S06699 Summary:

BILL NOS06699
 
SAME ASNo same as
 
SPONSORSEWARD
 
COSPNSRHANNON, LARKIN
 
MLTSPNSR
 
DELETE
 
Establishes the New York health insurance exchange study commission providing for a study of whether the state should establish and operate a New York health insurance exchange or participate in a regional exchange and specifying requirements to be included in such study.
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S06699 Actions:

BILL NOS06699
 
03/11/2012REFERRED TO INSURANCE
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S06699 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          6699
 
                    IN SENATE
 
                                     March 11, 2012
                                       ___________
 
        Introduced  by  Sens.  SEWARD, HANNON -- read twice and ordered printed,
          and when printed to be committed to the Committee on Insurance
 
        AN ACT to establish the New York health insurance exchange study commis-
          sion providing for a study of whether the state should  establish  and
          operate  a  New  York  health  insurance  exchange or participate in a

          regional exchange and specifying requirements to be included  in  such
          study; and providing for the repeal of such provisions upon expiration
          thereof
 
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
 
     1    Section 1. There is hereby  created  the  New  York  health  insurance
     2  exchange study commission.
     3    §  2.  a. The commission shall consist of nine members to be appointed
     4  as follows: the commissioner of the department  of  health;  the  super-
     5  intendent  of  the  department  of  financial  services;  three  members
     6  appointed by the governor from affected state agencies  and  the  gover-
     7  nor's  office, one of whom shall be appointed chair of the commission by
     8  the governor; two senators appointed by the temporary president  of  the

     9  senate;  and two members of the assembly appointed by the speaker of the
    10  assembly. Vacancies in the membership of the commission shall be  filled
    11  in  the  manner  provided  for  original appointments. Membership on the
    12  commission shall not constitute a public office.
    13    b. Appointments by the temporary  president  of  the  senate  and  the
    14  speaker  of the assembly shall be made within fifteen days of the effec-
    15  tive date of this act.
    16    c. The first meeting of the New York health insurance  exchange  study
    17  commission  shall  be  held within fifteen days after all members of the
    18  commission are appointed.
    19    § 3. a. (1) The New York health insurance  exchange  study  commission
    20  shall  conduct  a  study to evaluate whether to create a New York health
    21  insurance exchange or participate in a regional exchange, as provided in

    22  the federal Patient Protection and Affordable Care Act, P.L. 111-148  as
    23  amended  by  the federal Health Care and Education Reconciliation Act of
    24  2010, P.L. 111-152.
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD15024-01-2

        S. 6699                             2
 
     1    (2) The study shall be paid for, to the extent possible, by a  federal
     2  grant  awarded  to the state for planning and establishment of insurance
     3  exchanges.
     4    (3)  The  New  York  health  insurance exchange study commission shall
     5  conduct or cause to be conducted a study of, and shall make  recommenda-
     6  tions upon:
     7    (i)  whether  the  state  should  proceed  with  the development of an
     8  exchange;

     9    (ii) where the recommendation is that the state  should  proceed  with
    10  the  development of an exchange, provide a work plan for the development
    11  of the exchange and identify any legislation  needed  to  implement  the
    12  exchange during the 2012 legislative budget session or subsequent legis-
    13  lative sessions;
    14    (iii)  whether  the  state  should  proceed with the development of an
    15  exchange within the state, as a partner with other states or  defer  the
    16  decision until 2013. If a deferral is recommended, the study shall iden-
    17  tify the additional work needed before a final decision can be made;
    18    (iv)  options being considered by other states in developing and oper-
    19  ating health insurance exchanges;
    20    (v) whether New York should proceed with the development of  a  health
    21  insurance  exchange  if  the  related  provisions in the federal Patient

