•  Summary 
  •  
  •  Actions 
  •  
  •  Floor Votes 
  •  
  •  Memo 
  •  
  •  Text 

S05652 Summary:

BILL NOS05652
 
SAME ASNo same as
 
SPONSORSEWARD
 
COSPNSRHANNON, LARKIN
 
MLTSPNSR
 
Add Art 9 Title 6-A SS2911 - 2921, Pub Auth L
 
Establishes the New York State Health Benefit exchange in accordance with the federal Patient Protection and Affordable Care Act, as amended by the federal Health Care and Education Reconciliation Act of 2010.
Go to top

S05652 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          5652
 
                               2011-2012 Regular Sessions
 
                    IN SENATE
 
                                      June 8, 2011
                                       ___________
 
        Introduced  by  Sens.  SEWARD, HANNON -- read twice and ordered printed,
          and when printed to be committed to the Committee on Rules
 
        AN ACT to amend the public authorities law, in relation to  establishing
          the  New  York  Health Benefit exchange in accordance with the federal
          Patient Protection and Affordable Care Act, as amended by the  federal

          Health Care and Education Reconciliation Act of 2010
 
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
 
     1    Section 1. Article 9 of the  public  authorities  law  is  amended  by
     2  adding a new title 6-A to read as follows:
     3                                   TITLE 6-A
     4                   NEW YORK STATE HEALTH BENEFIT EXCHANGE
     5  Section 2911. Short title.
     6          2912. Definitions.
     7          2913. Health benefit exchange.
     8          2914. Powers of the exchange.
     9          2915. Procurement.
    10          2916. Reports by the exchange.
    11          2917. Moneys of the authority.
    12          2918. Actions against the exchange.

    13          2919. Regional advisory committees.
    14          2920. Officers and employees.
    15          2921. Relation to other laws.
    16    § 2911. Short title. This title shall be known and may be cited as the
    17  "New York state health benefit exchange act".
    18    §  2912.  Definitions.  For  the  purpose of this title, the following
    19  definitions shall apply:
    20    1. "Board" or "board of directors" means the board of directors of the
    21  exchange.
    22    2. "Regional  advisory  committees"  means  New  York  health  benefit
    23  exchange advisory committees established pursuant to this title.
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.

                                                                   LBD11754-04-1

        S. 5652                             2
 
     1    3. "Commissioner" means the commissioner of health.
     2    4.  "Exchange"  means the New York health benefit exchange established
     3  pursuant to this title.
     4    5. "Federal act" means the patient protection and affordable care act,
     5  public law 111-148, as amended by the health care and  education  recon-
     6  ciliation  act of 2010, public law 111-152, and any regulations or guid-
     7  ance issued thereunder.
     8    6. "Health plan" means a policy, contract or certificate,  offered  or
     9  issued  by an insurer to provide, deliver, arrange for, pay for or reim-
    10  burse any of the costs of health care services.  "Health plan" shall not

    11  include the following:
    12    (a) Accident insurance or disability income insurance, or any combina-
    13  tion thereof;
    14    (b) Coverage issued as a supplement to liability insurance;
    15    (c) Liability insurance, including  general  liability  insurance  and
    16  automobile liability insurance;
    17    (d) Workers' compensation or similar insurance;
    18    (e) Automobile no-fault insurance;
    19    (f) Credit insurance;
    20    (g)  Other  similar  insurance coverage, as specified in federal regu-
    21  lations, under which benefits for medical care are  secondary  or  inci-
    22  dental to other insurance benefits;
    23    (h)  Limited  scope  dental or vision benefits, benefits for long-term

    24  care insurance, nursing home insurance,  home  care  insurance,  or  any
    25  combination  thereof,  or  such  other  similar, limited benefits health
    26  insurance as specified in  federal  regulations,  if  the  benefits  are
    27  provided  under  a separate policy, certificate or contract of insurance
    28  or are otherwise not an integral part of the plan;
    29    (i) Coverage only for a specified disease or illness, hospital  indem-
    30  nity, or other fixed indemnity coverage;
    31    (j)  Medicare  supplemental insurance as defined in section 1882(g)(1)
    32  of the federal social security act, coverage supplemental to the  cover-
    33  age  provided under chapter 55 of title 10 of the United States code, or
    34  similar supplemental coverage provided under a group health plan  if  it

    35  is  offered  as a separate policy, certificate or contract of insurance;
    36  or
    37    (k) The medical indemnity fund established pursuant to title  four  of
    38  article twenty-nine-D of the public health law.
    39    7.  "Insurer" means an insurance company subject to article thirty-two
    40  or forty-three of the insurance law, or a health  maintenance  organiza-
    41  tion  certified  pursuant to article forty-four of the public health law
    42  that contracts or offers to contract to provide, deliver,  arrange,  pay
    43  or reimburse any of the costs of health care services.
    44    8.  "Qualified  dental plan" means a limited scope dental plan that is
    45  issued by an insurer and certified in accordance  with  section  twenty-
    46  nine hundred fourteen of this title.

