Requires that bills which relate to mandating certain health insurance coverage be reviewed by the superintendent of insurance to assess the impact of such mandate including cost; requires the superintendent of insurance to study the costs and other aspects of existing health insurance coverage mandates.
BILL NUMBER: S1761
TITLE OF BILL : An act to amend the legislative law and the insurance law, in relation to mandated health insurance benefits
PURPOSE : To better ascertain the costs associated with proposed and existing mandated health insurance benefits.
SUMMARY OF SPECIFIC PROVISIONS : Section one declares legislative intent. Section two adds a new §68 to the Legislative Law to require that legislation mandating health insurance benefits be reviewed by the Superintendent of Insurance prior to legislative action. Section three adds a new §213 to the Insurance Law to provide for that review by the Superintendent. Section four requires the Superintendent to study costs and other aspects of existing mandates. Section five is the effective date.
JUSTIFICATION : Numerous pieces of legislation are introduced annually which seek to mandate specific health insurance benefits or seek to require insurers to cover the services of a particular health care provider. Some of these proposals may improve the cost/benefit status of health care, while others may be more costly than can be justified. Unfortunately, there is no uniform standard for determining and evaluating the costs and benefits of such proposals. This bill would establish such a cost/benefit study for each proposal, and would enable the Legislature to make an better informed judgement about the merits of each bill. The study of existing mandated health insurance benefits is timely in light of the growing crisis in the affordability and availability of health insurance.
HISTORY OF BILL : See A.9695 of 1990, A.4370 of 1991, S.6716/A.9145 of 1992, S.2190/A.3792 of 1993-94, S.2426/A.4015 of 1995-96, S.1682 of 1997-98, S.1538-A of 1999-2000, S.1603 of 2001-02, S.1069-A/A.4576-A of 2003-04, S.1852A/A.3449A of 2005-06, S.1314/A.3138 of 2007-08.
FISCAL IMPACT : No direct fiscal impact. If the bill were to result in lower total costs for health care, public programs such as Medicaid and Medicare would save money.
EFFECTIVE DATE : September 1.
STATE OF NEW YORK ________________________________________________________________________ 1761 2009-2010 Regular Sessions IN SENATE February 6, 2009 ___________Introduced by Sen. FARLEY -- read twice and ordered printed, and when printed to be committed to the Committee on Investigations and Govern- ment Operations AN ACT to amend the legislative law and the insurance law, in relation to mandated health insurance benefits THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. Legislative intent. The legislature finds that there is a growing crisis in both the availability and cost of health insurance. Millions of New Yorkers, many of whom are employed, are uninsured. Many persons who would otherwise purchase individual coverage are precluded from doing so because of the cost. Numerous factors can be tied to the escalating cost of health insurance such as the aging population, tech- nological advances, the cost of malpractice insurance and the unknown cost of mandated benefits and services. The legislature further finds a need to explore every avenue which might lead to lower costs and increased availability of health insur- ance. The legislature therefore desires to examine the process by which mandated benefits and services are incorporated into New York's statutes and to evaluate the costs associated with the existing statutory and regulatory requirements which mandate the current coverages and services. Therefore, the legislature declares that no bills which mandate a particular benefit or service shall be considered by a stand- ing committee until a full assessment, by the New York state insurance department, is made of the impact of the proposed mandated benefit. Further, the legislature directs the superintendent of insurance to undertake a study of existing health insurance mandates, concentrating on several specific aspects and possible consequences of mandated bene- fits and services. S 2. The legislative law is amended by adding a new section 68 to read as follows:EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD04065-01-9 S. 1761 2
