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A08514 Summary:

BILL NO    A08514 

SAME AS    SAME AS S05849

SPONSOR    Morelle (MS)

COSPNSR    Gottfried, Brennan, Silver, Farrell, Canestrari, Peoples-Stokes,
           Rivera P, Kavanagh, Bronson, Clark, Brindisi, Rodriguez, Rosenthal

MLTSPNSR   

Add Art 10-E SS3980 - 3993, Pub Auth L; amd SS17 & 19, Pub Off L

Establishes the New York Health Benefit Exchange which will facilitate the
purchase and sale of qualified health plans in the individual market in NY and
will incorporate a small business health options program to assist qualified
employers in facilitating the enrollment of their employees in qualified health
plans offered in the group market.
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A08514 Text:

                           S T A T E   O F   N E W   Y O R K
       ________________________________________________________________________

                                         8514

                              2011-2012 Regular Sessions

                                 I N  A S S E M B L Y

                                     June 23, 2011
                                      ___________

       Introduced  by  M.  of  A. MORELLE, GOTTFRIED, BRENNAN, SILVER, FARRELL,
         CANESTRARI -- (at request of the Governor) -- read once  and  referred
         to the Committee on Ways and Means

       AN  ACT to amend the public authorities law and the public officers law,
         in relation to the  establishment  of  the  New  York  Health  Benefit
         Exchange

         THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
       BLY, DO ENACT AS FOLLOWS:

    1    Section 1. This act shall be known and may be cited as the  "New  York
    2  Health Benefit Exchange Act".
    3    S  2.  The  public  authorities law is amended by adding a new article
    4  10-E to read as follows:
    5                                 ARTICLE 10-E
    6                      NEW YORK HEALTH BENEFIT EXCHANGE
    7  SECTION 3980. STATEMENT OF POLICY AND PURPOSES.
    8          3981. DEFINITIONS.
    9          3982. ESTABLISHMENT OF THE NEW YORK HEALTH BENEFIT EXCHANGE.
   10          3983. GENERAL POWERS OF THE EXCHANGE.
   11          3984. FUNCTIONS OF THE EXCHANGE.
   12          3985. SPECIAL FUNCTIONS OF THE EXCHANGE RELATED TO  HEALTH  PLAN
   13                   CERTIFICATION AND QUALIFIED HEALTH PLAN OVERSIGHT.
   14          3986. REGIONAL ADVISORY COMMITTEES.
   15          3987. FUNDING OF THE EXCHANGE.
   16          3988. STUDIES, FINDINGS AND RECOMMENDATIONS.
   17          3989. TAX EXEMPTION AND TAX CONTRACT BY THE STATE.
   18          3990. OFFICERS AND EMPLOYEES.
   19          3991. LIMITATION OF LIABILITY; INDEMNIFICATION.
   20          3992. CONTINGENCY FOR FEDERAL FUNDING.
   21          3993. CONSTRUCTION.
   22    S  3980. STATEMENT OF POLICY AND PURPOSES. THE PURPOSE OF THIS ARTICLE
   23  IS TO ESTABLISH AN AMERICAN HEALTH BENEFIT  EXCHANGE  IN  NEW  YORK,  IN

        EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                             [ ] is old law to be omitted.
                                                                  LBD12048-11-1
       A. 8514                             2

    1  CONFORMANCE WITH THE FEDERAL PATIENT PROTECTION AND AFFORDABLE CARE ACT,
    2  PUBLIC  LAW  111-148, AS AMENDED BY THE HEALTH CARE AND EDUCATION RECON-
    3  CILIATION ACT OF 2010, PUBLIC LAW 111-152.  THE EXCHANGE  SHALL  FACILI-
    4  TATE  ENROLLMENT  IN HEALTH COVERAGE, THE PURCHASE AND SALE OF QUALIFIED
    5  HEALTH PLANS IN THE INDIVIDUAL MARKET IN THIS STATE, AND ENROLL INDIVID-
    6  UALS IN HEALTH COVERAGE FOR WHICH THEY ARE ELIGIBLE IN  ACCORDANCE  WITH
    7  FEDERAL LAW. THE EXCHANGE ALSO SHALL INCORPORATE A SMALL BUSINESS HEALTH
    8  OPTIONS  PROGRAM  ("SHOP") TO ASSIST QUALIFIED EMPLOYERS IN FACILITATING
    9  THE ENROLLMENT OF THEIR EMPLOYEES IN QUALIFIED HEALTH PLANS  OFFERED  IN
   10  THE  GROUP  MARKET.    IT  IS THE INTENT OF THE LEGISLATURE, THROUGH THE
   11  ESTABLISHMENT OF THE EXCHANGE, TO PROMOTE QUALITY AND AFFORDABLE  HEALTH
   12  COVERAGE  AND  CARE,  REDUCE  THE NUMBER OF UNINSURED PERSONS, PROVIDE A
   13  TRANSPARENT MARKETPLACE, EDUCATE CONSUMERS AND ASSIST  INDIVIDUALS  WITH
   14  ACCESS  TO  COVERAGE,  PREMIUM  ASSISTANCE  TAX CREDITS AND COST-SHARING
   15  REDUCTIONS.
   16    S 3981. DEFINITIONS. FOR PURPOSES OF THIS ARTICLE, THE FOLLOWING DEFI-
   17  NITIONS SHALL APPLY:
   18    1. "BOARD" OR "BOARD OF DIRECTORS" MEANS THE BOARD OF DIRECTORS OF THE
   19  EXCHANGE.
   20    2. "REGIONAL ADVISORY COMMITTEES" MEANS THE NEW  YORK  HEALTH  BENEFIT
   21  EXCHANGE REGIONAL ADVISORY COMMITTEES ESTABLISHED PURSUANT TO THIS ARTI-
   22  CLE.
   23    3. "COMMISSIONER" MEANS THE COMMISSIONER OF HEALTH.
   24    4.  "EXCHANGE"  MEANS THE NEW YORK HEALTH BENEFIT EXCHANGE ESTABLISHED
   25  PURSUANT TO THIS ARTICLE.
   26    5. "FEDERAL ACT" MEANS THE PATIENT PROTECTION AND AFFORDABLE CARE ACT,
   27  PUBLIC LAW 111-148, AS AMENDED BY THE HEALTH CARE AND  EDUCATION  RECON-
   28  CILIATION  ACT OF 2010, PUBLIC LAW 111-152, AND ANY REGULATIONS OR GUID-
   29  ANCE ISSUED THEREUNDER.
   30    6. "HEALTH PLAN" MEANS A POLICY, CONTRACT OR CERTIFICATE,  OFFERED  OR
   31  ISSUED  BY AN INSURER TO PROVIDE, DELIVER, ARRANGE FOR, PAY FOR OR REIM-
   32  BURSE ANY OF THE COSTS OF HEALTH CARE SERVICES. HEALTH  PLAN  SHALL  NOT
   33  INCLUDE THE FOLLOWING:
   34    (A) ACCIDENT INSURANCE OR DISABILITY INCOME INSURANCE, OR ANY COMBINA-
   35  TION THEREOF;
   36    (B) COVERAGE ISSUED AS A SUPPLEMENT TO LIABILITY INSURANCE;
   37    (C)  LIABILITY  INSURANCE,  INCLUDING  GENERAL LIABILITY INSURANCE AND
   38  AUTOMOBILE LIABILITY INSURANCE;
   39    (D) WORKERS' COMPENSATION OR SIMILAR INSURANCE;
   40    (E) AUTOMOBILE NO-FAULT INSURANCE;
   41    (F) CREDIT INSURANCE;
   42    (G) OTHER SIMILAR INSURANCE COVERAGE, AS SPECIFIED  IN  FEDERAL  REGU-
   43  LATIONS,  UNDER  WHICH  BENEFITS FOR MEDICAL CARE ARE SECONDARY OR INCI-
   44  DENTAL TO OTHER INSURANCE BENEFITS;
   45    (H) LIMITED SCOPE DENTAL OR VISION BENEFITS,  BENEFITS  FOR  LONG-TERM
   46  CARE  INSURANCE,  NURSING  HOME  INSURANCE,  HOME CARE INSURANCE, OR ANY
   47  COMBINATION THEREOF, OR SUCH  OTHER  SIMILAR,  LIMITED  BENEFITS  HEALTH
   48  INSURANCE  AS  SPECIFIED  IN  FEDERAL  REGULATIONS,  IF THE BENEFITS ARE
   49  PROVIDED UNDER A SEPARATE POLICY, CERTIFICATE OR CONTRACT  OF  INSURANCE
   50  OR ARE OTHERWISE NOT AN INTEGRAL PART OF THE PLAN;
   51    (I)  COVERAGE ONLY FOR A SPECIFIED DISEASE OR ILLNESS, HOSPITAL INDEM-
   52  NITY, OR OTHER FIXED INDEMNITY COVERAGE;
   53    (J) MEDICARE SUPPLEMENTAL INSURANCE AS DEFINED IN  SECTION  1882(G)(1)
   54  OF  THE FEDERAL SOCIAL SECURITY ACT, COVERAGE SUPPLEMENTAL TO THE COVER-
   55  AGE PROVIDED UNDER CHAPTER 55 OF TITLE 10 OF THE UNITED STATES CODE,  OR
   56  SIMILAR  SUPPLEMENTAL  COVERAGE PROVIDED UNDER A GROUP HEALTH PLAN IF IT
       A. 8514                             3

    1  IS OFFERED AS A SEPARATE POLICY, CERTIFICATE OR CONTRACT  OF  INSURANCE;
    2  OR
    3    (K)  THE  MEDICAL INDEMNITY FUND ESTABLISHED PURSUANT TO TITLE FOUR OF
    4  ARTICLE TWENTY-NINE-D OF THE PUBLIC HEALTH LAW.
    5    7. "INSURER" MEANS AN INSURANCE COMPANY SUBJECT TO ARTICLE  THIRTY-TWO
    6  OR  FORTY-THREE  OF THE INSURANCE LAW, OR A HEALTH MAINTENANCE ORGANIZA-
    7  TION CERTIFIED PURSUANT TO ARTICLE FORTY-FOUR OF THE PUBLIC  HEALTH  LAW
    8  THAT  CONTRACTS  OR OFFERS TO CONTRACT TO PROVIDE, DELIVER, ARRANGE, PAY
    9  OR REIMBURSE ANY OF THE COSTS OF HEALTH CARE SERVICES.
   10    8. "QUALIFIED DENTAL PLAN" MEANS A LIMITED SCOPE DENTAL PLAN  THAT  IS
   11  ISSUED   BY   AN  INSURER  AND  CERTIFIED  IN  ACCORDANCE  WITH  SECTION
   12  THIRTY-NINE HUNDRED EIGHTY-FIVE OF THIS ARTICLE.
   13    9. "QUALIFIED EMPLOYER" MEANS A SMALL EMPLOYER THAT ELECTS TO MAKE ITS
   14  FULL-TIME EMPLOYEES ELIGIBLE FOR ONE  OR  MORE  QUALIFIED  HEALTH  PLANS
   15  THROUGH THE EXCHANGE.
   16    10.  "QUALIFIED  HEALTH PLAN" MEANS A HEALTH PLAN THAT IS ISSUED BY AN
   17  INSURER AND CERTIFIED IN ACCORDANCE  WITH  SECTION  THIRTY-NINE  HUNDRED
   18  EIGHTY-FIVE OF THIS ARTICLE.
   19    11.  "QUALIFIED  INDIVIDUAL"  MEANS  AN INDIVIDUAL, INCLUDING A MINOR,
   20  WHO:
   21    (A) IS SEEKING TO ENROLL IN A QUALIFIED HEALTH PLAN OFFERED  TO  INDI-
   22  VIDUALS THROUGH THE EXCHANGE;
   23    (B) RESIDES IN THIS STATE;
   24    (C)  AT THE TIME OF ENROLLMENT, IS NOT INCARCERATED, OTHER THAN INCAR-
   25  CERATION PENDING THE DISPOSITION OF CHARGES; AND
   26    (D) IS, AND IS REASONABLY EXPECTED TO BE, FOR THE  ENTIRE  PERIOD  FOR
   27  WHICH  ENROLLMENT  IS SOUGHT, A CITIZEN OR NATIONAL OF THE UNITED STATES
   28  OR AN ALIEN LAWFULLY PRESENT IN THE UNITED STATES.
   29    12. "SECRETARY" MEANS THE SECRETARY OF THE UNITED STATES DEPARTMENT OF
   30  HEALTH AND HUMAN SERVICES.
   31    13. "SHOP" MEANS THE SMALL BUSINESS HEALTH OPTIONS PROGRAM DESIGNED TO
   32  ASSIST QUALIFIED EMPLOYERS IN THIS STATE IN FACILITATING THE  ENROLLMENT
   33  OF THEIR EMPLOYEES IN QUALIFIED HEALTH PLANS OFFERED IN THE GROUP MARKET
   34  IN THIS STATE.
   35    14. "SMALL EMPLOYER" MEANS, FOR PLAN YEARS PRIOR TO JANUARY FIRST, TWO
   36  THOUSAND  SIXTEEN,  AN EMPLOYER THAT EMPLOYED AN AVERAGE OF AT LEAST ONE
   37  BUT NOT MORE THAN FIFTY EMPLOYEES ON BUSINESS DAYS DURING THE  PRECEDING
   38  CALENDAR  YEAR. FOR PLAN YEARS BEGINNING ON AND AFTER JANUARY FIRST, TWO
   39  THOUSAND SIXTEEN, SMALL EMPLOYER MEANS  AN  EMPLOYER  THAT  EMPLOYED  AN
   40  AVERAGE OF AT LEAST ONE BUT NOT MORE THAN ONE HUNDRED EMPLOYEES ON BUSI-
   41  NESS  DAYS DURING THE PRECEDING CALENDAR YEAR. FOR PURPOSES OF THE DEFI-
   42  NITION OF SMALL EMPLOYER:
   43    (A) ALL PERSONS TREATED AS A SINGLE  EMPLOYER  UNDER  SUBSECTION  (B),
   44  (C),  (M)  OR  (O)  OF  SECTION 414 OF THE INTERNAL REVENUE CODE OF 1986
   45  SHALL BE TREATED AS A SINGLE EMPLOYER;
   46    (B) AN EMPLOYER AND ANY PREDECESSOR EMPLOYER SHALL  BE  TREATED  AS  A
   47  SINGLE EMPLOYER;
   48    (C)  ALL EMPLOYEES SHALL BE COUNTED, INCLUDING PART-TIME EMPLOYEES AND
   49  EMPLOYEES WHO ARE NOT ELIGIBLE FOR COVERAGE THROUGH THE EMPLOYER;
   50    (D) IF AN EMPLOYER WAS  NOT  IN  EXISTENCE  THROUGHOUT  THE  PRECEDING
   51  CALENDAR  YEAR,  THEN  THE  DETERMINATION  OF WHETHER THAT EMPLOYER IS A
   52  SMALL EMPLOYER SHALL BE BASED UPON THE AVERAGE NUMBER OF EMPLOYEES  THAT
   53  THE  EMPLOYER  REASONABLY  EXPECTS  TO  EMPLOY  ON  BUSINESS DAYS IN THE
   54  CURRENT CALENDAR YEAR;
   55    (E) IF A QUALIFIED EMPLOYER THAT MAKES ENROLLMENT IN QUALIFIED  HEALTH
   56  PLANS  AVAILABLE  TO  ITS  EMPLOYEES THROUGH THE EXCHANGE CEASES TO BE A
       A. 8514                             4

