S.F. _____ H.F. _____ Section 1. NEW SECTION . 505.18B State-based exchange —— 1 fund. 2 1. As used in this section, unless the context otherwise 3 requires: 4 a. “Commissioner” means the commissioner of insurance. 5 b. “State-based exchange” means a state, federal, or 6 partnership exchange or marketplace operating in the state 7 pursuant to, including regulations issued pursuant to, section 8 1311 of the federal Patient Protection and Affordable Care Act, 9 Pub. L. No. 111-148, as amended. 10 2. a. The commissioner shall develop and submit an 11 application for a state innovation waiver pursuant to section 12 505.18A on or before December 31, 2026. 13 b. At the direction of the governor, the commissioner 14 shall have the authority to create, establish, implement, 15 administer, or otherwise operate a state-based exchange and, 16 if the application for a state innovation under paragraph “a” 17 is approved, shall do so in accordance with the approved state 18 innovation waiver. 19 3. a. A state-based exchange fund is created in the state 20 treasury under the control of the division. Notwithstanding 21 any provision of law to the contrary, the fund shall consist 22 of moneys appropriated by the general assembly for purposes of 23 this section and any other moneys that are lawfully available 24 to the division for purposes of this section, including but not 25 limited to moneys obtained or accepted by the division from the 26 federal government, user fees, and grants. The fund shall be 27 used by the division for purposes of this section. 28 b. Notwithstanding section 8.33, moneys appropriated in this 29 section that remain unencumbered or unobligated at the close 30 of the fiscal year shall not revert but shall remain available 31 for expenditure for the purposes designated. Notwithstanding 32 section 12C.7, subsection 2, interest or earnings on moneys in 33 the fund shall be credited to the fund. 34 4. a. Except as provided in this subsection, all documents, 35 -1- LSB 5505XL (7) 91 nls/ko 1/ 4

S.F. _____ H.F. _____ materials, complaints, investigations, or other information in 1 the possession or control of the division for purposes of this 2 section, or for purposes of complying with federal requirements 3 for a federal health insurance exchange, shall be confidential 4 records not subject to disclosure pursuant to chapter 22, 5 shall not be subject to subpoena, and shall not be subject to 6 discovery or be admissible in evidence in any private civil 7 action in which the division is a named party. However, the 8 division is authorized to use the confidential information 9 without further disclosure to carry out the division’s duties 10 under this chapter and, to the extent authorized by law, in the 11 furtherance of any regulatory or legal action brought as part 12 of the commissioner’s official duties. 13 b. Notwithstanding paragraph “a” , the commissioner may do 14 any of the following: 15 (1) Share confidential information with a state-based 16 exchange of another state, a regulatory authority, a state 17 department, a law enforcement agency, or a federal authority 18 provided that the recipient agrees in writing to maintain 19 the confidentiality and privileged status of the document, 20 material, or other information. 21 (2) Receive documents, materials, or information, including 22 otherwise confidential and privileged documents, materials, 23 or information, from a state-based exchange of another state, 24 regulatory authority, state department, law enforcement agency, 25 or federal authority and shall maintain as confidential or 26 privileged any documents, materials, or other information 27 received with notice or the understanding that the documents, 28 materials, or other information received is confidential and 29 privileged under the laws of the jurisdiction that is the 30 source of the documents, materials, or other information. 31 (3) No waiver of any applicable privilege or claim of 32 confidentiality in the confidential information shall occur as 33 a result of disclosure or sharing of confidential or privileged 34 documents, materials, or other information authorized by this 35 -2- LSB 5505XL (7) 91 nls/ko 2/ 4

S.F. _____ H.F. _____ section. 1 c. This subsection shall not prohibit the commissioner 2 from releasing a final, adjudicated order, including but not 3 limited to a certification, recertification, decertification, 4 or suspension of a qualified health plan if the order is 5 otherwise subject to public disclosure, to a database or other 6 clearinghouse service maintained by a federal authority. 7 5. The commissioner may adopt rules pursuant to chapter 8 17A to administer this section. The commissioner may adopt 9 emergency rules under section 17A.4, subsection 3, and section 10 17A.5, subsection 2, paragraph “b” , to administer this section 11 and the rules shall be effective immediately upon filing unless 12 a later date is specified in the rules. Any rules adopted 13 in accordance with this section shall also be published as a 14 notice of intended action as provided in section 17A.4. 15 Sec. 2. EFFECTIVE DATE. This Act, being deemed of immediate 16 importance, takes effect upon enactment. 17 EXPLANATION 18 The inclusion of this explanation does not constitute agreement with 19 the explanation’s substance by the members of the general assembly. 20 This bill relates to the establishment of a state-based 21 exchange and the creation of a state-based exchange fund. 22 The bill defines “state-based exchange” as a state, federal, 23 or partnership exchange or marketplace operating in the state 24 pursuant to section 1311 of the federal Patient Protection and 25 Affordable Care Act, Pub. L. No. 111-148. 26 The bill requires the commissioner of insurance 27 (commissioner) to develop and submit an application for a 28 state innovation waiver pursuant to Code section 505.18A on or 29 before December 31, 2026. Under the bill, at the direction 30 of the governor, the commissioner shall have the authority to 31 create, establish, implement, administer, or otherwise operate 32 a state-based exchange and, if the application for a state 33 innovation is approved, shall do so in accordance with the 34 approved state innovation waiver. A state-based exchange fund 35 -3- LSB 5505XL (7) 91 nls/ko 3/ 4

S.F. _____ H.F. _____ (fund) is created in the state treasury under the control of 1 the insurance division (division) and shall consist of moneys 2 appropriated by the general assembly and any other moneys that 3 are lawfully available to the division to be used for purposes 4 of the bill, including but not limited to moneys obtained or 5 accepted by the division from the federal government, user 6 fees, and grants. 7 All documents, materials, complaints, investigations, or 8 other information in the possession or control of the division 9 for purposes of the state-based exchange, or for complying with 10 federal requirements for a federal health insurance exchange, 11 are confidential records not subject to subpoena or discovery, 12 or admissible into evidence, as provided in the bill, unless an 13 exception enumerated in the bill is applicable. 14 The commissioner may adopt rules, including emergency rules, 15 to administer the bill. 16 The bill, being deemed of immediate importance, takes effect 17 upon enactment. 18 -4- LSB 5505XL (7) 91 nls/ko 4/ 4