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.
S6699-2011 Actions
- Mar 11, 2012: REFERRED TO INSURANCE
S6699-2011 Meetings
Insurance: Mar 19, 2012S6699-2011 Memo
BILL NUMBER:S6699 TITLE OF BILL: 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 PURPOSE: To require a study to fully evaluate the costs associated with creation of a New York Health Insurance Exchange. SUMMARY OF PROVISIONS: Section 1. Creates a New York Health Insurance Exchange Commission. Section 2. Provides for the membership of the Commission. Section 3. Sets forth the required information which must be considered by the Commission in the conduct of its study. Section 4. Grants access to records of the relevant Departments to the Commission. Section 5. Allows the Commission to contract with entities necessary to its mission. Section 6. Allows the members to receive their actual and necessary expenses for their service. Section 7. Grants the Commission the powers of a legislative committee under the law. Section 8. Requires the Commission to submit its recommendations no later than August 1, 2012. Section 9. Provides an immediate effective date but provides for a sunset of the Commission on April 1, 2016. EXISTING LAW: None. JUSTIFICATION: There has been much debate over the perceived costs and benefits that may or may not result from the establishment of a New York Health Insur- ance Exchange. As part of this debate, rhetoric has clouded what should be a simple and factual inquiry. This legislation seeks to provide a positive framework to study and evaluate in a deliberative and balanced manner the issue of creation of the establishment a Health Insurance Exchange in New York, as well as potential alternatives such as a regional exchange. LEGISLATIVE HISTORY: New Bill. FISCAL IMPLICATIONS: None to the state. LOCAL FISCAL IMPLICATIONS: None. EFFECTIVE DATE: Immediately, provided however that the Commission will be repealed on April 1, 2016.
S6699-2011 Text
S T A T E O F N E W Y O R K
________________________________________________________________________
6699
I N 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:
Section 1. There is hereby created the New York health insurance
exchange study commission.
S 2. a. The commission shall consist of nine members to be appointed
as follows: the commissioner of the department of health; the super-
intendent of the department of financial services; three members
appointed by the governor from affected state agencies and the gover-
nor's office, one of whom shall be appointed chair of the commission by
the governor; two senators appointed by the temporary president of the
senate; and two members of the assembly appointed by the speaker of the
assembly. Vacancies in the membership of the commission shall be filled
in the manner provided for original appointments. Membership on the
commission shall not constitute a public office.
b. Appointments by the temporary president of the senate and the
speaker of the assembly shall be made within fifteen days of the effec-
tive date of this act.
c. The first meeting of the New York health insurance exchange study
commission shall be held within fifteen days after all members of the
commission are appointed.
S 3. a. (1) The New York health insurance exchange study commission
shall conduct a study to evaluate whether to create a New York health
insurance exchange or participate in a regional exchange, as provided in
the federal Patient Protection and Affordable Care Act, P.L. 111-148 as
amended by the federal Health Care and Education Reconciliation Act of
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
(2) The study shall be paid for, to the extent possible, by a federal
grant awarded to the state for planning and establishment of insurance
exchanges.
(3) The New York health insurance exchange study commission shall
conduct or cause to be conducted a study of, and shall make recommenda-
tions upon:
(i) whether the state should proceed with the development of an
exchange;
(ii) where the recommendation is that the state should proceed with
the development of an exchange, provide a work plan for the development
of the exchange and identify any legislation needed to implement the
exchange during the 2012 legislative budget session or subsequent legis-
lative sessions;
(iii) whether the state should proceed with the development of an
exchange within the state, as a partner with other states or defer the
decision until 2013. If a deferral is recommended, the study shall iden-
tify the additional work needed before a final decision can be made;
(iv) options being considered by other states in developing and oper-
ating health insurance exchanges;
(v) whether New York should proceed with the development of a health
insurance exchange if the related provisions in the federal Patient
Protection and Affordable Care Act, P.L. 111-148 as amended by the
federal Health Care and Education Reconciliation Act of 2010, P.L. 111-
152 are repealed;
(vi) the costs associated with the development and implementation of a
state based exchange, including but not limited to:
(A) the projected costs associated with the increased enrollment in
Medicaid, particularly as more individuals enroll to avoid the require-
ment of the individual mandate;
(B) the impact of the health insurance industry fee, an annual fee
imposed on health insurance providers, including Medicaid, under the
federal Patient Protection and Affordable Care Act, P.L. 111-148;
(C) the cost and coverage impacts of the exchange, including the cost
to the insurance market outside of the exchange;
(D) the estimated five year budget for the exchange operations and an
analysis of funding options to achieve self-sustainability by January 1,
2015;
(E) the costs to both individual and group policies associated with
any benefits required under the insurance law or regulations thereunder,
that are not to be identified as essential health benefits;
(F) the costs to both individual and group policies associated with
any benefits permitted by the insurance law or regulations thereunder,
that are not to be identified as essential health benefits;
(G) the costs of the essential health benefit plan; and
(H) the costs and/or savings associated with establishing a basic
health plan; and
(vii) the structure and mission of health insurance exchange regional
advisory committees and the role the regional advisory committees will
have in an exchange.
b. (1) The commission shall conduct or cause to be conducted a study
of, and shall make recommendations upon, the essential health benefits
identified by the federal secretary of health and human services pursu-
ant to section 1302(b) of the federal Patient Protection and Affordable
Care Act, P.L. 111-148 as amended by the federal Health Care and Educa-
tion Reconciliation Act of 2010, P.L. 111-152 and of the benefits
required under the insurance law or regulations promulgated thereunder
S. 6699 3
that are not determined by the federal secretary of health and human
services to be essential health benefits. Such study 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 Patient Protection and Affordable Care
Act, P.L. 111-148 as amended by the federal Health Care and Education
Reconciliation Act of 2010, P.L. 111-152 of extending any benefits
required under the insurance law or regulations promulgated thereunder
to policies and contracts sold through the exchange.
