A04267 Summary:

BILL NOA04267
 
SAME ASNo Same As
 
SPONSORZebrowski
 
COSPNSRBenedetto, Thiele, Burdick, Gunther, Conrad
 
MLTSPNSR
 
Add Art 2 Title 3-A §§245 - 245-d, Pub Health L; add §99-r, St Fin L
 
Establishes the New York state public health care option program to provide a comprehensive and affordable health care insurance option for all residents of this state; establishes the New York state public health care option program fund.
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A04267 Actions:

BILL NOA04267
 
02/14/2023referred to health
01/03/2024referred to health
07/15/2024enacting clause stricken
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A04267 Committee Votes:

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A04267 Floor Votes:

There are no votes for this bill in this legislative session.
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A04267 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          4267
 
                               2023-2024 Regular Sessions
 
                   IN ASSEMBLY
 
                                    February 14, 2023
                                       ___________
 
        Introduced by M. of A. ZEBROWSKI, BENEDETTO, THIELE, BURDICK, GUNTHER --
          read once and referred to the Committee on Health
 
        AN  ACT  to amend the public health law, in relation to establishing the
          New York state public health care option program;  and  to  amend  the
          state  finance  law,  in  relation  to establishing the New York state
          public health care option program fund
 
          The People of the State of New York, represented in Senate and  Assem-
        bly, do enact as follows:
 
     1    Section  1.  Article 2 of the public health law is amended by adding a
     2  new title 3-A to read as follows:
     3                                 TITLE III-A
     4              NEW YORK STATE PUBLIC HEALTH CARE OPTION PROGRAM
     5  Section 245.   Definitions.
     6          245-a. Public option program established.
     7          245-b. Powers of the commissioner.
     8          245-c. Member costs; limitations.
     9          245-d. Board of trustees.
    10    § 245. Definitions. As used in this title the  terms  shall  have  the
    11  following meanings:
    12    1.  "Board"  means  the board of trustees of the New York state public
    13  health care option program.
    14    2. "Cost sharing expense"  means  deductibles,  co-insurance,  co-pay-
    15  ments, or any other required similar expense incurred by a member. "Cost
    16  sharing  expense"  shall not include premiums or any expenses related to
    17  services or providers that are out of the program's network.
    18    3. "Health care provider" means any individual or entity authorized to
    19  provide medical and/or health care services to members of the program.
    20    4. "Health care service" means any health care service, including care
    21  coordination, included as a benefit under the program.
    22    5. "Member" means an individual who is enrolled in the program.

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD04745-01-3

        A. 4267                             2
 
     1    6. "New York state public health care option program", "public  option
     2  program",  and  "program"  mean  the  New  York state public health care
     3  option program created by  section  two  hundred  forty-five-a  of  this
     4  title.
     5    7.  "New  York state public health care option program fund" means the
     6  New York state public health care option program fund established  under
     7  section ninety-nine-r of the state finance law.
     8    8.  "Participating  provider" means any individual or entity that is a
     9  health care provider qualified and approved by the programs  to  provide
    10  health  care  services  to  members  under the program, or a health care
    11  organization.
    12    § 245-a. Public option program established. The New York state  public
    13  health care option program is hereby established. The commissioner shall
    14  establish  and implement the program pursuant to this title. The program
    15  shall provide a  comprehensive  and  affordable  health  care  insurance
    16  option  for  all  residents  of  this  state who choose to enroll in the
    17  program. The commissioner shall ensure that  coverage  provided  through
    18  the  program  is  competitive  in  terms  of affordability, benefits and
    19  access to quality health care providers.   Every resident of  the  state
    20  shall be eligible and entitled to enroll as a member under the program.
    21    § 245-b. Powers of the commissioner. In carrying out the provisions of
    22  this act, the commissioner shall have the power and authority to:
    23    1.  Establish  premiums  for  which  members are responsible and other
    24  charges for enrolling in or being a member under the program.
    25    2. Ensure that the program's plans shall be available  for  enrollment
    26  on the Marketplace as provided in title seven of this article.
    27    3.  Establish  criteria  and standards for health care providers to be
    28  qualified for participation in the program and grounds for revocation of
    29  such participation.
    30    4. Establish coverage  for  the  program  including  all  health  care
    31  services  that  members  would  be  eligible  to receive and maintain an
    32  updated list of participating providers. Such coverage shall ensure that
    33  all plans meet the requirements  of  a  qualified  health  plan  by  the
    34  Marketplace  pursuant to section two hundred sixty-eight-c of this arti-
    35  cle.
    36    5. Establish and maintain procedures  and  standards  for  recognizing
    37  health care providers located out of the state for purposes of providing
    38  coverage under the program for out-of-state health care services.
    39    6.  Develop  payment  methodologies and rates for health care services
    40  provided by participating providers including a methodology for  reason-
    41  able and customary fees for out of network health care services incurred
    42  by members.
    43    7.  Create  an  enrollment  process  for  employers with less than one
    44  hundred employees to  participate  in  the  program.  Any  participating
    45  employer  shall meet standards established by the commissioner including
    46  but not limited  to,  establishing  an  annual  limitation  on  employee
    47  contributions  and  provisions for compliance with applicable collective
    48  bargaining agreements.  Notwithstanding any provision to  the  contrary,
    49  any  employee  of a participating employer may enroll as a member of the
    50  program regardless of whether they are a resident of the state.
    51    8. Submit an implementation plan to the governor and state legislature
    52  no later than twelve months following the effective date of this section
    53  that will provide a detailed plan on timelines for enrollment, coverage,
    54  premium schedule, benefits and other relevant information related to the
    55  implementation of the program.

