Section 12-15-44.5-10 - Benefits for adult group; negotiation of plan limitations(a) The secretary has the authority to provide benefits to individuals eligible under the adult group described in 42 CFR 435.119 only in accordance with this chapter.(b) The secretary may negotiate and make changes to the plan, except that the secretary may not negotiate or change the plan that would do the following: (1) Reduce the following: (A) Contribution amounts below the minimum levels set forth in section 4.7 of this chapter.(B) Deductible amounts below the minimum amount established in section 4.5(c) of this chapter.(2) Remove or reduce the penalties for nonpayment set forth in section 4.7 of this chapter.(3) Revise the use of the health care account requirement set forth in section 4.5 of this chapter.(4) Include noncommercial benefits or add additional plan benefits in a manner inconsistent with section 3.5 of this chapter.(5) Allow services to begin:(A) without the payment established or required by; or(B) earlier than the time frames otherwise established by; section 4.7 of this chapter.
(6) Reduce financial penalties for the inappropriate use of the emergency room below the minimum levels set forth in section 5.7 of this chapter.(7) Permit members to change health plans without cause in a manner inconsistent with section 4.7(g) of this chapter.(8) Operate the plan in a manner that would obligate the state to financial participation beyond the level of state appropriations or funding otherwise authorized for the plan.(c) The secretary may make changes to the plan under this chapter if the changes are required by federal law or regulation.Amended by P.L. 30-2016, SEC. 35, eff. 7/1/2016.Added by P.L. 213-2015, SEC. 136, eff. 5/7/2015, retroactive.