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.
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.