    47    9. "Qualified employer" means a small employer that elects to make its
    48  full-time  employees  eligible  for  one  or more qualified health plans
    49  through the exchange.
    50    10. "Qualified health plan" means a health plan that is issued  by  an
    51  insurer  and  certified  in  accordance with section twenty-nine hundred
    52  fourteen of this title.
    53    11. "Qualified individual" means an  individual,  including  a  minor,
    54  who:
    55    (a)  is  seeking to enroll in a qualified health plan offered to indi-
    56  viduals through the exchange;

        S. 5652                             3
 
     1    (b) resides in this state;
     2    (c)  at the time of enrollment, is not incarcerated, other than incar-

     3  ceration pending the disposition of charges; and
     4    (d) is, and is reasonably expected to be, for the  entire  period  for
     5  which  enrollment  is sought, a citizen or national of the United States
     6  or an alien lawfully present in the United States.
     7    12. "Secretary" means the secretary of the United States department of
     8  health and human services.
     9    13. "SHOP" means the small business health options program designed to
    10  assist qualified employers in this state in facilitating the  enrollment
    11  of their employees in qualified health plans offered in the group market
    12  in this state.
    13    14.  "Small  employer"  shall be defined pursuant to legislation to be
    14  adopted following the issuance of the report and recommendation required

    15  by section twenty-nine hundred sixteen of this title; provided, however,
    16  that such definition shall be consistent with the definition  of  "small
    17  employer" that applies for employers purchasing health insurance outside
    18  of the exchange.
    19    15. "Small group market" means the health insurance market under which
    20  individuals  receive  health  insurance coverage on behalf of themselves
    21  and their dependents through a group health plan maintained by  a  small
    22  employer.
    23    16. "Superintendent" means the superintendent of insurance until Octo-
    24  ber  third,  two  thousand  eleven, when such term shall mean the super-
    25  intendent of financial services.
    26    § 2913. Health benefit exchange. 1. The New York state health  benefit

    27  exchange  is  hereby  established  as a public authority pursuant to the
    28  provisions of this chapter.
    29    2. The exchange shall operate subject to the supervision  and  control
    30  of  a  board  of  directors.  It shall consist of eleven directors to be
    31  appointed as provided in subdivision three of this section.
    32    3. The board shall be composed of the following directors:
    33    (a) Two non-voting ex officio directors: The  superintendent  and  the
    34  commissioner or their designees;
    35    (b) Three directors shall be appointed by the governor;
    36    (c) Two directors shall be appointed by the temporary president of the
    37  senate;
    38    (d) Two directors shall be appointed by the speaker of the assembly;

    39    (e)  One  director  shall  be  appointed by the minority leader of the
    40  senate;
    41    (f) One director shall be appointed by  the  minority  leader  of  the
    42  assembly.
    43    4.  Appointments  shall  be  made  no  later than sixty days after the
    44  effective date of this title. In the event that a particular appointment
    45  is not made within sixty days, the governor shall appoint an  individual
    46  of his or her choosing to fill the vacancy.
    47    5. Directors of the board, other than an ex officio director, shall be
    48  appointed for a term of four years, except that the initial appointments
    49  by  the  temporary  president  of the senate and speaker of the assembly
    50  shall be for a term of five years, and the initial appointments  by  the

    51  minority  leaders  in the senate and assembly shall be for a term of two
    52  years. Each director shall continue to serve until a successor has  been
    53  appointed and qualified. Vacancies shall be filled by appointment by the
    54  initial  appointing authority for the unexpired term. Five voting direc-
    55  tors shall constitute a quorum for the purpose of organizing the author-
    56  ity and conducting the business thereof. The board shall  determine  the

        S. 5652                             4
 
     1  times,  places  and  frequency of its meetings, however, the board shall
     2  meet at least quarterly.
     3    6.  A  chair shall be nominated by the governor among his or her allo-
     4  cated nominees and be subject to  confirmation  by  the  senate.    Each