    1  SMALL EMPLOYER BY REASON OF AN INCREASE IN THE NUMBER OF ITS  EMPLOYEES,
    2  THEN  THE  EMPLOYER SHALL CONTINUE TO BE TREATED AS A QUALIFIED EMPLOYER
    3  FOR PURPOSES OF THIS ARTICLE FOR THE PERIOD BEGINNING WITH THE  INCREASE
    4  AND  ENDING  WITH THE FIRST DAY ON WHICH THE EMPLOYER DOES NOT MAKE SUCH
    5  ENROLLMENT AVAILABLE TO ITS EMPLOYEES; AND
    6    (F) NOTWITHSTANDING PARAGRAPHS (A) THROUGH (E) OF THIS SUBDIVISION, AN
    7  EMPLOYER ALSO SHALL BE CONSIDERED A SMALL EMPLOYER IF  THE  COVERAGE  IT
    8  OFFERS  WOULD BE CONSIDERED SMALL GROUP COVERAGE UNDER THE INSURANCE LAW
    9  AND REGULATIONS PROMULGATED THEREUNDER PROVIDED THAT IT IS NOT OTHERWISE
   10  PROHIBITED UNDER THE FEDERAL ACT.
   11    15. "SMALL GROUP MARKET" MEANS THE HEALTH INSURANCE MARKET UNDER WHICH
   12  INDIVIDUALS RECEIVE HEALTH INSURANCE COVERAGE ON  BEHALF  OF  THEMSELVES
   13  AND  THEIR  DEPENDENTS THROUGH A GROUP HEALTH PLAN MAINTAINED BY A SMALL
   14  EMPLOYER.
   15    16. "SUPERINTENDENT" MEANS THE SUPERINTENDENT OF INSURANCE UNTIL OCTO-
   16  BER THIRD, TWO THOUSAND ELEVEN, WHEN SUCH TERM  SHALL  MEAN  THE  SUPER-
   17  INTENDENT OF FINANCIAL SERVICES.
   18    S  3982.  ESTABLISHMENT  OF  THE NEW YORK HEALTH BENEFIT EXCHANGE.  1.
   19  THERE IS HEREBY CREATED A PUBLIC BENEFIT CORPORATION TO BE KNOWN AS  THE
   20  NEW  YORK  HEALTH  BENEFIT  EXCHANGE.  SUCH  CORPORATION SHALL BE A BODY
   21  CORPORATE AND POLITIC.
   22    2. THE PURPOSE OF THE EXCHANGE IS TO FACILITATE THE PURCHASE AND  SALE
   23  OF  QUALIFIED  HEALTH  PLANS, ASSIST QUALIFIED EMPLOYERS IN FACILITATING
   24  THE ENROLLMENT OF THEIR EMPLOYEES IN QUALIFIED HEALTH PLANS THROUGH  THE
   25  SMALL  BUSINESS  HEALTH  OPTIONS  PROGRAM,  ENROLL INDIVIDUALS IN HEALTH
   26  COVERAGE FOR WHICH THEY ARE ELIGIBLE IN ACCORDANCE WITH FEDERAL LAW  AND
   27  CARRY OUT OTHER FUNCTIONS SET FORTH IN THIS ARTICLE.
   28    3. (A) THE EXCHANGE SHALL BE GOVERNED BY A BOARD OF DIRECTORS CONSIST-
   29  ING  OF NINE VOTING DIRECTORS, INCLUDING THE COMMISSIONER AND THE SUPER-
   30  INTENDENT, WHO SHALL SERVE AS EX OFFICIO DIRECTORS.
   31    (B) SEVEN DIRECTORS SHALL BE APPOINTED BY THE GOVERNOR,  TWO  OF  WHOM
   32  SHALL BE APPOINTED UPON THE RECOMMENDATION OF THE TEMPORARY PRESIDENT OF
   33  THE SENATE AND TWO OF WHOM SHALL BE APPOINTED UPON THE RECOMMENDATION OF
   34  THE SPEAKER OF THE ASSEMBLY.  EACH PERSON APPOINTED AS A DIRECTOR PURSU-
   35  ANT TO THIS PARAGRAPH SHALL HAVE EXPERTISE IN ONE OR MORE OF THE FOLLOW-
   36  ING AREAS:
   37    (I) INDIVIDUAL HEALTH CARE COVERAGE;
   38    (II) SMALL EMPLOYER HEALTH CARE COVERAGE;
   39    (III) HEALTH BENEFITS ADMINISTRATION;
   40    (IV) HEALTH CARE FINANCE;
   41    (V) PUBLIC OR PRIVATE HEALTH CARE DELIVERY SYSTEMS; AND
   42    (VI) PURCHASING HEALTH PLAN COVERAGE.
   43    (C) RECOMMENDATIONS AND APPOINTMENTS SHALL TAKE INTO CONSIDERATION THE
   44  EXPERTISE  OF OTHER DIRECTORS RECOMMENDED AND APPOINTED PURSUANT TO THIS
   45  SUBDIVISION, SO THAT THE BOARD COMPOSITION REFLECTS A DIVERSITY OF EXPE-
   46  RIENCE.
   47    (D) RECOMMENDATIONS BY THE TEMPORARY PRESIDENT OF THE SENATE  AND  THE
   48  SPEAKER OF THE ASSEMBLY SHALL BE MADE WITHIN SIXTY DAYS OF THE EFFECTIVE
   49  DATE  OF  THIS ARTICLE, WITHIN SIXTY DAYS OF THE OCCURRENCE OF A VACANCY
   50  OR WITHIN SIXTY DAYS PRIOR TO THE EXPIRATION OF A TERM.
   51    4. THE GOVERNOR SHALL APPOINT A CHAIR OF  THE  BOARD  FROM  AMONG  THE
   52  DIRECTORS  WHO SHALL BE SUBJECT TO THE ADVICE AND CONSENT OF THE SENATE.
   53  ANY DIRECTOR APPOINTED BY THE GOVERNOR AS CHAIR OF THE BOARD  MAY  SERVE
   54  AS  ACTING  CHAIR UNTIL SUCH TIME AS A VOTE FOR CONFIRMATION IS TAKEN BY
   55  THE SENATE. NO DIRECTOR APPOINTED AS CHAIR  SHALL  SERVE  AS  CHAIR,  OR
       A. 8514                             5

    1  CONTINUE  TO  SERVE  AS  ACTING  CHAIR,  IF  THE SENATE HAS VOTED NOT TO
    2  CONFIRM SUCH DIRECTOR AS CHAIR.
    3    5.  (A)  THE  TERMS OF THE DIRECTORS, OTHER THAN THE EX OFFICIO DIREC-
    4  TORS, SHALL BE THREE YEARS, PROVIDED, HOWEVER, THAT THE INITIAL TERMS OF
    5  ONE OF THE DIRECTORS APPOINTED  UPON  RECOMMENDATION  OF  THE  TEMPORARY
    6  PRESIDENT OF THE SENATE, ONE OF THE DIRECTORS APPOINTED UPON RECOMMENDA-
    7  TION  OF THE SPEAKER OF THE ASSEMBLY, AND ONE OF THE DIRECTORS APPOINTED
    8  BY THE GOVERNOR WITHOUT RECOMMENDATION SHALL BE FOR TWO YEARS.
    9    (B) VACANCIES OCCURRING OTHERWISE THAN BY EXPIRATION OF TERM OF OFFICE
   10  SHALL BE FILLED FOR THE  UNEXPIRED  TERM  IN  THE  MANNER  PROVIDED  FOR
   11  ORIGINAL APPOINTMENT.
   12    6. THE DIRECTORS SHALL NOT RECEIVE ANY COMPENSATION FOR THEIR SERVICES
   13  AS DIRECTORS.
   14    7.  (A)  EACH  DIRECTOR SHALL HAVE THE RESPONSIBILITY AND DUTY TO MEET
   15  THE REQUIREMENTS OF THIS ARTICLE, THE FEDERAL ACT,  AND  ALL  APPLICABLE
   16  STATE  AND  FEDERAL LAWS AND REGULATIONS TO SERVE THE PUBLIC INTEREST OF
   17  THE INDIVIDUALS  AND  SMALL  BUSINESSES  SEEKING  HEALTH  CARE  COVERAGE
   18  THROUGH THE EXCHANGE, CONSISTENT WITH SECTION TWENTY-EIGHT HUNDRED TWEN-
   19  TY-FOUR OF THIS CHAPTER.
   20    (B)  EACH  DIRECTOR  SHALL  BE  A  STATE  OFFICER  OR EMPLOYEE FOR THE
   21  PURPOSES OF SECTIONS SEVENTY-THREE AND SEVENTY-FOUR OF THE PUBLIC  OFFI-
   22  CERS LAW.
   23    (C) NO DIRECTOR MAY BE EMPLOYED OR OTHERWISE RETAINED BY THE EXCHANGE.
   24    8.  (A) THE BOARD MAY CREATE SUCH COMMITTEES AS THE BOARD DEEMS NECES-
   25  SARY. THE FIRST MEETING OF THE BOARD SHALL BE HELD  WITHIN  THIRTY  DAYS
   26  AFTER  ALL  DIRECTORS  ARE INITIALLY APPOINTED.  AT THE FIRST MEETING OF
   27  THE BOARD, AND AT THE FIRST MEETING IN EACH SUBSEQUENT YEAR,  THE  BOARD
   28  SHALL  ELECT  FROM  AMONG  ITS  MEMBERS A SECRETARY AND A TREASURER. THE
   29  BOARD ALSO SHALL ELECT SUCH OTHER OFFICERS AS IT SHALL  DEEM  NECESSARY.
   30  THE  OFFICERS  SO  ELECTED  SHALL  HAVE  SUCH  POWERS  AND DUTIES AS ARE
   31  ASSIGNED BY THE BY-LAWS AND THIS CHAPTER.
   32    (B) THE BOARD, AND ANY COMMITTEE THEREOF, MAY HOLD MEETINGS  BY  ELEC-
   33  TRONIC MEANS CONSISTENT WITH ARTICLE SEVEN OF THE PUBLIC OFFICERS LAW.
   34    S  3983.  GENERAL  POWERS OF THE EXCHANGE. THE EXCHANGE SHALL HAVE THE
   35  FOLLOWING POWERS TO BE USED IN FURTHERANCE OF ITS CORPORATE PURPOSES:
   36    1. TO SUE AND BE SUED AND TO PARTICIPATE IN ACTIONS  AND  PROCEEDINGS,
   37  WHETHER JUDICIAL, ADMINISTRATIVE, ARBITRATIVE OR OTHERWISE;
   38    2.  TO  HAVE A CORPORATE SEAL, AND TO ALTER SUCH SEAL AT PLEASURE, AND
   39  TO USE IT BY CAUSING IT OR A FACSIMILE TO BE  AFFIXED  OR  IMPRESSED  OR
   40  REPRODUCED IN ANY OTHER MANNER;
   41    3.  TO  PURCHASE,  RECEIVE,  TAKE  BY  GRANT, GIFT, DEVISE, BEQUEST OR
   42  OTHERWISE, LEASE, OR OTHERWISE ACQUIRE, OWN, HOLD, IMPROVE, EMPLOY,  USE
   43  AND OTHERWISE DEAL IN AND WITH, REAL OR PERSONAL PROPERTY, OR ANY INTER-
   44  EST THEREIN, WHEREVER SITUATED;
   45    4. TO SELL, CONVEY, LEASE, EXCHANGE, TRANSFER OR OTHERWISE DISPOSE OF,
   46  OR  MORTGAGE  OR PLEDGE, OR CREATE A SECURITY INTEREST IN, ALL OR ANY OF
   47  ITS PROPERTY, OR ANY INTEREST THEREIN, WHEREVER SITUATED;
   48    5. TO MAKE CONTRACTS,  GIVE  GUARANTEES  AND  INCUR  LIABILITIES,  AND
   49  BORROW  MONEY;  PROVIDED,  HOWEVER,  THAT  THE  EXCHANGE SHALL NOT ISSUE
   50  BONDS;
   51    6. TO INVEST AND REINVEST ITS  FUNDS,  AND  TAKE  AND  HOLD  REAL  AND
   52  PERSONAL  PROPERTY  AS  SECURITY  FOR  THE PAYMENT OF FUNDS SO LOANED OR
   53  INVESTED;
   54    7. TO MAKE AND ALTER BY-LAWS FOR ITS ORGANIZATION AND MANAGEMENT;
       A. 8514                             6

