Bill S5849-2011

Establishes the New York Health Benefit Exchange

Establishes the New York Health Benefit Exchange which will facilitate the purchase and sale of qualified health plans in the individual market in NY and will incorporate a small business health options program to assist qualified employers in facilitating the enrollment of their employees in qualified health plans offered in the group market.

Details

Actions

  • Jan 4, 2012: REFERRED TO CORPORATIONS, AUTHORITIES AND COMMISSIONS
  • Jun 24, 2011: RECOMMITTED TO RULES
  • Jun 23, 2011: ORDERED TO THIRD READING CAL.1539
  • Jun 23, 2011: REFERRED TO RULES

Meetings

Votes

Memo

BILL NUMBER:S5849

TITLE OF BILL:

An act to amend the public authorities law and the public officers law, in relation to the establishment of the New York Health Benefit Exchange

PURPOSE OF BILL:

This bill would establish the New York Health Benefit Exchange ("Exchange"), a public benefit corporation that will serve as a marketplace for the purchase and sale of qualified health plans in the State of New York, in accordance with the Patient Protection and Affordable Care Act, Pub. L. 111-148, and the Health Care and Education Reconciliation Act, Pub. L. 111- 152, collectively referred to as the "Affordable Care Act" ("ACA").

SUMMARY OF PROVISIONS:

Section 1 of the bill would provide that the bill, upon enactment, would be known as the "New York Health Benefit Exchange Act."

Section 2 of the bill would add new Public Authorities Law ("PAL") Article 10-E to establish the Exchange as a public benefit corporation.

New PAL § 3980 would set forth a statement of policy and purposes.

New PAL § 3981 would define certain key terms.

New PAL § 3982 would establish the Exchange as a public benefit corporation to be managed by a Board of Directors ("Board"). The Board would consist of nine directors, including two ex officio members: the Superintendent of Insurance (effective October 3, 2011, the Superintendent of Financial Services) and the Commissioner of Health. Seven additional directors, who would be required to meet the qualifications specified in the bill, would be appointed by the Governor, two on the recommendation of the Temporary President of the Senate and two on the recommendation of the Speaker of the Assembly. The chair would be appointed by the Governor and confirmed by the Senate, and all directors would be subject to the ethics and conflict of interest provisions set forth in Public Officers Law ("POL") §§ 73 and 74.

New PAL § 3983 would set forth the general corporate powers of the Exchange, including the power to sue and be sued, enter into contracts, make by-laws, and promulgate rules and regulations to carry out its corporate purposes.

New PAL § 3984 would set forth the functions of the Exchange, including:

o making qualified health plans, including certain qualified dental plans, available to qualified individuals and qualified employers beginning on or before January 1, 2014 [new PAL § 3984(1)];

o assigning ratings to qualified health plans offered through the Exchange in accordance with federal criteria [new PAL § 3984(2)];

o utilizing a standardized format for presenting health benefit options in the Exchange [new PAL § 3984(3)];

o establishing enrollment periods consistent with the Insurance Law, unless the Insurance Law conflicts with the ACA and guidance promulgated thereunder [new PAL § 3984(4)];

o implementing procedures for the certification, recertification and decertification of health plans as qualified health plans, consistent with guidelines issued pursuant to ACA § 1311(c), as further detailed in new PAL § 3985 [new PAL § 3984(5)];

o requiring that qualified health plans offer the "essential benefits" that will be defined by the Secretary of Health and Human Services ("Secretary") pursuant to ACA § 1302(b) and any additional benefits required under the Insurance Law, provided that the State assumes the cost of such additional benefits [new PAL § 3984(6)];

o ensuring that insurers offering health plans through the exchange do not charge an individual a fee or penalty for termination of coverage [new PAL § 3984(7)];

o providing for the operation of a toll-free telephone hotline to respond to requests for assistance [new PAL § 3984(8)];

o maintaining an Internet website through which enrollees and prospective enrollees of qualified health plans may obtain standardized comparative information on such plans [new PAL § 3984(9)];

o making available by electronic means a calculator to allow individuals to determine the actual cost of coverage after application of any available premium tax credits under Internal Revenue Code ("IRC") § 36B and cost-sharing reductions under ACA 1402 [new PAL § 3984(10)];

o establishing a program under which the Exchange awards grants to entities to serve as navigators under ACA § 1311(i) and associated regulations [new PAL § 3984(11)];

o informing individuals of eligibility requirements for the State's public health insurance programs (e.g., Medicaid, Child Health Plus, or any applicable state or local public health insurance program) and, if eligible, enrolling them in such programs [new PAL § 3984(12)];

o granting certifications attesting that, for purposes of the individual responsibility penalty under IRC § 5000A, an individual is exempt from the individual responsibility requirement or from the penalty pursuant to ACA § 1411 [new PAL § 3984(13)];

o transmitting to the Secretary of the Treasury information about certification granted to individuals and employees about individuals who have notified the Exchange that they have changed employers, and

about individuals who ceased coverage under a qualified health plan [new PAL § 3984(14)];

o providing each employer with the name of each employee of the employer who ceased coverage under a qualified health plan, and who was determined eligible for a premium tax credit because the employer did not offer minimum essential coverage, or because the coverage was either unaffordable or did not provide the required minimum actuarial value pursuant to federal law [new PAL § 3984(15)];

o operating a Small Business Health Options Program ("SHOP") pursuant to ACA § 1311, through which qualified employers will be able to access coverage for their employees [new PAL § 3984(16)];

o entering into agreements with federal and state agencies and other state exchanges to carry out its responsibilities, and with local departments of social services to coordinate enrollments in other social services programs, provided that such agreements include adequate protections with respect to the confidentiality of the information to be shared and comply with all state and federal laws and regulations [new PAL § 3984(17)];

o performing duties required by the Secretary or the Secretary of the Treasury related to determining eligibility for premium tax credits, reduced cost-sharing, or individual responsibility requirement exemptions [new PAL § 3984(18)];

o meeting certain financial integrity requirements under ACA § 1313 [new PAL § 3984(19)];

o consulting with the Regional Advisory Committees created under the bill and with relevant stakeholders, including health care consumers who are enrollees in health plans; individuals and entities with experience in facilitating enrollment in health plans; representatives of small businesses and self-employed individuals; the state Medicaid program and local departments of social services; advocates for enrolling hard to reach populations; health care providers; and insurers [new PAL § 3984(20)];

o submitting information provided by Exchange applicants for verification in accordance with the requirements of ACA § 1411(c) [new PAL § 3984(21)];

o establishing rules and regulations as set forth in new PAL 3983(8), as deemed necessary by the Board, that shall not conflict with or prevent the application of regulations promulgated by the Secretary [new PAL § 3984(22)]; and

o determining eligibility, providing notices, and providing opportunities for appeal and redetermination in accordance with the requirements of ACA §§ 1411 and 1413 [new PAL § 3984(23)].

New PAL § 3985 would describe the Exchange's obligations with regard to the certification of health plans and the oversight of qualified health plans.

New PAL § 3986 would establish five Regional Advisory Committees, which will be representative of the interests of health care consumers, small business, the medical community and insurers. The Regional Advisory Committees will provide advice to the Exchange, which will reflect findings about regional variations regarding the availability of health insurance coverage and other issues deemed necessary by such committees and the Board.

New PAL § 3987 would provide that the Exchange will be financially self-sufficient by January 1,2015, and that the Exchange will study and make recommendations for achieving such self-sufficiency as set forth in new PAL § 3988(5). In addition, as required by federal law, PAL § 3987 would require the Exchange to publish on its website information about its administrative costs. This section would also prohibit transfers of funding from the Exchange to the General Fund or, absent an appropriation, from the General Fund to the Exchange.

New PAL § 3988 would provide that the Exchange will study or cause to be studied certain matters related to its future operations, and will report its findings and recommendations to the Governor, the Temporary President of the Senate and the Speaker of the Assembly. In particular, the Exchange would, on or before April 1, 2012:

o compare the "essential benefits" identified by the Secretary to the benefits mandated by State law and recommend whether any or all of such State-mandated benefits should be offered through the Exchange at State expense [new PAL § 3988(1)];

o consider issues such as whether insurers participating in the Exchange must offer all health plans sold in the Exchange to individuals outside of the Exchange; how to develop and implement the transitional reinsurance program required under the ACA; whether to merge the individual and small group health insurance markets for rating purposes; and whether to increase the size of small employers from not more than 50 employees to not more than an average of 100 employees prior to January 1, 2016 [new PAL § 3988(2)];

o make recommendations regarding the "basic health plan program" [new PAL § 3988(3)];

o make recommendations as to the advantages and disadvantages of the Exchange serving as an active purchaser, a selective contractor or a clearinghouse of insurance [new PAL § 3988(4)];

o make recommendations regarding the funding and self-sufficiency of the Exchange [new PAL § 3988(5)];

· make recommendations regarding benchmark benefits [new PAL § 3988(6)];

o make recommendations upon the impact of the Exchange on the Healthy NY and Family Health Plus employer partnership programs [new PAL 3988(7)];

o make recommendations on procedures under which licensed health insurance producers, chambers of commerce and business associations

may enroll in the Exchange and assist individuals in applying for premium tax credits and cost sharing reductions [new PAL . 3988(8)];

o make recommendations on the criteria for eligibility to serve as a navigator [new PAL § 3988(9)];

o make recommendations on the role of the Exchange in decreasing disparities in health care service, including disparities on the basis of race and ethnicity [new PAL § 3988(10)];

o make recommendations upon whether and to what extent health savings accounts should be offered through the Exchange [new PAL § 3988(11)]; and

o make recommendations on how to integrate public health insurance coverage with the Exchange [new PAL § 3988(12)].

In addition, on or before December 1, 2016, recommend whether to allow large employers to participate in the Exchange beginning January 1, 2017 [new PAL § 3988(13)].

New PAL § 3989 would provide that the Exchange would be exempt from state taxation.

New PAL § 3990 would authorize the Board to appoint employees to serve as senior managerial staff, who would be exempt from the civil service system; all other employees would be subject to civil service.

New PAL § 3991 would make Public Officers Law ("POL") §§ 17 and 19, regarding representation by the Attorney General and indemnification for damages, applicable to directors, officers and employees of the Exchange.

New PAL § 3392 would set forth language making the operation of new PAL Article 10-E contingent on sufficient federal financial support to establish and implement the Exchange.

New PAL § 3393 would provide that nothing in new PAL Article 10-E, and no action taken by the Exchange, shall-be construed to preempt or supersede the authority of the Commissioner or the Superintendent or to exempt insurers, insurance producers or qualified health plans from the Insurance Law, the Public Health Law or the regulations promulgated thereunder.

Section 3 of the bill would add new POL § 17(1)(x) to include employees of the Exchange in the list of state employees entitled to representation by the Attorney General in civil litigation.

Section 4 of the bill would add new POL § 19(1)(j) to include employees of the Exchange in the list of state employees entitled to indemnification of damages awarded in a judgment or settlement.

Section 5 of the bill would provide for severability of the bill in the event any part of it is deemed unenforceable.

Section 6 of the bill would provide that in the event the United States Supreme Court finds the ACA unconstitutional or the United

States Congress repeals the ACA, the Legislature will convene within 180 days of such decision or repeals to consider legislative options.

Section 7 of the bill would provide that the bill would take effect immediately, and clarifies that the Department of Health or the Insurance Department would be authorized to continue administering federal grants already received.

EXISTING LAW:

The Affordable Care Act requires each state to either establish a state American Health Benefit Exchange or participate in a regional exchange, through which individuals and small groups will be able to purchase health insurance in the form of a qualified health benefit plan. If the state does neither, its residents will be required to participate in a federal Health Benefit Exchange.

STATEMENT IN SUPPORT:

New York State has long been a leader in promoting access to comprehensive health insurance coverage. The commitment to the health of the people of the State, and its ongoing efforts to implement reforms that promote the availability of affordable, quality care are consistent with the goals of the Affordable Care Act: to reduce the number of uninsured persons, provide a transparent and centralized marketplace for insurance coverage, educate consumers and small businesses about their options, and assist individuals and employees with access to programs, premium assistance tax credits and cost-sharing reductions. To achieve those objectives, the ACA includes provisions that, among other things, expand eligibility for public insurance programs, transform the health insurance system through the use of exchanges and other market reforms, encourage quality and efficiency in the delivery of health care services, and develop programs that emphasize preventive care.

The ACA requires that each state demonstrate to the federal government the ability to operate an American Health Benefit Exchange or the federal government will operate an exchange for the State. For a number of reasons, it is critical that New York is able to design its own exchange. First, the State is best positioned to understand the complicated issues and far reaching policy ramifications of establishing and operating a new exchange within the existing commercial insurance market. Such consideration must encompass matters such as the ability of insurers to compete fairly and the ability of consumers to access affordable, quality care, and would be needlessly complicated if the market within the exchange is regulated by the federal government while the market outside the exchange is regulated by the State.

Second, the federal government simply will not be equipped to understand and give appropriate consideration to the unique regional and economic needs of New York's individual and small business health insurance markets and the diversity of New York's population, with its ethnic, cultural and language differences. Third, operation of the Exchange by the State is the most certain way to ensure that consumers continue to enjoy the important protections currently

embodied in state law, such as the assurance that older adults are not charged higher premiums on account of their age.

Fourth, the ACA requires the Exchange to evaluate an individual's eligibility for Medicaid and other public health coverage and enroll them if eligible. This means that it will be critical to coordinate the operations of the Exchange with the State's administration of these programs, which will achieve efficiencies and economies of scale and help reduce Medicaid spending by the State and local governments. From the county perspective, such spending represents a large percentage of local budgets and accounts for a significant portion of property taxes; accordingly, any efficiencies resulting from the State's operation of the Exchange would inure to the benefit of local taxpayers.

For these reasons, it is essential that the State enact legislation establishing an Exchange, and that such legislation conform to the requirements of the ACA. Moreover, if such legislation is not enacted in timely fashion, the State risks losing the opportunity to apply for significant federal funding to establish the Exchange.