     5  director  shall  receive reimbursement for his or her actual and reason-
     6  able expenses in the performance of his or her duties hereunder.
     7    7. The board shall appoint a chief executive officer of the  New  York
     8  state  health  benefit  exchange.  The  chief executive officer shall be
     9  subject to confirmation by the state senate in accordance  with  section
    10  twenty-eight hundred fifty-two of this article.
    11    8. Directors shall be subject to the provisions for removal prescribed
    12  in section twenty-eight hundred twenty-seven of this article.
    13    9.  To  the extent practicable, directors appointed to the board shall
    14  collectively have demonstrated expertise in all of the following  areas,

    15  provided  that  each  director  shall  have demonstrated expertise in at
    16  least one of the following areas:
    17    (a) individual health care coverage;
    18    (b) small employer health care coverage;
    19    (c) health benefits plan administration;
    20    (d) health care finance or economics;
    21    (e) purchasing health plan coverage, including agents, brokers,  cham-
    22  bers of commerce and other employer associations; and
    23    (f) delivery of health care services.
    24    10.  In  making  appointments to the board, the appointing authorities
    25  shall take into consideration  the  cultural,  ethnic  and  geographical
    26  diversity  of  the  state  so  that  the  board's composition accurately
    27  reflects the various regions of the state.

    28    11. The board shall adopt formal  mechanisms  to  avoid  conflicts  of
    29  interests by its directors or the staff of the exchange.
    30    12.  The  exchange  shall  be  subject to the provisions of the public
    31  officers law. In the event  regulatory  authority  is  provided  to  the
    32  exchange,  the  exchange  shall  be  subject to the state administrative
    33  procedure act.
    34    13. Except as expressly provided by this title, the board shall not:
    35    (a) have the power to tax, assess, impose fees or impose assessments;
    36    (b) have the power to issue bonds, notes,  or  any  other  debt  obli-
    37  gations;
    38    (c) exercise any additional powers, duties or functions with regard to
    39  the  operation  of  the exchange unless the governor and the legislature

    40  authorizes such additional powers, duties or functions through enactment
    41  of subsequent legislation;
    42    (d) regulate health insurers, health insurance plans, or health insur-
    43  ance producers.
    44    14. The board shall have a fiduciary relationship with the exchange.
    45    § 2914. Powers of the exchange. 1. Nothing  contained  in  this  title
    46  shall  be  interpreted  to authorize the exchange to exercise regulatory
    47  authority, unless and until expressly authorized by the legislature, and
    48  the powers of the exchange shall be limited to the following:
    49    (a) To appoint officers, agents and employees, prescribe their  duties
    50  and  qualifications and fix their compensation subject to the provisions

    51  of the civil service law,  including  the  chief  executive  officer  as
    52  referred to in subdivision seven of section twenty-nine hundred thirteen
    53  of this title.
    54    (b)  Acquire,  lease,  purchase, own, manage, hold and dispose of real
    55  and personal property, and lease, convey or deal in or enter into agree-

        S. 5652                             5
 
     1  ments with respect to such property on any terms necessary or incidental
     2  to the carrying out of these purposes.
     3    (c) To make and alter by-laws for its organization and management.
     4    (d)  To  enter  into  contracts subject to section twenty-nine hundred
     5  fifteen of this title, and  to  execute  all  instruments  necessary  or
     6  convenient.

     7    (e)  To  retain  and  employ  private consultants on a contract basis,
     8  subject to section  twenty-nine  hundred  fifteen  of  this  title,  for
     9  rendering professional and technical assistance and advice.
    10    (f) To accept or apply for any gifts or any grant of funds or property
    11  from  the  federal government or from the state of New York or any other
    12  federal or state public body  or  political  subdivision  or  any  other
    13  person and to comply with the terms and conditions thereof.
    14    (g)  To  acquire, hold and dispose of personal property for its corpo-
    15  rate purposes.
    16    (h) The exchange may enter into  information-sharing  agreements  with
    17  federal  and  state  agencies and other state exchanges to carry out its

    18  responsibilities under  this  title  provided  such  agreements  include
    19  adequate protections with respect to the confidentiality of the informa-
    20  tion shared and comply with all state and federal laws.
    21    2. The exchange shall:
    22    (a)  Implement  procedures  for the certification, recertification and
    23  decertification, consistent with guidelines developed by  the  secretary
    24  under section 1311(c) of the Federal act and as authorized by the enact-
    25  ment of future state legislation regarding health benefit plans as qual-
    26  ified health plans.
    27    (b)  Implement  procedures for authorizing qualified dental plans that
    28  offer  limited   scope   dental   benefits   consistent   with   section

    29  1311(d)(2)(B)(ii)  of  the Federal act, and provide that if at least one
    30  qualified dental plan is authorized to be offered through the  exchange,
    31  certification  of a health benefit plan as a qualified health plan under
    32  paragraph (a) of this subdivision,  shall  not  be  denied  because  the
    33  health  benefit  plan  does  not offer the dental benefits required of a
    34  qualified dental plan.
    35    (c) Provide for the operation of  a  toll-free  telephone  hotline  to
    36  respond to requests for assistance.
    37    (d) Provide for enrollment periods, which are consistent with compara-
    38  ble  enrollment  periods in the insurance law, as provided under section
    39  1311(c)(6) of the Federal act.