    1    8. TO MAKE AND ALTER RULES AND REGULATIONS AS NECESSARY  TO  IMPLEMENT
    2  THE  PROVISIONS  OF THIS ARTICLE, SUBJECT TO THE PROVISIONS OF THE STATE
    3  ADMINISTRATIVE PROCEDURE ACT;
    4    9.  TO  HIRE  EMPLOYEES,  CONSISTENT  WITH SECTION THIRTY-NINE HUNDRED
    5  NINETY OF THIS ARTICLE;
    6    10. TO DESIGNATE THE DEPOSITORIES OF ITS MONEY;
    7    11. TO ESTABLISH ITS FISCAL YEAR;
    8    12. TO INSURE OR OTHERWISE PROVIDE FOR THE INSURANCE OF THE EXCHANGE'S
    9  PROPERTY OR OPERATIONS AND AGAINST SUCH OTHER RISKS AS THE EXCHANGE  MAY
   10  DEEM ADVISABLE;
   11    13.  TO  RECEIVE  AND SPEND MONEY FOR ANY OF ITS CORPORATE PURPOSES IN
   12  ACCORDANCE WITH THIS ARTICLE; AND
   13    14. TO APPLY FOR, ACCEPT THE AWARD OF, AND SPEND ANY  AVAILABLE  GRANT
   14  MONEY.
   15    S 3984. FUNCTIONS OF THE EXCHANGE.  THE EXCHANGE SHALL:
   16    1.  (A) MAKE AVAILABLE QUALIFIED HEALTH PLANS TO QUALIFIED INDIVIDUALS
   17  AND QUALIFIED EMPLOYERS BEGINNING ON OR BEFORE JANUARY FIRST, TWO  THOU-
   18  SAND  FOURTEEN,  PROVIDED THAT COVERAGE UNDER SUCH QUALIFIED PLANS SHALL
   19  NOT BECOME EFFECTIVE PRIOR TO SUCH DATE AND SHALL NOT MAKE AVAILABLE ANY
   20  HEALTH PLAN THAT IS NOT A QUALIFIED HEALTH PLAN;
   21    (B) MAKE AVAILABLE QUALIFIED DENTAL PLANS TO QUALIFIED INDIVIDUALS AND
   22  QUALIFIED EMPLOYERS BEGINNING ON OR BEFORE JANUARY FIRST,  TWO  THOUSAND
   23  FOURTEEN, PROVIDED THAT COVERAGE UNDER SUCH QUALIFIED DENTAL PLANS SHALL
   24  NOT  BECOME  EFFECTIVE  PRIOR  TO  SUCH  DATE,  EITHER  SEPARATELY OR IN
   25  CONJUNCTION WITH A QUALIFIED HEALTH PLAN, IF SUCH PLAN  PROVIDES  PEDIA-
   26  TRIC  DENTAL  BENEFITS MEETING THE REQUIREMENTS OF SECTION 1302(B)(1)(J)
   27  OF THE FEDERAL ACT;
   28    2. ASSIGN A RATING TO EACH QUALIFIED HEALTH PLAN OFFERED  THROUGH  THE
   29  EXCHANGE  IN  ACCORDANCE  WITH  THE  CRITERIA DEVELOPED BY THE SECRETARY
   30  PURSUANT TO SECTION 1311(C)(3) OF THE FEDERAL ACT,  AND  DETERMINE  EACH
   31  QUALIFIED HEALTH PLAN'S LEVEL OF COVERAGE IN ACCORDANCE WITH REGULATIONS
   32  ISSUED BY THE SECRETARY PURSUANT TO SECTION 1302(D)(2)(A) OF THE FEDERAL
   33  ACT;
   34    3. UTILIZE A STANDARDIZED FORMAT FOR PRESENTING HEALTH BENEFIT OPTIONS
   35  IN  THE  EXCHANGE,  INCLUDING THE USE OF THE UNIFORM OUTLINE OF COVERAGE
   36  ESTABLISHED UNDER SECTION 2715 OF THE FEDERAL PUBLIC HEALTH SERVICE ACT;
   37    4. PROVIDE FOR ENROLLMENT PERIODS PURSUANT TO THE FEDERAL ACT  OR  THE
   38  INSURANCE  LAW,  WHICHEVER IS IN THE BEST INTEREST OF QUALIFIED INDIVID-
   39  UALS AND QUALIFIED EMPLOYERS, AFTER THE INITIAL  ENROLLMENT  PERIOD  HAS
   40  BEEN ESTABLISHED AS REQUIRED IN THE FEDERAL ACT; PROVIDED, HOWEVER, THAT
   41  IF  ENROLLMENT PERIODS PURSUANT TO THE INSURANCE LAW CONFLICT WITH RULES
   42  ADOPTED BY THE SECRETARY, THEN ENROLLMENT PERIODS PURSUANT TO THE FEDER-
   43  AL ACT SHALL APPLY;
   44    5. IMPLEMENT PROCEDURES FOR  THE  CERTIFICATION,  RECERTIFICATION  AND
   45  DECERTIFICATION  OF  HEALTH  PLANS AS QUALIFIED HEALTH PLANS, CONSISTENT
   46  WITH GUIDELINES DEVELOPED BY THE SECRETARY PURSUANT TO  SECTION  1311(C)
   47  OF  THE  FEDERAL ACT AND SECTION THIRTY-NINE HUNDRED EIGHTY-FIVE OF THIS
   48  ARTICLE;
   49    6. REQUIRE QUALIFIED HEALTH PLANS TO OFFER THOSE  BENEFITS  DETERMINED
   50  BY  THE  SECRETARY  TO  BE ESSENTIAL HEALTH BENEFITS PURSUANT TO SECTION
   51  1302(B) OF THE FEDERAL ACT (EXCEPT  AS  PROVIDED  IN  PARAGRAPH  (B)  OF
   52  SUBDIVISION  ONE  OF  SECTION THREE THOUSAND NINE HUNDRED EIGHTY-FIVE OF
   53  THIS ARTICLE) AND SUCH ADDITIONAL BENEFITS AS MAY BE  REQUIRED  PURSUANT
   54  TO  THE  INSURANCE  LAW, PROVIDED THAT THE STATE HAS ASSUMED THE COST OF
   55  SUCH ADDITIONAL BENEFITS AS REQUIRED UNDER SECTION 1311(D)(3)(B) OF  THE
   56  FEDERAL ACT;
       A. 8514                             7

    1    7.  ENSURE THAT INSURERS OFFERING HEALTH PLANS THROUGH THE EXCHANGE DO
    2  NOT CHARGE AN INDIVIDUAL A FEE OR PENALTY FOR TERMINATION OF COVERAGE;
    3    8.  PROVIDE  FOR  THE  OPERATION  OF  A TOLL-FREE TELEPHONE HOTLINE TO
    4  RESPOND TO REQUESTS FOR ASSISTANCE;
    5    9. MAINTAIN AN INTERNET WEBSITE THROUGH WHICH ENROLLEES  AND  PROSPEC-
    6  TIVE ENROLLEES OF QUALIFIED HEALTH PLANS MAY OBTAIN STANDARDIZED COMPAR-
    7  ATIVE INFORMATION ON SUCH PLANS AND PUBLIC HEALTH PROGRAMS;
    8    10.  ESTABLISH  AND MAKE AVAILABLE BY ELECTRONIC MEANS A CALCULATOR TO
    9  DETERMINE THE ACTUAL COST OF  COVERAGE  AFTER  THE  APPLICATION  OF  ANY
   10  PREMIUM  TAX  CREDIT  UNDER  SECTION 36B OF THE INTERNAL REVENUE CODE OF
   11  1986 AND ANY COST-SHARING REDUCTION UNDER SECTION 1402  OF  THE  FEDERAL
   12  ACT;
   13    11.  ESTABLISH  A  PROGRAM  UNDER  WHICH THE EXCHANGE AWARDS GRANTS TO
   14  ENTITIES TO SERVE AS NAVIGATORS, IN ACCORDANCE WITH SECTION  1311(I)  OF
   15  THE FEDERAL ACT AND REGULATIONS ADOPTED THEREUNDER;
   16    12.  IN  ACCORDANCE WITH SECTION 1413 OF THE FEDERAL ACT, INFORM INDI-
   17  VIDUALS OF ELIGIBILITY REQUIREMENTS FOR THE MEDICAID PROGRAM UNDER TITLE
   18  XIX OF THE SOCIAL SECURITY ACT, THE CHILDREN'S HEALTH INSURANCE  PROGRAM
   19  (CHIP)  UNDER  TITLE  XXI  OF  THE SOCIAL SECURITY ACT OR ANY APPLICABLE
   20  STATE OR LOCAL PUBLIC HEALTH INSURANCE PROGRAM AND IF, THROUGH SCREENING
   21  OF THE APPLICATION BY THE EXCHANGE, THE EXCHANGE  DETERMINES  THAT  SUCH
   22  INDIVIDUALS  ARE  ELIGIBLE FOR ANY SUCH PROGRAM, ENROLL SUCH INDIVIDUALS
   23  IN SUCH PROGRAM;
   24    13. PURSUANT TO SECTION 1411 OF THE FEDERAL ACT, GRANT A CERTIFICATION
   25  ATTESTING THAT, FOR PURPOSES OF THE  INDIVIDUAL  RESPONSIBILITY  PENALTY
   26  UNDER  SECTION 5000A OF THE INTERNAL REVENUE CODE OF 1986, AN INDIVIDUAL
   27  IS EXEMPT FROM THE INDIVIDUAL RESPONSIBILITY  REQUIREMENT  OR  FROM  THE
   28  PENALTY IMPOSED BY THAT SECTION BECAUSE:
   29    (A) THERE IS NO AFFORDABLE QUALIFIED HEALTH PLAN AVAILABLE THROUGH THE
   30  EXCHANGE OR THE INDIVIDUAL'S EMPLOYER, COVERING THE INDIVIDUAL; OR
   31    (B) THE INDIVIDUAL MEETS THE REQUIREMENTS FOR ANY OTHER SUCH EXEMPTION
   32  FROM THE INDIVIDUAL RESPONSIBILITY REQUIREMENT OR PENALTY;
   33    14.  TRANSMIT  TO THE SECRETARY OF THE UNITED STATES DEPARTMENT OF THE
   34  TREASURY:
   35    (A) A LIST OF THE INDIVIDUALS TO WHOM THE EXCHANGE GRANTED  A  CERTIF-
   36  ICATION  UNDER  SUBDIVISION THIRTEEN OF THIS SECTION, INCLUDING THE NAME
   37  AND TAXPAYER IDENTIFICATION NUMBER OF EACH INDIVIDUAL;
   38    (B) THE NAME AND TAXPAYER IDENTIFICATION NUMBER OF EACH INDIVIDUAL WHO
   39  WAS AN EMPLOYEE OF AN EMPLOYER WHO WAS DETERMINED TO BE ELIGIBLE FOR THE
   40  PREMIUM TAX CREDIT UNDER SECTION 36B OF THE  INTERNAL  REVENUE  CODE  OF
   41  1986 BECAUSE:
   42    (I)  THE EMPLOYER DID NOT PROVIDE MINIMUM ESSENTIAL COVERAGE AS DETER-
   43  MINED BY THE SECRETARY PURSUANT TO SECTION 1311(D) OF THE  FEDERAL  ACT;
   44  OR
   45    (II)  THE  EMPLOYER  PROVIDED THE MINIMUM ESSENTIAL COVERAGE AS DETER-
   46  MINED BY THE SECRETARY PURSUANT TO SECTION 1311(D) OF THE  FEDERAL  ACT,
   47  BUT IT WAS DETERMINED UNDER SECTION 36B(C)(2)(C) OF THE INTERNAL REVENUE
   48  CODE OF 1986 TO EITHER BE UNAFFORDABLE TO THE EMPLOYEE OR TO NOT PROVIDE
   49  THE REQUIRED MINIMUM ACTUARIAL VALUE; AND
   50    (C) THE NAME AND TAXPAYER IDENTIFICATION NUMBER OF:
   51    (I)  EACH  INDIVIDUAL  WHO  NOTIFIES  THE EXCHANGE PURSUANT TO SECTION
   52  1411(B)(4) OF THE FEDERAL ACT THAT HE OR SHE HAS CHANGED EMPLOYERS; AND
   53    (II) EACH INDIVIDUAL WHO CEASES COVERAGE UNDER A QUALIFIED HEALTH PLAN
   54  DURING A PLAN YEAR AND THE EFFECTIVE DATE OF THAT CESSATION;
   55    15. PROVIDE TO EACH EMPLOYER THE NAME OF EACH EMPLOYEE OF THE EMPLOYER
   56  DESCRIBED IN PARAGRAPH (B) OF SUBDIVISION FOURTEEN OF THIS  SECTION  WHO
       A. 8514                             8

