)(4), (5) and (6) shall serve for an original term of one (1) year. The board members selected pursuant to subdivisions (b)(8), (9), (12) and (13) shall serve for an original term of two (2) years. The board members selected pursuant to subdivisions (b)(7), (10) and (11) shall serve for an original term of three (3) years. Thereafter, all board members selected pursuant to subdivisions (b)(4) - (11) shall serve for a term of three (3) years. Board members appointed pursuant to subdivisions (b)(12) and (13) shall not be appointed to the board until after Access Tennessee awards an initial contract to an administrator of the pool.
(g) Board members shall receive no compensation, but shall be reimbursed for all travel expenses in accordance with state travel regulations.
(h) Vacancies in the board shall be filled by the appropriate appointing authority. Board members may be removed by their respective appointing authority for cause.
(i) In order to assist the board, there shall be an advisory committee consisting of five (5) representatives of insurers that offer health insurance coverage in the state of Tennessee who shall be selected by the commissioner. The advisory committee may provide advice on insurance related issues, including, but not limited to, benefit design and market impact of the plans created and offered by Access Tennessee.
(j) The board, on an annual basis, shall submit to the commissioner and the comptroller of the treasury a funding plan and a plan for operation of the pool and any amendments necessary or suitable to assure the fair, reasonable and efficient administration of the pool and its financial solvency, based upon timely and accurate actuarial assumptions. The plan of operation shall become effective upon approval, in writing, by the commissioner and the comptroller of the treasury.
(k) The commissioner and the comptroller of the treasury shall approve the funding plan and the plan of operation, if they determine that the plans assure the financial solvency of the pool, the efficient administration of the pool, and otherwise are in compliance with this part.
(l) If the board fails to submit a suitable plan of operation within one hundred eighty (180) days after the appointment of the board or at any time thereafter fails to submit suitable amendments to the plan of operation, the commissioner may initiate actions necessary or advisable to effectuate this part. The actions shall continue in effect until modified by the commissioner or superseded by a plan of operation submitted by the board and approved by the commissioner and the comptroller. To the extent that the actions include the promulgation of rules to effectuate this part, the rules shall be promulgated as public necessity rules pursuant to § 4-5-209.
(m) The plan of operation shall:
(1) Establish procedures for operation of the pool;
(2) Establish procedures for selecting an administrator, in accordance with § 56-7-2909;
(3) Establish procedures to create a fund, under management of the board, for administrative expenses;
(4) Establish procedures for the handling, accounting, and auditing of assets, moneys and claims of the pool and the pool administrator;
(5) Develop and implement a program to publicize the existence of the pool, the eligibility requirements, and procedures for enrollment, and to maintain public awareness of the pool;
(6) Establish procedures under which applicants and participants may have grievances reviewed by a grievance committee appointed by the board. The grievances shall be reported to the board after completion of the review. The board shall retain all written complaints regarding the plan for at least three (3) years;
(7) Establish procedures to implement the requirements of § 56-7-2909(g); and
(8) Provide for other matters as may be necessary and proper for the execution of the board's powers, duties and obligations under this part.
(n) The funding plan shall:
(1) Establish premium rates for the upcoming year, pursuant to § 56-7-2911(a);
(2) Establish an assessment rate for insurers and insurance arrangements, pursuant to § 56-7-2911(a)(2); provided, however, that the total amount of the assessments authorized under § 56-7-2911(a)(2) for a fiscal year shall not exceed the amount appropriated by the state to the pool for that same fiscal year; and
(3) Identify other available funds for the pool, including any legislative appropriations and federal funding.
(o) There shall be no liability on the part of, and no cause of action of any nature shall arise against, the commissioner or the board members, or any of their employees or agents, for any omission or any action taken by them within the scope of their duties arising from this part, except for willful, malicious or criminal acts or omissions done for personal gain.
56-7-2903. Creation of Access Tennessee health insurance pool Board of directors Advisory committee Funding plan and plan of operation Promulgation of rules Errors and omissions by commissioner or board members. [Effective until June 30, 2010. See the Compiler's Notes.]
(a) There is created a nonprofit entity known as Access Tennessee to operate an insurance pool to provide health insurance coverage pursuant to this part. The pool shall be known as the Access Tennessee health insurance pool.
(b) Access Tennessee shall operate the pool subject to the supervision and control of a board of directors composed of thirteen (13) members. The commissioner shall, within ninety (90) days after July 1, 2006, give notice to all insurers of the time and place for the initial organizational meeting of the board. The board shall consist of the following members:
(1) The commissioner of finance and administration or the commissioner's designee;
(2) The commissioner of health or the commissioner's designee;
(3) The commissioner of mental health and developmental disabilities or the commissioner's designee;
(4) One (1) representative of the Tennessee Hospital Association, selected by the commissioner;
(5) One (1) representative of the Tennessee Medical Association, selected by the commissioner;
(6) One (1) member involved primarily as a producer in the business of health insurance, selected by the commissioner;
(7) One (1) member of the general public, selected by the commissioner;
(8) One (1) member selected by the speaker of the house of representatives;
(9) One (1) member selected by the speaker of the senate;
(10) One (1) representative of an employer of greater than or equal to five hundred (500) employees that is self-insured, selected by the commissioner;
(11) One (1) representative of an employer of less than five hundred (500) employees that is commercially insured, selected by the commissioner;
(12) One (1) representative of a hospital medical service corporation, selected by the commissioner, unless, pursuant to subsection (d), no such representative is able to serve, in which case this position shall be filled by a representative of another insurer; and
(13) One (1) representative of an insurer other than a hospital medical service corporation, selected by the commissioner, unless, pursuant to subsection (d), no such representative is able to serve, in which case this position shall be filled by a representative of another insurer.