    22  Protection and Affordable Care Act,  P.L.  111-148  as  amended  by  the
    23  federal  Health Care and Education Reconciliation Act of 2010, P.L. 111-
    24  152 are repealed;
    25    (vi) the costs associated with the development and implementation of a
    26  state based exchange, including but not limited to:
    27    (A) the projected costs associated with the  increased  enrollment  in
    28  Medicaid,  particularly as more individuals enroll to avoid the require-
    29  ment of the individual mandate;
    30    (B) the impact of the health insurance industry  fee,  an  annual  fee
    31  imposed  on  health  insurance  providers, including Medicaid, under the
    32  federal Patient Protection and Affordable Care Act, P.L. 111-148;
    33    (C) the cost and coverage impacts of the exchange, including the  cost
    34  to the insurance market outside of the exchange;
    35    (D)  the estimated five year budget for the exchange operations and an

    36  analysis of funding options to achieve self-sustainability by January 1,
    37  2015;
    38    (E) the costs to both individual and group  policies  associated  with
    39  any benefits required under the insurance law or regulations thereunder,
    40  that are not to be identified as essential health benefits;
    41    (F)  the  costs  to both individual and group policies associated with
    42  any benefits permitted by the insurance law or  regulations  thereunder,
    43  that are not to be identified as essential health benefits;
    44    (G) the costs of the essential health benefit plan; and
    45    (H)  the  costs  and/or  savings  associated with establishing a basic
    46  health plan; and
    47    (vii) the structure and mission of health insurance exchange  regional
    48  advisory  committees  and the role the regional advisory committees will
    49  have in an exchange.
    50    b. (1) The commission shall conduct or cause to be conducted  a  study

    51  of,  and  shall make recommendations upon, the essential health benefits
    52  identified by the federal secretary of health and human services  pursu-
    53  ant  to section 1302(b) of the federal Patient Protection and Affordable
    54  Care Act, P.L. 111-148 as amended by the federal Health Care and  Educa-
    55  tion  Reconciliation  Act  of  2010,  P.L.  111-152  and of the benefits
    56  required under the insurance law or regulations  promulgated  thereunder

        S. 6699                             3
 
     1  that  are  not  determined  by the federal secretary of health and human
     2  services to be essential health benefits. Such study and recommendations
     3  shall address matters including, but not limited to:
     4    (i)  whether  the essential health benefits required to be included in
     5  policies and contracts sold through the exchange should be sold to simi-

     6  larly situated individuals and groups purchasing coverage outside of the
     7  exchange;
     8    (ii) whether any benefits required under the insurance  law  or  regu-
     9  lations  promulgated  thereunder  that  are  not identified as essential
    10  health benefits by the secretary should no longer be required  in  poli-
    11  cies or contracts sold either through the exchange or to similarly situ-
    12  ated individuals and groups outside of the exchange;
    13    (iii) the costs of extending any benefits required under the insurance
    14  law or regulations promulgated thereunder to policies and contracts sold
    15  through the exchange; and
    16    (iv)   mechanisms   to   finance   any   costs   pursuant  to  section
    17  1311(d)(3)(B)(ii) of the federal Patient Protection and Affordable  Care
    18  Act,  P.L.  111-148  as amended by the federal Health Care and Education

    19  Reconciliation Act of 2010,  P.L.  111-152  of  extending  any  benefits
    20  required  under  the insurance law or regulations promulgated thereunder
    21  to policies and contracts sold through the exchange.
    22    (2) In making its recommendations, the commission shall  consider  the
    23  individual  and small group markets outside of the exchange and consider
    24  approaches to prevent marketplace disruption, remain consistent with the
    25  exchange and avoid anti-selection.
    26    c. The commission shall conduct or cause to be conducted a  study  of,
    27  and shall make recommendations upon:
    28    (1)  whether insurers participating in the exchange should be required
    29  to offer all health plans sold in the exchange to individuals  or  small
    30  groups purchasing coverage outside of the exchange;
    31    (2)  whether  the  individual and small group markets should be placed
    32  entirely inside the exchange;

