Provides that the New York state health care quality and cost containment commission shall: evaluate each mandated benefit; investigate current practices of health plans with regard to the mandated benefit; investigate the potential premium impact of repealing and/or modifying the mandated benefits on all segments of the insurance market; hold at least two public hearings; submit a report to the legislature; makes related provisions.
STATE OF NEW YORK
________________________________________________________________________
4498
2025-2026 Regular Sessions
IN ASSEMBLY
February 4, 2025
___________
Introduced by M. of A. JENSEN -- read once and referred to the Committee
on Insurance
AN ACT to amend the insurance law, in relation to the New York state
health care quality and cost containment commission
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Section 213 of the insurance law, as added by section 1 of
2 part L of chapter 57 of the laws of 2007, is amended to read as follows:
3 § 213. New York state health care quality and cost containment commis-
4 sion. (a) There is hereby established within the department a commis-
5 sion, to be known as the "New York state health care quality and cost
6 containment commission". The commission shall consist of thirteen
7 members appointed by the governor, one of whom shall be the superinten-
8 dent, one of whom shall be the commissioner of health, and six of whom
9 shall be appointed on the recommendation of the legislative leaders, two
10 on the recommendation of the temporary president of the senate, two on
11 the recommendation of the speaker of the assembly, one on the recommen-
12 dation of the minority leader of the senate, and one on the recommenda-
13 tion of the minority leader of the assembly. All members shall serve at
14 the pleasure of the governor, and vacancies shall be appointed in the
15 same manner as original appointments. Members of the commission shall
16 serve without compensation, but shall be reimbursed for reasonable trav-
17 el expenses. In making appointments to the commission, the governor
18 shall ensure that the interests of health care consumers, small busi-
19 nesses, the medical community and health plans are represented on the
20 commission, and that the commission include at least one actuary, one
21 expert on health benefits, having no less than fifteen years of direct
22 experience with health benefits, and one physician. All members of the
23 commission shall be seated no later than ninety days after the effective
24 date of the chapter of the laws of two thousand twenty-five which
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD02869-01-5
A. 4498 2
1 amended this section and all vacancies shall be filled as soon as prac-
2 ticable.
3 (b)(1) The purpose of the commission shall be to analyze the impact on
4 health insurance costs and quality of proposed legislation which would
5 mandate that health benefits be offered or made available in individual
6 and group health insurance policies, contracts and comprehensive health
7 service plans, including legislation that affects the delivery of health
8 benefits or services or the reimbursement of health care providers.
9 (2) The governor, the chair of the senate insurance committee and the
10 chair of the assembly insurance committee may request in writing that
11 the commission evaluate a proposed mandated benefit. Upon receiving such
12 a request, the commission [may, by a majority vote of its members,]
13 shall undertake an evaluation of such proposed mandated benefit.
14 (3) In evaluating a proposed mandated benefit, the commission shall:
15 (A) investigate the current practices of health plans with regard to
16 the proposed mandated benefit, and, to the extent possible, self-funded
17 health benefit plans;
18 (B) investigate the potential premium impact of the proposed mandated
19 benefits on all segments of the insurance market, as well as the poten-
20 tial for avoided costs through early detection and treatment of condi-
21 tions, or more cost-effective delivery of medical services; [and]
22 (C) analyze the most current [medical] and credible evidence based
23 medicine literature regarding the proposed mandated benefit published in
24 peer reviewed medical literature generally recognized by the relevant
25 medical community to determine the effectiveness of the proposed
26 mandated benefit and its impact on health care quality[.]; and
27 (D) investigate the potential cost to the state of the proposed
28 mandated benefits in light of the implementation of the federal afforda-
29 ble care act.
30 (4) In evaluating a proposed mandated benefit, the commission may hold
31 one or more public hearings, and shall strive to obtain independent and
32 verifiable information from diverse sources within the healthcare indus-
33 try, medical community and among health care consumers with regard to
34 the proposed mandated benefit.
35 (c) To assist the commission in its duties, and upon the direction of
36 the commission, the superintendent is authorized to enter into one or
37 more contracts with independent entities and organizations with demon-
38 strable expertise in health care quality, finance, utilization and actu-
39 arial services. For the purposes of this section, the superintendent
40 shall not enter into contracts with health plans, entities or organiza-
41 tions owned or controlled by health plans, or with significant business
42 relationships with health plans.
43 (d) Upon completion of its evaluation of a proposed mandated benefit
44 pursuant to this section, the commission shall deliver a written report
45 of its findings to the chair of the assembly insurance committee and the
46 chair of the senate insurance committee.
47 (e)(1) Beginning no later than nine months after the commission is
48 seated, and reoccurring no less often than once every three years, the
49 commission shall analyze the impact on health insurance costs and quali-
50 ty of all state laws which mandate that health benefits be offered or
51 made available in individual and group health insurance policies,
52 contracts and comprehensive health service plans, including but not
53 limited to laws that affect the delivery of health benefits or services
54 or the reimbursement of health care providers.
55 (2) In evaluating each mandated benefit, the commission shall:
A. 4498 3
1 (A) investigate the current practices of health plans with regard to
2 the mandated benefit, and, to the extent possible, self-funded health
3 benefit plans including but not limited to avoided costs through early
4 detection and treatment of conditions, or more cost-effective delivery
5 of medical services;
6 (B) investigate the potential premium impact of repealing and/or modi-
7 fying the mandated benefits on all segments of the insurance market;
8 (C) analyze the most current and credible evidence based medicine
9 literature regarding the mandated benefit published in peer reviewed
10 medical literature generally recognized by the relevant medical communi-
11 ty to determine the effectiveness of the mandated benefit and its impact
12 on health care quality; and
13 (D) investigate the potential cost to the state of the proposed
14 mandated benefits in light of the implementation of the federal afforda-
15 ble care act.
16 (3) In evaluating mandated benefits, the commission shall hold no less
17 than two public hearings, and shall strive to obtain independent and
18 verifiable information from diverse sources within the health care
19 industry, medical community and among health care consumers with regard
20 to each mandated benefit.
21 (4)(A) On or before the first day of February, two thousand twenty-
22 six, the commission shall submit to the legislature and disseminate to
23 the public recommendations for the repeal and/or modification of state
24 laws which mandate benefits, along with a single piece of legislation
25 necessary to implement such recommendations. These recommendations shall
26 not be expected to increase the average premium in the state. Upon
27 receipt of such recommendations, the implementing legislation therefor
28 shall be introduced in both houses of the legislature without any amend-
29 ments within five days.
30 (B) The legislation introduced pursuant to subparagraph (A) of this
31 paragraph shall be voted upon, without amendment, by both such houses of
32 the legislature within ninety days, but not sooner than thirty days,
33 after the commission submits its recommendations to the legislature. If
34 approved, the legislature shall forward such legislation to the governor
35 within five days.
36 § 2. This act shall take effect immediately.