(c) The commissioner and the speakers of the senate and the house of representatives, in making appointments to the board, shall strive to ensure that the membership of the board is representative of the state's geographic and demographic composition, with appropriate attention to the representation of women and minorities.
(d) No individual representing an entity selected to administer the pool, pursuant to § 56-7-2909, or its affiliates shall serve on the board. Any appointed board member who represents an entity or affiliate that has the intention of serving as administrator of the pool shall be prohibited from serving as the administrator, unless the board member provides written notice to the board of the entity's or affiliate's intent to bid on the contract for administrator. The notice shall be delivered to the board at least six (6) months prior to the release of any request for proposal (RFP) seeking to select or renew an administrator. In the event the notice is delivered, the board member shall simultaneously resign the board member's membership on the board.
(e) The commissioner shall, on an annual basis, designate one (1) member of the board to serve as chair and one (1) member of the board to serve as vice chair.
(f) The board members selected pursuant to subdivisions (b)(4), (5) and (6) shall serve for an original term of one (1) year. The board members selected pursuant to subdivisions (b)(8), (9), (12) and (13) shall serve for an original term of two (2) years. The board members selected pursuant to subdivisions (b)(7), (10) and (11) shall serve for an original term of three (3) years. Thereafter, all board members selected pursuant to subdivisions (b)(4) - (11) shall serve for a term of three (3) years. Board members appointed pursuant to subdivisions (b)(12) and (13) shall not be appointed to the board until after Access Tennessee awards an initial contract to an administrator of the pool.
(g) Board members shall receive no compensation, but shall be reimbursed for all travel expenses in accordance with state travel regulations.
(h) Vacancies in the board shall be filled by the appropriate appointing authority. Board members may be removed by their respective appointing authority for cause.
(i) In order to assist the board, there shall be an advisory committee consisting of five (5) representatives of insurers that offer health insurance coverage in the state of Tennessee who shall be selected by the commissioner. The advisory committee may provide advice on insurance related issues, including, but not limited to, benefit design and market impact of the plans created and offered by Access Tennessee.
(j) The board, on an annual basis, shall submit to the commissioner and the comptroller of the treasury a funding plan and a plan for operation of the pool and any amendments necessary or suitable to assure the fair, reasonable and efficient administration of the pool and its financial solvency, based upon timely and accurate actuarial assumptions. The plan of operation shall become effective upon approval, in writing, by the commissioner and the comptroller of the treasury.
(k) The commissioner and the comptroller of the treasury shall approve the funding plan and the plan of operation, if they determine that the plans assure the financial solvency of the pool, the efficient administration of the pool, and otherwise are in compliance with this part.
(l) If the board fails to submit a suitable plan of operation within one hundred eighty (180) days after the appointment of the board or at any time thereafter fails to submit suitable amendments to the plan of operation, the commissioner may initiate actions necessary or advisable to effectuate this part. The actions shall continue in effect until modified by the commissioner or superseded by a plan of operation submitted by the board and approved by the commissioner and the comptroller. To the extent that the actions include the promulgation of rules to effectuate this part, the rules shall be promulgated as public necessity rules pursuant to § 4-5-209.
(m) The plan of operation shall:
(1) Establish procedures for operation of the pool;
(2) Establish procedures for selecting an administrator, in accordance with § 56-7-2909;
(3) Establish procedures to create a fund, under management of the board, for administrative expenses;
(4) Establish procedures for the handling, accounting, and auditing of assets, moneys and claims of the pool and the pool administrator;
(5) Develop and implement a program to publicize the existence of the pool, the eligibility requirements, and procedures for enrollment, and to maintain public awareness of the pool;
(6) Establish procedures under which applicants and participants may have grievances reviewed by a grievance committee appointed by the board. The grievances shall be reported to the board after completion of the review. The board shall retain all written complaints regarding the plan for at least three (3) years;
(7) Establish procedures to implement the requirements of § 56-7-2909(g); and
(8) Provide for other matters as may be necessary and proper for the execution of the board's powers, duties and obligations under this part.
(n) The funding plan shall:
(1) Establish premium rates for the upcoming year, pursuant to § 56-7-2911(a);
(2) Establish an assessment rate for insurers and insurance arrangements, pursuant to § 56-7-2911(a)(2); provided, however, that the total amount of the assessments authorized under § 56-7-2911(a)(2) for a fiscal year shall not exceed the amount appropriated by the state to the pool for that same fiscal year; and
(3) Identify other available funds for the pool, including any legislative appropriations and federal funding.
(o) There shall be no liability on the part of, and no cause of action of any nature shall arise against, the commissioner or the board members, or any of their employees or agents, for any omission or any action taken by them within the scope of their duties arising from this part, except for willful, malicious or criminal acts or omissions done for personal gain.