The purpose of this legislation is to establish a single Exchange in New York - a centralized, customer-service oriented marketplace where individuals and small groups will be able to purchase qualified health plans, receive eligibility and subsidy determinations, and be enrolled in a range of coverage options, including public health coverage programs - operated by a governmental entity with the flexibility to meet the ambitious deadlines set by the ACA. A state that chooses to operate its own Exchange must demonstrate to the United States Department of Health and Human Services ("HHS") by January 1, 2013 that such Exchange will be operational by January 1, 2014. Each Exchange must begin accepting applications by July 1, 2013, and must be operational by January 1, 2014.

The Exchange will be established as a public benefit corporation managed by a Board of Directors. Seven of the nine members of the Board will have expertise in relevant areas, including individual health care coverage, small employer health care coverage, health benefits administration, health care finance, public or private health care delivery systems, and purchasing health plan coverage. The remaining members - the Superintendent and the Commissioner will serve as ex officio, voting members of the Board.

The Board will consult with five Regional Advisory Committees, comprised of 25 representatives of stakeholders from sectors that will be impacted by the operation of the Exchange, including health plan consumer advocates, small business consumer representatives, health care providers, agents, brokers, insurers and labor organizations. The Committees will provide advice and recommendations to the Board reflecting findings about regional variations regarding the availability of health insurance coverage and other issues deemed necessary by the Committees and the Board.

The Exchange will make available qualified health plans, including certain qualified dental plans, to qualified individuals and employers beginning on or before January 1, 2014 (to take effect no

earlier than such date). Under this legislation, the Exchange will implement procedures for the certification, recertification and decertification of health plans as qualified health plans. The Exchange will also assign ratings to qualified health plans in accordance with the ACA.

The bill also provides certain protections meant to assist individuals in using the Exchange. For example, the bill provides that the Exchange will operate a toll-free telephone line to assist consumers and an Internet website containing standardized comparative information on qualified health plans. The website will feature a calculator allowing individuals to determine the actual cost of coverage. The bill also requires the Exchange to establish a program to award grants to entities to serve as "navigators" to help educate consumers and facilitate enrollment.

In addition, the Exchange will include a Small Business Health Options Program ("SHOP"), which will assist small employers in facilitating the enrollment of their employees in qualified health plans offered in the group market. Until January 1,2016, a "small employer" will be defined as an employer with an average of less than 50 employees. On January 1, 2016, the term will apply to employers with an average of up to 100 employers. Under this bill, and as permitted under federal law, the Exchange will consider whether to expand the definition before 2016.

The ACA imposes a number of requirements regarding financial integrity, which are reflected in the bill. In addition, because the bill creates a new article within the Public Authorities Law, various provisions of law that do not expressly appear in the bill will apply to the operations of the Exchange, such as quorum requirements for Board meetings. To promote transparency, the Exchange will be subject to the Freedom of Information Law and Board meetings will be subject to the Open Meetings Law.

The participation of the ex officio directors on the Board is essential to the success of the Exchange. The nature of the Exchange and the need to integrate its functions with the regulation of the insurance markets necessitates the close involvement of the Superintendent. The engagement of the Commissioner is important, largely because the Exchange must work seamlessly with Medicaid, Child Health Plus ("CHP") and other public coverage programs, supported by a new, ACA compliant integrated eligibility and enrollment system. As required by the ACA, the Exchange will screen individuals to see if they are eligible for Medicaid or other public coverage programs and, if they are eligible, enroll them in such programs.

As many as one million additional people are expected to enroll in Medicaid or CHP as a result of the individual mandate, and one million people are expected to enroll in the Exchange, of whom approximately 75 percent will qualify for subsidies. It is expected that large numbers of people will transition back and forth between private health insurance and public health insurance programs as their job statuses and incomes change, making it particularly important to properly integrate the Exchange with public health

insurance programs, including Medicaid, CHP and, if established, the "Basic Health Program."

This legislation also recognizes that there are additional decisions that need to be made and implemented by certain dates, many of which will require the introduction and enactment of additional legislation, and establishes a framework for such decisions to be made. Specifically, the bill requires the Exchange to conduct a study, or arrange for a study to be conducted, on several of these discussion points, and mandates that the Board submit a report of its findings and recommendations on each such issue to the Governor and the leaders of the Legislature by specified dates. As to certain matters, no study is necessary and the Exchange is charged only with making recommendations.

The areas for study and review include: (1) the "essential benefits" that will be identified by the Secretary in comparison to the benefits mandated by current State law; (2) changes in the insurance market, such as whether insurers participating in the Exchange must offer all health plans sold in the Exchange to individuals outside of the Exchange, how to implement the transitional reinsurance program, whether to merge the individual and small group health insurance markets for rating purposes, and whether to increase the size of small employers from not more than an average of 50 employees to not more than an average of 100 employees prior to 2016; (3) the "basic health plan program;" (4) whether the Exchange should serve as an active purchaser, selective contractor or a clearinghouse of insurance; (5) funding of the Exchange; (6) the benchmark benefits; and (7) whether to allow large employers to participate in the Exchange beginning January 1, 2017.

BUDGET IMPLICATIONS:

Enactment of this bill will not have any fiscal implications during the upcoming fiscal years. While the ACA requires each Exchange to be "self-sustaining" by January 1, 2015, federal funds will support the planning, implementation and operation of the Exchange through December 2014. New York has already been selected to receive funding under an Early Innovator Grant ($27 million) and an Exchange Planning Grant ($1 million), which will help the state design and implement the necessary information technology ("IT") infrastructure needed to operate its Exchange.

In June, DOH expects to apply for a Level 1 Establishment Grant, which makes a year's worth of funding available to states that have made some progress under their Exchange Planning Grant. Level 2 Establishment Grants will provide funding through December 31, 2014 to applicants that are further along in the establishment of an Exchange, and are dependent on having a governance structure and the legal authority to operate the Exchange. With the enactment of this legislation, assuming other applicable criteria are met, New York will qualify to apply for such grant.

EFFECTIVE DATE:

This bill would take effect immediately.


