senate Bill S5849

Establishes the New York Health Benefit Exchange

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Bill Status


  • Introduced
  • In Committee
  • On Floor Calendar
    • Passed Senate
    • Passed Assembly
  • Delivered to Governor
  • Signed/Vetoed by Governor
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actions

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

Summary

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.

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Bill Details

See Assembly Version of this Bill:
A8514
Versions:
S5849
Legislative Cycle:
2011-2012
Current Committee:
Senate Corporations, Authorities And Commissions
Law Section:
Public Authorities Law
Laws Affected:
Add Art 10-E §§3980 - 3993, Pub Auth L; amd §§17 & 19, Pub Off L

Sponsor 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.


view bill text
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  5849

                       2011-2012 Regular Sessions

                            I N  S E N A T E

                              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

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD12048-11-1

S. 5849                             2

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

S. 5849                             3

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

S. 5849                             4

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

S. 5849                             5

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;

S. 5849                             6

  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;

S. 5849                             7

  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

S. 5849                             8

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

S. 5849                             9

  (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;

S. 5849                            10

  (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

S. 5849                            11

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

S. 5849                            12

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. 5849                            13

  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

S. 5849                            14

  (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

S. 5849                            15

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.

S. 5849                            16

  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.

S. 5849                            17

  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. 5849                            18

  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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