    33    (3) whether the benefits in the individual  and  small  group  markets
    34  should  be  standardized  inside  the exchange or inside and outside the
    35  exchange;
    36    (4) how to develop and implement the transitional reinsurance  program
    37  for  the  individual  market  and  any  other risk adjustment mechanisms
    38  developed in accordance with sections 1341, 1342 and 1343 of the federal
    39  Patient Protection and Affordable Care Act, P.L. 111-148 as  amended  by
    40  the  federal  Health Care and Education Reconciliation Act of 2010, P.L.
    41  111-152;
    42    (5) whether to merge the individual and small group  health  insurance
    43  markets  for  rating  purposes  including an analysis of the impact such
    44  merger would have on premiums;
    45    (6) whether to increase the size of small employers from an average of
    46  at least one but not more than fifty employees to an average of at least

    47  one but not more than one hundred employees prior to January first,  two
    48  thousand sixteen;
    49    (7)  how  to account for sole proprietors in defining small employers;
    50  and
    51    (8) whether to revise the definition of  small  employer  outside  the
    52  exchange  to  be consistent with the definition as it applies within the
    53  exchange.
    54    d. The commission shall conduct or cause to be conducted a  study  of,
    55  and  shall make recommendations upon, whether the state should establish
    56  a basic health plan program  identified  by  the  federal  secretary  of

        S. 6699                             4
 
     1  health  and  human  services  pursuant  to  section  1331 of the federal
     2  Patient Protection and Affordable Care Act, P.L. 111-148 as  amended  by
     3  the  federal  Health Care and Education Reconciliation Act of 2010, P.L.
     4  111-152.

     5    e.  The  commission shall conduct or cause to be conducted a study of,
     6  and shall make recommendations upon, the advantages and disadvantages of
     7  the exchange serving as an active purchaser, a selective contractor,  or
     8  clearinghouse of insurance.
     9    f.  The  commission shall conduct or cause to be conducted a study of,
    10  and shall make recommendations upon:
    11    (1) the anticipated annual operating expenses of the exchange, includ-
    12  ing but not limited to  the  development  of  any  multi-year  financial
    13  models; and
    14    (2)  the  options  to  generate  funding for the ongoing operation and
    15  self-sufficiency of the exchange including but not  limited  to  assess-
    16  ments upon insurers and providers.
    17    g.  The  commission shall conduct or cause to be conducted a study of,
    18  and shall make recommendations upon, the benchmark  benefits  identified

    19  by  the  secretary  and of the benefits required under the public health
    20  law or the social services law  or  regulations  promulgated  thereunder
    21  that  are not determined by the secretary to be benchmark benefits. Such
    22  study and recommendations shall address matters including but not limit-
    23  ed to:
    24    (1) whether any benefits required under the public health law  or  the
    25  social  services  law or regulations promulgated thereunder that are not
    26  identified as benchmark benefits by the secretary should continue to  be
    27  required  as covered benefits available to newly medicaid-eligible indi-
    28  viduals inside the exchange;
    29    (2) the costs of extending any  benefits  required  under  the  public
    30  health  law or the social services law or regulations promulgated there-
    31  under as covered benefits available to newly medicaid-eligible  individ-
    32  uals through the exchange; and

    33    (3)  mechanisms  to  finance  any costs pursuant to the federal act of
    34  extending any benefits required under  the  public  health  law  or  the
    35  social  services  law  or regulations promulgated thereunder to policies
    36  and contracts sold through the exchange.
    37    h. The commission shall make recommendations upon the  impact  of  the
    38  establishment  and  operation  of  the  exchange on the Healthy New York
    39  Program established pursuant to section forty-three  hundred  twenty-six
    40  of  the  insurance  law  and the Family Health Plus Employer Partnership
    41  Program established pursuant to section three hundred  sixty-nine-ff  of
    42  the social services law.
    43    i.  The  commission shall conduct or cause to be conducted a study of,
    44  and shall make recommendations upon,  procedures  under  which  licensed
    45  health  insurance  producers,  chambers of commerce and business associ-

    46  ations may enroll individuals and employers in any qualified health plan
    47  in the individual or small group market as soon as the plan  is  offered
    48  through  the exchange; and to assist individuals in applying for premium
    49  tax credits and cost-sharing  reductions  for  plans  sold  through  the
    50  exchange; and
    51    j.  The  commission shall conduct or cause to be conducted a study of,
    52  and shall make recommendations upon, the  criteria  for  eligibility  to
    53  serve  as  a  navigator  for  purposes of section 1311(i) of the federal
    54  Patient Protection and Affordable Care Act, P.L. 111-148 as  amended  by
    55  the  federal  Health Care and Education Reconciliation Act of 2010, P.L.
    56  111-152 and any guidance issued thereunder.