Text

STATE OF NEW YORK ________________________________________________________________________ 5849 2011-2012 Regular Sessions IN SENATE June 23, 2011 ___________
Introduced by Sens. SEWARD, HANNON -- (at request of the Governor) -- read twice and ordered printed, and when printed to be committed to the Committee on Rules AN ACT to amend the public authorities law and the public officers law, in relation to the establishment of the New York Health Benefit Exchange THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. This act shall be known and may be cited as the "New York Health Benefit Exchange Act". S 2. The public authorities law is amended by adding a new article 10-E to read as follows: ARTICLE 10-E NEW YORK HEALTH BENEFIT EXCHANGE SECTION 3980. STATEMENT OF POLICY AND PURPOSES. 3981. DEFINITIONS. 3982. ESTABLISHMENT OF THE NEW YORK HEALTH BENEFIT EXCHANGE. 3983. GENERAL POWERS OF THE EXCHANGE. 3984. FUNCTIONS OF THE EXCHANGE. 3985. SPECIAL FUNCTIONS OF THE EXCHANGE RELATED TO HEALTH PLAN CERTIFICATION AND QUALIFIED HEALTH PLAN OVERSIGHT. 3986. REGIONAL ADVISORY COMMITTEES. 3987. FUNDING OF THE EXCHANGE. 3988. STUDIES, FINDINGS AND RECOMMENDATIONS. 3989. TAX EXEMPTION AND TAX CONTRACT BY THE STATE. 3990. OFFICERS AND EMPLOYEES. 3991. LIMITATION OF LIABILITY; INDEMNIFICATION. 3992. CONTINGENCY FOR FEDERAL FUNDING. 3993. CONSTRUCTION. S 3980. STATEMENT OF POLICY AND PURPOSES. THE PURPOSE OF THIS ARTICLE IS TO ESTABLISH AN AMERICAN HEALTH BENEFIT EXCHANGE IN NEW YORK, IN
CONFORMANCE WITH THE FEDERAL PATIENT PROTECTION AND AFFORDABLE CARE ACT, PUBLIC LAW 111-148, AS AMENDED BY THE HEALTH CARE AND EDUCATION RECON- CILIATION ACT OF 2010, PUBLIC LAW 111-152. THE EXCHANGE SHALL FACILI- TATE ENROLLMENT IN HEALTH COVERAGE, THE PURCHASE AND SALE OF QUALIFIED HEALTH PLANS IN THE INDIVIDUAL MARKET IN THIS STATE, AND ENROLL INDIVID- UALS IN HEALTH COVERAGE FOR WHICH THEY ARE ELIGIBLE IN ACCORDANCE WITH FEDERAL LAW. THE EXCHANGE ALSO SHALL INCORPORATE A SMALL BUSINESS HEALTH OPTIONS PROGRAM ("SHOP") TO ASSIST QUALIFIED EMPLOYERS IN FACILITATING THE ENROLLMENT OF THEIR EMPLOYEES IN QUALIFIED HEALTH PLANS OFFERED IN THE GROUP MARKET. IT IS THE INTENT OF THE LEGISLATURE, THROUGH THE ESTABLISHMENT OF THE EXCHANGE, TO PROMOTE QUALITY AND AFFORDABLE HEALTH COVERAGE AND CARE, REDUCE THE NUMBER OF UNINSURED PERSONS, PROVIDE A TRANSPARENT MARKETPLACE, EDUCATE CONSUMERS AND ASSIST INDIVIDUALS WITH ACCESS TO COVERAGE, PREMIUM ASSISTANCE TAX CREDITS AND COST-SHARING REDUCTIONS. S 3981. DEFINITIONS. FOR PURPOSES OF THIS ARTICLE, THE FOLLOWING DEFI- NITIONS SHALL APPLY: 1. "BOARD" OR "BOARD OF DIRECTORS" MEANS THE BOARD OF DIRECTORS OF THE EXCHANGE. 2. "REGIONAL ADVISORY COMMITTEES" MEANS THE NEW YORK HEALTH BENEFIT EXCHANGE REGIONAL ADVISORY COMMITTEES ESTABLISHED PURSUANT TO THIS ARTI- CLE. 3. "COMMISSIONER" MEANS THE COMMISSIONER OF HEALTH. 4. "EXCHANGE" MEANS THE NEW YORK HEALTH BENEFIT EXCHANGE ESTABLISHED PURSUANT TO THIS ARTICLE. 5. "FEDERAL ACT" MEANS THE PATIENT PROTECTION AND AFFORDABLE CARE ACT, PUBLIC LAW 111-148, AS AMENDED BY THE HEALTH CARE AND EDUCATION RECON- CILIATION ACT OF 2010, PUBLIC LAW 111-152, AND ANY REGULATIONS OR GUID- ANCE ISSUED THEREUNDER. 6. "HEALTH PLAN" MEANS A POLICY, CONTRACT OR CERTIFICATE, OFFERED OR ISSUED BY AN INSURER TO PROVIDE, DELIVER, ARRANGE FOR, PAY FOR OR REIM- BURSE ANY OF THE COSTS OF HEALTH CARE SERVICES. HEALTH PLAN SHALL NOT INCLUDE THE FOLLOWING: (A) ACCIDENT INSURANCE OR DISABILITY INCOME INSURANCE, OR ANY COMBINA- TION THEREOF; (B) COVERAGE ISSUED AS A SUPPLEMENT TO LIABILITY INSURANCE; (C) LIABILITY INSURANCE, INCLUDING GENERAL LIABILITY INSURANCE AND AUTOMOBILE LIABILITY INSURANCE; (D) WORKERS' COMPENSATION OR SIMILAR INSURANCE; (E) AUTOMOBILE NO-FAULT INSURANCE; (F) CREDIT INSURANCE; (G) OTHER SIMILAR INSURANCE COVERAGE, AS SPECIFIED IN FEDERAL REGU- LATIONS, UNDER WHICH BENEFITS FOR MEDICAL CARE ARE SECONDARY OR INCI- DENTAL TO OTHER INSURANCE BENEFITS; (H) LIMITED SCOPE DENTAL OR VISION BENEFITS, BENEFITS FOR LONG-TERM CARE INSURANCE, NURSING HOME INSURANCE, HOME CARE INSURANCE, OR ANY COMBINATION THEREOF, OR SUCH OTHER SIMILAR, LIMITED BENEFITS HEALTH INSURANCE AS SPECIFIED IN FEDERAL REGULATIONS, IF THE BENEFITS ARE PROVIDED UNDER A SEPARATE POLICY, CERTIFICATE OR CONTRACT OF INSURANCE OR ARE OTHERWISE NOT AN INTEGRAL PART OF THE PLAN; (I) COVERAGE ONLY FOR A SPECIFIED DISEASE OR ILLNESS, HOSPITAL INDEM- NITY, OR OTHER FIXED INDEMNITY COVERAGE; (J) MEDICARE SUPPLEMENTAL INSURANCE AS DEFINED IN SECTION 1882(G)(1) OF THE FEDERAL SOCIAL SECURITY ACT, COVERAGE SUPPLEMENTAL TO THE COVER- AGE PROVIDED UNDER CHAPTER 55 OF TITLE 10 OF THE UNITED STATES CODE, OR SIMILAR SUPPLEMENTAL COVERAGE PROVIDED UNDER A GROUP HEALTH PLAN IF IT
IS OFFERED AS A SEPARATE POLICY, CERTIFICATE OR CONTRACT OF INSURANCE; OR (K) THE MEDICAL INDEMNITY FUND ESTABLISHED PURSUANT TO TITLE FOUR OF ARTICLE TWENTY-NINE-D OF THE PUBLIC HEALTH LAW. 7. "INSURER" MEANS AN INSURANCE COMPANY SUBJECT TO ARTICLE THIRTY-TWO OR FORTY-THREE OF THE INSURANCE LAW, OR A HEALTH MAINTENANCE ORGANIZA- TION CERTIFIED PURSUANT TO ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH LAW THAT CONTRACTS OR OFFERS TO CONTRACT TO PROVIDE, DELIVER, ARRANGE, PAY OR REIMBURSE ANY OF THE COSTS OF HEALTH CARE SERVICES. 8. "QUALIFIED DENTAL PLAN" MEANS A LIMITED SCOPE DENTAL PLAN THAT IS ISSUED BY AN INSURER AND CERTIFIED IN ACCORDANCE WITH SECTION THIRTY-NINE HUNDRED EIGHTY-FIVE OF THIS ARTICLE. 9. "QUALIFIED EMPLOYER" MEANS A SMALL EMPLOYER THAT ELECTS TO MAKE ITS FULL-TIME EMPLOYEES ELIGIBLE FOR ONE OR MORE QUALIFIED HEALTH PLANS THROUGH THE EXCHANGE. 10. "QUALIFIED HEALTH PLAN" MEANS A HEALTH PLAN THAT IS ISSUED BY AN INSURER AND CERTIFIED IN ACCORDANCE WITH SECTION THIRTY-NINE HUNDRED EIGHTY-FIVE OF THIS ARTICLE. 11. "QUALIFIED INDIVIDUAL" MEANS AN INDIVIDUAL, INCLUDING A MINOR, WHO: (A) IS SEEKING TO ENROLL IN A QUALIFIED HEALTH PLAN OFFERED TO INDI- VIDUALS THROUGH THE EXCHANGE; (B) RESIDES IN THIS STATE; (C) AT THE TIME OF ENROLLMENT, IS NOT INCARCERATED, OTHER THAN INCAR- CERATION PENDING THE DISPOSITION OF CHARGES; AND (D) IS, AND IS REASONABLY EXPECTED TO BE, FOR THE ENTIRE PERIOD FOR WHICH ENROLLMENT IS SOUGHT, A CITIZEN OR NATIONAL OF THE UNITED STATES OR AN ALIEN LAWFULLY PRESENT IN THE UNITED STATES. 12. "SECRETARY" MEANS THE SECRETARY OF THE UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES. 13. "SHOP" MEANS THE SMALL BUSINESS HEALTH OPTIONS PROGRAM DESIGNED TO ASSIST QUALIFIED EMPLOYERS IN THIS STATE IN FACILITATING THE ENROLLMENT OF THEIR EMPLOYEES IN QUALIFIED HEALTH PLANS OFFERED IN THE GROUP MARKET IN THIS STATE. 14. "SMALL EMPLOYER" MEANS, FOR PLAN YEARS PRIOR TO JANUARY FIRST, TWO THOUSAND SIXTEEN, AN EMPLOYER THAT EMPLOYED AN AVERAGE OF AT LEAST ONE BUT NOT MORE THAN FIFTY EMPLOYEES ON BUSINESS DAYS DURING THE PRECEDING CALENDAR YEAR. FOR PLAN YEARS BEGINNING ON AND AFTER JANUARY FIRST, TWO THOUSAND SIXTEEN, SMALL EMPLOYER MEANS AN EMPLOYER THAT EMPLOYED AN AVERAGE OF AT LEAST ONE BUT NOT MORE THAN ONE HUNDRED EMPLOYEES ON BUSI- NESS DAYS DURING THE PRECEDING CALENDAR YEAR. FOR PURPOSES OF THE DEFI- NITION OF SMALL EMPLOYER: (A) ALL PERSONS TREATED AS A SINGLE EMPLOYER UNDER SUBSECTION (B), (C), (M) OR (O) OF SECTION 414 OF THE INTERNAL REVENUE CODE OF 1986 SHALL BE TREATED AS A SINGLE EMPLOYER; (B) AN EMPLOYER AND ANY PREDECESSOR EMPLOYER SHALL BE TREATED AS A SINGLE EMPLOYER; (C) ALL EMPLOYEES SHALL BE COUNTED, INCLUDING PART-TIME EMPLOYEES AND EMPLOYEES WHO ARE NOT ELIGIBLE FOR COVERAGE THROUGH THE EMPLOYER; (D) IF AN EMPLOYER WAS NOT IN EXISTENCE THROUGHOUT THE PRECEDING CALENDAR YEAR, THEN THE DETERMINATION OF WHETHER THAT EMPLOYER IS A SMALL EMPLOYER SHALL BE BASED UPON THE AVERAGE NUMBER OF EMPLOYEES THAT THE EMPLOYER REASONABLY EXPECTS TO EMPLOY ON BUSINESS DAYS IN THE CURRENT CALENDAR YEAR; (E) IF A QUALIFIED EMPLOYER THAT MAKES ENROLLMENT IN QUALIFIED HEALTH PLANS AVAILABLE TO ITS EMPLOYEES THROUGH THE EXCHANGE CEASES TO BE A
SMALL EMPLOYER BY REASON OF AN INCREASE IN THE NUMBER OF ITS EMPLOYEES, THEN THE EMPLOYER SHALL CONTINUE TO BE TREATED AS A QUALIFIED EMPLOYER FOR PURPOSES OF THIS ARTICLE FOR THE PERIOD BEGINNING WITH THE INCREASE AND ENDING WITH THE FIRST DAY ON WHICH THE EMPLOYER DOES NOT MAKE SUCH ENROLLMENT AVAILABLE TO ITS EMPLOYEES; AND (F) NOTWITHSTANDING PARAGRAPHS (A) THROUGH (E) OF THIS SUBDIVISION, AN EMPLOYER ALSO SHALL BE CONSIDERED A SMALL EMPLOYER IF THE COVERAGE IT OFFERS WOULD BE CONSIDERED SMALL GROUP COVERAGE UNDER THE INSURANCE LAW AND REGULATIONS PROMULGATED THEREUNDER PROVIDED THAT IT IS NOT OTHERWISE PROHIBITED UNDER THE FEDERAL ACT. 15. "SMALL GROUP MARKET" MEANS THE HEALTH INSURANCE MARKET UNDER WHICH INDIVIDUALS RECEIVE HEALTH INSURANCE COVERAGE ON BEHALF OF THEMSELVES AND THEIR DEPENDENTS THROUGH A GROUP HEALTH PLAN MAINTAINED BY A SMALL EMPLOYER. 16. "SUPERINTENDENT" MEANS THE SUPERINTENDENT OF INSURANCE UNTIL OCTO- BER THIRD, TWO THOUSAND ELEVEN, WHEN SUCH TERM SHALL MEAN THE SUPER- INTENDENT OF FINANCIAL SERVICES. S 3982. ESTABLISHMENT OF THE NEW YORK HEALTH BENEFIT EXCHANGE. 1. THERE IS HEREBY CREATED A PUBLIC BENEFIT CORPORATION TO BE KNOWN AS THE NEW YORK HEALTH BENEFIT EXCHANGE. SUCH CORPORATION SHALL BE A BODY CORPORATE AND POLITIC. 2. THE PURPOSE OF THE EXCHANGE IS TO FACILITATE THE PURCHASE AND SALE OF QUALIFIED HEALTH PLANS, ASSIST QUALIFIED EMPLOYERS IN FACILITATING THE ENROLLMENT OF THEIR EMPLOYEES IN QUALIFIED HEALTH PLANS THROUGH THE SMALL BUSINESS HEALTH OPTIONS PROGRAM, ENROLL INDIVIDUALS IN HEALTH COVERAGE FOR WHICH THEY ARE ELIGIBLE IN ACCORDANCE WITH FEDERAL LAW AND CARRY OUT OTHER FUNCTIONS SET FORTH IN THIS ARTICLE. 