    40    (e) Maintain an internet web site through which enrollees and prospec-
    41  tive enrollees of qualified health plans and qualified dental plans  may
    42  obtain standardized comparative information on such plans.
    43    (f)  Publish  the  average costs of licensing, regulatory fees and any
    44  other payments required by the exchange and the administrative costs  of
    45  the  exchange,  including information on monies lost to waste, fraud and
    46  abuse, on an internet web site to educate individuals on such costs.
    47    (g) Inform individuals, in accordance with section 1413 of the Federal
    48  act, of eligibility requirements for the Medicaid  program  under  Title
    49  XIX  of the Social Security Act, as amended from time to time, the Chil-

    50  dren's Health Insurance Program (CHIP) under Title  XXI  of  the  Social
    51  Security  Act,  as  amended  from  time to time, or any applicable state
    52  public program including Family Health Plus and HEALTHY NY,  and  enroll
    53  an individual in such program to the extent required by the Federal act,
    54  if  the exchange determines, through screening of the application by the
    55  exchange, that such individual is eligible for any such program.    Upon

        S. 5652                             6
 
     1  enrollment,  such eligible individual shall be referred to the appropri-
     2  ate local department of social services.
     3    (h)  Establish  and make available by electronic means a calculator to

     4  determine the actual cost of coverage after application of  any  premium
     5  tax  credit under section 36B of the Internal Revenue Code and any cost-
     6  sharing reduction under section 1402 of the Federal act.
     7    (i) Establish a small business health options program (SHOP)  exchange
     8  through  which qualified employers may enroll in qualified health plans.
     9  The SHOP exchange shall provide employers the ability to select a health
    10  plan or plans through which their employees are provided coverage, or at
    11  the option of the employer, allow each employee to enroll  in  any  plan
    12  offered  through the SHOP exchange at the level of coverage specified by
    13  the employer. The exchange shall not have the authority to either  merge

    14  the  individual and small group markets or merge the SHOP with the indi-
    15  vidual market exchange.  Other than for purposes of sharing  information
    16  technology,  the  SHOP exchange shall operate separate and distinct from
    17  those activities of the exchange intended to facilitate  the  enrollment
    18  of individuals.
    19    (j) Grant a certification, subject to section 1411 of the Federal act,
    20  attesting  that,  for  purposes of the individual responsibility penalty
    21  under section 5000A of the  Internal  Revenue  Code,  an  individual  is
    22  exempt from the individual responsibility requirement or from the penal-
    23  ty imposed by said section 5000A because:
    24    (i) There is no affordable qualified health plan available through the

    25  exchange, or the individual's employer, covering the individual; or
    26    (ii)  The  individual  meets  the  requirements  for  any  other  such
    27  exemption from the individual responsibility requirement or penalty.
    28    (k) Provide to the secretary of the treasury of the United States  the
    29  following:
    30    (i)  A list of the individuals granted a certification under paragraph
    31  (j) of this subdivision, including the name and taxpayer  identification
    32  number of each individual;
    33    (ii)  The  name  and taxpayer identification number of each individual
    34  who was an employee of an employer but who was determined to be eligible
    35  for the premium tax credit under section 36B  of  the  Internal  Revenue
    36  Code because:

    37    (1)  The  employer  did  not provide minimum essential health benefits
    38  coverage; or
    39    (2) The employer provided the minimum essential coverage  but  it  was
    40  determined under section 36B(c)(2)(C) of the Internal Revenue Code to be
    41  unaffordable  to  the  employee  or did not provide the required minimum
    42  actuarial value; and
    43    (iii) The name and taxpayer identification number of:
    44    (1) Each individual who notifies the exchange under section 1411(b)(4)
    45  of the Federal act that such individual has changed employers; and
    46    (2) Each individual who ceases coverage under a qualified health  plan
    47  during a plan year and the effective date of that cessation.
    48    (l) Provide to each employer the name of each employee of the employer