    1  CEASES COVERAGE UNDER A QUALIFIED HEALTH PLAN DURING A PLAN YEAR AND THE
    2  EFFECTIVE DATE OF THE CESSATION;
    3    16.  OPERATE A SMALL BUSINESS HEALTH OPTIONS PROGRAM ("SHOP") PURSUANT
    4  TO SECTION 1311 OF THE FEDERAL ACT  THROUGH  WHICH  QUALIFIED  EMPLOYERS
    5  ACCESS COVERAGE FOR THEIR EMPLOYEES, AND MAY:
    6    (A) PERMIT QUALIFIED EMPLOYERS TO SPECIFY A LEVEL OF COVERAGE SO THEIR
    7  EMPLOYEES  MAY  ENROLL  IN ANY QUALIFIED HEALTH PLAN OFFERED THROUGH THE
    8  SHOP AT THE SPECIFIED LEVEL OF COVERAGE OR,  UNLESS  PROHIBITED  BY  THE
    9  FEDERAL  ACT,  PROVIDE  A SPECIFIC AMOUNT OR OTHER PAYMENT FORMULATED IN
   10  ACCORDANCE WITH THE FEDERAL ACT TO BE USED AS PART OF AN EMPLOYEE CHOICE
   11  PLAN; AND
   12    (B) PROVIDE PREMIUM AGGREGATION AND OTHER RELATED SERVICES TO MINIMIZE
   13  ADMINISTRATIVE BURDENS FOR QUALIFIED EMPLOYERS;
   14    17. ENTER INTO AGREEMENTS AS NECESSARY WITH:  (A)  FEDERAL  AND  STATE
   15  AGENCIES  AND  OTHER  STATE  EXCHANGES TO CARRY OUT ITS RESPONSIBILITIES
   16  UNDER  THIS  ARTICLE,  PROVIDED   SUCH   AGREEMENTS   INCLUDE   ADEQUATE
   17  PROTECTIONS WITH RESPECT TO THE CONFIDENTIALITY OF ANY INFORMATION TO BE
   18  SHARED AND COMPLY WITH ALL STATE AND FEDERAL LAWS AND REGULATIONS; AND
   19    (B)  LOCAL  DEPARTMENTS OF SOCIAL SERVICES TO COORDINATE ENROLLMENT IN
   20  OTHER SOCIAL SERVICES PROGRAMS, AS APPROPRIATE, PROVIDED SUCH AGREEMENTS
   21  INCLUDE ADEQUATE PROTECTIONS WITH RESPECT TO THE CONFIDENTIALITY OF  ANY
   22  INFORMATION  TO BE SHARED AND COMPLY WITH ALL STATE AND FEDERAL LAWS AND
   23  REGULATIONS;
   24    18. PERFORM DUTIES REQUIRED BY THE SECRETARY OR THE SECRETARY  OF  THE
   25  UNITED  STATES  DEPARTMENT OF THE TREASURY RELATED TO DETERMINING ELIGI-
   26  BILITY FOR PREMIUM TAX  CREDITS,  REDUCED  COST-SHARING,  OR  INDIVIDUAL
   27  RESPONSIBILITY REQUIREMENT EXEMPTIONS;
   28    19.  MEET  FINANCIAL  INTEGRITY REQUIREMENTS UNDER SECTION 1313 OF THE
   29  FEDERAL ACT AND THIS CHAPTER, INCLUDING:
   30    (A) KEEPING AN ACCURATE ACCOUNTING OF ALL  ACTIVITIES,  RECEIPTS,  AND
   31  EXPENDITURES  AND ANNUALLY SUBMITTING TO THE SECRETARY A REPORT CONCERN-
   32  ING SUCH ACCOUNTINGS, WITH A COPY OF SUCH REPORT PROVIDED TO THE  GOVER-
   33  NOR, THE TEMPORARY PRESIDENT OF THE SENATE AND THE SPEAKER OF THE ASSEM-
   34  BLY; AND
   35    (B)  FULLY  COOPERATING WITH ANY INVESTIGATION CONDUCTED BY THE SECRE-
   36  TARY PURSUANT TO THE SECRETARY'S AUTHORITY UNDER  SECTION  1313  OF  THE
   37  FEDERAL ACT AND ALLOWING THE SECRETARY, IN COORDINATION WITH THE INSPEC-
   38  TOR  GENERAL  OF  THE  UNITED  STATES  DEPARTMENT  OF  HEALTH  AND HUMAN
   39  SERVICES, TO:
   40    (I) INVESTIGATE THE AFFAIRS OF THE EXCHANGE;
   41    (II) EXAMINE THE PROPERTIES AND RECORDS OF THE EXCHANGE; AND
   42    (III) REQUIRE PERIODIC REPORTS IN RELATION TO THE ACTIVITIES UNDERTAK-
   43  EN BY THE EXCHANGE;
   44    20. (A) CONSULT WITH  THE  REGIONAL  ADVISORY  COMMITTEES  ESTABLISHED
   45  PURSUANT TO SECTION THIRTY-NINE HUNDRED EIGHTY-SIX OF THIS ARTICLE; AND
   46    (B)  CONSULT WITH STAKEHOLDERS RELEVANT TO CARRYING OUT THE ACTIVITIES
   47  REQUIRED UNDER THIS ARTICLE, INCLUDING BUT NOT LIMITED TO:
   48    (I) HEALTH CARE CONSUMERS WHO ARE ENROLLEES IN HEALTH PLANS;
   49    (II) INDIVIDUALS AND ENTITIES WITH EXPERIENCE IN FACILITATING  ENROLL-
   50  MENT IN HEALTH PLANS;
   51    (III)  REPRESENTATIVES  OF SMALL BUSINESSES AND SELF-EMPLOYED INDIVID-
   52  UALS;
   53    (IV) STATE MEDICAID OFFICES, INCLUDING  LOCAL  DEPARTMENTS  OF  SOCIAL
   54  SERVICES;
   55    (V) ADVOCATES FOR ENROLLING HARD TO REACH POPULATIONS;
   56    (VI) HEALTH CARE PROVIDERS; AND
       A. 8514                             9

    1    (VII) INSURERS;
    2    21.  SUBMIT  INFORMATION PROVIDED BY EXCHANGE APPLICANTS FOR VERIFICA-
    3  TION AS REQUIRED BY SECTION 1411(C) OF THE FEDERAL ACT;
    4    22. ESTABLISH RULES AND REGULATIONS, PURSUANT TO SUBDIVISION EIGHT  OF
    5  SECTION  THIRTY-NINE  HUNDRED  EIGHTY-THREE OF THIS ARTICLE, THAT DO NOT
    6  CONFLICT WITH OR PREVENT THE APPLICATION OF REGULATIONS  PROMULGATED  BY
    7  THE SECRETARY; AND
    8    23.  DETERMINE ELIGIBILITY, PROVIDE NOTICES, AND PROVIDE OPPORTUNITIES
    9  FOR APPEAL AND REDETERMINATION IN ACCORDANCE WITH  THE  REQUIREMENTS  OF
   10  SECTIONS 1411 AND 1413 OF THE FEDERAL ACT.
   11    S  3985.  SPECIAL  FUNCTIONS  OF  THE  EXCHANGE RELATED TO HEALTH PLAN
   12  CERTIFICATION AND QUALIFIED HEALTH PLAN  OVERSIGHT.    1.  HEALTH  PLANS
   13  CERTIFIED BY THE EXCHANGE SHALL MEET THE FOLLOWING REQUIREMENTS:
   14    (A) THE INSURER OFFERING THE HEALTH PLAN:
   15    (I) IS LICENSED OR CERTIFIED BY THE SUPERINTENDENT OR COMMISSIONER AND
   16  MEETS  THE  REQUIREMENTS  OF SECTION 1301(A)(1)(C)(I) OF THE FEDERAL ACT
   17  AND ANY GUIDANCE ISSUED THEREUNDER;
   18    (II) OFFERS AT LEAST ONE QUALIFIED HEALTH PLAN IN EACH OF  THE  SILVER
   19  AND GOLD LEVELS;
   20    (III)  HAS FILED WITH AND RECEIVED APPROVAL FROM THE SUPERINTENDENT OF
   21  ITS PREMIUM RATES AND POLICY OR CONTRACT FORMS PURSUANT TO THE INSURANCE
   22  LAW AND THE PUBLIC HEALTH LAW;
   23    (IV) DOES NOT CHARGE ANY CANCELLATION FEES OR PENALTIES  IN  VIOLATION
   24  OF  SUBDIVISION SEVEN OF SECTION THIRTY-NINE HUNDRED EIGHTY-FOUR OF THIS
   25  ARTICLE; AND
   26    (V) COMPLIES WITH THE REGULATIONS DEVELOPED  BY  THE  SECRETARY  UNDER
   27  SECTION  1311(C)  OF  THE FEDERAL ACT AND SUCH OTHER REQUIREMENTS AS THE
   28  EXCHANGE MAY ESTABLISH;
   29    (B) THE HEALTH PLAN: (I) PROVIDES THE ESSENTIAL HEALTH BENEFITS  PACK-
   30  AGE  DESCRIBED  IN  SECTION 1302(A) OF THE FEDERAL ACT AND INCLUDES SUCH
   31  ADDITIONAL BENEFITS AS MAY BE REQUIRED PURSUANT TO  THE  INSURANCE  LAW,
   32  PROVIDED THAT THE STATE HAS ASSUMED THE COST OF SUCH ADDITIONAL BENEFITS
   33  AS  REQUIRED UNDER SECTION 1311(D)(3)(B) OF THE FEDERAL ACT, EXCEPT THAT
   34  THE HEALTH PLAN SHALL NOT BE REQUIRED TO PROVIDE ESSENTIAL BENEFITS THAT
   35  DUPLICATE THE MINIMUM BENEFITS OF QUALIFIED DENTAL PLANS IF:
   36    (A) THE EXCHANGE HAS DETERMINED THAT AT  LEAST  ONE  QUALIFIED  DENTAL
   37  PLAN IS AVAILABLE TO SUPPLEMENT THE HEALTH PLAN'S COVERAGE; AND
   38    (B)  THE  INSURER MAKES PROMINENT DISCLOSURE AT THE TIME IT OFFERS THE
   39  HEALTH PLAN, IN A FORM APPROVED BY THE EXCHANGE, THAT THE PLAN DOES  NOT
   40  PROVIDE  THE FULL RANGE OF ESSENTIAL PEDIATRIC BENEFITS, AND THAT QUALI-
   41  FIED DENTAL PLANS PROVIDING THOSE BENEFITS AND OTHER DENTAL BENEFITS NOT
   42  COVERED BY THE PLAN ARE OFFERED THROUGH THE EXCHANGE;
   43    (II) PROVIDES AT LEAST A  BRONZE  LEVEL  OF  COVERAGE  AS  DEFINED  IN
   44  SECTION  1302(D)  OF  THE FEDERAL ACT, UNLESS THE PLAN IS CERTIFIED AS A
   45  QUALIFIED CATASTROPHIC PLAN, AS DEFINED IN SECTION 1302(E) OF THE FEDER-
   46  AL  ACT,  AND  SHALL  ONLY  BE  OFFERED  TO  INDIVIDUALS  ELIGIBLE   FOR
   47  CATASTROPHIC COVERAGE;
   48    (III)  HAS  COST-SHARING REQUIREMENTS, INCLUDING DEDUCTIBLES, WHICH DO
   49  NOT EXCEED THE LIMITS ESTABLISHED UNDER SECTION 1302(C) OF  THE  FEDERAL
   50  ACT AND ANY REQUIREMENTS OF THE EXCHANGE;
   51    (IV)  COMPLIES  WITH REGULATIONS PROMULGATED BY THE SECRETARY PURSUANT
   52  TO SECTION 1311(C) OF THE FEDERAL ACT, WHICH INCLUDE  MINIMUM  STANDARDS
   53  IN  THE AREAS OF MARKETING PRACTICES, NETWORK ADEQUACY, ESSENTIAL COMMU-
   54  NITY PROVIDERS IN UNDERSERVED AREAS, ACCREDITATION, QUALITY IMPROVEMENT,
   55  UNIFORM ENROLLMENT FORMS AND DESCRIPTIONS OF COVERAGE AND INFORMATION ON
   56  QUALITY MEASURES FOR HEALTH BENEFIT PLAN PERFORMANCE;
       A. 8514                            10