S 68. BILLS MANDATING HEALTH INSURANCE BENEFITS. A BILL WHICH ENACTS OR AMENDS ANY PROVISION OF LAW MANDATING EITHER HEALTH INSURANCE COVER- AGE FOR SPECIFIC HEALTH SERVICES OR FOR CERTAIN PROVIDERS OF HEALTH CARE SERVICES AS PART OF INDIVIDUAL, GROUP OR BLANKET ACCIDENT AND HEALTH INSURANCE POLICIES, OR CONTRACTS ISSUED BY HOSPITAL OR HEALTH SERVICE CORPORATIONS SHALL, PRIOR TO CONSIDERATION BY A STANDING COMMITTEE, BE REVIEWED PURSUANT TO SECTION TWO HUNDRED FIFTEEN OF THE INSURANCE LAW. FOR THE PURPOSES OF THIS SECTION, A MANDATED OPTION SHALL NOT BE CONSID- ERED A MANDATED BENEFIT. S 3. The insurance law is amended by adding a new section 215 to read as follows: S 215. MANDATED HEALTH INSURANCE BENEFITS. (A) PURSUANT TO THIS SECTION AND SECTION SIXTY-EIGHT OF THE LEGISLATIVE LAW, IT SHALL BE THE DUTY OF THE SUPERINTENDENT TO ASSESS THE IMPACT OF ANY BILL MANDATING EITHER HEALTH INSURANCE COVERAGE FOR SPECIFIC HEALTH SERVICES OR FOR CERTAIN PROVIDERS OF HEALTH CARE SERVICES AS PART OF INDIVIDUAL, GROUP OR BLANKET ACCIDENT AND HEALTH INSURANCE POLICIES, OR CONTRACTS ISSUED BY HOSPITAL OR HEALTH SERVICE CORPORATIONS. (B) TO CARRY OUT THE PURPOSES OF THIS SECTION, THE SUPERINTENDENT SHALL ASSESS THE IMPACT OF THE PROPOSED MANDATED BENEFIT, INCLUDING COSTS TO EMPLOYERS AND INSURERS, COSTS TO THE HEALTH CARE SYSTEM AND OTHER FACTORS WHICH THE SUPERINTENDENT DEEMS APPROPRIATE. AS PART OF SUCH ASSESSMENT, THE SUPERINTENDENT SHALL CONSULT WITH PERSONS WHO ARE LIKELY TO BE AFFECTED BY THE PROPOSED MANDATE, INCLUDING REPRESENTATIVES OF: COMMERCIAL HEALTH INSURANCE COMPANIES, HOSPITAL AND HEALTH SERVICE CORPORATIONS, SMALL BUSINESS, MAJOR INDUSTRY, THE HOSPITAL INDUSTRY, PHYSICIANS, PROVIDERS OF SERVICES SPECIFIED IN THE BILL AND OTHER PERSONS WHOM THE SUPERINTENDENT DEEMS APPROPRIATE. THE INFORMATION RECEIVED FROM SUCH SOURCES SHALL BE INCLUDED IN THE SUPERINTENDENT'S ASSESSMENT, WHICH SHALL BE FORWARDED WITHIN THIRTY DAYS OF THE INTRODUC- TION OF THE BILL TO THE SPONSOR OF THE BILL AND THE CHAIRMAN AND RANKING MINORITY MEMBER OF THE STANDING COMMITTEE TO WHICH THE BILL WAS REFERRED. SHOULD THE SUPERINTENDENT FAIL TO REPORT BACK HIS FINDINGS TO THE SPONSOR WITHIN THE ALLOTTED THIRTY DAYS, THE BILL SHALL BE DEEMED ACTIVE AND CAN BE ACTED ON BY THE STANDING COMMITTEE TO WHICH SUCH BILL WAS REFERRED. S 4. (a) The superintendent of insurance shall undertake a study of existing mandated health insurance benefits. The study shall include, at a minimum and to the extent that information is available, the follow- ing: (1) The extent to which the treatment or service is utilized by a significant portion of the population; (2) The extent to which the treatment or service is available to the population; (3) The extent to which the mandated insurance coverage has increased or decreased the cost of the treatment or service over the past five years; (4) The extent to which the mandated insurance coverage has affected the number and types of providers of the mandated treatment or service over the past five years; (5) The extent to which insurance coverage of the health care service or provider has increased or decreased the insurance premium and admin- istrative expenses of policyholders; (6) The impact of indirect costs, which are costs other than premiums and administrative costs, on the question of the costs and benefits of coverage;S. 1761 3
(7) The impact of this coverage on the total cost of health care; and (8) The effects on the cost of health care to employers and employees. (b) The superintendent of insurance shall further consider: (1) The extent to which the need for mandated benefits outweighs the costs associated with the mandate; and (2) The advisability of mandating the availability of benefits which are presently mandated. (c) The superintendent of insurance shall forward a report of the study to the legislature on or before December 31, 2012. S 5. This act shall take effect on the first of September next succeeding the date on which it shall have become a law, except that section four of this act shall take effect immediately.