3. (A) THE EXCHANGE SHALL BE GOVERNED BY A BOARD OF DIRECTORS CONSIST- ING OF NINE VOTING DIRECTORS, INCLUDING THE COMMISSIONER AND THE SUPER- INTENDENT, WHO SHALL SERVE AS EX OFFICIO DIRECTORS. (B) SEVEN DIRECTORS SHALL BE APPOINTED BY THE GOVERNOR, TWO OF WHOM SHALL BE APPOINTED UPON THE RECOMMENDATION OF THE TEMPORARY PRESIDENT OF THE SENATE AND TWO OF WHOM SHALL BE APPOINTED UPON THE RECOMMENDATION OF THE SPEAKER OF THE ASSEMBLY. EACH PERSON APPOINTED AS A DIRECTOR PURSU- ANT TO THIS PARAGRAPH SHALL HAVE EXPERTISE IN ONE OR MORE OF THE FOLLOW- ING AREAS: (I) INDIVIDUAL HEALTH CARE COVERAGE; (II) SMALL EMPLOYER HEALTH CARE COVERAGE; (III) HEALTH BENEFITS ADMINISTRATION; (IV) HEALTH CARE FINANCE; (V) PUBLIC OR PRIVATE HEALTH CARE DELIVERY SYSTEMS; AND (VI) PURCHASING HEALTH PLAN COVERAGE. (C) RECOMMENDATIONS AND APPOINTMENTS SHALL TAKE INTO CONSIDERATION THE EXPERTISE OF OTHER DIRECTORS RECOMMENDED AND APPOINTED PURSUANT TO THIS SUBDIVISION, SO THAT THE BOARD COMPOSITION REFLECTS A DIVERSITY OF EXPE- RIENCE. (D) RECOMMENDATIONS BY THE TEMPORARY PRESIDENT OF THE SENATE AND THE SPEAKER OF THE ASSEMBLY SHALL BE MADE WITHIN SIXTY DAYS OF THE EFFECTIVE DATE OF THIS ARTICLE, WITHIN SIXTY DAYS OF THE OCCURRENCE OF A VACANCY OR WITHIN SIXTY DAYS PRIOR TO THE EXPIRATION OF A TERM. 4. THE GOVERNOR SHALL APPOINT A CHAIR OF THE BOARD FROM AMONG THE DIRECTORS WHO SHALL BE SUBJECT TO THE ADVICE AND CONSENT OF THE SENATE. ANY DIRECTOR APPOINTED BY THE GOVERNOR AS CHAIR OF THE BOARD MAY SERVE AS ACTING CHAIR UNTIL SUCH TIME AS A VOTE FOR CONFIRMATION IS TAKEN BY THE SENATE. NO DIRECTOR APPOINTED AS CHAIR SHALL SERVE AS CHAIR, OR
CONTINUE TO SERVE AS ACTING CHAIR, IF THE SENATE HAS VOTED NOT TO CONFIRM SUCH DIRECTOR AS CHAIR. 5. (A) THE TERMS OF THE DIRECTORS, OTHER THAN THE EX OFFICIO DIREC- TORS, SHALL BE THREE YEARS, PROVIDED, HOWEVER, THAT THE INITIAL TERMS OF ONE OF THE DIRECTORS APPOINTED UPON RECOMMENDATION OF THE TEMPORARY PRESIDENT OF THE SENATE, ONE OF THE DIRECTORS APPOINTED UPON RECOMMENDA- TION OF THE SPEAKER OF THE ASSEMBLY, AND ONE OF THE DIRECTORS APPOINTED BY THE GOVERNOR WITHOUT RECOMMENDATION SHALL BE FOR TWO YEARS. (B) VACANCIES OCCURRING OTHERWISE THAN BY EXPIRATION OF TERM OF OFFICE SHALL BE FILLED FOR THE UNEXPIRED TERM IN THE MANNER PROVIDED FOR ORIGINAL APPOINTMENT. 6. THE DIRECTORS SHALL NOT RECEIVE ANY COMPENSATION FOR THEIR SERVICES AS DIRECTORS. 7. (A) EACH DIRECTOR SHALL HAVE THE RESPONSIBILITY AND DUTY TO MEET THE REQUIREMENTS OF THIS ARTICLE, THE FEDERAL ACT, AND ALL APPLICABLE STATE AND FEDERAL LAWS AND REGULATIONS TO SERVE THE PUBLIC INTEREST OF THE INDIVIDUALS AND SMALL BUSINESSES SEEKING HEALTH CARE COVERAGE THROUGH THE EXCHANGE, CONSISTENT WITH SECTION TWENTY-EIGHT HUNDRED TWEN- TY-FOUR OF THIS CHAPTER. (B) EACH DIRECTOR SHALL BE A STATE OFFICER OR EMPLOYEE FOR THE PURPOSES OF SECTIONS SEVENTY-THREE AND SEVENTY-FOUR OF THE PUBLIC OFFI- CERS LAW. (C) NO DIRECTOR MAY BE EMPLOYED OR OTHERWISE RETAINED BY THE EXCHANGE. 8. (A) THE BOARD MAY CREATE SUCH COMMITTEES AS THE BOARD DEEMS NECES- SARY. THE FIRST MEETING OF THE BOARD SHALL BE HELD WITHIN THIRTY DAYS AFTER ALL DIRECTORS ARE INITIALLY APPOINTED. AT THE FIRST MEETING OF THE BOARD, AND AT THE FIRST MEETING IN EACH SUBSEQUENT YEAR, THE BOARD SHALL ELECT FROM AMONG ITS MEMBERS A SECRETARY AND A TREASURER. THE BOARD ALSO SHALL ELECT SUCH OTHER OFFICERS AS IT SHALL DEEM NECESSARY. THE OFFICERS SO ELECTED SHALL HAVE SUCH POWERS AND DUTIES AS ARE ASSIGNED BY THE BY-LAWS AND THIS CHAPTER. (B) THE BOARD, AND ANY COMMITTEE THEREOF, MAY HOLD MEETINGS BY ELEC- TRONIC MEANS CONSISTENT WITH ARTICLE SEVEN OF THE PUBLIC OFFICERS LAW. S 3983. GENERAL POWERS OF THE EXCHANGE. THE EXCHANGE SHALL HAVE THE FOLLOWING POWERS TO BE USED IN FURTHERANCE OF ITS CORPORATE PURPOSES: 1. TO SUE AND BE SUED AND TO PARTICIPATE IN ACTIONS AND PROCEEDINGS, WHETHER JUDICIAL, ADMINISTRATIVE, ARBITRATIVE OR OTHERWISE; 2. TO HAVE A CORPORATE SEAL, AND TO ALTER SUCH SEAL AT PLEASURE, AND TO USE IT BY CAUSING IT OR A FACSIMILE TO BE AFFIXED OR IMPRESSED OR REPRODUCED IN ANY OTHER MANNER; 3. TO PURCHASE, RECEIVE, TAKE BY GRANT, GIFT, DEVISE, BEQUEST OR OTHERWISE, LEASE, OR OTHERWISE ACQUIRE, OWN, HOLD, IMPROVE, EMPLOY, USE AND OTHERWISE DEAL IN AND WITH, REAL OR PERSONAL PROPERTY, OR ANY INTER- EST THEREIN, WHEREVER SITUATED; 4. TO SELL, CONVEY, LEASE, EXCHANGE, TRANSFER OR OTHERWISE DISPOSE OF, OR MORTGAGE OR PLEDGE, OR CREATE A SECURITY INTEREST IN, ALL OR ANY OF ITS PROPERTY, OR ANY INTEREST THEREIN, WHEREVER SITUATED; 5. TO MAKE CONTRACTS, GIVE GUARANTEES AND INCUR LIABILITIES, AND BORROW MONEY; PROVIDED, HOWEVER, THAT THE EXCHANGE SHALL NOT ISSUE BONDS; 6. TO INVEST AND REINVEST ITS FUNDS, AND TAKE AND HOLD REAL AND PERSONAL PROPERTY AS SECURITY FOR THE PAYMENT OF FUNDS SO LOANED OR INVESTED; 7. TO MAKE AND ALTER BY-LAWS FOR ITS ORGANIZATION AND MANAGEMENT;
8. TO MAKE AND ALTER RULES AND REGULATIONS AS NECESSARY TO IMPLEMENT THE PROVISIONS OF THIS ARTICLE, SUBJECT TO THE PROVISIONS OF THE STATE ADMINISTRATIVE PROCEDURE ACT; 9. TO HIRE EMPLOYEES, CONSISTENT WITH SECTION THIRTY-NINE HUNDRED NINETY OF THIS ARTICLE; 10. TO DESIGNATE THE DEPOSITORIES OF ITS MONEY; 11. TO ESTABLISH ITS FISCAL YEAR; 12. TO INSURE OR OTHERWISE PROVIDE FOR THE INSURANCE OF THE EXCHANGE'S PROPERTY OR OPERATIONS AND AGAINST SUCH OTHER RISKS AS THE EXCHANGE MAY DEEM ADVISABLE; 13. TO RECEIVE AND SPEND MONEY FOR ANY OF ITS CORPORATE PURPOSES IN ACCORDANCE WITH THIS ARTICLE; AND 14. TO APPLY FOR, ACCEPT THE AWARD OF, AND SPEND ANY AVAILABLE GRANT MONEY. S 3984. FUNCTIONS OF THE EXCHANGE. THE EXCHANGE SHALL: 1. (A) MAKE AVAILABLE QUALIFIED HEALTH PLANS TO QUALIFIED INDIVIDUALS AND QUALIFIED EMPLOYERS BEGINNING ON OR BEFORE JANUARY FIRST, TWO THOU- SAND FOURTEEN, PROVIDED THAT COVERAGE UNDER SUCH QUALIFIED PLANS SHALL NOT BECOME EFFECTIVE PRIOR TO SUCH DATE AND SHALL NOT MAKE AVAILABLE ANY HEALTH PLAN THAT IS NOT A QUALIFIED HEALTH PLAN; (B) MAKE AVAILABLE QUALIFIED DENTAL PLANS TO QUALIFIED INDIVIDUALS AND QUALIFIED EMPLOYERS BEGINNING ON OR BEFORE JANUARY FIRST, TWO THOUSAND FOURTEEN, PROVIDED THAT COVERAGE UNDER SUCH QUALIFIED DENTAL PLANS SHALL NOT BECOME EFFECTIVE PRIOR TO SUCH DATE, EITHER SEPARATELY OR IN CONJUNCTION WITH A QUALIFIED HEALTH PLAN, IF SUCH PLAN PROVIDES PEDIA- TRIC DENTAL BENEFITS MEETING THE REQUIREMENTS OF SECTION 1302(B)(1)(J) OF THE FEDERAL ACT; 2. ASSIGN A RATING TO EACH QUALIFIED HEALTH PLAN OFFERED THROUGH THE EXCHANGE IN ACCORDANCE WITH THE CRITERIA DEVELOPED BY THE SECRETARY PURSUANT TO SECTION 1311(C)(3) OF THE FEDERAL ACT, AND DETERMINE EACH QUALIFIED HEALTH PLAN'S LEVEL OF COVERAGE IN ACCORDANCE WITH REGULATIONS ISSUED BY THE SECRETARY PURSUANT TO SECTION 1302(D)(2)(A) OF THE FEDERAL ACT; 3. UTILIZE A STANDARDIZED FORMAT FOR PRESENTING HEALTH BENEFIT OPTIONS IN THE EXCHANGE, INCLUDING THE USE OF THE UNIFORM OUTLINE OF COVERAGE ESTABLISHED UNDER SECTION 2715 OF THE FEDERAL PUBLIC HEALTH SERVICE ACT; 4. PROVIDE FOR ENROLLMENT PERIODS PURSUANT TO THE FEDERAL ACT OR THE INSURANCE LAW, WHICHEVER IS IN THE BEST INTEREST OF QUALIFIED INDIVID- UALS AND QUALIFIED EMPLOYERS, AFTER THE INITIAL ENROLLMENT PERIOD HAS BEEN ESTABLISHED AS REQUIRED IN THE FEDERAL ACT; PROVIDED, HOWEVER, THAT IF ENROLLMENT PERIODS PURSUANT TO THE INSURANCE LAW CONFLICT WITH RULES ADOPTED BY THE SECRETARY, THEN ENROLLMENT PERIODS PURSUANT TO THE FEDER- AL ACT SHALL APPLY; 5. IMPLEMENT PROCEDURES FOR THE CERTIFICATION, RECERTIFICATION AND DECERTIFICATION OF HEALTH PLANS AS QUALIFIED HEALTH PLANS, CONSISTENT WITH GUIDELINES DEVELOPED BY THE SECRETARY PURSUANT TO SECTION 1311(C) OF THE FEDERAL ACT AND SECTION THIRTY-NINE HUNDRED EIGHTY-FIVE OF THIS ARTICLE; 6. REQUIRE QUALIFIED HEALTH PLANS TO OFFER THOSE BENEFITS DETERMINED BY THE SECRETARY TO BE ESSENTIAL HEALTH BENEFITS PURSUANT TO SECTION 1302(B) OF THE FEDERAL ACT (EXCEPT AS PROVIDED IN PARAGRAPH (B) OF SUBDIVISION ONE OF SECTION THREE THOUSAND NINE HUNDRED EIGHTY-FIVE OF THIS ARTICLE) AND SUCH ADDITIONAL BENEFITS AS MAY BE REQUIRED PURSUANT TO THE INSURANCE LAW, PROVIDED THAT THE STATE HAS ASSUMED THE COST OF SUCH ADDITIONAL BENEFITS AS REQUIRED UNDER SECTION 1311(D)(3)(B) OF THE FEDERAL ACT;