(2) In making its recommendations, the commission 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 commission shall conduct or cause to be conducted a study of,
and shall make recommendations upon:
(1) 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;
(2) whether the individual and small group markets should be placed
entirely inside the exchange;
(3) whether the benefits in the individual and small group markets
should be standardized inside the exchange or inside and outside the
exchange;
(4) 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
Patient Protection and Affordable Care Act, P.L. 111-148 as amended by
the federal Health Care and Education Reconciliation Act of 2010, P.L.
111-152;
(5) 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;
(6) 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;
(7) how to account for sole proprietors in defining small employers;
and
(8) whether to revise the definition of small employer outside the
exchange to be consistent with the definition as it applies within the
exchange.
d. The commission shall conduct or cause to be conducted a study of,
and shall make recommendations upon, whether the state should establish
a basic health plan program identified by the federal secretary of
S. 6699 4
health and human services pursuant to section 1331 of the federal
Patient Protection and Affordable Care Act, P.L. 111-148 as amended by
the federal Health Care and Education Reconciliation Act of 2010, P.L.
111-152.
e. The commission shall conduct or cause to be conducted a study of,
and shall make recommendations upon, the advantages and disadvantages of
the exchange serving as an active purchaser, a selective contractor, or
clearinghouse of insurance.
f. The commission shall conduct or cause to be conducted a study of,
and shall make recommendations upon:
(1) the anticipated annual operating expenses of the exchange, includ-
ing but not limited to the development of any multi-year financial
models; and
(2) the options to generate funding for the ongoing operation and
self-sufficiency of the exchange including but not limited to assess-
ments upon insurers and providers.
g. The commission shall conduct or cause to be conducted a study of,
and shall make 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 and recommendations shall address matters including but not limit-
ed to:
(1) 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;
(2) 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
(3) 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.
h. The commission 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.
i. The commission shall conduct or cause to be conducted a study of,
and shall make recommendations upon, procedures under which licensed
health insurance producers, chambers of commerce and business associ-
ations 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
j. The commission shall conduct or cause to be conducted a study of,
and shall make recommendations upon, the criteria for eligibility to
serve as a navigator for purposes of section 1311(i) of the federal
Patient Protection and Affordable Care Act, P.L. 111-148 as amended by
the federal Health Care and Education Reconciliation Act of 2010, P.L.
111-152 and any guidance issued thereunder.
S. 6699 5
k. The commission shall conduct or cause to be conducted a study of,
and shall make 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 ethnic-
ity, in accordance with section forty-three hundred two of the federal
Patient Protection and Affordable Care Act, P.L. 111-148 as amended by
the federal Health Care and Education Reconciliation Act of 2010, P.L.
111-152.
l. The commission shall make recommendations upon whether and to what
extent health savings accounts should be offered through the exchange.
m. The commission shall conduct or cause to be conducted a study of,
and shall make recommendations upon, whether to allow large employers to
participate in the exchange beginning January first, two thousand seven-
teen, and shall take into account any excess of premium growth outside
of the exchange as compared to the rate of such growth inside the
exchange.
n. The commission shall conduct or cause to be conducted a study of,
and shall make 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 federal secretary of health and human
services, on or before August first, two thousand twelve.
o. Notwithstanding any provision of subdivisions a through m of this
section, if the commission determines that any recommendations required
under any such subdivision cannot be submitted by the specified date
because federal guidance or regulations necessary to complete such
recommendations have not been issued, the exchange may establish a new
and reasonable date for such completion and submission.
p. (1) Any of the studies required under this section may be combined
with other studies required under this section or otherwise undertaken
by the exchange to the extent feasible and timely.
(2) In lieu of conducting or causing to be conducted any of the
studies required under this section, the exchange may rely upon any
other study or studies, in whole or in part, completed prior to the date
on which the exchange submits its recommendations, if the exchange
determines that such study or studies are sufficiently reliable.
S 4. The New York health insurance exchange study commission shall
receive and have access to all studies and evaluations conducted by the
department of health and the department of financial services, and any
studies and evaluations conducted by third party organizations on behalf
of the department of health and the department of financial services, in
relation to the health insurance exchange.
S 5. The New York health insurance exchange study commission shall
have the authority to contract with experts and consultants as may be
useful in conducting the study.
S 6. The members of the commission shall receive no compensation for
their services, but shall be allowed their actual and necessary expenses
incurred in the performance of their duties pursuant to this act.
S 7. The commission may meet within and without the state and shall
have all the powers of a legislative committee pursuant to the legisla-
tive law.
S 8. a. The commission shall submit its recommendations under subdivi-
sions a, b, c, d, e, f, g, h, i, j, k and l of section three of this act
to the governor, the temporary president of the senate and the speaker
of the assembly on or before August 1, 2012.
S. 6699 6
b. The commission shall submit its recommendations under subdivisions
m and n of section three of this act to the governor, the temporary
president of the senate and the speaker of the assembly on or before
December 1, 2015.
S 9. This act shall take effect immediately and shall expire and be
deemed repealed April 1, 2016.
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 United States License.
Permissions beyond the scope of this license are available at http://www.nysenate.gov/copyright-policy.
Open Legislation comments facilitate discussion of New York State legislation. All comments are subject to moderation. Comments deemed off-topic, commercial, campaign-related, self-promotional; or that contain profanity or hate speech; or that links to sites outside of the nysenate.gov domain are not permitted, and will not be published. Comment moderation is generally performed Monday through Friday.
*By contributing or voting you agree to the Terms of Participation and Privacy Policy and verify you are over 13.
Discuss!
blog comments powered by Disqus