    1    (V) COMPLIES WITH THE INSURANCE LAW AND THE PUBLIC HEALTH LAW REQUIRE-
    2  MENTS APPLICABLE TO HEALTH INSURANCE ISSUED IN THIS STATE AND ANY  REGU-
    3  LATIONS  PROMULGATED  PURSUANT  THERETO  THAT  DO  NOT  CONFLICT WITH OR
    4  PREVENT THE APPLICATION OF FEDERAL REQUIREMENTS; AND
    5    (C)  THE  EXCHANGE  DETERMINES  THAT  MAKING THE HEALTH PLAN AVAILABLE
    6  THROUGH THE EXCHANGE IS IN THE INTEREST  OF  QUALIFIED  INDIVIDUALS  AND
    7  QUALIFIED EMPLOYERS IN THIS STATE.
    8    2. THE EXCHANGE SHALL NOT EXCLUDE A HEALTH PLAN:
    9    (A) ON THE BASIS THAT THE HEALTH PLAN IS A FEE-FOR-SERVICE PLAN;
   10    (B)  THROUGH THE IMPOSITION OF PREMIUM PRICE CONTROLS BY THE EXCHANGE;
   11  OR
   12    (C) ON THE BASIS THAT THE HEALTH PLAN PROVIDES TREATMENTS NECESSARY TO
   13  PREVENT PATIENTS' DEATHS IN CIRCUMSTANCES THE  EXCHANGE  DETERMINES  ARE
   14  INAPPROPRIATE OR TOO COSTLY.
   15    3.  THE  EXCHANGE  SHALL  REQUIRE  EACH  INSURER  CERTIFIED OR SEEKING
   16  CERTIFICATION OF A HEALTH PLAN AS A QUALIFIED HEALTH PLAN TO:
   17    (A) SUBMIT A JUSTIFICATION FOR ANY PREMIUM INCREASE  TO  THE  EXCHANGE
   18  PRIOR TO IMPLEMENTATION OF SUCH INCREASE.  THE INSURER SHALL PROMINENTLY
   19  POST THE INFORMATION ON ITS INTERNET WEBSITE; PROVIDED, HOWEVER, THAT IF
   20  INFORMATION  SUBMITTED  TO  THE  SUPERINTENDENT AS A JUSTIFICATION FOR A
   21  PREMIUM RATE ADJUSTMENT PURSUANT TO THE INSURANCE  LAW,  OR  INFORMATION
   22  POSTED  TO  AN  INSURER'S  INTERNET  WEBSITE,  OTHERWISE  MEETS  FEDERAL
   23  REQUIREMENTS, THEN SUBMISSION OF A COPY OF THE SAME JUSTIFICATION TO THE
   24  EXCHANGE OR USE OF THE SAME POSTING SHALL BE DEEMED SUFFICIENT  TO  MEET
   25  THE REQUIREMENTS OF THIS SECTION.  THE EXCHANGE SHALL TAKE THIS INFORMA-
   26  TION,  AND  THE  INFORMATION  AND  THE  RECOMMENDATIONS  PROVIDED TO THE
   27  EXCHANGE BY THE SUPERINTENDENT UNDER SECTION 1003  OF  THE  FEDERAL  ACT
   28  (RELATING  TO  PATTERNS OR PRACTICES OF EXCESSIVE OR UNJUSTIFIED PREMIUM
   29  INCREASES), INTO CONSIDERATION WHEN DETERMINING  WHETHER  TO  ALLOW  THE
   30  INSURER  TO MAKE HEALTH PLANS AVAILABLE THROUGH THE EXCHANGE.  SUCH RATE
   31  INCREASES SHALL BE SUBJECT TO THE PRIOR APPROVAL OF  THE  SUPERINTENDENT
   32  PURSUANT TO THE INSURANCE LAW;
   33    (B)(I)  MAKE  AVAILABLE  TO THE PUBLIC AND SUBMIT TO THE EXCHANGE, THE
   34  SECRETARY AND THE SUPERINTENDENT, ACCURATE AND TIMELY DISCLOSURE OF:
   35    (A) CLAIMS PAYMENT POLICIES AND PRACTICES;
   36    (B) PERIODIC FINANCIAL DISCLOSURES;
   37    (C) DATA ON ENROLLMENT AND DISENROLLMENT;
   38    (D) DATA ON THE NUMBER OF CLAIMS THAT ARE DENIED;
   39    (E) DATA ON RATING PRACTICES;
   40    (F) INFORMATION ON COST-SHARING AND PAYMENTS WITH RESPECT TO ANY  OUT-
   41  OF-NETWORK COVERAGE;
   42    (G)  INFORMATION  ON  ENROLLEE AND PARTICIPANT RIGHTS UNDER TITLE I OF
   43  THE FEDERAL ACT; AND
   44    (H) OTHER INFORMATION AS DETERMINED APPROPRIATE BY THE SECRETARY;
   45    (II) THE INFORMATION SHALL BE PROVIDED IN PLAIN LANGUAGE, AS THAT TERM
   46  IS DEFINED IN SECTION 1311(E)(3)(B) OF THE FEDERAL ACT, AND IN  GUIDANCE
   47  JOINTLY  ISSUED THEREUNDER BY THE SECRETARY AND THE FEDERAL SECRETARY OF
   48  LABOR; AND
   49    (C) PROVIDE TO INDIVIDUALS, IN A TIMELY MANNER UPON THE REQUEST OF THE
   50  INDIVIDUAL, THE AMOUNT OF COST-SHARING,  INCLUDING  DEDUCTIBLES,  COPAY-
   51  MENTS,  AND  COINSURANCE, UNDER THE INDIVIDUAL'S HEALTH PLAN OR COVERAGE
   52  THAT THE INDIVIDUAL WOULD BE RESPONSIBLE FOR PAYING WITH RESPECT TO  THE
   53  FURNISHING OF A SPECIFIC ITEM OR SERVICE BY A PARTICIPATING PROVIDER. AT
   54  A  MINIMUM,  THIS  INFORMATION SHALL BE MADE AVAILABLE TO THE INDIVIDUAL
   55  THROUGH AN INTERNET WEBSITE AND  THROUGH  OTHER  MEANS  FOR  INDIVIDUALS
   56  WITHOUT  ACCESS  TO  THE INTERNET; PROVIDED, HOWEVER, THAT TO THE EXTENT
       A. 8514                            11

    1  THAT REQUIREMENTS UNDER THE INSURANCE LAW OR THE PUBLIC HEALTH LAW  MEET
    2  THE  STANDARDS  OF  THE  FEDERAL  ACT, AN INSURER'S COMPLIANCE WITH SUCH
    3  STATE REQUIREMENTS SHALL BE SUFFICIENT TO MEET THE REQUIREMENTS OF  THIS
    4  SECTION.
    5    4.  (A)  THE PROVISIONS OF THIS ARTICLE THAT APPLY TO QUALIFIED HEALTH
    6  PLANS ALSO SHALL APPLY TO THE EXTENT RELEVANT TO QUALIFIED DENTAL  PLANS
    7  EXCEPT  AS  MODIFIED IN ACCORDANCE WITH THE PROVISIONS OF PARAGRAPHS (B)
    8  AND (C) OF THIS SUBDIVISION OR OTHERWISE REQUIRED BY THE EXCHANGE.
    9    (B) THE QUALIFIED DENTAL PLAN SHALL BE  LIMITED  TO  DENTAL  AND  ORAL
   10  HEALTH BENEFITS, WITHOUT SUBSTANTIALLY DUPLICATING THE BENEFITS TYPICAL-
   11  LY  OFFERED  BY  HEALTH BENEFIT PLANS WITHOUT DENTAL COVERAGE, AND SHALL
   12  INCLUDE,  AT  A  MINIMUM,  THE  ESSENTIAL  PEDIATRIC   DENTAL   BENEFITS
   13  PRESCRIBED  BY  THE  SECRETARY  PURSUANT TO SECTION 1302(B)(1)(J) OF THE
   14  FEDERAL ACT, AND SUCH OTHER DENTAL BENEFITS AS THE EXCHANGE OR SECRETARY
   15  MAY SPECIFY IN REGULATIONS.
   16    (C) INSURERS MAY  JOINTLY  OFFER  A  COMPREHENSIVE  PLAN  THROUGH  THE
   17  EXCHANGE  IN  WHICH  AN  INSURER  PROVIDES THE DENTAL BENEFITS THROUGH A
   18  QUALIFIED DENTAL PLAN AND AN INSURER PROVIDES THE OTHER BENEFITS THROUGH
   19  A QUALIFIED HEALTH PLAN, PROVIDED THAT THE PLANS ARE  PRICED  SEPARATELY
   20  AND ALSO ARE MADE AVAILABLE FOR PURCHASE SEPARATELY AT THE SAME PRICE.
   21    S  3986. REGIONAL ADVISORY COMMITTEES. 1. THERE ARE HEREBY CREATED THE
   22  NEW YORK HEALTH BENEFIT EXCHANGE REGIONAL ADVISORY COMMITTEES ("ADVISORY
   23  COMMITTEES"). ONE REGIONAL ADVISORY COMMITTEE SHALL BE ESTABLISHED WITH-
   24  IN EACH OF FIVE REGIONS, TO BE KNOWN AS  THE  "NEW  YORK  CITY  REGION,"
   25  "METROPOLITAN  SUBURBAN REGION," "NORTHERN REGION," "CENTRAL REGION" AND
   26  "WESTERN REGION." THE BOARD SHALL DETERMINE THE COUNTIES  THAT  MAKE  UP
   27  SUCH REGIONS.
   28    2. EACH REGIONAL ADVISORY COMMITTEE SHALL BE COMPRISED OF FIVE MEMBERS
   29  APPOINTED  BY  THE  GOVERNOR,  ONE  OF  WHOM SHALL BE APPOINTED UPON THE
   30  RECOMMENDATION OF THE TEMPORARY PRESIDENT OF THE SENATE AND ONE OF  WHOM
   31  SHALL  BE APPOINTED UPON THE RECOMMENDATION OF THE SPEAKER OF THE ASSEM-
   32  BLY.
   33    3. TERMS SHALL BE THREE  YEARS.    MEMBERS  SHALL  SERVE  UNTIL  THEIR
   34  SUCCESSORS ARE APPOINTED. MEMBERS MAY SERVE UP TO TWO CONSECUTIVE TERMS.
   35    4.  VACANCIES  SHALL BE FILLED IN THE SAME MANNER AS ORIGINAL APPOINT-
   36  MENTS, AND SUCCESSORS SHALL SERVE FOR THE  REMAINDER  OF  THE  UNEXPIRED
   37  TERM TO WHICH THEY ARE APPOINTED.
   38    5.  RECOMMENDATIONS  BY  THE TEMPORARY PRESIDENT OF THE SENATE AND THE
   39  SPEAKER OF THE ASSEMBLY SHALL BE MADE WITHIN SIXTY DAYS OF THE EFFECTIVE
   40  DATE OF THIS ARTICLE OR THE OCCURRENCE OF A  VACANCY,  OR  WITHIN  SIXTY
   41  DAYS PRIOR TO THE EXPIRATION OF A TERM.
   42    6. THE MEMBERS OF EACH REGIONAL ADVISORY COMMITTEE SHALL INCLUDE:
   43    (A)  REPRESENTATIVES  FROM THE FOLLOWING CATEGORIES, BUT NOT MORE THAN
   44  TWO FROM ANY SINGLE CATEGORY:
   45    (I) HEALTH PLAN CONSUMER ADVOCATES;
   46    (II) SMALL BUSINESS CONSUMER REPRESENTATIVES;
   47    (III) HEALTH CARE PROVIDER REPRESENTATIVES;
   48    (IV) REPRESENTATIVES OF THE HEALTH INSURANCE INDUSTRY;
   49    (B) REPRESENTATIVES FROM THE FOLLOWING CATEGORIES, BUT NOT  MORE  THAN
   50  ONE FROM EITHER CATEGORY:
   51    (I) LICENSED INSURANCE PRODUCERS; AND
   52    (II) REPRESENTATIVES OF LABOR ORGANIZATIONS.
   53    7.  THE BOARD SHALL SELECT THE CHAIR OF EACH REGIONAL ADVISORY COMMIT-
   54  TEE FROM AMONG THE MEMBERS OF SUCH  COMMITTEE.  THE  BOARD  SHALL  ADOPT
   55  RULES  FOR  THE  GOVERNANCE OF THE REGIONAL ADVISORY COMMITTEES AND EACH
       A. 8514                            12

