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EXPLANATION-Matter enclosed in bold-faced brackets [thus] in this bill is not enacted
and is intended to be omitted in the law.
SECOND REGULAR SESSION
SENATE BILL NO. 848
103RD GENERAL ASSEMBLY
INTRODUCED BY SENATOR BROWN (16).
5294S.01I KRISTINA MARTIN, Secretary
AN ACT
To repeal section 376.1186, RSMo, relating to state-based health benefit exchanges.
Be it enacted by the General Assembly of the State of Missouri, as follows:
Section A. Section 376.1186, RSMo, is repealed, to read 1
as follows:2
[376.1186. 1. No state-based health 1
benefit exchange may be established, created, or 2
operated within this state in order to implement 3
Section 1311 of the federal health care act, 42 4
U.S.C. Section 18031, or any other provision of 5
the federal health care act that relates to the 6
creation and operation of a state-based health 7
benefit exchange, unless the authority to create 8
or operate such an exchange is enacted into law 9
through: 10
(1) A bill as prescribed by Article III of 11
the Missouri Constitution; 12
(2) An initiative petition as prescribed 13
by Article III, Section 50 of the Missouri 14
Constitution; or 15
(3) A referendum as prescribed by Article 16
III, Section 52(a) of the Missouri Constitution. 17
2. In no case shall the authority for 18
establishing, administering, or operating a 19
state-based health benefit exchange in Missouri 20
be based upon an executive order issued by the 21
governor of Missouri. 22
3. No department, agency, instrumentality 23
or political subdivision of the state of 24
Missouri shall establish any program, promulgate 25
any rule, policy, guideline or plan or change 26
any program, rule, policy or guideline to 27
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implement, establish, create, administer or 28
otherwise operate a state-based health benefit 29
exchange described in the federal health care 30
act unless such department, agency, 31
instrumentality or political subdivision has 32
received statutory authority to do so in a 33
manner consistent with subsection 1 of this 34
section. No department, agency, instrumentality 35
or political subdivision of the state of 36
Missouri shall act as an eligible entity as 37
described in Section 1311(f)(3)(B) of the 38
federal health care act to perform one or more 39
of the responsibilities of a state-based health 40
benefit exchange unless authorized by statute or 41
a regulation validly promulgated pursuant to 42
such statute. 43
4. No department, agency, instrumentality, 44
or political subdivision of this state shall 45
apply for, accept or expend federal moneys 46
related to the creation, implementation or 47
operation of a state-based health benefit 48
exchange or a federally facilitated health 49
benefit exchange unless such acceptance or 50
expenditure is authorized by statute or an 51
appropriations bill. 52
5. No department, agency, instrumentality, 53
political subdivision, public officer or 54
employee of this state shall enter into any 55
agreement or any obligation to establish, 56
administer, or operate a federally facilitated 57
health benefit exchange described in Section 58
1321(c)(1) of the federal health care act unless 59
such department, agency, instrumentality, 60
political subdivision, public officer or 61
employee of this state has received statutory 62
authority to enter into such agreements or 63
obligations. No department, agency, 64
instrumentality, political subdivision, public 65
officer or employee of this state shall provide 66
assistance or resources of any kind to any 67
department, agency, public official, employee or 68
agent of the federal government related to the 69
creation or operation of a federally facilitated 70
health benefit exchange unless such assistance 71
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or resources are authorized by state statute or 72
a regulation promulgated thereto or such 73
assistance or resources are specifically 74
required by federal law. 75
6. Any taxpayer of this state or any 76
member of the general assembly shall have 77
standing to bring suit against the state of 78
Missouri or any official, department, division, 79
agency, or political subdivision of this state 80
which is in violation of this section in any 81
court with jurisdiction to enforce the 82
provisions of this section. The court shall 83
award attorney's fees, court costs, and all 84
reasonable expenses incurred by the taxpayer or 85
member of the general assembly if the court 86
finds that the provisions of this section have 87
been violated. Such attorney's fees, court 88
costs, and reasonable expenses shall be paid 89
from funds appropriated to the department, 90
division, agency, or any political subdivision 91
of this state determined to have violated, in 92
whole or in part, the provisions of this 93
section. In no case shall the award of 94
attorney's fees, court costs, or reasonable 95
expenses be paid from the legal defense fund, 96
nor shall any department, division, agency, or 97
political subdivision of this state request, or 98
be granted, additional appropriations in order 99
to satisfy an award made under this section. 100
7. As used in this section, the term 101
"federal health care act" shall mean the federal 102
Patient Protection and Affordable Care Act, 103
Public Law 111-148, as amended by the federal 104
Health Care and Education Reconciliation Act of 105
2010, Public Law 111-152, and any amendments 106
thereto, or regulations or guidance issued under 107
such federal acts. 108
8. As used in this section, the term 109
"state-based health benefit exchange" means a 110
governmental agency or nonprofit entity 111
established by the state of Missouri and not the 112
federal government that meets the applicable 113
requirements of Section 1311 of the federal 114
health care act and regulations promulgated 115
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thereto and makes qualified health care plans 116
available to qualified individuals and qualified 117
employers. The term "state-based health benefit 118
exchange" includes regional or other interstate 119
exchanges and subsidiary exchanges as described 120
in Section 1311(f)(1) and (2) of the federal 121
health care act. The term "federally 122
facilitated health benefit exchange" means a 123
health benefit exchange established and operated 124
by the Secretary of Health and Human Services 125
under Section 1321(c)(1) of the federal health 126
care act, either directly or through agreement 127
with a not-for-profit entity.] 128
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