7. ENSURE THAT INSURERS OFFERING HEALTH PLANS THROUGH THE EXCHANGE DO NOT CHARGE AN INDIVIDUAL A FEE OR PENALTY FOR TERMINATION OF COVERAGE; 8. PROVIDE FOR THE OPERATION OF A TOLL-FREE TELEPHONE HOTLINE TO RESPOND TO REQUESTS FOR ASSISTANCE; 9. MAINTAIN AN INTERNET WEBSITE THROUGH WHICH ENROLLEES AND PROSPEC- TIVE ENROLLEES OF QUALIFIED HEALTH PLANS MAY OBTAIN STANDARDIZED COMPAR- ATIVE INFORMATION ON SUCH PLANS AND PUBLIC HEALTH PROGRAMS; 10. ESTABLISH AND MAKE AVAILABLE BY ELECTRONIC MEANS A CALCULATOR TO DETERMINE THE ACTUAL COST OF COVERAGE AFTER THE APPLICATION OF ANY PREMIUM TAX CREDIT UNDER SECTION 36B OF THE INTERNAL REVENUE CODE OF 1986 AND ANY COST-SHARING REDUCTION UNDER SECTION 1402 OF THE FEDERAL ACT; 11. ESTABLISH A PROGRAM UNDER WHICH THE EXCHANGE AWARDS GRANTS TO ENTITIES TO SERVE AS NAVIGATORS, IN ACCORDANCE WITH SECTION 1311(I) OF THE FEDERAL ACT AND REGULATIONS ADOPTED THEREUNDER; 12. IN ACCORDANCE WITH SECTION 1413 OF THE FEDERAL ACT, INFORM INDI- VIDUALS OF ELIGIBILITY REQUIREMENTS FOR THE MEDICAID PROGRAM UNDER TITLE XIX OF THE SOCIAL SECURITY ACT, THE CHILDREN'S HEALTH INSURANCE PROGRAM (CHIP) UNDER TITLE XXI OF THE SOCIAL SECURITY ACT OR ANY APPLICABLE STATE OR LOCAL PUBLIC HEALTH INSURANCE PROGRAM AND IF, THROUGH SCREENING OF THE APPLICATION BY THE EXCHANGE, THE EXCHANGE DETERMINES THAT SUCH INDIVIDUALS ARE ELIGIBLE FOR ANY SUCH PROGRAM, ENROLL SUCH INDIVIDUALS IN SUCH PROGRAM; 13. PURSUANT TO SECTION 1411 OF THE FEDERAL ACT, GRANT A CERTIFICATION ATTESTING THAT, FOR PURPOSES OF THE INDIVIDUAL RESPONSIBILITY PENALTY UNDER SECTION 5000A OF THE INTERNAL REVENUE CODE OF 1986, AN INDIVIDUAL IS EXEMPT FROM THE INDIVIDUAL RESPONSIBILITY REQUIREMENT OR FROM THE PENALTY IMPOSED BY THAT SECTION BECAUSE: (A) THERE IS NO AFFORDABLE QUALIFIED HEALTH PLAN AVAILABLE THROUGH THE EXCHANGE OR THE INDIVIDUAL'S EMPLOYER, COVERING THE INDIVIDUAL; OR (B) THE INDIVIDUAL MEETS THE REQUIREMENTS FOR ANY OTHER SUCH EXEMPTION FROM THE INDIVIDUAL RESPONSIBILITY REQUIREMENT OR PENALTY; 14. TRANSMIT TO THE SECRETARY OF THE UNITED STATES DEPARTMENT OF THE TREASURY: (A) A LIST OF THE INDIVIDUALS TO WHOM THE EXCHANGE GRANTED A CERTIF- ICATION UNDER SUBDIVISION THIRTEEN OF THIS SECTION, INCLUDING THE NAME AND TAXPAYER IDENTIFICATION NUMBER OF EACH INDIVIDUAL; (B) THE NAME AND TAXPAYER IDENTIFICATION NUMBER OF EACH INDIVIDUAL WHO WAS AN EMPLOYEE OF AN EMPLOYER WHO WAS DETERMINED TO BE ELIGIBLE FOR THE PREMIUM TAX CREDIT UNDER SECTION 36B OF THE INTERNAL REVENUE CODE OF 1986 BECAUSE: (I) THE EMPLOYER DID NOT PROVIDE MINIMUM ESSENTIAL COVERAGE AS DETER- MINED BY THE SECRETARY PURSUANT TO SECTION 1311(D) OF THE FEDERAL ACT; OR (II) THE EMPLOYER PROVIDED THE MINIMUM ESSENTIAL COVERAGE AS DETER- MINED BY THE SECRETARY PURSUANT TO SECTION 1311(D) OF THE FEDERAL ACT, BUT IT WAS DETERMINED UNDER SECTION 36B(C)(2)(C) OF THE INTERNAL REVENUE CODE OF 1986 TO EITHER BE UNAFFORDABLE TO THE EMPLOYEE OR TO NOT PROVIDE THE REQUIRED MINIMUM ACTUARIAL VALUE; AND (C) THE NAME AND TAXPAYER IDENTIFICATION NUMBER OF: (I) EACH INDIVIDUAL WHO NOTIFIES THE EXCHANGE PURSUANT TO SECTION 1411(B)(4) OF THE FEDERAL ACT THAT HE OR SHE HAS CHANGED EMPLOYERS; AND (II) EACH INDIVIDUAL WHO CEASES COVERAGE UNDER A QUALIFIED HEALTH PLAN DURING A PLAN YEAR AND THE EFFECTIVE DATE OF THAT CESSATION; 15. PROVIDE TO EACH EMPLOYER THE NAME OF EACH EMPLOYEE OF THE EMPLOYER DESCRIBED IN PARAGRAPH (B) OF SUBDIVISION FOURTEEN OF THIS SECTION WHO
CEASES COVERAGE UNDER A QUALIFIED HEALTH PLAN DURING A PLAN YEAR AND THE EFFECTIVE DATE OF THE CESSATION; 16. OPERATE A SMALL BUSINESS HEALTH OPTIONS PROGRAM ("SHOP") PURSUANT TO SECTION 1311 OF THE FEDERAL ACT THROUGH WHICH QUALIFIED EMPLOYERS ACCESS COVERAGE FOR THEIR EMPLOYEES, AND MAY: (A) PERMIT QUALIFIED EMPLOYERS TO SPECIFY A LEVEL OF COVERAGE SO THEIR EMPLOYEES MAY ENROLL IN ANY QUALIFIED HEALTH PLAN OFFERED THROUGH THE SHOP AT THE SPECIFIED LEVEL OF COVERAGE OR, UNLESS PROHIBITED BY THE FEDERAL ACT, PROVIDE A SPECIFIC AMOUNT OR OTHER PAYMENT FORMULATED IN ACCORDANCE WITH THE FEDERAL ACT TO BE USED AS PART OF AN EMPLOYEE CHOICE PLAN; AND (B) PROVIDE PREMIUM AGGREGATION AND OTHER RELATED SERVICES TO MINIMIZE ADMINISTRATIVE BURDENS FOR QUALIFIED EMPLOYERS; 17. ENTER INTO AGREEMENTS AS NECESSARY WITH: (A) FEDERAL AND STATE AGENCIES AND OTHER STATE EXCHANGES TO CARRY OUT ITS RESPONSIBILITIES UNDER THIS ARTICLE, PROVIDED SUCH AGREEMENTS INCLUDE ADEQUATE PROTECTIONS WITH RESPECT TO THE CONFIDENTIALITY OF ANY INFORMATION TO BE SHARED AND COMPLY WITH ALL STATE AND FEDERAL LAWS AND REGULATIONS; AND (B) LOCAL DEPARTMENTS OF SOCIAL SERVICES TO COORDINATE ENROLLMENT IN OTHER SOCIAL SERVICES PROGRAMS, AS APPROPRIATE, PROVIDED SUCH AGREEMENTS INCLUDE ADEQUATE PROTECTIONS WITH RESPECT TO THE CONFIDENTIALITY OF ANY INFORMATION TO BE SHARED AND COMPLY WITH ALL STATE AND FEDERAL LAWS AND REGULATIONS; 18. PERFORM DUTIES REQUIRED BY THE SECRETARY OR THE SECRETARY OF THE UNITED STATES DEPARTMENT OF THE TREASURY RELATED TO DETERMINING ELIGI- BILITY FOR PREMIUM TAX CREDITS, REDUCED COST-SHARING, OR INDIVIDUAL RESPONSIBILITY REQUIREMENT EXEMPTIONS; 19. MEET FINANCIAL INTEGRITY REQUIREMENTS UNDER SECTION 1313 OF THE FEDERAL ACT AND THIS CHAPTER, INCLUDING: (A) KEEPING AN ACCURATE ACCOUNTING OF ALL ACTIVITIES, RECEIPTS, AND EXPENDITURES AND ANNUALLY SUBMITTING TO THE SECRETARY A REPORT CONCERN- ING SUCH ACCOUNTINGS, WITH A COPY OF SUCH REPORT PROVIDED TO THE GOVER- NOR, THE TEMPORARY PRESIDENT OF THE SENATE AND THE SPEAKER OF THE ASSEM- BLY; AND (B) FULLY COOPERATING WITH ANY INVESTIGATION CONDUCTED BY THE SECRE- TARY PURSUANT TO THE SECRETARY'S AUTHORITY UNDER SECTION 1313 OF THE FEDERAL ACT AND ALLOWING THE SECRETARY, IN COORDINATION WITH THE INSPEC- TOR GENERAL OF THE UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES, TO: (I) INVESTIGATE THE AFFAIRS OF THE EXCHANGE; (II) EXAMINE THE PROPERTIES AND RECORDS OF THE EXCHANGE; AND (III) REQUIRE PERIODIC REPORTS IN RELATION TO THE ACTIVITIES UNDERTAK- EN BY THE EXCHANGE; 20. (A) CONSULT WITH THE REGIONAL ADVISORY COMMITTEES ESTABLISHED PURSUANT TO SECTION THIRTY-NINE HUNDRED EIGHTY-SIX OF THIS ARTICLE; AND (B) CONSULT WITH STAKEHOLDERS RELEVANT TO CARRYING OUT THE ACTIVITIES REQUIRED UNDER THIS ARTICLE, INCLUDING BUT NOT LIMITED TO: (I) HEALTH CARE CONSUMERS WHO ARE ENROLLEES IN HEALTH PLANS; (II) INDIVIDUALS AND ENTITIES WITH EXPERIENCE IN FACILITATING ENROLL- MENT IN HEALTH PLANS; (III) REPRESENTATIVES OF SMALL BUSINESSES AND SELF-EMPLOYED INDIVID- UALS; (IV) STATE MEDICAID OFFICES, INCLUDING LOCAL DEPARTMENTS OF SOCIAL SERVICES; (V) ADVOCATES FOR ENROLLING HARD TO REACH POPULATIONS; (VI) HEALTH CARE PROVIDERS; AND
(VII) INSURERS; 21. SUBMIT INFORMATION PROVIDED BY EXCHANGE APPLICANTS FOR VERIFICA- TION AS REQUIRED BY SECTION 1411(C) OF THE FEDERAL ACT; 22. ESTABLISH RULES AND REGULATIONS, PURSUANT TO SUBDIVISION EIGHT OF SECTION THIRTY-NINE HUNDRED EIGHTY-THREE OF THIS ARTICLE, THAT DO NOT CONFLICT WITH OR PREVENT THE APPLICATION OF REGULATIONS PROMULGATED BY THE SECRETARY; AND 23. DETERMINE ELIGIBILITY, PROVIDE NOTICES, AND PROVIDE OPPORTUNITIES FOR APPEAL AND REDETERMINATION IN ACCORDANCE WITH THE REQUIREMENTS OF SECTIONS 1411 AND 1413 OF THE FEDERAL ACT. S 3985. SPECIAL FUNCTIONS OF THE EXCHANGE RELATED TO HEALTH PLAN CERTIFICATION AND QUALIFIED HEALTH PLAN OVERSIGHT. 1. HEALTH PLANS CERTIFIED BY THE EXCHANGE SHALL MEET THE FOLLOWING REQUIREMENTS: (A) THE INSURER OFFERING THE HEALTH PLAN: (I) IS LICENSED OR CERTIFIED BY THE SUPERINTENDENT OR COMMISSIONER AND MEETS THE REQUIREMENTS OF SECTION 1301(A)(1)(C)(I) OF THE FEDERAL ACT AND ANY GUIDANCE ISSUED THEREUNDER; (II) OFFERS AT LEAST ONE QUALIFIED HEALTH PLAN IN EACH OF THE SILVER AND GOLD LEVELS; (III) HAS FILED WITH AND RECEIVED APPROVAL FROM THE SUPERINTENDENT OF ITS PREMIUM RATES AND POLICY OR CONTRACT FORMS PURSUANT TO THE INSURANCE LAW AND THE PUBLIC HEALTH LAW; (IV) DOES NOT CHARGE ANY CANCELLATION FEES OR PENALTIES IN VIOLATION OF SUBDIVISION SEVEN OF SECTION THIRTY-NINE HUNDRED EIGHTY-FOUR OF THIS ARTICLE; AND (V) COMPLIES WITH THE REGULATIONS DEVELOPED BY THE SECRETARY UNDER SECTION 1311(C) OF THE FEDERAL ACT AND SUCH OTHER REQUIREMENTS AS THE EXCHANGE MAY ESTABLISH; (B) THE HEALTH PLAN: (I) PROVIDES THE ESSENTIAL HEALTH BENEFITS PACK- AGE DESCRIBED IN SECTION 1302(A) OF THE FEDERAL ACT AND INCLUDES SUCH ADDITIONAL BENEFITS AS MAY BE REQUIRED PURSUANT TO THE INSURANCE LAW, PROVIDED THAT THE STATE HAS ASSUMED THE COST OF SUCH ADDITIONAL BENEFITS AS REQUIRED UNDER SECTION 1311(D)(3)(B) OF THE FEDERAL ACT, EXCEPT THAT THE HEALTH PLAN SHALL NOT BE REQUIRED TO PROVIDE ESSENTIAL BENEFITS THAT DUPLICATE THE MINIMUM BENEFITS OF QUALIFIED DENTAL PLANS IF: (A) THE EXCHANGE HAS DETERMINED THAT AT LEAST ONE QUALIFIED DENTAL PLAN IS AVAILABLE TO SUPPLEMENT THE HEALTH PLAN'S COVERAGE; AND (B) THE INSURER MAKES PROMINENT DISCLOSURE AT THE TIME IT OFFERS THE HEALTH PLAN, IN A FORM APPROVED BY THE EXCHANGE, THAT THE PLAN DOES NOT PROVIDE THE FULL RANGE OF ESSENTIAL PEDIATRIC BENEFITS, AND THAT QUALI- FIED DENTAL PLANS PROVIDING THOSE BENEFITS AND OTHER DENTAL BENEFITS NOT COVERED BY THE PLAN ARE OFFERED THROUGH THE EXCHANGE; (II) PROVIDES AT LEAST A BRONZE LEVEL OF COVERAGE AS DEFINED IN SECTION 1302(D) OF THE FEDERAL ACT, UNLESS THE PLAN IS CERTIFIED AS A QUALIFIED CATASTROPHIC PLAN, AS DEFINED IN SECTION 1302(E) OF THE FEDER- AL ACT, AND SHALL ONLY BE OFFERED TO INDIVIDUALS ELIGIBLE FOR CATASTROPHIC COVERAGE; (III) HAS COST-SHARING REQUIREMENTS, INCLUDING DEDUCTIBLES, WHICH DO NOT EXCEED THE LIMITS ESTABLISHED UNDER SECTION 1302(C) OF THE FEDERAL ACT AND ANY REQUIREMENTS OF THE EXCHANGE; (IV) COMPLIES WITH REGULATIONS PROMULGATED BY THE SECRETARY PURSUANT TO SECTION 1311(C) OF THE FEDERAL ACT, WHICH INCLUDE MINIMUM STANDARDS IN THE AREAS OF MARKETING PRACTICES, NETWORK ADEQUACY, ESSENTIAL COMMU- NITY PROVIDERS IN UNDERSERVED AREAS, ACCREDITATION, QUALITY IMPROVEMENT, UNIFORM ENROLLMENT FORMS AND DESCRIPTIONS OF COVERAGE AND INFORMATION ON QUALITY MEASURES FOR HEALTH BENEFIT PLAN PERFORMANCE;