        A. 4267                             3
 
     1    9. Seek all applicable federal waivers or other federal approvals  for
     2  the  operations  of  the program including federal approval to authorize
     3  the use of premium tax credits for applicable members for enrollment  in
     4  the program.
     5    10.  Utilize  any  funds  from  the  New York state public health care
     6  option program fund  for  purposes  supporting  the  operations  of  the
     7  program.
     8    §  245-c.  Member costs; limitations. 1. The commissioner shall estab-
     9  lish a base rate for enrollment in the program. The rates for enrollment
    10  shall include a formula that adjusts premiums based  on  household  size
    11  and  income.  The  premium  schedule  and  formula shall ensure that the
    12  program remains viable, but at the lowest possible cost to members.  The
    13  commissioner  shall  establish  benchmark goals for premiums that should
    14  seek to be below comparable commercially available plans.
    15    2. The commissioner shall determine other deductibles, co-payments  or
    16  co-insurance  under  the  program  in  a manner that ensures the program
    17  remains viable but is affordable for members.
    18    3. The commissioner shall establish  an  annual  limitation  for  cost
    19  sharing  expenses  for members and annually update such limitation. Such
    20  limitation shall be based on  cost  growth  factor  established  by  the
    21  commissioner.
    22    4. The commissioner shall ensure that eligible members can receive any
    23  applicable premium tax credits.
    24    §  245-d. Board of trustees. 1. The board of the New York State public
    25  health care option program is hereby established within the department.
    26    2. The board shall, at the request of the  commissioner,  develop  and
    27  submit  recommendations related to the implementation of this title. The
    28  commissioner may propose regulations under this title for  consideration
    29  by  the  board.  The board shall have power to establish and amend regu-
    30  lations to effectuate the  provisions  of  this  title  which  shall  be
    31  subject to approval by the commissioner.
    32    3.  The  board shall be comprised of thirteen trustees to be appointed
    33  as follows:
    34    a. the commissioner of health and the superintendent of the department
    35  of financial services shall serve as ex-officio trustees;
    36    b. five trustees shall be appointed by the governor;
    37    c. two trustees shall be appointed by the temporary president  of  the
    38  senate;
    39    d. two trustees shall be appointed by the speaker of the assembly;
    40    e.  one  trustee  shall  be  appointed  by  the minority leader of the
    41  senate; and
    42    f. one trustee shall be appointed by the minority leader of the assem-
    43  bly.
    44    4. The board shall meet at least four times each calendar year.  Meet-
    45  ings shall be held upon the call of the chair and  as  provided  by  the
    46  board. A majority of the appointed trustees shall constitute a quorum of
    47  the  board. Actions may be taken, and motions and resolutions adopted by
    48  the board with the affirmative vote of  at  least  seven  trustees.  The
    49  board  may  establish  an  executive committee to exercise any powers or
    50  duties of the board as it may provide, and other  committees  to  assist
    51  the board or the executive committee. The chair of the board shall chair
    52  the  executive committee and shall appoint the chair and trustees of all
    53  other committees. The board may appoint one or more advisory committees.
    54  Members of advisory committees need not be trustees of the board.

        A. 4267                             4
 
     1    5. The trustees of the board shall serve terms of four years.   Subse-
     2  quent  appointments  upon  the expiration of term shall be filled in the
     3  same manner as the original appointment.
     4    6.  The  trustees  of  the  board shall elect one of their trustees to
     5  serve as chairperson during his or her appointment term or for a  period
     6  of four years, whichever is shorter.
     7    7. Trustees of the board shall serve without compensation but shall be
     8  allowed  their actual and necessary expenses incurred in the performance
     9  of their duties.
    10    8. The board and its committees and advisory  committees  may  request
    11  and  receive  the  assistance  of  the department and any other state or
    12  local governmental entity in exercising its powers and duties.
    13    9. The board, in consultation with the commissioner, may submit recom-
    14  mendations to the governor and legislature related to the provisions  of
    15  this article.
    16    10.  Within twelve months from the enactment of this title, the board,
    17  in consultation with the commissioner, shall make  a  recommendation  to
    18  the governor and legislature on whether any additional revenue, taxes or
    19  assessments are necessary to implement the program.
    20    §  2. The state finance law is amended by adding a new section 99-r to
    21  read as follows:
    22    § 99-r. New York state public health care option  program  fund.    1.
    23  There  is hereby established in the joint custody of the comptroller and
    24  the commissioner of taxation and finance a debt service fund to be known
    25  as the "New York state public health care option program fund".
    26    2. Such fund shall consist of all revenues received through  premiums,
    27  co-insurance or other related fees from members enrolled in the New York
    28  state  public  health  care  option program pursuant to title three-A of
    29  article two of the public health law, any federal payments received  for
    30  such  purpose,  state  funds transferred to the fund for the purposes of
    31  support for the New York state public health care option program or  any
    32  other  revenue  generated  that  is  dedicated  towards  the  purpose of
    33  supporting the New York state public health care option program. Nothing
    34  contained in this section shall prevent the state from receiving grants,
    35  gifts or bequests for the purposes  of  the  fund  as  defined  in  this
    36  section and depositing them into the fund according to law.
    37    3.  The  moneys in such fund shall be expended and transferred for the
    38  purposes of operating the New  York  state  public  health  care  option
    39  program and any reasonable expenses related thereto.
    40    § 3. This act shall take effect on the one hundred eightieth day after
    41  it shall have become a law.
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