    49  described in subparagraph (ii) of paragraph (k) of this subdivision, who
    50  ceases coverage under a qualified health plan during a plan year and the
    51  effective date of the cessation.
    52    (m)  Perform  duties required of, or delegated to, the exchange by the
    53  secretary or the secretary of the treasury of the United States  related
    54  to determining eligibility for premium tax credits, reduced cost-sharing
    55  or individual responsibility requirement exemptions.
    56    (n) Consult with stakeholders, including, but not limited to:

        S. 5652                             7
 
     1    (i)  Educated  health  care  consumers  who are enrollees in qualified
     2  health plans;

     3    (ii)  Individuals and entities with experience in facilitating enroll-
     4  ment in qualified health plans;
     5    (iii) Representatives of small employers  and  self-employed  individ-
     6  uals; and
     7    (iv) Advocates for enrolling hard-to-reach populations.
     8    (o) Meet the following financial integrity requirements:
     9    (i)  Keep  an  accurate  accounting  of  all  activities, receipts and
    10  expenditures and annually submit a report concerning such accountings to
    11  the governor, the temporary president of the senate, the speaker of  the
    12  assembly,  the minority leader of the senate, and the minority leader of
    13  the assembly;
    14    (ii) Fully cooperate with any investigation conducted by the secretary

    15  pursuant to the secretary's authority under the Federal  act  and  allow
    16  the  secretary, in coordination with the inspector general of the United
    17  States department of health and  human  services  and  any  officers  of
    18  competent jurisdiction, to:
    19    (1) Investigate the affairs of the exchange;
    20    (2) Examine the properties and records of the exchange; and
    21    (3)  Require periodic reports in relation to the activities undertaken
    22  by the exchange;
    23    (iii) Not use any funds in carrying  out  its  activities  under  this
    24  title, that are intended for the administrative and operational expenses
    25  of  the  exchange,  for staff retreats, promotional giveaways, excessive

    26  executive compensation or promotion of federal or state legislative  and
    27  regulatory modifications.
    28    (p)  As  authorized  under  section  1312(e)  of  the Federal act, the
    29  exchange shall permit agents and brokers to:
    30    (i) enroll qualified individuals and qualified employers in any quali-
    31  fied health plans offered in the exchange; and
    32    (ii) assist qualified individuals and qualified employers in  applying
    33  for premium tax credits and cost-sharing reductions for plans offered in
    34  the exchange.
    35    §  2915. Procurement. 1. Information technology contracts resulting in
    36  a sole technology platform entered into by the exchange under the amount
    37  of one million dollars shall be exempt from the competitive bid  process

    38  pursuant  to  sections one hundred twelve and one hundred sixty-three of
    39  the state finance law and any other law to the contrary.
    40    2. Information technology contracts resulting  in  a  sole  technology
    41  platform  in  the amount of one million dollars or more, entered into by
    42  the exchange, shall be exempt from the competitive bid  or  request  for
    43  proposal process pursuant to sections one hundred twelve and one hundred
    44  sixty-three  of the state finance law and any other law to the contrary;
    45  provided, however:
    46    (a) the exchange shall post on its website, or otherwise  make  avail-
    47  able, for a period not less than sixty days:
    48    (i)  a  description  of the of proposed services to be provided by the

    49  contractor and any related services;
    50    (ii) the criteria for selection of a contractor or contractors;
    51    (iii) the period of time during which prospective contractors may seek
    52  selection, which shall be no less than thirty days after  such  informa-
    53  tion is first posted on the website; and
    54    (iv)  the  manner  by  which  a  prospective  contractor may seek such
    55  selection, which may include submission by electronic means;

        S. 5652                             8
 
     1    (b) all reasonable and responsive submissions that are  received  from
     2  prospective contractors shall be reviewed by the exchange; and
     3    (c)  the exchange shall select such contractor or contractors that, in

     4  its discretion, have demonstrated the ability to effectively, efficient-
     5  ly, and economically implement the requirements necessary and consistent
     6  with the criteria established by this title and the  Federal  act;  have
     7  the  requisite expertise and financial resources; have demonstrated that
     8  their directors, members,  managers,  partners  or  operators  have  the
     9  requisite  character,  competence  and standing in the industry, and are
    10  best suited to serve the purposes of this title.
    11    3. Contracts entered into by the exchange  pursuant  to  this  section
    12  shall  be  subject  to  section  one  hundred thirty-nine-j of the state
    13  finance law.
    14    § 2916. Reports by the exchange. 1. On or before  January  first,  two