(V) COMPLIES WITH THE INSURANCE LAW AND THE PUBLIC HEALTH LAW REQUIRE- MENTS APPLICABLE TO HEALTH INSURANCE ISSUED IN THIS STATE AND ANY REGU- LATIONS PROMULGATED PURSUANT THERETO THAT DO NOT CONFLICT WITH OR PREVENT THE APPLICATION OF FEDERAL REQUIREMENTS; AND (C) THE EXCHANGE DETERMINES THAT MAKING THE HEALTH PLAN AVAILABLE THROUGH THE EXCHANGE IS IN THE INTEREST OF QUALIFIED INDIVIDUALS AND QUALIFIED EMPLOYERS IN THIS STATE. 2. THE EXCHANGE SHALL NOT EXCLUDE A HEALTH PLAN: (A) ON THE BASIS THAT THE HEALTH PLAN IS A FEE-FOR-SERVICE PLAN; (B) THROUGH THE IMPOSITION OF PREMIUM PRICE CONTROLS BY THE EXCHANGE; OR (C) ON THE BASIS THAT THE HEALTH PLAN PROVIDES TREATMENTS NECESSARY TO PREVENT PATIENTS' DEATHS IN CIRCUMSTANCES THE EXCHANGE DETERMINES ARE INAPPROPRIATE OR TOO COSTLY. 3. THE EXCHANGE SHALL REQUIRE EACH INSURER CERTIFIED OR SEEKING CERTIFICATION OF A HEALTH PLAN AS A QUALIFIED HEALTH PLAN TO: (A) SUBMIT A JUSTIFICATION FOR ANY PREMIUM INCREASE TO THE EXCHANGE PRIOR TO IMPLEMENTATION OF SUCH INCREASE. THE INSURER SHALL PROMINENTLY POST THE INFORMATION ON ITS INTERNET WEBSITE; PROVIDED, HOWEVER, THAT IF INFORMATION SUBMITTED TO THE SUPERINTENDENT AS A JUSTIFICATION FOR A PREMIUM RATE ADJUSTMENT PURSUANT TO THE INSURANCE LAW, OR INFORMATION POSTED TO AN INSURER'S INTERNET WEBSITE, OTHERWISE MEETS FEDERAL REQUIREMENTS, THEN SUBMISSION OF A COPY OF THE SAME JUSTIFICATION TO THE EXCHANGE OR USE OF THE SAME POSTING SHALL BE DEEMED SUFFICIENT TO MEET THE REQUIREMENTS OF THIS SECTION. THE EXCHANGE SHALL TAKE THIS INFORMA- TION, AND THE INFORMATION AND THE RECOMMENDATIONS PROVIDED TO THE EXCHANGE BY THE SUPERINTENDENT UNDER SECTION 1003 OF THE FEDERAL ACT (RELATING TO PATTERNS OR PRACTICES OF EXCESSIVE OR UNJUSTIFIED PREMIUM INCREASES), INTO CONSIDERATION WHEN DETERMINING WHETHER TO ALLOW THE INSURER TO MAKE HEALTH PLANS AVAILABLE THROUGH THE EXCHANGE. SUCH RATE INCREASES SHALL BE SUBJECT TO THE PRIOR APPROVAL OF THE SUPERINTENDENT PURSUANT TO THE INSURANCE LAW; (B)(I) MAKE AVAILABLE TO THE PUBLIC AND SUBMIT TO THE EXCHANGE, THE SECRETARY AND THE SUPERINTENDENT, ACCURATE AND TIMELY DISCLOSURE OF: (A) CLAIMS PAYMENT POLICIES AND PRACTICES; (B) PERIODIC FINANCIAL DISCLOSURES; (C) DATA ON ENROLLMENT AND DISENROLLMENT; (D) DATA ON THE NUMBER OF CLAIMS THAT ARE DENIED; (E) DATA ON RATING PRACTICES; (F) INFORMATION ON COST-SHARING AND PAYMENTS WITH RESPECT TO ANY OUT- OF-NETWORK COVERAGE; (G) INFORMATION ON ENROLLEE AND PARTICIPANT RIGHTS UNDER TITLE I OF THE FEDERAL ACT; AND (H) OTHER INFORMATION AS DETERMINED APPROPRIATE BY THE SECRETARY; (II) THE INFORMATION SHALL BE PROVIDED IN PLAIN LANGUAGE, AS THAT TERM IS DEFINED IN SECTION 1311(E)(3)(B) OF THE FEDERAL ACT, AND IN GUIDANCE JOINTLY ISSUED THEREUNDER BY THE SECRETARY AND THE FEDERAL SECRETARY OF LABOR; AND (C) PROVIDE TO INDIVIDUALS, IN A TIMELY MANNER UPON THE REQUEST OF THE INDIVIDUAL, THE AMOUNT OF COST-SHARING, INCLUDING DEDUCTIBLES, COPAY- MENTS, AND COINSURANCE, UNDER THE INDIVIDUAL'S HEALTH PLAN OR COVERAGE THAT THE INDIVIDUAL WOULD BE RESPONSIBLE FOR PAYING WITH RESPECT TO THE FURNISHING OF A SPECIFIC ITEM OR SERVICE BY A PARTICIPATING PROVIDER. AT A MINIMUM, THIS INFORMATION SHALL BE MADE AVAILABLE TO THE INDIVIDUAL THROUGH AN INTERNET WEBSITE AND THROUGH OTHER MEANS FOR INDIVIDUALS WITHOUT ACCESS TO THE INTERNET; PROVIDED, HOWEVER, THAT TO THE EXTENT
THAT REQUIREMENTS UNDER THE INSURANCE LAW OR THE PUBLIC HEALTH LAW MEET THE STANDARDS OF THE FEDERAL ACT, AN INSURER'S COMPLIANCE WITH SUCH STATE REQUIREMENTS SHALL BE SUFFICIENT TO MEET THE REQUIREMENTS OF THIS SECTION. 4. (A) THE PROVISIONS OF THIS ARTICLE THAT APPLY TO QUALIFIED HEALTH PLANS ALSO SHALL APPLY TO THE EXTENT RELEVANT TO QUALIFIED DENTAL PLANS EXCEPT AS MODIFIED IN ACCORDANCE WITH THE PROVISIONS OF PARAGRAPHS (B) AND (C) OF THIS SUBDIVISION OR OTHERWISE REQUIRED BY THE EXCHANGE. (B) THE QUALIFIED DENTAL PLAN SHALL BE LIMITED TO DENTAL AND ORAL HEALTH BENEFITS, WITHOUT SUBSTANTIALLY DUPLICATING THE BENEFITS TYPICAL- LY OFFERED BY HEALTH BENEFIT PLANS WITHOUT DENTAL COVERAGE, AND SHALL INCLUDE, AT A MINIMUM, THE ESSENTIAL PEDIATRIC DENTAL BENEFITS PRESCRIBED BY THE SECRETARY PURSUANT TO SECTION 1302(B)(1)(J) OF THE FEDERAL ACT, AND SUCH OTHER DENTAL BENEFITS AS THE EXCHANGE OR SECRETARY MAY SPECIFY IN REGULATIONS. (C) INSURERS MAY JOINTLY OFFER A COMPREHENSIVE PLAN THROUGH THE EXCHANGE IN WHICH AN INSURER PROVIDES THE DENTAL BENEFITS THROUGH A QUALIFIED DENTAL PLAN AND AN INSURER PROVIDES THE OTHER BENEFITS THROUGH A QUALIFIED HEALTH PLAN, PROVIDED THAT THE PLANS ARE PRICED SEPARATELY AND ALSO ARE MADE AVAILABLE FOR PURCHASE SEPARATELY AT THE SAME PRICE. S 3986. REGIONAL ADVISORY COMMITTEES. 1. THERE ARE HEREBY CREATED THE NEW YORK HEALTH BENEFIT EXCHANGE REGIONAL ADVISORY COMMITTEES ("ADVISORY COMMITTEES"). ONE REGIONAL ADVISORY COMMITTEE SHALL BE ESTABLISHED WITH- IN EACH OF FIVE REGIONS, TO BE KNOWN AS THE "NEW YORK CITY REGION," "METROPOLITAN SUBURBAN REGION," "NORTHERN REGION," "CENTRAL REGION" AND "WESTERN REGION." THE BOARD SHALL DETERMINE THE COUNTIES THAT MAKE UP SUCH REGIONS. 2. EACH REGIONAL ADVISORY COMMITTEE SHALL BE COMPRISED OF FIVE MEMBERS APPOINTED BY THE GOVERNOR, ONE OF WHOM SHALL BE APPOINTED UPON THE RECOMMENDATION OF THE TEMPORARY PRESIDENT OF THE SENATE AND ONE OF WHOM SHALL BE APPOINTED UPON THE RECOMMENDATION OF THE SPEAKER OF THE ASSEM- BLY. 3. TERMS SHALL BE THREE YEARS. MEMBERS SHALL SERVE UNTIL THEIR SUCCESSORS ARE APPOINTED. MEMBERS MAY SERVE UP TO TWO CONSECUTIVE TERMS. 4. VACANCIES SHALL BE FILLED IN THE SAME MANNER AS ORIGINAL APPOINT- MENTS, AND SUCCESSORS SHALL SERVE FOR THE REMAINDER OF THE UNEXPIRED TERM TO WHICH THEY ARE APPOINTED. 5. RECOMMENDATIONS BY THE TEMPORARY PRESIDENT OF THE SENATE AND THE SPEAKER OF THE ASSEMBLY SHALL BE MADE WITHIN SIXTY DAYS OF THE EFFECTIVE DATE OF THIS ARTICLE OR THE OCCURRENCE OF A VACANCY, OR WITHIN SIXTY DAYS PRIOR TO THE EXPIRATION OF A TERM. 6. THE MEMBERS OF EACH REGIONAL ADVISORY COMMITTEE SHALL INCLUDE: (A) REPRESENTATIVES FROM THE FOLLOWING CATEGORIES, BUT NOT MORE THAN TWO FROM ANY SINGLE CATEGORY: (I) HEALTH PLAN CONSUMER ADVOCATES; (II) SMALL BUSINESS CONSUMER REPRESENTATIVES; (III) HEALTH CARE PROVIDER REPRESENTATIVES; (IV) REPRESENTATIVES OF THE HEALTH INSURANCE INDUSTRY; (B) REPRESENTATIVES FROM THE FOLLOWING CATEGORIES, BUT NOT MORE THAN ONE FROM EITHER CATEGORY: (I) LICENSED INSURANCE PRODUCERS; AND (II) REPRESENTATIVES OF LABOR ORGANIZATIONS. 7. THE BOARD SHALL SELECT THE CHAIR OF EACH REGIONAL ADVISORY COMMIT- TEE FROM AMONG THE MEMBERS OF SUCH COMMITTEE. THE BOARD SHALL ADOPT RULES FOR THE GOVERNANCE OF THE REGIONAL ADVISORY COMMITTEES AND EACH
REGIONAL ADVISORY COMMITTEE SHALL MEET AT LEAST ONCE EACH QUARTER AND AT SUCH OTHER TIMES AS DETERMINED BY THE BOARD TO BE NECESSARY. 8. MEMBERS OF THE REGIONAL ADVISORY COMMITTEES SHALL SERVE WITHOUT COMPENSATION. 9. THE REGIONAL ADVISORY COMMITTEES SHALL MAKE FINDINGS AND RECOMMEN- DATIONS REGARDING REGIONAL VARIATIONS IN THE OPERATION OF THE EXCHANGE, WHICH SHALL BE SUBMITTED TO THE BOARD OF DIRECTORS, POSTED ON THE WEBSITE OF THE EXCHANGE, AND CONSIDERED BY THE BOARD IN A REASONABLY TIMELY FASHION. SUCH FINDINGS AND RECOMMENDATIONS SHALL BE MADE ON AN ANNUAL BASIS, ON A DATE DETERMINED BY THE BOARD, AND AT SUCH OTHER TIMES AS THE BOARD OR ANY REGIONAL ADVISORY COMMITTEE DEEMS APPROPRIATE. S 3987. FUNDING OF THE EXCHANGE. 1. THE EXCHANGE SHALL BE FINANCIALLY SELF-SUFFICIENT BY JANUARY FIRST, TWO THOUSAND FIFTEEN. 2. THE EXCHANGE SHALL CONDUCT OR CAUSE TO BE CONDUCTED A STUDY OF, AND SHALL REPORT ITS FINDINGS AND RECOMMENDATIONS UPON, THE OPTIONS TO GENERATE FUNDING FOR THE ONGOING OPERATION OF THE EXCHANGE, AS PROVIDED FOR IN SUBDIVISION EIGHT OF SECTION THIRTY-NINE HUNDRED EIGHTY-EIGHT OF THIS ARTICLE. 3. THE EXCHANGE SHALL PUBLISH ON ITS INTERNET WEBSITE THE FEES AND ANY OTHER PAYMENTS REQUIRED BY THE EXCHANGE, AND THE ADMINISTRATIVE COSTS OF THE EXCHANGE, TO EDUCATE CONSUMERS ON SUCH COSTS AND THE AMOUNT OF MONIES LOST TO WASTE, FRAUD AND ABUSE. 4. THE EXCHANGE SHALL NOT UTILIZE ANY FUNDS INTENDED FOR THE ADMINIS- TRATIVE AND OPERATIONAL EXPENSES OF THE EXCHANGE FOR STAFF RETREATS, PROMOTIONAL GIVEAWAYS, EXCESSIVE EXECUTIVE COMPENSATION, OR PROMOTION OF FEDERAL OR STATE LEGISLATIVE AND REGULATORY MODIFICATIONS PURSUANT TO SECTION 1411(C) OF THE FEDERAL ACT. 5. THE MONEYS OF THE EXCHANGE SHALL, EXCEPT AS OTHERWISE PROVIDED IN THIS SECTION, BE DEPOSITED IN A GENERAL ACCOUNT CALLED THE NEW YORK HEALTH BENEFIT EXCHANGE ACCOUNT AND SUCH OTHER ACCOUNTS AS THE EXCHANGE MAY DEEM NECESSARY, PURSUANT TO RESOLUTION OF THE BOARD, FOR THE TRANS- ACTION OF ITS BUSINESS AND SHALL BE PAID OUT AS AUTHORIZED BY THE CHAIR OF THE BOARD OR BY SUCH OTHER PERSON OR PERSONS AS THE CHAIR MAY DESIG- NATE. 6. NO FUNDS OF THE EXCHANGE SHALL BE TRANSFERRED TO THE GENERAL FUND OR ANY SPECIAL REVENUE FUND OR SHALL BE USED FOR ANY PURPOSE OTHER THAN THE PURPOSES SET FORTH IN THIS ARTICLE. NO FUNDS SHALL BE TRANSFERRED FROM THE GENERAL FUND OR ANY SPECIAL REVENUE FUND TO THE EXCHANGE WITH- OUT AN APPROPRIATION. 7. THE ACCOUNTS OF THE EXCHANGE SHALL BE SUBJECT TO SUPERVISION OF THE COMPTROLLER AND SUCH ACCOUNTS SHALL INCLUDE RECEIPTS, EXPENDITURES, CONTRACTS AND OTHER MATTERS WHICH PERTAIN TO THE FISCAL SOUNDNESS OF THE EXCHANGE. 8. NOTWITHSTANDING ANY LAW TO THE CONTRARY, AND IN ACCORDANCE WITH SECTION FOUR OF THE STATE FINANCE LAW, UPON REQUEST OF THE DIRECTOR OF THE BUDGET, IN CONSULTATION WITH THE COMMISSIONER, THE SUPERINTENDENT AND THE CHAIR OF THE BOARD, THE COMPTROLLER IS HEREBY AUTHORIZED AND DIRECTED TO SUBALLOCATE OR TRANSFER SPECIAL REVENUE FEDERAL FUNDS APPRO- PRIATED TO THE DEPARTMENT OF HEALTH FOR PLANNING AND IMPLEMENTING VARI- OUS HEALTHCARE AND INSURANCE REFORM INITIATIVES AUTHORIZED BY FEDERAL LEGISLATION, INCLUDING, BUT NOT LIMITED TO, THE PATIENT PROTECTION AND AFFORDABLE CARE ACT (P.L. 111-148) AND THE HEALTH CARE AND EDUCATION RECONCILIATION ACT OF 2010 (P.L. 111-152) TO THE NEW YORK STATE HEALTH BENEFIT EXCHANGE. MONEYS SUBALLOCATED OR TRANSFERRED PURSUANT TO THIS SECTION SHALL BE PAID OUT OF THE FUND UPON AUDIT AND WARRANT OF THE STATE COMPTROLLER ON VOUCHERS CERTIFIED OR APPROVED BY THE EXCHANGE.
