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
________________________________________________________________________
6010
2019-2020 Regular Sessions
IN ASSEMBLY
February 26, 2019
___________
Introduced by M. of A. LAWRENCE -- read once and referred to the Commit-
tee 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 nineteen which amended
25 this section and all vacancies shall be filled as soon as practicable.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD02710-01-9
A. 6010 2
1 (b)(1) The purpose of the commission shall be to analyze the impact on
2 health insurance costs and quality of proposed legislation which would
3 mandate that health benefits be offered or made available in individual
4 and group health insurance policies, contracts and comprehensive health
5 service plans, including legislation that affects the delivery of health
6 benefits or services or the reimbursement of health care providers.
7 (2) The governor, the chair of the senate insurance committee and the
8 chair of the assembly insurance committee may request in writing that
9 the commission evaluate a proposed mandated benefit. Upon receiving such
10 a request, the commission [may, by a majority vote of its members,]
11 shall undertake an evaluation of such proposed mandated benefit.
12 (3) In evaluating a proposed mandated benefit, the commission shall:
13 (A) investigate the current practices of health plans with regard to
14 the proposed mandated benefit, and, to the extent possible, self-funded
15 health benefit plans;
16 (B) investigate the potential premium impact of the proposed mandated
17 benefits on all segments of the insurance market, as well as the poten-
18 tial for avoided costs through early detection and treatment of condi-
19 tions, or more cost-effective delivery of medical services; [and]
20 (C) analyze the most current [medical] and credible evidence based
21 medicine literature regarding the proposed mandated benefit published in
22 peer reviewed medical literature generally recognized by the relevant
23 medical community to determine the effectiveness of the proposed
24 mandated benefit and its impact on health care quality[.]; and
25 (D) investigate the potential cost to the state of the proposed
26 mandated benefits in light of the implementation of the federal afforda-
27 ble care act.
28 (4) In evaluating a proposed mandated benefit, the commission may hold
29 one or more public hearings, and shall strive to obtain independent and
30 verifiable information from diverse sources within the healthcare indus-
31 try, medical community and among health care consumers with regard to
32 the proposed mandated benefit.
33 (c) To assist the commission in its duties, and upon the direction of
34 the commission, the superintendent is authorized to enter into one or
35 more contracts with independent entities and organizations with demon-
36 strable expertise in health care quality, finance, utilization and actu-
37 arial services. For the purposes of this section, the superintendent
38 shall not enter into contracts with health plans, entities or organiza-
39 tions owned or controlled by health plans, or with significant business
40 relationships with health plans.
41 (d) Upon completion of its evaluation of a proposed mandated benefit
42 pursuant to this section, the commission shall deliver a written report
43 of its findings to the chair of the assembly insurance committee and the
44 chair of the senate insurance committee.
45 (e)(1) Beginning no later than nine months after the commission is
46 seated, and reoccurring no less often than once every three years, the
47 commission shall analyze the impact on health insurance costs and quali-
48 ty of all state laws which mandate that health benefits be offered or
49 made available in individual and group health insurance policies,
50 contracts and comprehensive health service plans, including but not
51 limited to laws that affect the delivery of health benefits or services
52 or the reimbursement of health care providers.
53 (2) In evaluating each mandated benefit, the commission shall:
54 (A) investigate the current practices of health plans with regard to
55 the mandated benefit, and, to the extent possible, self-funded health
56 benefit plans including but not limited to avoided costs through early
A. 6010 3
1 detection and treatment of conditions, or more cost-effective delivery
2 of medical services;
3 (B) investigate the potential premium impact of repealing and/or modi-
4 fying the mandated benefits on all segments of the insurance market;
5 (C) analyze the most current and credible evidence based medicine
6 literature regarding the mandated benefit published in peer reviewed
7 medical literature generally recognized by the relevant medical communi-
8 ty to determine the effectiveness of the mandated benefit and its impact
9 on health care quality; and
10 (D) investigate the potential cost to the state of the proposed
11 mandated benefits in light of the implementation of the federal afforda-
12 ble care act.
13 (3) In evaluating mandated benefits, the commission shall hold no less
14 than two public hearings, and shall strive to obtain independent and
15 verifiable information from diverse sources within the health care
16 industry, medical community and among health care consumers with regard
17 to each mandated benefit.
18 (4)(A) On or before the first day of February, two thousand twenty,
19 the commission shall submit to the legislature and disseminate to the
20 public recommendations for the repeal and/or modification of state laws
21 which mandate benefits, along with a single piece of legislation neces-
22 sary to implement such recommendations. These recommendations shall not
23 be expected to increase the average premium in the state. Upon receipt
24 of such recommendations, the implementing legislation therefor shall be
25 introduced in both houses of the legislature without any amendments
26 within five days.
27 (B) The legislation introduced pursuant to subparagraph (A) of this
28 paragraph shall be voted upon, without amendment, by both such houses of
29 the legislature within ninety days, but not sooner than thirty days,
30 after the commission submits its recommendations to the legislature. If
31 approved, the legislature shall forward such legislation to the governor
32 within five days.
33 § 2. This act shall take effect immediately.