    15  thousand  twelve,  the  board shall submit a report to the governor, the
    16  temporary president of the senate, the  speaker  of  the  assembly,  the
    17  minority  leader of the senate, and the minority leader of the assembly,
    18  which shall include, but is  not  limited  to,  recommendations  on  the
    19  following:
    20    (a) Establishment of a basic health plan;
    21    (b) How to establish a separate individual health insurance market and
    22  a small employer health insurance market within the exchange;
    23    (c)  Advantages and disadvantages of revising the definition of "small
    24  employer" prior to the date required by the federal act  from  not  more
    25  than  fifty  employees  to  not more than one hundred employees based on

    26  actuarial analyses of projected impacts on premium rates for both  indi-
    27  viduals and small employers and establishment of a consistent definition
    28  both  inside  and  outside  the  exchange  for the purposes of state and
    29  federal law;
    30    (d) Evaluation of requiring qualified  health  plans  to  provide  the
    31  essential  health  benefits  package, as described in section 1302(a) of
    32  the Federal act, along with specific costs of including  state  mandated
    33  benefits  and  recommendations  as  to  how to finance the costs of such
    34  additional benefits;
    35    (e) Value of allowing large employers to participate in  the  exchange
    36  beginning in two thousand seventeen;
    37    (f)  Whether health savings accounts should be offered in the exchange

    38  and in what  manner  young  adults  will  benefit  from  health  savings
    39  accounts;
    40    (g)  The  efficacy of merging the individual and small employer health
    41  insurance markets and the subsequent effect on premium rates on New York
    42  small employers and individuals based on actuarial analyses for each  of
    43  the health plan options under the Federal act;
    44    (h)  A  process  to  determine  each  qualified health plan's level of
    45  coverage in accordance with regulations issued by  the  secretary  under
    46  section 1302(d)(2)(A) of the Federal act;
    47    (i)  Steps  to  implement the assignment of a rating to each qualified
    48  health plan offered through the exchange in accordance with the criteria

    49  developed by the secretary under section 1311(c)(3) of the Federal act;
    50    (j) Recommendations on how to avoid  duplicative  oversight  functions
    51  with other state and local agencies and entities.
    52    (k)  The role of the exchange as it relates to public health insurance
    53  coverage, including medicaid, child health plus, family health plus  and
    54  healthy New York;
    55    (l)  The  advantages  and disadvantages of the exchange to serve as an
    56  active purchaser, a selective contractor, or clearinghouse of insurance;

        S. 5652                             9
 
     1    (m) Risk adjustment methodologies to  meet  the  requirements  of  the
     2  Federal act;
     3    (n)  A  plan  to  award  Navigator  grants  in accordance with section

     4  1311(i) of the Federal act and an analysis of the requirements for serv-
     5  ing as a Navigator;
     6    (o) Ways to ensure that the exchange is  financially  self-sustainable
     7  by the year two thousand fifteen, as required by the Federal act;
     8    (p)  An  analysis  of  ways to conform the definitions of medical loss
     9  ratio in a manner that is consistent with the Federal act;
    10    (q) An analysis  of  regional  variations  in  the  operation  of  the
    11  exchange and their incorporation within the exchange; and
    12    (r)  Certifying insurance plans operating within the exchange pursuant
    13  to the guidelines enumerated in the Federal act.
    14    2. The exchange shall have no authority neither expressed nor  implied

    15  to  implement recommendations on the issues set forth in subdivision one
    16  of this section without further statutory authority.
    17    3. The board shall  consider  the  recommendations  developed  by  the
    18  regional  advisory  committees,  established pursuant to section twenty-
    19  nine hundred nineteen of this title, when developing the recommendations
    20  required by this section.
    21    § 2917.   Moneys of the authority. 1.  The  moneys  of  the  authority
    22  shall,  except  as otherwise provided in this section, be deposited in a
    23  general account called  the  New  York  state  health  benefit  exchange
    24  account  and  such  other  accounts as the authority may deem necessary,
    25  pursuant to resolution of the authority board, for  the  transaction  of

    26  its  business  and shall be paid out on checks signed by the chairman of
    27  the authority or by such other person or persons as  the  authority  may
    28  authorize.
    29    2. All moneys of the authority derived from state appropriations shall
    30  be  paid  to the comptroller of the state as agent of the authority, who
    31  shall not commingle such moneys with other moneys. Such moneys shall  be
    32  deposited  in  a  separate  bank account or accounts. The moneys in such
    33  accounts shall be paid out on check of the comptroller on requisition of
    34  the chair of the authority or of such other person  or  persons  as  the
    35  authority  may authorize to make such requisitions. All deposits of such
    36  moneys shall, if required  by  the  comptroller  or  the  authority,  be