        S. 6699                             5
 
     1    k. The commission shall conduct or cause to be conducted a  study  of,

     2  and  shall  make  recommendations  upon,  the  role  of  the exchange in
     3  decreasing health disparities in health care services  and  performance,
     4  including but not limited to disparities on the basis of race or ethnic-
     5  ity,  in  accordance with section forty-three hundred two of the federal
     6  Patient Protection and Affordable Care Act, P.L. 111-148 as  amended  by
     7  the  federal  Health Care and Education Reconciliation Act of 2010, P.L.
     8  111-152.
     9    l. The commission shall make recommendations upon whether and to  what
    10  extent health savings accounts should be offered through the exchange.
    11    m.  The  commission shall conduct or cause to be conducted a study of,
    12  and shall make recommendations upon, whether to allow large employers to
    13  participate in the exchange beginning January first, two thousand seven-
    14  teen, and shall take into account any excess of premium  growth  outside

    15  of  the  exchange  as  compared  to  the  rate of such growth inside the
    16  exchange.
    17    n. The commission shall conduct or cause to be conducted a  study  of,
    18  and  shall  make  recommendations upon, the integration of public health
    19  insurance programs, including Medicaid, Child Health  Plus,  and  Family
    20  Health  Plus  within the exchange, which may include such reports as are
    21  periodically submitted to the federal  secretary  of  health  and  human
    22  services, on or before August first, two thousand twelve.
    23    o.  Notwithstanding  any provision of subdivisions a through m of this
    24  section, if the commission determines that any recommendations  required
    25  under  any  such  subdivision  cannot be submitted by the specified date
    26  because federal guidance  or  regulations  necessary  to  complete  such
    27  recommendations  have  not been issued, the exchange may establish a new

    28  and reasonable date for such completion and submission.
    29    p. (1) Any of the studies required under this section may be  combined
    30  with  other  studies required under this section or otherwise undertaken
    31  by the exchange to the extent feasible and timely.
    32    (2) In lieu of conducting or  causing  to  be  conducted  any  of  the
    33  studies  required  under  this  section,  the exchange may rely upon any
    34  other study or studies, in whole or in part, completed prior to the date
    35  on which the exchange  submits  its  recommendations,  if  the  exchange
    36  determines that such study or studies are sufficiently reliable.
    37    §  4.  The  New  York health insurance exchange study commission shall
    38  receive and have access to all studies and evaluations conducted by  the
    39  department  of  health and the department of financial services, and any

    40  studies and evaluations conducted by third party organizations on behalf
    41  of the department of health and the department of financial services, in
    42  relation to the health insurance exchange.
    43    § 5. The New York health insurance  exchange  study  commission  shall
    44  have  the  authority  to contract with experts and consultants as may be
    45  useful in conducting the study.
    46    § 6. The members of the commission shall receive no  compensation  for
    47  their services, but shall be allowed their actual and necessary expenses
    48  incurred in the performance of their duties pursuant to this act.
    49    §  7.  The  commission may meet within and without the state and shall
    50  have all the powers of a legislative committee pursuant to the  legisla-
    51  tive law.
    52    § 8. a. The commission shall submit its recommendations under subdivi-

    53  sions a, b, c, d, e, f, g, h, i, j, k and l of section three of this act
    54  to  the  governor, the temporary president of the senate and the speaker
    55  of the assembly on or before August 1, 2012.

        S. 6699                             6
 
     1    b. The commission shall submit its recommendations under  subdivisions
     2  m  and  n  of  section  three of this act to the governor, the temporary
     3  president of the senate and the speaker of the  assembly  on  or  before
     4  December 1, 2015.
     5    §  9.  This  act shall take effect immediately and shall expire and be
     6  deemed repealed April 1, 2016.
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