S 3988. STUDIES, FINDINGS AND RECOMMENDATIONS. 1. (A) THE EXCHANGE SHALL CONDUCT OR CAUSE TO BE CONDUCTED A STUDY OF, AND SHALL MAKE FIND- INGS AND RECOMMENDATIONS UPON, THE ESSENTIAL HEALTH BENEFITS IDENTIFIED BY THE SECRETARY PURSUANT TO SECTION 1302(B) OF THE FEDERAL ACT AND OF THE BENEFITS REQUIRED UNDER THE INSURANCE LAW OR REGULATIONS PROMULGATED THEREUNDER THAT ARE NOT DETERMINED BY THE SECRETARY TO BE ESSENTIAL HEALTH BENEFITS. SUCH STUDY, FINDINGS AND RECOMMENDATIONS SHALL ADDRESS MATTERS INCLUDING BUT NOT LIMITED TO: (I) WHETHER THE ESSENTIAL HEALTH BENEFITS REQUIRED TO BE INCLUDED IN POLICIES AND CONTRACTS SOLD THROUGH THE EXCHANGE SHOULD BE SOLD TO SIMI- LARLY SITUATED INDIVIDUALS AND GROUPS PURCHASING COVERAGE OUTSIDE OF THE EXCHANGE; (II) WHETHER ANY BENEFITS REQUIRED UNDER THE INSURANCE LAW OR REGU- LATIONS PROMULGATED THEREUNDER THAT ARE NOT IDENTIFIED AS ESSENTIAL HEALTH BENEFITS BY THE SECRETARY SHOULD NO LONGER BE REQUIRED IN POLI- CIES OR CONTRACTS SOLD EITHER THROUGH THE EXCHANGE OR TO SIMILARLY SITU- ATED INDIVIDUALS AND GROUPS OUTSIDE OF THE EXCHANGE; (III) THE COSTS OF EXTENDING ANY BENEFITS REQUIRED UNDER THE INSURANCE LAW OR REGULATIONS PROMULGATED THEREUNDER TO POLICIES AND CONTRACTS SOLD THROUGH THE EXCHANGE; AND (IV) MECHANISMS TO FINANCE ANY COSTS PURSUANT TO SECTION 1311(D)(3)(B)(II) OF THE FEDERAL ACT OF EXTENDING ANY BENEFITS REQUIRED UNDER THE INSURANCE LAW OR REGULATIONS PROMULGATED THEREUNDER TO POLI- CIES AND CONTRACTS SOLD THROUGH THE EXCHANGE. (B) IN MAKING ITS FINDINGS AND RECOMMENDATIONS, THE EXCHANGE SHALL CONSIDER THE INDIVIDUAL AND SMALL GROUP MARKETS OUTSIDE OF THE EXCHANGE AND CONSIDER APPROACHES TO PREVENT MARKETPLACE DISRUPTION, REMAIN CONSISTENT WITH THE EXCHANGE AND AVOID ANTI-SELECTION. (C) THE EXCHANGE SHALL SUBMIT A REPORT OF ITS FINDINGS AND RECOMMENDA- TIONS TO THE GOVERNOR, THE TEMPORARY PRESIDENT OF THE SENATE AND THE SPEAKER OF THE ASSEMBLY ON OR BEFORE APRIL FIRST, TWO THOUSAND TWELVE. 2. (A) THE EXCHANGE SHALL CONDUCT OR CAUSE TO BE CONDUCTED A STUDY OF, AND SHALL MAKE FINDINGS AND RECOMMENDATIONS UPON: (I) WHETHER INSURERS PARTICIPATING IN THE EXCHANGE SHOULD BE REQUIRED TO OFFER ALL HEALTH PLANS SOLD IN THE EXCHANGE TO INDIVIDUALS OR SMALL GROUPS PURCHASING COVERAGE OUTSIDE OF THE EXCHANGE; (II) WHETHER THE INDIVIDUAL AND SMALL GROUP MARKETS SHOULD BE PLACED ENTIRELY INSIDE THE EXCHANGE; (III) WHETHER THE BENEFITS IN THE INDIVIDUAL AND SMALL GROUP MARKETS SHOULD BE STANDARDIZED INSIDE THE EXCHANGE OR INSIDE AND OUTSIDE THE EXCHANGE; (IV) HOW TO DEVELOP AND IMPLEMENT THE TRANSITIONAL REINSURANCE PROGRAM FOR THE INDIVIDUAL MARKET AND ANY OTHER RISK ADJUSTMENT MECHANISMS DEVELOPED IN ACCORDANCE WITH SECTIONS 1341, 1342 AND 1343 OF THE FEDERAL ACT; (V) WHETHER TO MERGE THE INDIVIDUAL AND SMALL GROUP HEALTH INSURANCE MARKETS FOR RATING PURPOSES INCLUDING AN ANALYSIS OF THE IMPACT SUCH MERGER WOULD HAVE ON PREMIUMS; (VI) WHETHER TO INCREASE THE SIZE OF SMALL EMPLOYERS FROM AN AVERAGE OF AT LEAST ONE BUT NOT MORE THAN FIFTY EMPLOYEES TO AN AVERAGE OF AT LEAST ONE BUT NOT MORE THAN ONE HUNDRED EMPLOYEES PRIOR TO JANUARY FIRST, TWO THOUSAND SIXTEEN; (VII) HOW TO ACCOUNT FOR SOLE PROPRIETORS IN DEFINING "SMALL EMPLOY- ERS"; AND
(VIII) WHETHER TO REVISE THE DEFINITION OF "SMALL EMPLOYER" OUTSIDE THE EXCHANGE TO BE CONSISTENT WITH THE DEFINITION AS IT APPLIES WITHIN THE EXCHANGE. (B) THE EXCHANGE SHALL SUBMIT A REPORT OF ITS FINDINGS AND RECOMMENDA- TIONS TO THE GOVERNOR, THE TEMPORARY PRESIDENT OF THE SENATE AND THE SPEAKER OF THE ASSEMBLY ON OR BEFORE APRIL FIRST, TWO THOUSAND TWELVE. 3. (A) THE EXCHANGE SHALL CONDUCT OR CAUSE TO BE CONDUCTED A STUDY OF, AND SHALL MAKE FINDINGS AND RECOMMENDATIONS UPON, WHETHER THE STATE SHOULD ESTABLISH A BASIC HEALTH PLAN PROGRAM IDENTIFIED BY THE SECRETARY PURSUANT TO SECTION 1331 OF THE FEDERAL ACT. (B) THE EXCHANGE SHALL SUBMIT A REPORT OF ITS FINDINGS AND RECOMMENDA- TIONS TO THE GOVERNOR, THE TEMPORARY PRESIDENT OF THE SENATE AND THE SPEAKER OF THE ASSEMBLY ON OR BEFORE APRIL FIRST, TWO THOUSAND TWELVE. 4. (A) THE EXCHANGE SHALL CONDUCT OR CAUSE TO BE CONDUCTED A STUDY OF, AND SHALL MAKE FINDINGS AND RECOMMENDATIONS UPON, THE ADVANTAGES AND DISADVANTAGES OF THE EXCHANGE SERVING AS AN ACTIVE PURCHASER, A SELEC- TIVE CONTRACTOR, OR CLEARINGHOUSE OF INSURANCE. (B) THE EXCHANGE SHALL SUBMIT A REPORT OF ITS FINDINGS AND RECOMMENDA- TIONS TO THE GOVERNOR, THE TEMPORARY PRESIDENT OF THE SENATE AND THE SPEAKER OF THE ASSEMBLY ON OR BEFORE APRIL FIRST, TWO THOUSAND TWELVE. 5. (A) THE EXCHANGE SHALL CONDUCT OR CAUSE TO BE CONDUCTED A STUDY OF, AND SHALL MAKE FINDINGS AND RECOMMENDATIONS UPON, (I) THE ANTICIPATED ANNUAL OPERATING EXPENSES OF THE EXCHANGE, INCLUDING BUT NOT LIMITED TO THE DEVELOPMENT OF ANY MULTI-YEAR FINANCIAL MODELS; AND (II) THE OPTIONS TO GENERATE FUNDING FOR THE ONGOING OPERATION AND SELF-SUFFICIENCY OF THE EXCHANGE INCLUDING BUT NOT LIMITED TO ASSESSMENTS UPON INSURERS AND PROVIDERS. (B) THE EXCHANGE SHALL SUBMIT A REPORT OF ITS FINDINGS AND RECOMMENDA- TIONS TO THE GOVERNOR, THE TEMPORARY PRESIDENT OF THE SENATE AND THE SPEAKER OF THE ASSEMBLY ON OR BEFORE APRIL FIRST, TWO THOUSAND TWELVE. 6. (A) THE EXCHANGE SHALL CONDUCT OR CAUSE TO BE CONDUCTED A STUDY OF, AND SHALL MAKE FINDINGS AND RECOMMENDATIONS UPON, THE BENCHMARK BENEFITS IDENTIFIED BY THE SECRETARY AND OF THE BENEFITS REQUIRED UNDER THE PUBLIC HEALTH LAW OR THE SOCIAL SERVICES LAW OR REGULATIONS PROMULGATED THEREUNDER THAT ARE NOT DETERMINED BY THE SECRETARY TO BE BENCHMARK BENEFITS. SUCH STUDY, FINDINGS AND RECOMMENDATIONS SHALL ADDRESS MATTERS INCLUDING BUT NOT LIMITED TO: (I) WHETHER ANY BENEFITS REQUIRED UNDER THE PUBLIC HEALTH LAW OR THE SOCIAL SERVICES LAW OR REGULATIONS PROMULGATED THEREUNDER THAT ARE NOT IDENTIFIED AS BENCHMARK BENEFITS BY THE SECRETARY SHOULD CONTINUE TO BE REQUIRED AS COVERED BENEFITS AVAILABLE TO NEWLY MEDICAID-ELIGIBLE INDI- VIDUALS INSIDE THE EXCHANGE; (II) THE COSTS OF EXTENDING ANY BENEFITS REQUIRED UNDER THE PUBLIC HEALTH LAW OR THE SOCIAL SERVICES LAW OR REGULATIONS PROMULGATED THERE- UNDER AS COVERED BENEFITS AVAILABLE TO NEWLY MEDICAID-ELIGIBLE INDIVID- UALS THROUGH THE EXCHANGE; AND (III) MECHANISMS TO FINANCE ANY COSTS PURSUANT TO THE FEDERAL ACT OF EXTENDING ANY BENEFITS REQUIRED UNDER THE PUBLIC HEALTH LAW OR THE SOCIAL SERVICES LAW OR REGULATIONS PROMULGATED THEREUNDER TO POLICIES AND CONTRACTS SOLD THROUGH THE EXCHANGE. (B) THE EXCHANGE SHALL SUBMIT A REPORT OF ITS FINDINGS AND RECOMMENDA- TIONS TO THE GOVERNOR, THE TEMPORARY PRESIDENT OF THE SENATE AND THE SPEAKER OF THE ASSEMBLY ON OR BEFORE APRIL FIRST, TWO THOUSAND TWELVE. 7. (A) THE EXCHANGE SHALL MAKE RECOMMENDATIONS UPON THE IMPACT OF THE ESTABLISHMENT AND OPERATION OF THE EXCHANGE ON THE HEALTHY NEW YORK PROGRAM ESTABLISHED PURSUANT TO SECTION FORTY-THREE HUNDRED TWENTY-SIX
OF THE INSURANCE LAW AND THE FAMILY HEALTH PLUS EMPLOYER PARTNERSHIP PROGRAM ESTABLISHED PURSUANT TO SECTION THREE HUNDRED SIXTY-NINE-FF OF THE SOCIAL SERVICES LAW. (B) THE EXCHANGE SHALL NOTIFY THE GOVERNOR, THE TEMPORARY PRESIDENT OF THE SENATE AND THE SPEAKER OF THE ASSEMBLY OF ITS RECOMMENDATIONS ON OR BEFORE APRIL FIRST, TWO THOUSAND TWELVE. 8. (A) THE BOARD SHALL CONDUCT OR CAUSE TO BE CONDUCTED A STUDY OF, AND SHALL MAKE FINDINGS AND RECOMMENDATIONS UPON, PROCEDURES UNDER WHICH LICENSED HEALTH INSURANCE PRODUCERS, CHAMBERS OF COMMERCE AND BUSINESS ASSOCIATIONS MAY ENROLL INDIVIDUALS AND EMPLOYERS IN ANY QUALIFIED HEALTH PLAN IN THE INDIVIDUAL OR SMALL GROUP MARKET AS SOON AS THE PLAN IS OFFERED THROUGH THE EXCHANGE; AND TO ASSIST INDIVIDUALS IN APPLYING FOR PREMIUM TAX CREDITS AND COST-SHARING REDUCTIONS FOR PLANS SOLD THROUGH THE EXCHANGE; AND (B) THE BOARD SHALL SUBMIT A REPORT OF ITS FINDINGS AND RECOMMENDA- TIONS TO THE GOVERNOR, THE TEMPORARY PRESIDENT OF THE SENATE AND SPEAKER OF THE ASSEMBLY ON OR BEFORE APRIL FIRST, TWO THOUSAND TWELVE. 9. (A) THE EXCHANGE SHALL CONDUCT OR CAUSE TO BE CONDUCTED A STUDY OF, AND SHALL MAKE FINDINGS AND RECOMMENDATIONS UPON, THE CRITERIA FOR ELIGIBILITY TO SERVE AS A NAVIGATOR FOR PURPOSES OF SECTION 1311(I) OF THE FEDERAL ACT, ANY GUIDANCE ISSUED THEREUNDER AND SUBDIVISION FOURTEEN OF SECTION THIRTY-NINE HUNDRED EIGHTY-FOUR OF THIS ARTICLE. (B) THE EXCHANGE SHALL SUBMIT A REPORT OF ITS FINDINGS AND RECOMMENDA- TIONS TO THE GOVERNOR, THE TEMPORARY PRESIDENT OF THE SENATE AND THE SPEAKER OF THE ASSEMBLY ON OR BEFORE APRIL FIRST, TWO THOUSAND TWELVE. 10. (A) THE EXCHANGE SHALL CONDUCT OR CAUSE TO BE CONDUCTED A STUDY OF, AND SHALL MAKE FINDINGS AND RECOMMENDATIONS UPON, THE ROLE OF THE EXCHANGE IN DECREASING HEALTH DISPARITIES IN HEALTH CARE SERVICES AND PERFORMANCE, INCLUDING BUT NOT LIMITED TO DISPARITIES ON THE BASIS OF RACE OR ETHNICITY, IN ACCORDANCE WITH SECTION FORTY-THREE HUNDRED TWO OF THE FEDERAL ACT. (B) THE EXCHANGE SHALL SUBMIT A REPORT OF ITS FINDINGS AND RECOMMENDA- TIONS TO THE GOVERNOR, THE TEMPORARY PRESIDENT OF THE SENATE AND THE SPEAKER OF THE ASSEMBLY ON OR BEFORE APRIL FIRST, TWO THOUSAND TWELVE. 11. (A) THE EXCHANGE SHALL MAKE RECOMMENDATIONS UPON WHETHER AND TO WHAT EXTENT HEALTH SAVINGS ACCOUNTS SHOULD BE OFFERED THROUGH THE EXCHANGE. (B) THE EXCHANGE SHALL NOTIFY THE GOVERNOR, THE TEMPORARY PRESIDENT OF THE SENATE AND THE SPEAKER OF THE ASSEMBLY OF ITS RECOMMENDATIONS ON OR BEFORE APRIL FIRST, TWO THOUSAND TWELVE. 12. (A) THE EXCHANGE SHALL CONDUCT OR CAUSE TO BE CONDUCTED A STUDY OF, AND SHALL MAKE FINDINGS AND RECOMMENDATIONS UPON, WHETHER TO ALLOW LARGE EMPLOYERS TO PARTICIPATE IN THE EXCHANGE BEGINNING JANUARY FIRST, TWO THOUSAND SEVENTEEN, AND SHALL TAKE INTO ACCOUNT ANY EXCESS OF PREMI- UM GROWTH OUTSIDE OF THE EXCHANGE AS COMPARED TO THE RATE OF SUCH GROWTH INSIDE THE EXCHANGE. (B) THE EXCHANGE SHALL SUBMIT A REPORT OF ITS FINDINGS AND RECOMMENDA- TIONS TO THE GOVERNOR, THE TEMPORARY PRESIDENT OF THE SENATE AND THE SPEAKER OF THE ASSEMBLY ON OR BEFORE DECEMBER FIRST, TWO THOUSAND SIXTEEN. 13. THE EXCHANGE SHALL CONDUCT, OR CAUSE TO BE CONDUCTED, A STUDY OF, AND SHALL MAKE FINDINGS AND RECOMMENDATIONS UPON, THE INTEGRATION OF PUBLIC HEALTH INSURANCE PROGRAMS, INCLUDING MEDICAID, CHILD HEALTH PLUS, AND FAMILY HEALTH PLUS WITHIN THE EXCHANGE, WHICH MAY INCLUDE SUCH REPORTS AS ARE PERIODICALLY SUBMITTED TO THE SECRETARY, ON OR BEFORE APRIL FIRST, TWO THOUSAND TWELVE.