    37  secured  by  obligations of the United States of America or of the state
    38  of New York of a market value equal at all times to the  amount  of  the
    39  deposit  and  all  banks and trust companies are authorized to give such
    40  security for such deposits.
    41    3. The comptroller of the state and  his  or  her  legally  authorized
    42  representatives are hereby authorized and empowered from time to time to
    43  examine the accounts and books of the authority, including its receipts,
    44  disbursements,  contracts,  sinking  funds,  investments  and  any other
    45  matters relating to its financial standing.
    46    4. The board shall ensure that the establishment, operation and admin-
    47  istrative functions of the exchange do not  exceed  the  combination  of

    48  federal  funds,  private  donations  and  other  non-general fund moneys
    49  available for this purpose. No funds of the  exchange  shall  be  trans-
    50  ferred  to the general fund or any special revenue fund or shall be used
    51  for any purpose other than the purposes set  forth  in  this  title.  No
    52  funds  shall be transferred from the general fund or any special revenue
    53  fund to the exchange. No liability incurred by the exchange  or  any  of
    54  its officers or employees may be satisfied using moneys from the general
    55  fund.

        S. 5652                            10
 
     1    5.  Notwithstanding any law to the contrary, the comptroller is hereby
     2  authorized and directed to transfer all the unencumbered balance for the

     3  purposes of establishing and operating the New York state health benefit
     4  exchange upon monies received pursuant to the federal Patient Protection
     5  and  Affordable Care Act (Public Law 111-148), as amended by the federal
     6  Health Care  and  Education  Reconciliation  Act  of  2010  (Public  Law
     7  111-152),  and any amendments thereto, or regulations or guidance issued
     8  under those acts, in the medical assistance and survey account,  or  any
     9  other  account  of  the  state that receives such funds, to the New York
    10  state health  benefit  exchange,  unless  expressly  prohibited  by  the
    11  contract's terms or by law.
    12    §  2918.  Actions  against  the  exchange. Neither any director of the

    13  exchange nor any officer, employee, or  agent  of  the  exchange,  while
    14  acting  within  the  scope  of  their authority, shall be subject to any
    15  personal liability resulting from the exercise or carrying out of any of
    16  the exchange's purposes or powers.
    17    § 2919. Regional advisory committees. 1. There shall be eight regional
    18  advisory committees. There shall be six members of each  regional  advi-
    19  sory  committee.  Such regional advisory committees shall provide exper-
    20  tise and recommendations to the board. The regional advisory  committees
    21  shall  be composed of individual stakeholders from the geographic region
    22  including, but not limited to,  carriers,  producers,  agents,  brokers,

    23  chambers  of  commerce,  employer  associations,  health care providers,
    24  small employers, and consumers.    Members  of  each  regional  advisory
    25  committee  shall  be  appointed  in  equal  numbers by the governor, the
    26  temporary president of the senate and the speaker of the  assembly.  The
    27  appointing  officers shall submit to the board their appointments to the
    28  regional advisory committees no later than sixty days after  the  effec-
    29  tive  date of this title.  In the event that a particular appointment is
    30  not made within sixty days, the governor shall appoint an individual  of
    31  his  or  her choosing to fill the vacancy. The regional advisory commit-
    32  tees shall commence their duties sixty days after the effective date  of
    33  this title.

    34    2. There shall be the following eight regions:
    35    (a) Long Island, consisting of Nassau and Suffolk counties;
    36    (b) New York city;
    37    (c)  Hudson  Valley,  consisting  of  Ulster, Duchess, Orange, Putnam,
    38  Rockland, and Westchester counties;
    39    (d) Capital District, consisting of Albany, Columbia, Fulton,  Greene,
    40  Montgomery,  Rensselaer,  Saratoga,  Schenectady, Schoharie, Warren, and
    41  Washington counties;
    42    (e) Central, consisting of Cayuga, Cortland, Herkimer, Madison,  Onei-
    43  da, Onondaga, Oswego, Seneca, and Tompkins counties;
    44    (f)  North  Country, consisting of Clinton, Essex, Franklin, Hamilton,
    45  Jefferson, Lewis, and St. Lawrence counties;