    1  REGIONAL ADVISORY COMMITTEE SHALL MEET AT LEAST ONCE EACH QUARTER AND AT
    2  SUCH OTHER TIMES AS DETERMINED BY THE BOARD TO BE NECESSARY.
    3    8.  MEMBERS  OF  THE  REGIONAL ADVISORY COMMITTEES SHALL SERVE WITHOUT
    4  COMPENSATION.
    5    9. THE REGIONAL ADVISORY COMMITTEES SHALL MAKE FINDINGS AND  RECOMMEN-
    6  DATIONS  REGARDING REGIONAL VARIATIONS IN THE OPERATION OF THE EXCHANGE,
    7  WHICH SHALL BE SUBMITTED TO  THE  BOARD  OF  DIRECTORS,  POSTED  ON  THE
    8  WEBSITE  OF  THE  EXCHANGE,  AND CONSIDERED BY THE BOARD IN A REASONABLY
    9  TIMELY FASHION. SUCH FINDINGS AND RECOMMENDATIONS SHALL BE  MADE  ON  AN
   10  ANNUAL BASIS, ON A DATE DETERMINED BY THE BOARD, AND AT SUCH OTHER TIMES
   11  AS THE BOARD OR ANY REGIONAL ADVISORY COMMITTEE DEEMS APPROPRIATE.
   12    S 3987. FUNDING OF THE EXCHANGE.  1. THE EXCHANGE SHALL BE FINANCIALLY
   13  SELF-SUFFICIENT BY JANUARY FIRST, TWO THOUSAND FIFTEEN.
   14    2. THE EXCHANGE SHALL CONDUCT OR CAUSE TO BE CONDUCTED A STUDY OF, AND
   15  SHALL  REPORT  ITS  FINDINGS  AND  RECOMMENDATIONS  UPON, THE OPTIONS TO
   16  GENERATE FUNDING FOR THE ONGOING OPERATION OF THE EXCHANGE, AS  PROVIDED
   17  FOR  IN SUBDIVISION EIGHT OF SECTION THIRTY-NINE HUNDRED EIGHTY-EIGHT OF
   18  THIS ARTICLE.
   19    3.  THE EXCHANGE SHALL PUBLISH ON ITS INTERNET WEBSITE  THE  FEES  AND
   20  ANY  OTHER  PAYMENTS  REQUIRED  BY  THE EXCHANGE, AND THE ADMINISTRATIVE
   21  COSTS OF THE EXCHANGE, TO EDUCATE CONSUMERS ON SUCH COSTS AND THE AMOUNT
   22  OF MONIES LOST TO WASTE, FRAUD AND ABUSE.
   23    4. THE EXCHANGE SHALL NOT UTILIZE ANY FUNDS INTENDED FOR THE  ADMINIS-
   24  TRATIVE  AND  OPERATIONAL  EXPENSES  OF THE EXCHANGE FOR STAFF RETREATS,
   25  PROMOTIONAL GIVEAWAYS, EXCESSIVE EXECUTIVE COMPENSATION, OR PROMOTION OF
   26  FEDERAL OR STATE LEGISLATIVE AND REGULATORY  MODIFICATIONS  PURSUANT  TO
   27  SECTION 1411(C) OF THE FEDERAL ACT.
   28    5.  THE  MONEYS OF THE EXCHANGE SHALL, EXCEPT AS OTHERWISE PROVIDED IN
   29  THIS SECTION, BE DEPOSITED IN A GENERAL  ACCOUNT  CALLED  THE  NEW  YORK
   30  HEALTH  BENEFIT EXCHANGE ACCOUNT AND SUCH OTHER ACCOUNTS AS THE EXCHANGE
   31  MAY DEEM NECESSARY, PURSUANT TO RESOLUTION OF THE BOARD, FOR THE  TRANS-
   32  ACTION  OF ITS BUSINESS AND SHALL BE PAID OUT AS AUTHORIZED BY THE CHAIR
   33  OF THE BOARD OR BY SUCH OTHER PERSON OR PERSONS AS THE CHAIR MAY  DESIG-
   34  NATE.
   35    6.  NO  FUNDS OF THE EXCHANGE SHALL BE TRANSFERRED TO THE GENERAL FUND
   36  OR ANY SPECIAL REVENUE FUND OR SHALL BE USED FOR ANY PURPOSE OTHER  THAN
   37  THE  PURPOSES  SET FORTH IN THIS ARTICLE.  NO FUNDS SHALL BE TRANSFERRED
   38  FROM THE GENERAL FUND OR ANY SPECIAL REVENUE FUND TO THE EXCHANGE  WITH-
   39  OUT AN APPROPRIATION.
   40    7. THE ACCOUNTS OF THE EXCHANGE SHALL BE SUBJECT TO SUPERVISION OF THE
   41  COMPTROLLER  AND  SUCH  ACCOUNTS  SHALL  INCLUDE RECEIPTS, EXPENDITURES,
   42  CONTRACTS AND OTHER MATTERS WHICH PERTAIN TO THE FISCAL SOUNDNESS OF THE
   43  EXCHANGE.
   44    8. NOTWITHSTANDING ANY LAW TO THE CONTRARY,  AND  IN  ACCORDANCE  WITH
   45  SECTION  FOUR  OF THE STATE FINANCE LAW, UPON REQUEST OF THE DIRECTOR OF
   46  THE BUDGET, IN CONSULTATION WITH THE  COMMISSIONER,  THE  SUPERINTENDENT
   47  AND  THE  CHAIR  OF  THE BOARD, THE COMPTROLLER IS HEREBY AUTHORIZED AND
   48  DIRECTED TO SUBALLOCATE OR TRANSFER SPECIAL REVENUE FEDERAL FUNDS APPRO-
   49  PRIATED TO THE DEPARTMENT OF HEALTH FOR PLANNING AND IMPLEMENTING  VARI-
   50  OUS  HEALTHCARE  AND  INSURANCE REFORM INITIATIVES AUTHORIZED BY FEDERAL
   51  LEGISLATION, INCLUDING, BUT NOT LIMITED TO, THE PATIENT  PROTECTION  AND
   52  AFFORDABLE  CARE  ACT  (P.L.  111-148) AND THE HEALTH CARE AND EDUCATION
   53  RECONCILIATION ACT OF 2010 (P.L. 111-152) TO THE NEW YORK  STATE  HEALTH
   54  BENEFIT  EXCHANGE.  MONEYS  SUBALLOCATED OR TRANSFERRED PURSUANT TO THIS
   55  SECTION SHALL BE PAID OUT OF THE FUND UPON  AUDIT  AND  WARRANT  OF  THE
   56  STATE COMPTROLLER ON VOUCHERS CERTIFIED OR APPROVED BY THE EXCHANGE.
       A. 8514                            13

    1    S  3988.  STUDIES,  FINDINGS AND RECOMMENDATIONS.  1. (A) THE EXCHANGE
    2  SHALL CONDUCT OR CAUSE TO BE CONDUCTED A STUDY OF, AND SHALL MAKE  FIND-
    3  INGS  AND RECOMMENDATIONS UPON, THE ESSENTIAL HEALTH BENEFITS IDENTIFIED
    4  BY THE SECRETARY PURSUANT TO SECTION 1302(B) OF THE FEDERAL ACT  AND  OF
    5  THE BENEFITS REQUIRED UNDER THE INSURANCE LAW OR REGULATIONS PROMULGATED
    6  THEREUNDER  THAT  ARE  NOT  DETERMINED  BY THE SECRETARY TO BE ESSENTIAL
    7  HEALTH BENEFITS. SUCH STUDY, FINDINGS AND RECOMMENDATIONS SHALL  ADDRESS
    8  MATTERS INCLUDING BUT NOT LIMITED TO:
    9    (I)  WHETHER  THE ESSENTIAL HEALTH BENEFITS REQUIRED TO BE INCLUDED IN
   10  POLICIES AND CONTRACTS SOLD THROUGH THE EXCHANGE SHOULD BE SOLD TO SIMI-
   11  LARLY SITUATED INDIVIDUALS AND GROUPS PURCHASING COVERAGE OUTSIDE OF THE
   12  EXCHANGE;
   13    (II) WHETHER ANY BENEFITS REQUIRED UNDER THE INSURANCE  LAW  OR  REGU-
   14  LATIONS  PROMULGATED  THEREUNDER  THAT  ARE  NOT IDENTIFIED AS ESSENTIAL
   15  HEALTH BENEFITS BY THE SECRETARY SHOULD NO LONGER BE REQUIRED  IN  POLI-
   16  CIES OR CONTRACTS SOLD EITHER THROUGH THE EXCHANGE OR TO SIMILARLY SITU-
   17  ATED INDIVIDUALS AND GROUPS OUTSIDE OF THE EXCHANGE;
   18    (III) THE COSTS OF EXTENDING ANY BENEFITS REQUIRED UNDER THE INSURANCE
   19  LAW OR REGULATIONS PROMULGATED THEREUNDER TO POLICIES AND CONTRACTS SOLD
   20  THROUGH THE EXCHANGE; AND
   21    (IV)   MECHANISMS   TO   FINANCE   ANY   COSTS   PURSUANT  TO  SECTION
   22  1311(D)(3)(B)(II) OF THE FEDERAL ACT OF EXTENDING ANY BENEFITS  REQUIRED
   23  UNDER  THE  INSURANCE LAW OR REGULATIONS PROMULGATED THEREUNDER TO POLI-
   24  CIES AND CONTRACTS SOLD THROUGH THE EXCHANGE.
   25    (B) IN MAKING ITS FINDINGS AND  RECOMMENDATIONS,  THE  EXCHANGE  SHALL
   26  CONSIDER  THE INDIVIDUAL AND SMALL GROUP MARKETS OUTSIDE OF THE EXCHANGE
   27  AND  CONSIDER  APPROACHES  TO  PREVENT  MARKETPLACE  DISRUPTION,  REMAIN
   28  CONSISTENT WITH THE EXCHANGE AND AVOID ANTI-SELECTION.
   29    (C) THE EXCHANGE SHALL SUBMIT A REPORT OF ITS FINDINGS AND RECOMMENDA-
   30  TIONS  TO  THE  GOVERNOR,  THE TEMPORARY PRESIDENT OF THE SENATE AND THE
   31  SPEAKER OF THE ASSEMBLY ON OR BEFORE APRIL FIRST, TWO THOUSAND TWELVE.
   32    2. (A) THE EXCHANGE SHALL CONDUCT OR CAUSE TO BE CONDUCTED A STUDY OF,
   33  AND SHALL MAKE FINDINGS AND RECOMMENDATIONS UPON: (I)  WHETHER  INSURERS
   34  PARTICIPATING  IN  THE  EXCHANGE  SHOULD BE REQUIRED TO OFFER ALL HEALTH
   35  PLANS SOLD IN THE EXCHANGE TO INDIVIDUALS  OR  SMALL  GROUPS  PURCHASING
   36  COVERAGE OUTSIDE OF THE EXCHANGE;
   37    (II)  WHETHER  THE INDIVIDUAL AND SMALL GROUP MARKETS SHOULD BE PLACED
   38  ENTIRELY INSIDE THE EXCHANGE;
   39    (III) WHETHER THE BENEFITS IN THE INDIVIDUAL AND SMALL  GROUP  MARKETS
   40  SHOULD  BE  STANDARDIZED  INSIDE  THE EXCHANGE OR INSIDE AND OUTSIDE THE
   41  EXCHANGE;
   42    (IV) HOW TO DEVELOP AND IMPLEMENT THE TRANSITIONAL REINSURANCE PROGRAM
   43  FOR THE INDIVIDUAL MARKET  AND  ANY  OTHER  RISK  ADJUSTMENT  MECHANISMS
   44  DEVELOPED IN ACCORDANCE WITH SECTIONS 1341, 1342 AND 1343 OF THE FEDERAL
   45  ACT;
   46    (V)  WHETHER  TO MERGE THE INDIVIDUAL AND SMALL GROUP HEALTH INSURANCE
   47  MARKETS FOR RATING PURPOSES INCLUDING AN ANALYSIS  OF  THE  IMPACT  SUCH
   48  MERGER WOULD HAVE ON PREMIUMS;
   49    (VI)  WHETHER  TO INCREASE THE SIZE OF SMALL EMPLOYERS FROM AN AVERAGE
   50  OF AT LEAST ONE BUT NOT MORE THAN FIFTY EMPLOYEES TO AN  AVERAGE  OF  AT
   51  LEAST  ONE  BUT  NOT  MORE  THAN  ONE HUNDRED EMPLOYEES PRIOR TO JANUARY
   52  FIRST, TWO THOUSAND SIXTEEN;
   53    (VII) HOW TO ACCOUNT FOR SOLE PROPRIETORS IN DEFINING  "SMALL  EMPLOY-
   54  ERS"; AND
       A. 8514                            14

