senate Bill S6699

Establishes the New York health insurance exchange study commission

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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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  • 11 / Mar / 2012
    • REFERRED TO INSURANCE

Summary

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.

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Bill Details

Versions:
S6699
Legislative Cycle:
2011-2012
Current Committee:
Senate Insurance
Law Section:
Insurance

Sponsor 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.

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

                                  6699

                            I N  S E N A T E

                             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.

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