    46    (g) Western, consisting  of  Chautauqua,  Erie,  Genesee,  Livingston,
    47  Monroe, Niagara, Ontario, Orleans, Wayne, Wyoming and Yates counties;
    48    (h)  Southern  Tier,  consisting  of  Allegany,  Cattaraugus,  Broome,
    49  Chemung, Chenango, Delaware, Otsego, Schuyler,  Steuben,  Sullivan,  and
    50  Tioga counties.
    51    3.  Each regional advisory committee shall develop recommendations for
    52  the establishment, implementation, and operation of the New  York  state
    53  health  benefit  exchange  including  recommendations for regional vari-
    54  ations in the operation of the exchange.  In carrying out its functions,
    55  a regional  advisory  committee  shall  foster  discussions  among,  and
    56  conduct  formal  public hearings with requisite public notice to solicit

        S. 5652                            11
 
     1  input from, local stakeholder interests, including but not  limited  to,
     2  carriers,  insurance  producers, consumers, health care providers, cham-
     3  bers of commerce and other employer associations, small businesses,  and
     4  community-based  organizations. Not later than December first, two thou-
     5  sand eleven, and annually thereafter, each regional  advisory  committee
     6  shall transmit to the board a report containing its recommendations. The
     7  failure of any regional advisory committee to perform the duties imposed
     8  by  this section shall not affect the obligation of the board to perform
     9  the duties imposed by section twenty-nine hundred sixteen of this title.

    10    § 2920. Officers and employees. 1. The board shall have the  power  to
    11  appoint employees to serve as senior managerial staff of the exchange as
    12  necessary,  who  shall  be designated to be in the exempt class of civil
    13  service. The board shall also have the power to fix the salaries of such
    14  employees.
    15    2. Any public officer or employee of a  state  department,  agency  or
    16  commission  may  be  transferred to the exchange without examination and
    17  without loss of any civil service  status  or  rights  to  a  comparable
    18  office,  position or employment with the exchange; provided, however, no
    19  such transfer may be made without the consent of the head of the depart-
    20  ment, agency or commission.

    21    3. The salary or compensation of any such officer or  employee,  after
    22  such transfer, shall be paid by the exchange.
    23    4.  Any  officer  or  employee transferred to the exchange pursuant to
    24  this section, who are members of or benefit under any  existing  pension
    25  or  retirement fund or system, shall continue to have all rights, privi-
    26  leges, obligations and status with respect to such fund or system as are
    27  now prescribed by law, but during the period of their employment by  the
    28  exchange,  all  contributions to such funds or systems to be paid by the
    29  employer on account of such officers or employees shall be paid  by  the
    30  exchange.
    31    5. A transferred employee shall remain in the same collective bargain-

    32  ing unit as was the case prior to his or her transfer; successor employ-
    33  ees  to the positions held by such transferred employees shall, consist-
    34  ent with the provisions of article fourteen of the civil service law, be
    35  included in the same unit as their predecessors.  Employees  serving  in
    36  positions  in newly created titles shall be assigned to the same collec-
    37  tive bargaining unit as they would  have  been  assigned  to  were  such
    38  titles  created  prior  to  the  establishment  of the exchange. Nothing
    39  contained in this article shall be construed (a) to diminish the  rights
    40  of  employees  pursuant  to  a collective bargaining agreement or (b) to
    41  affect existing law with respect to an application to the public employ-

    42  ment relations board seeking a designation by  the  board  that  certain
    43  persons are managerial or confidential.
    44    §  2921.  Relation to other laws. Nothing in this title, and no action
    45  taken by the exchange pursuant to this  title,  shall  be  construed  to
    46  preempt or supersede the authority of the superintendent to regulate the
    47  business  of insurance within this state or the authority of the commis-
    48  sioner to regulate entities certified pursuant to article forty-four  of
    49  the public health law.
    50    §  2.  Severability clause. If any clause, sentence, paragraph, subdi-
    51  vision, section or part of this act shall be adjudged by  any  court  of
    52  competent  jurisdiction  to  be invalid, such judgment shall not affect,

    53  impair, or invalidate the remainder thereof, but shall  be  confined  in
    54  its  operation  to the clause, sentence, paragraph, subdivision, section
    55  or part thereof directly involved in the controversy in which such judg-
    56  ment shall have been rendered. It is hereby declared to be the intent of

        S. 5652                            12
 
     1  the legislature that this act would  have  been  enacted  even  if  such
     2  invalid  provisions  had  not  been included herein, except in the event
     3  that, if any provision of the federal Patient Protection and  Affordable
     4  Care  Act or the federal Health Care and Education Reconciliation Act of
     5  2010 is held to be unconstitutional by the United States  Supreme  Court
     6  or  is  repealed  by  the United States Congress, then this act shall be
     7  null and void.
     8    § 3. This act shall take effect immediately.
Go to top