    1    (VIII)  WHETHER  TO  REVISE THE DEFINITION OF "SMALL EMPLOYER" OUTSIDE
    2  THE EXCHANGE TO BE CONSISTENT WITH THE DEFINITION AS IT  APPLIES  WITHIN
    3  THE EXCHANGE.
    4    (B) THE EXCHANGE SHALL SUBMIT A REPORT OF ITS FINDINGS AND RECOMMENDA-
    5  TIONS  TO  THE  GOVERNOR,  THE TEMPORARY PRESIDENT OF THE SENATE AND THE
    6  SPEAKER OF THE ASSEMBLY ON OR BEFORE APRIL FIRST, TWO THOUSAND TWELVE.
    7    3. (A) THE EXCHANGE SHALL CONDUCT OR CAUSE TO BE CONDUCTED A STUDY OF,
    8  AND SHALL MAKE FINDINGS AND  RECOMMENDATIONS  UPON,  WHETHER  THE  STATE
    9  SHOULD ESTABLISH A BASIC HEALTH PLAN PROGRAM IDENTIFIED BY THE SECRETARY
   10  PURSUANT TO SECTION 1331 OF THE FEDERAL ACT.
   11    (B) THE EXCHANGE SHALL SUBMIT A REPORT OF ITS FINDINGS AND RECOMMENDA-
   12  TIONS  TO  THE  GOVERNOR,  THE TEMPORARY PRESIDENT OF THE SENATE AND THE
   13  SPEAKER OF THE ASSEMBLY ON OR BEFORE APRIL FIRST, TWO THOUSAND TWELVE.
   14    4. (A) THE EXCHANGE SHALL CONDUCT OR CAUSE TO BE CONDUCTED A STUDY OF,
   15  AND SHALL MAKE FINDINGS AND RECOMMENDATIONS  UPON,  THE  ADVANTAGES  AND
   16  DISADVANTAGES  OF  THE EXCHANGE SERVING AS AN ACTIVE PURCHASER, A SELEC-
   17  TIVE CONTRACTOR, OR CLEARINGHOUSE OF INSURANCE.
   18    (B) THE EXCHANGE SHALL SUBMIT A REPORT OF ITS FINDINGS AND RECOMMENDA-
   19  TIONS TO THE GOVERNOR, THE TEMPORARY PRESIDENT OF  THE  SENATE  AND  THE
   20  SPEAKER OF THE ASSEMBLY ON OR BEFORE APRIL FIRST, TWO THOUSAND TWELVE.
   21    5. (A) THE EXCHANGE SHALL CONDUCT OR CAUSE TO BE CONDUCTED A STUDY OF,
   22  AND  SHALL  MAKE  FINDINGS AND RECOMMENDATIONS UPON, (I) THE ANTICIPATED
   23  ANNUAL OPERATING EXPENSES OF THE EXCHANGE, INCLUDING BUT NOT LIMITED  TO
   24  THE DEVELOPMENT OF ANY MULTI-YEAR FINANCIAL MODELS; AND (II) THE OPTIONS
   25  TO  GENERATE  FUNDING  FOR THE ONGOING OPERATION AND SELF-SUFFICIENCY OF
   26  THE EXCHANGE INCLUDING BUT NOT LIMITED TO ASSESSMENTS UPON INSURERS  AND
   27  PROVIDERS.
   28    (B) THE EXCHANGE SHALL SUBMIT A REPORT OF ITS FINDINGS AND RECOMMENDA-
   29  TIONS  TO  THE  GOVERNOR,  THE TEMPORARY PRESIDENT OF THE SENATE AND THE
   30  SPEAKER OF THE ASSEMBLY ON OR BEFORE APRIL FIRST, TWO THOUSAND TWELVE.
   31    6. (A) THE EXCHANGE SHALL CONDUCT OR CAUSE TO BE CONDUCTED A STUDY OF,
   32  AND SHALL MAKE FINDINGS AND RECOMMENDATIONS UPON, THE BENCHMARK BENEFITS
   33  IDENTIFIED BY THE SECRETARY AND  OF  THE  BENEFITS  REQUIRED  UNDER  THE
   34  PUBLIC  HEALTH LAW OR THE SOCIAL SERVICES LAW OR REGULATIONS PROMULGATED
   35  THEREUNDER THAT ARE NOT DETERMINED BY  THE  SECRETARY  TO  BE  BENCHMARK
   36  BENEFITS. SUCH STUDY, FINDINGS AND RECOMMENDATIONS SHALL ADDRESS MATTERS
   37  INCLUDING BUT NOT LIMITED TO:
   38    (I)  WHETHER  ANY BENEFITS REQUIRED UNDER THE PUBLIC HEALTH LAW OR THE
   39  SOCIAL SERVICES LAW OR REGULATIONS PROMULGATED THEREUNDER THAT  ARE  NOT
   40  IDENTIFIED  AS BENCHMARK BENEFITS BY THE SECRETARY SHOULD CONTINUE TO BE
   41  REQUIRED AS COVERED BENEFITS AVAILABLE TO NEWLY MEDICAID-ELIGIBLE  INDI-
   42  VIDUALS INSIDE THE EXCHANGE;
   43    (II)  THE  COSTS  OF  EXTENDING ANY BENEFITS REQUIRED UNDER THE PUBLIC
   44  HEALTH LAW OR THE SOCIAL SERVICES LAW OR REGULATIONS PROMULGATED  THERE-
   45  UNDER  AS COVERED BENEFITS AVAILABLE TO NEWLY MEDICAID-ELIGIBLE INDIVID-
   46  UALS THROUGH THE EXCHANGE; AND
   47    (III) MECHANISMS TO FINANCE ANY COSTS PURSUANT TO THE FEDERAL  ACT  OF
   48  EXTENDING  ANY  BENEFITS  REQUIRED  UNDER  THE  PUBLIC HEALTH LAW OR THE
   49  SOCIAL SERVICES LAW OR REGULATIONS PROMULGATED  THEREUNDER  TO  POLICIES
   50  AND CONTRACTS SOLD THROUGH THE EXCHANGE.
   51    (B) THE EXCHANGE SHALL SUBMIT A REPORT OF ITS FINDINGS AND RECOMMENDA-
   52  TIONS  TO  THE  GOVERNOR,  THE TEMPORARY PRESIDENT OF THE SENATE AND THE
   53  SPEAKER OF THE ASSEMBLY ON OR BEFORE APRIL FIRST, TWO THOUSAND TWELVE.
   54    7. (A) THE EXCHANGE SHALL MAKE RECOMMENDATIONS UPON THE IMPACT OF  THE
   55  ESTABLISHMENT  AND  OPERATION  OF  THE  EXCHANGE ON THE HEALTHY NEW YORK
   56  PROGRAM ESTABLISHED PURSUANT TO SECTION FORTY-THREE  HUNDRED  TWENTY-SIX
       A. 8514                            15

    1  OF  THE  INSURANCE  LAW  AND THE FAMILY HEALTH PLUS EMPLOYER PARTNERSHIP
    2  PROGRAM ESTABLISHED PURSUANT TO SECTION THREE HUNDRED  SIXTY-NINE-FF  OF
    3  THE SOCIAL SERVICES LAW.
    4    (B) THE EXCHANGE SHALL NOTIFY THE GOVERNOR, THE TEMPORARY PRESIDENT OF
    5  THE  SENATE AND THE SPEAKER OF THE ASSEMBLY OF ITS RECOMMENDATIONS ON OR
    6  BEFORE APRIL FIRST, TWO THOUSAND TWELVE.
    7    8. (A) THE BOARD SHALL CONDUCT OR CAUSE TO BE CONDUCTED  A  STUDY  OF,
    8  AND SHALL MAKE FINDINGS AND RECOMMENDATIONS UPON, PROCEDURES UNDER WHICH
    9  LICENSED  HEALTH  INSURANCE PRODUCERS, CHAMBERS OF COMMERCE AND BUSINESS
   10  ASSOCIATIONS MAY ENROLL  INDIVIDUALS  AND  EMPLOYERS  IN  ANY  QUALIFIED
   11  HEALTH  PLAN IN THE INDIVIDUAL OR SMALL GROUP MARKET AS SOON AS THE PLAN
   12  IS OFFERED THROUGH THE EXCHANGE; AND TO ASSIST INDIVIDUALS  IN  APPLYING
   13  FOR  PREMIUM  TAX  CREDITS  AND  COST-SHARING  REDUCTIONS FOR PLANS SOLD
   14  THROUGH THE EXCHANGE; AND
   15    (B) THE BOARD SHALL SUBMIT A REPORT OF ITS  FINDINGS  AND  RECOMMENDA-
   16  TIONS TO THE GOVERNOR, THE TEMPORARY PRESIDENT OF THE SENATE AND SPEAKER
   17  OF THE ASSEMBLY ON OR BEFORE APRIL FIRST, TWO THOUSAND TWELVE.
   18    9. (A) THE EXCHANGE SHALL CONDUCT OR CAUSE TO BE CONDUCTED A STUDY OF,
   19  AND  SHALL  MAKE  FINDINGS  AND  RECOMMENDATIONS  UPON, THE CRITERIA FOR
   20  ELIGIBILITY TO SERVE AS A NAVIGATOR FOR PURPOSES OF SECTION  1311(I)  OF
   21  THE FEDERAL ACT, ANY GUIDANCE ISSUED THEREUNDER AND SUBDIVISION FOURTEEN
   22  OF SECTION THIRTY-NINE HUNDRED EIGHTY-FOUR OF THIS ARTICLE.
   23    (B) THE EXCHANGE SHALL SUBMIT A REPORT OF ITS FINDINGS AND RECOMMENDA-
   24  TIONS  TO  THE  GOVERNOR,  THE TEMPORARY PRESIDENT OF THE SENATE AND THE
   25  SPEAKER OF THE ASSEMBLY ON OR BEFORE APRIL FIRST, TWO THOUSAND TWELVE.
   26    10. (A) THE EXCHANGE SHALL CONDUCT OR CAUSE TO BE  CONDUCTED  A  STUDY
   27  OF,  AND  SHALL  MAKE FINDINGS AND RECOMMENDATIONS UPON, THE ROLE OF THE
   28  EXCHANGE IN DECREASING HEALTH DISPARITIES IN HEALTH  CARE  SERVICES  AND
   29  PERFORMANCE,  INCLUDING  BUT  NOT LIMITED TO DISPARITIES ON THE BASIS OF
   30  RACE OR ETHNICITY, IN ACCORDANCE WITH SECTION FORTY-THREE HUNDRED TWO OF
   31  THE FEDERAL ACT.
   32    (B) THE EXCHANGE SHALL SUBMIT A REPORT OF ITS FINDINGS AND RECOMMENDA-
   33  TIONS TO THE GOVERNOR, THE TEMPORARY PRESIDENT OF  THE  SENATE  AND  THE
   34  SPEAKER OF THE ASSEMBLY ON OR BEFORE APRIL FIRST, TWO THOUSAND TWELVE.
   35    11.  (A)  THE  EXCHANGE SHALL MAKE RECOMMENDATIONS UPON WHETHER AND TO
   36  WHAT EXTENT HEALTH  SAVINGS  ACCOUNTS  SHOULD  BE  OFFERED  THROUGH  THE
   37  EXCHANGE.
   38    (B) THE EXCHANGE SHALL NOTIFY THE GOVERNOR, THE TEMPORARY PRESIDENT OF
   39  THE  SENATE AND THE SPEAKER OF THE ASSEMBLY OF ITS RECOMMENDATIONS ON OR
   40  BEFORE APRIL FIRST, TWO THOUSAND TWELVE.
   41    12. (A) THE EXCHANGE SHALL CONDUCT OR CAUSE TO BE  CONDUCTED  A  STUDY
   42  OF,  AND  SHALL MAKE FINDINGS AND RECOMMENDATIONS UPON, WHETHER TO ALLOW
   43  LARGE EMPLOYERS TO PARTICIPATE IN THE EXCHANGE BEGINNING JANUARY  FIRST,
   44  TWO THOUSAND SEVENTEEN, AND SHALL TAKE INTO ACCOUNT ANY EXCESS OF PREMI-
   45  UM GROWTH OUTSIDE OF THE EXCHANGE AS COMPARED TO THE RATE OF SUCH GROWTH
   46  INSIDE THE EXCHANGE.
   47    (B) THE EXCHANGE SHALL SUBMIT A REPORT OF ITS FINDINGS AND RECOMMENDA-
   48  TIONS  TO  THE  GOVERNOR,  THE TEMPORARY PRESIDENT OF THE SENATE AND THE
   49  SPEAKER OF THE ASSEMBLY  ON  OR  BEFORE  DECEMBER  FIRST,  TWO  THOUSAND
   50  SIXTEEN.
   51    13.  THE EXCHANGE SHALL CONDUCT, OR CAUSE TO BE CONDUCTED, A STUDY OF,
   52  AND SHALL MAKE FINDINGS AND RECOMMENDATIONS  UPON,  THE  INTEGRATION  OF
   53  PUBLIC HEALTH INSURANCE PROGRAMS, INCLUDING MEDICAID, CHILD HEALTH PLUS,
   54  AND  FAMILY  HEALTH  PLUS  WITHIN  THE  EXCHANGE, WHICH MAY INCLUDE SUCH
   55  REPORTS AS ARE PERIODICALLY SUBMITTED TO THE  SECRETARY,  ON  OR  BEFORE
   56  APRIL FIRST, TWO THOUSAND TWELVE.
       A. 8514                            16