14. NOTWITHSTANDING ANY PROVISION OF SUBDIVISIONS ONE THROUGH THIRTEEN OF THIS SECTION, IF THE BOARD DETERMINES THAT ANY REPORT REQUIRED UNDER ANY SUCH SUBDIVISION CANNOT BE COMPLETED AND SUBMITTED BY THE SPECIFIED DATE, BECAUSE FEDERAL GUIDANCE OR REGULATIONS NECESSARY TO COMPLETE SUCH REPORT HAS NOT BEEN ISSUED, THE BOARD MAY ESTABLISH A NEW AND REASONABLE DATE FOR SUCH COMPLETION AND SUBMISSION. 15. ANY OF THE STUDIES AND REPORTS REQUIRED UNDER THIS SECTION MAY BE COMBINED WITH OTHER STUDIES AND REPORTS REQUIRED UNDER THIS SECTION OR OTHERWISE UNDERTAKEN BY THE EXCHANGE TO THE EXTENT FEASIBLE AND TIMELY. 16. THE EXCHANGE SHALL HAVE NO AUTHORITY, WHETHER EXPRESS OR IMPLIED, TO IMPLEMENT ANY RECOMMENDATION ON THE ISSUES SET FORTH IN SUBDIVISIONS ONE THROUGH TWELVE OF THIS SECTION WITHOUT FURTHER STATUTORY AUTHORITY; PROVIDED, HOWEVER, THAT NOTHING IN THIS SUBDIVISION SHALL BE DEEMED TO ALTER ANY POWERS EXPRESSLY GRANTED ELSEWHERE IN THIS ARTICLE. S 3989. TAX EXEMPTION AND TAX CONTRACT BY THE STATE. 1. IT IS HEREBY DETERMINED THAT THE CREATION OF THE EXCHANGE AND THE FULFILLMENT OF ITS CORPORATE PURPOSES IS IN ALL RESPECTS FOR THE BENEFIT OF THE PEOPLE OF THIS STATE AND IS A PUBLIC PURPOSE. ACCORDINGLY, THE EXCHANGE SHALL BE REGARDED AS PERFORMING AN ESSENTIAL GOVERNMENTAL FUNCTION IN THE EXER- CISE OF THE POWERS CONFERRED UPON IT BY THIS ARTICLE, AND THE EXCHANGE SHALL NOT BE REQUIRED TO PAY ANY FEES, TAXES, SPECIAL AD VALOREM LEVIES OR ASSESSMENTS OF ANY KIND, WHETHER STATE OR LOCAL, INCLUDING BUT NOT LIMITED TO FEES, TAXES, SPECIAL AD VALOREM LEVIES OR ASSESSMENTS ON REAL PROPERTY, FRANCHISE TAXES, SALES TAXES, TRANSFER TAXES, MORTGAGE TAXES OR OTHER TAXES, UPON OR WITH RESPECT TO ANY PROPERTY OWNED BY IT OR UNDER ITS JURISDICTION, CONTROL OR SUPERVISION, OR UPON THE USES THERE- OF, OR UPON OR WITH RESPECT TO ITS ACTIVITIES OR OPERATIONS IN FURTHER- ANCE OF THE POWERS CONFERRED UPON IT BY THIS ARTICLE, OR UPON OR WITH RESPECT TO ANY FARES, TOLLS, RENTALS, RATES, CHARGES, FEES, REVENUES OR OTHER INCOME RECEIVED BY THE EXCHANGE. 2. THE EXCHANGE MAY PAY, OR MAY ENTER INTO AGREEMENTS WITH ANY COUNTY OR MUNICIPALITY TO PAY, A SUM OR SUMS ANNUALLY OR OTHERWISE OR TO PROVIDE OTHER CONSIDERATIONS WITH RESPECT TO REAL PROPERTY OWNED BY THE EXCHANGE LOCATED WITHIN SUCH COUNTY OR MUNICIPALITY. S 3990. OFFICERS AND EMPLOYEES. 1. THE BOARD SHALL HAVE THE POWER TO APPOINT EMPLOYEES TO SERVE AS SENIOR MANAGERIAL STAFF OF THE EXCHANGE AS NECESSARY, WHO SHALL BE DESIGNATED TO BE IN THE EXEMPT CLASS OF CIVIL SERVICE. THE BOARD SHALL ALSO HAVE THE POWER TO FIX THE SALARIES OF SUCH EMPLOYEES. 2. ANY NEWLY HIRED EMPLOYEES WHO ARE NOT DESIGNATED TO BE IN THE EXEMPT CLASS OF CIVIL SERVICE PURSUANT TO SUBDIVISION ONE OF THIS SECTION AND WHO ARE NOT SUBJECT TO THE TRANSFER PROVISIONS SET FORTH IN SUBDIVISIONS FOUR, FIVE AND SIX OF THIS SECTION SHALL BE CONSIDERED FOR PURPOSES OF ARTICLE FOURTEEN OF THE CIVIL SERVICE LAW TO BE PUBLIC EMPLOYEES IN THE CIVIL SERVICE OF THE STATE, AND SHALL BE ASSIGNED TO THE APPROPRIATE COLLECTIVE BARGAINING UNIT BY THE EXCHANGE IN THE SAME MANNER AND CONSISTENT WITH THOSE EMPLOYEES DESCRIBED IN SUBDIVISION SIX OF THIS SECTION. 3. ANY PUBLIC OFFICER OR EMPLOYEE OF A STATE DEPARTMENT, AGENCY OR COMMISSION MAY BE TRANSFERRED TO THE EXCHANGE WITHOUT EXAMINATION AND WITHOUT LOSS OF ANY CIVIL SERVICE STATUS OR RIGHTS TO A COMPARABLE OFFICE, POSITION OR EMPLOYMENT WITH THE EXCHANGE; PROVIDED, HOWEVER, NO SUCH TRANSFER MAY BE MADE WITHOUT THE CONSENT OF THE HEAD OF THE DEPART- MENT, AGENCY OR COMMISSION. TRANSFERS SHALL BE MADE PURSUANT TO SUBDI- VISION TWO OF SECTION SEVENTY OF THE CIVIL SERVICE LAW.
4. THE SALARY OR COMPENSATION OF ANY SUCH OFFICER OR EMPLOYEE, AFTER SUCH TRANSFER, SHALL BE PAID BY THE EXCHANGE. 5. ANY OFFICER OR EMPLOYEE TRANSFERRED TO THE EXCHANGE PURSUANT TO THIS SECTION, WHO ARE MEMBERS OF OR BENEFIT UNDER ANY EXISTING PENSION OR RETIREMENT FUND OR SYSTEM, SHALL CONTINUE TO HAVE ALL RIGHTS, PRIVI- LEGES, OBLIGATIONS AND STATUS WITH RESPECT TO SUCH FUND OR SYSTEM AS ARE NOW PRESCRIBED BY LAW, BUT DURING THE PERIOD OF THEIR EMPLOYMENT BY THE EXCHANGE, ALL CONTRIBUTIONS TO SUCH FUNDS OR SYSTEMS TO BE PAID BY THE EMPLOYER ON ACCOUNT OF SUCH OFFICERS OR EMPLOYEES SHALL BE PAID BY THE EXCHANGE. 6. A TRANSFERRED EMPLOYEE SHALL REMAIN IN THE SAME COLLECTIVE BARGAIN- ING UNIT AS WAS THE CASE PRIOR TO HIS OR HER TRANSFER; SUCCESSOR EMPLOY- EES TO THE POSITIONS HELD BY SUCH TRANSFERRED EMPLOYEES SHALL, CONSIST- ENT WITH THE PROVISIONS OF ARTICLE FOURTEEN OF THE CIVIL SERVICE LAW, BE INCLUDED IN THE SAME UNIT AS THEIR PREDECESSORS. EMPLOYEES SERVING IN POSITIONS IN NEWLY CREATED TITLES SHALL BE ASSIGNED TO THE SAME COLLEC- TIVE BARGAINING UNIT AS THEY WOULD HAVE BEEN ASSIGNED TO WERE SUCH TITLES CREATED PRIOR TO THE ESTABLISHMENT OF THE EXCHANGE. NOTHING CONTAINED IN THIS ARTICLE SHALL BE CONSTRUED (A) TO DIMINISH THE RIGHTS OF EMPLOYEES PURSUANT TO A COLLECTIVE BARGAINING AGREEMENT OR (B) TO AFFECT EXISTING LAW WITH RESPECT TO AN APPLICATION TO THE PUBLIC EMPLOY- MENT RELATIONS BOARD SEEKING A DESIGNATION BY THE BOARD THAT CERTAIN PERSONS ARE MANAGERIAL OR CONFIDENTIAL. S 3991. LIMITATION OF LIABILITY; INDEMNIFICATION. THE PROVISIONS OF SECTIONS SEVENTEEN AND NINETEEN OF THE PUBLIC OFFICERS LAW SHALL BE APPLICABLE TO EXCHANGE EMPLOYEES, AS SUCH TERM IS DEFINED IN SECTIONS SEVENTEEN AND NINETEEN OF THE PUBLIC OFFICERS LAW; PROVIDED, HOWEVER, THAT NOTHING CONTAINED WITHIN THIS SECTION SHALL BE DEEMED TO PERMIT THE EXCHANGE TO EXTEND THE PROVISIONS OF SECTIONS SEVENTEEN AND NINETEEN OF THE PUBLIC OFFICERS LAW UPON ANY INDEPENDENT CONTRACTOR. S 3992. CONTINGENCY FOR FEDERAL FUNDING. THE IMPLEMENTATION OF THE PROVISIONS OF THIS ARTICLE SHALL BE CONTINGENT, AS DETERMINED BY THE DIRECTOR OF THE BUDGET, ON THE AVAILABILITY OF SUFFICIENT FEDERAL FINAN- CIAL SUPPORT FOR THE PLANNING AND IMPLEMENTATION OF HEALTH CARE AND INSURANCE REFORM INITIATIVES AUTHORIZED BY FEDERAL LEGISLATION TO ESTAB- LISH AND IMPLEMENT THE HEALTH BENEFIT EXCHANGE. S 3993. CONSTRUCTION. NOTHING IN THIS ARTICLE, AND NO ACTION TAKEN BY THE EXCHANGE PURSUANT HERETO, SHALL BE CONSTRUED TO: 1. PREEMPT OR SUPERSEDE THE AUTHORITY OF THE SUPERINTENDENT OR THE COMMISSIONER; OR 2. EXEMPT INSURERS, INSURANCE PRODUCERS OR QUALIFIED HEALTH PLANS FROM THE PUBLIC HEALTH LAW OR THE INSURANCE LAW AND REGULATIONS PROMULGATED THEREUNDER. S 3. Subdivision 1 of section 17 of the public officers law is amended by adding a new paragraph (x) to read as follows: (X) FOR PURPOSES OF THIS SECTION, THE TERM "EMPLOYEE" SHALL INCLUDE DIRECTORS, OFFICERS AND EMPLOYEES OF THE NEW YORK HEALTH BENEFIT EXCHANGE ESTABLISHED PURSUANT TO ARTICLE TEN-E OF THE PUBLIC AUTHORITIES LAW. S 4. Subdivision 1 of section 19 of the public officers law is amended by adding a new paragraph (j) to read as follows: (J) FOR PURPOSES OF THIS SECTION, THE TERM "EMPLOYEE" SHALL INCLUDE DIRECTORS, OFFICERS AND EMPLOYEES OF THE NEW YORK HEALTH BENEFIT EXCHANGE ESTABLISHED PURSUANT TO ARTICLE TEN-E OF THE PUBLIC AUTHORITIES LAW.
S 5. If any provision or application of this act shall be held to be invalid, or to violate or be inconsistent with any applicable federal law or regulation, that shall not affect other provisions or applica- tions of this act which can be given effect without that provision or application; and to that end, the provisions and applications of this act are severable; provided, however, that nothing in this section shall be deemed to invalidate the provisions of section 3992 of the public authorities law, as added by section two of this act. S 6. If the federal act is held to be unconstitutional by the supreme court of the United States or repealed by the United States Congress, the legislature shall convene within 180 days of such decision or congressional act to consider appropriate legislative options. S 7. This act shall take effect immediately; provided, however, that until such time as the members of the board of directors of the New York health benefit exchange are initially appointed pursuant to section 3982 of the public authorities law, as added by section two of this act, and the first meeting of such board is convened, nothing in this act shall be deemed to prevent the commissioner of health or the superintendent of insurance or, after October 3, 2011, the superintendent of financial services, from applying for, accepting the award of, and spending any available grant money pertaining to the establishment or operation of such exchange for purposes consistent with this act or, at any time, from accepting or spending grant money awarded prior to the enactment of this act.

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