    1    14. NOTWITHSTANDING ANY PROVISION OF SUBDIVISIONS ONE THROUGH THIRTEEN
    2  OF  THIS SECTION, IF THE BOARD DETERMINES THAT ANY REPORT REQUIRED UNDER
    3  ANY SUCH SUBDIVISION CANNOT BE COMPLETED AND SUBMITTED BY THE  SPECIFIED
    4  DATE, BECAUSE FEDERAL GUIDANCE OR REGULATIONS NECESSARY TO COMPLETE SUCH
    5  REPORT HAS NOT BEEN ISSUED, THE BOARD MAY ESTABLISH A NEW AND REASONABLE
    6  DATE FOR SUCH COMPLETION AND SUBMISSION.
    7    15.  ANY OF THE STUDIES AND REPORTS REQUIRED UNDER THIS SECTION MAY BE
    8  COMBINED WITH OTHER STUDIES AND REPORTS REQUIRED UNDER THIS  SECTION  OR
    9  OTHERWISE UNDERTAKEN BY THE EXCHANGE TO THE EXTENT FEASIBLE AND TIMELY.
   10    16.  THE EXCHANGE SHALL HAVE NO AUTHORITY, WHETHER EXPRESS OR IMPLIED,
   11  TO IMPLEMENT ANY RECOMMENDATION ON THE ISSUES SET FORTH IN  SUBDIVISIONS
   12  ONE  THROUGH TWELVE OF THIS SECTION WITHOUT FURTHER STATUTORY AUTHORITY;
   13  PROVIDED, HOWEVER, THAT NOTHING IN THIS SUBDIVISION SHALL BE  DEEMED  TO
   14  ALTER ANY POWERS EXPRESSLY GRANTED ELSEWHERE IN THIS ARTICLE.
   15    S  3989. TAX EXEMPTION AND TAX CONTRACT BY THE STATE.  1. IT IS HEREBY
   16  DETERMINED THAT THE CREATION OF THE EXCHANGE AND THE FULFILLMENT OF  ITS
   17  CORPORATE  PURPOSES  IS IN ALL RESPECTS FOR THE BENEFIT OF THE PEOPLE OF
   18  THIS STATE AND IS A PUBLIC PURPOSE. ACCORDINGLY, THE EXCHANGE  SHALL  BE
   19  REGARDED  AS  PERFORMING AN ESSENTIAL GOVERNMENTAL FUNCTION IN THE EXER-
   20  CISE OF THE POWERS CONFERRED UPON IT BY THIS ARTICLE, AND  THE  EXCHANGE
   21  SHALL  NOT BE REQUIRED TO PAY ANY FEES, TAXES, SPECIAL AD VALOREM LEVIES
   22  OR ASSESSMENTS OF ANY KIND, WHETHER STATE OR LOCAL,  INCLUDING  BUT  NOT
   23  LIMITED TO FEES, TAXES, SPECIAL AD VALOREM LEVIES OR ASSESSMENTS ON REAL
   24  PROPERTY,  FRANCHISE  TAXES, SALES TAXES, TRANSFER TAXES, MORTGAGE TAXES
   25  OR OTHER TAXES, UPON OR WITH RESPECT TO ANY  PROPERTY  OWNED  BY  IT  OR
   26  UNDER  ITS JURISDICTION, CONTROL OR SUPERVISION, OR UPON THE USES THERE-
   27  OF, OR UPON OR WITH RESPECT TO ITS ACTIVITIES OR OPERATIONS IN  FURTHER-
   28  ANCE  OF  THE  POWERS CONFERRED UPON IT BY THIS ARTICLE, OR UPON OR WITH
   29  RESPECT TO ANY FARES, TOLLS, RENTALS, RATES, CHARGES, FEES, REVENUES  OR
   30  OTHER INCOME RECEIVED BY THE EXCHANGE.
   31    2.  THE EXCHANGE MAY PAY, OR MAY ENTER INTO AGREEMENTS WITH ANY COUNTY
   32  OR MUNICIPALITY TO PAY, A SUM  OR  SUMS  ANNUALLY  OR  OTHERWISE  OR  TO
   33  PROVIDE  OTHER CONSIDERATIONS WITH RESPECT TO REAL PROPERTY OWNED BY THE
   34  EXCHANGE LOCATED WITHIN SUCH COUNTY OR MUNICIPALITY.
   35    S 3990. OFFICERS AND EMPLOYEES. 1. THE BOARD SHALL HAVE THE  POWER  TO
   36  APPOINT EMPLOYEES TO SERVE AS SENIOR MANAGERIAL STAFF OF THE EXCHANGE AS
   37  NECESSARY,  WHO  SHALL  BE DESIGNATED TO BE IN THE EXEMPT CLASS OF CIVIL
   38  SERVICE. THE BOARD SHALL ALSO HAVE THE POWER TO FIX THE SALARIES OF SUCH
   39  EMPLOYEES.
   40    2. ANY NEWLY HIRED EMPLOYEES WHO ARE  NOT  DESIGNATED  TO  BE  IN  THE
   41  EXEMPT  CLASS  OF  CIVIL  SERVICE  PURSUANT  TO  SUBDIVISION ONE OF THIS
   42  SECTION AND WHO ARE NOT SUBJECT TO THE TRANSFER PROVISIONS SET FORTH  IN
   43  SUBDIVISIONS  FOUR, FIVE AND SIX OF THIS SECTION SHALL BE CONSIDERED FOR
   44  PURPOSES OF ARTICLE FOURTEEN OF THE  CIVIL  SERVICE  LAW  TO  BE  PUBLIC
   45  EMPLOYEES  IN  THE  CIVIL SERVICE OF THE STATE, AND SHALL BE ASSIGNED TO
   46  THE APPROPRIATE COLLECTIVE BARGAINING UNIT BY THE EXCHANGE IN  THE  SAME
   47  MANNER  AND CONSISTENT WITH THOSE EMPLOYEES DESCRIBED IN SUBDIVISION SIX
   48  OF THIS SECTION.
   49    3. ANY PUBLIC OFFICER OR EMPLOYEE OF A  STATE  DEPARTMENT,  AGENCY  OR
   50  COMMISSION  MAY  BE  TRANSFERRED TO THE EXCHANGE WITHOUT EXAMINATION AND
   51  WITHOUT LOSS OF ANY CIVIL SERVICE  STATUS  OR  RIGHTS  TO  A  COMPARABLE
   52  OFFICE,  POSITION OR EMPLOYMENT WITH THE EXCHANGE; PROVIDED, HOWEVER, NO
   53  SUCH TRANSFER MAY BE MADE WITHOUT THE CONSENT OF THE HEAD OF THE DEPART-
   54  MENT, AGENCY OR COMMISSION.  TRANSFERS SHALL BE MADE PURSUANT TO  SUBDI-
   55  VISION TWO OF SECTION SEVENTY OF THE CIVIL SERVICE LAW.
       A. 8514                            17

    1    4.  THE  SALARY OR COMPENSATION OF ANY SUCH OFFICER OR EMPLOYEE, AFTER
    2  SUCH TRANSFER, SHALL BE PAID BY THE EXCHANGE.
    3    5.  ANY  OFFICER  OR  EMPLOYEE TRANSFERRED TO THE EXCHANGE PURSUANT TO
    4  THIS SECTION, WHO ARE MEMBERS OF OR BENEFIT UNDER ANY  EXISTING  PENSION
    5  OR  RETIREMENT FUND OR SYSTEM, SHALL CONTINUE TO HAVE ALL RIGHTS, PRIVI-
    6  LEGES, OBLIGATIONS AND STATUS WITH RESPECT TO SUCH FUND OR SYSTEM AS ARE
    7  NOW PRESCRIBED BY LAW, BUT DURING THE PERIOD OF THEIR EMPLOYMENT BY  THE
    8  EXCHANGE,  ALL  CONTRIBUTIONS TO SUCH FUNDS OR SYSTEMS TO BE PAID BY THE
    9  EMPLOYER ON ACCOUNT OF SUCH OFFICERS OR EMPLOYEES SHALL BE PAID  BY  THE
   10  EXCHANGE.
   11    6. A TRANSFERRED EMPLOYEE SHALL REMAIN IN THE SAME COLLECTIVE BARGAIN-
   12  ING UNIT AS WAS THE CASE PRIOR TO HIS OR HER TRANSFER; SUCCESSOR EMPLOY-
   13  EES  TO THE POSITIONS HELD BY SUCH TRANSFERRED EMPLOYEES SHALL, CONSIST-
   14  ENT WITH THE PROVISIONS OF ARTICLE FOURTEEN OF THE CIVIL SERVICE LAW, BE
   15  INCLUDED IN THE SAME UNIT AS THEIR PREDECESSORS.  EMPLOYEES  SERVING  IN
   16  POSITIONS  IN NEWLY CREATED TITLES SHALL BE ASSIGNED TO THE SAME COLLEC-
   17  TIVE BARGAINING UNIT AS THEY WOULD  HAVE  BEEN  ASSIGNED  TO  WERE  SUCH
   18  TITLES  CREATED  PRIOR  TO  THE  ESTABLISHMENT  OF THE EXCHANGE. NOTHING
   19  CONTAINED IN THIS ARTICLE SHALL BE CONSTRUED (A) TO DIMINISH THE  RIGHTS
   20  OF  EMPLOYEES  PURSUANT  TO  A COLLECTIVE BARGAINING AGREEMENT OR (B) TO
   21  AFFECT EXISTING LAW WITH RESPECT TO AN APPLICATION TO THE PUBLIC EMPLOY-
   22  MENT RELATIONS BOARD SEEKING A DESIGNATION BY  THE  BOARD  THAT  CERTAIN
   23  PERSONS ARE MANAGERIAL OR CONFIDENTIAL.
   24    S  3991.  LIMITATION OF LIABILITY; INDEMNIFICATION.  THE PROVISIONS OF
   25  SECTIONS SEVENTEEN AND NINETEEN OF THE  PUBLIC  OFFICERS  LAW  SHALL  BE
   26  APPLICABLE  TO  EXCHANGE  EMPLOYEES, AS SUCH TERM IS DEFINED IN SECTIONS
   27  SEVENTEEN AND NINETEEN OF THE PUBLIC OFFICERS  LAW;  PROVIDED,  HOWEVER,
   28  THAT NOTHING CONTAINED WITHIN THIS SECTION SHALL BE DEEMED TO PERMIT THE
   29  EXCHANGE  TO EXTEND THE PROVISIONS OF SECTIONS SEVENTEEN AND NINETEEN OF
   30  THE PUBLIC OFFICERS LAW UPON ANY INDEPENDENT CONTRACTOR.
   31    S 3992. CONTINGENCY FOR FEDERAL FUNDING.   THE IMPLEMENTATION  OF  THE
   32  PROVISIONS  OF  THIS  ARTICLE  SHALL BE CONTINGENT, AS DETERMINED BY THE
   33  DIRECTOR OF THE BUDGET, ON THE AVAILABILITY OF SUFFICIENT FEDERAL FINAN-
   34  CIAL SUPPORT FOR THE PLANNING AND  IMPLEMENTATION  OF  HEALTH  CARE  AND
   35  INSURANCE REFORM INITIATIVES AUTHORIZED BY FEDERAL LEGISLATION TO ESTAB-
   36  LISH AND IMPLEMENT THE HEALTH BENEFIT EXCHANGE.
   37    S 3993. CONSTRUCTION.  NOTHING IN THIS ARTICLE, AND NO ACTION TAKEN BY
   38  THE EXCHANGE PURSUANT HERETO, SHALL BE CONSTRUED TO:
   39    1.  PREEMPT  OR  SUPERSEDE  THE AUTHORITY OF THE SUPERINTENDENT OR THE
   40  COMMISSIONER; OR
   41    2. EXEMPT INSURERS, INSURANCE PRODUCERS OR QUALIFIED HEALTH PLANS FROM
   42  THE PUBLIC HEALTH LAW OR THE INSURANCE LAW AND  REGULATIONS  PROMULGATED
   43  THEREUNDER.
   44    S 3. Subdivision 1 of section 17 of the public officers law is amended
   45  by adding a new paragraph (x) to read as follows:
   46    (X)  FOR  PURPOSES  OF THIS SECTION, THE TERM "EMPLOYEE" SHALL INCLUDE
   47  DIRECTORS, OFFICERS  AND  EMPLOYEES  OF  THE  NEW  YORK  HEALTH  BENEFIT
   48  EXCHANGE ESTABLISHED PURSUANT TO ARTICLE TEN-E OF THE PUBLIC AUTHORITIES
   49  LAW.
   50    S 4. Subdivision 1 of section 19 of the public officers law is amended
   51  by adding a new paragraph (j) to read as follows:
   52    (J)  FOR  PURPOSES  OF THIS SECTION, THE TERM "EMPLOYEE" SHALL INCLUDE
   53  DIRECTORS, OFFICERS  AND  EMPLOYEES  OF  THE  NEW  YORK  HEALTH  BENEFIT
   54  EXCHANGE ESTABLISHED PURSUANT TO ARTICLE TEN-E OF THE PUBLIC AUTHORITIES
   55  LAW.
       A. 8514                            18

    1    S  5.  If any provision or application of this act shall be held to be
    2  invalid, or to violate or be inconsistent with  any  applicable  federal
    3  law  or  regulation,  that shall not affect other provisions or applica-
    4  tions of this act which can be given effect without  that  provision  or
    5  application;  and  to  that end, the provisions and applications of this
    6  act are severable; provided, however, that nothing in this section shall
    7  be deemed to invalidate the provisions of section  3992  of  the  public
    8  authorities law, as added by section two of this act.
    9    S  6. If the federal act is held to be unconstitutional by the supreme
   10  court of the United States or repealed by the  United  States  Congress,
   11  the  legislature  shall  convene  within  180  days  of such decision or
   12  congressional act to consider appropriate legislative options.
   13    S 7. This act shall take effect immediately; provided,  however,  that
   14  until such time as the members of the board of directors of the New York
   15  health benefit exchange are initially appointed pursuant to section 3982
   16  of  the public authorities law, as added by section two of this act, and
   17  the first meeting of such board is convened, nothing in this  act  shall
   18  be deemed to prevent the commissioner of health or the superintendent of
   19  insurance  or,  after  October  3, 2011, the superintendent of financial
   20  services, from applying for, accepting the award of,  and  spending  any
   21  available  grant  money  pertaining to the establishment or operation of
   22  such exchange for purposes consistent with this act  or,  at  any  time,
   23  from accepting or spending grant money awarded prior to the enactment of
   24  this act.
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