senate Bill S3042

Amended

Relates to the New York state health care quality and cost containment 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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actions

  • 29 / Jan / 2013
    • REFERRED TO INSURANCE
  • 03 / Jun / 2013
    • 1ST REPORT CAL.948
  • 04 / Jun / 2013
    • 2ND REPORT CAL.
  • 05 / Jun / 2013
    • ADVANCED TO THIRD READING
  • 17 / Jun / 2013
    • PASSED SENATE
  • 17 / Jun / 2013
    • DELIVERED TO ASSEMBLY
  • 17 / Jun / 2013
    • REFERRED TO INSURANCE
  • 08 / Jan / 2014
    • DIED IN ASSEMBLY
  • 08 / Jan / 2014
    • RETURNED TO SENATE
  • 08 / Jan / 2014
    • REFERRED TO INSURANCE
  • 29 / Jan / 2014
    • AMEND AND RECOMMIT TO INSURANCE
  • 29 / Jan / 2014
    • PRINT NUMBER 3042A

Summary

Provides that the New York state health care quality and cost containment commission shall evaluate each mandated benefit; investigate current practices of health plans with regard to the mandated benefit; investigate the potential premium impact of repealing and/or modifying the mandated benefits on all segments of the insurance market; hold at least two public hearings; and submit a report to the legislature; makes related provisions.

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Bill Details

Versions:
S3042
S3042A
Legislative Cycle:
2013-2014
Current Committee:
Senate Insurance
Law Section:
Insurance Law
Laws Affected:
Amd ยง213, Ins L

Sponsor Memo

BILL NUMBER:S3042

TITLE OF BILL: An act to amend the insurance law, in relation to the
New York state health care quality and cost containment commission

PURPOSE: To ensure that New York does not mandate healthcare benefits
that impose increased costs without meaningful increases in healthcare
quality.

SUMMARY OF PROVISIONS:

Section 1 requires that the commission be seated in a timely manner,
ensures that the commission includes appointees with the
qualifications to accurately assess healthcare mandates, and directs
the commission to evaluate proposed benefits using evidence based
medicine and in light of the implementation of the Affordable Care
Act. Furthermore this section provides for a complete quality and cost
review of all mandated benefits currently in existence, and requires
follow up reviews of all mandated benefits every three years.
Following these reviews, the commission will issue recommendations for
the repeal and/or modification of mandate benefits, which are not
found to meet standards for costs and or quality, to be voted on by
the legislature, without amendments.

Section 2 provides for an immediate effective date.

EXISTING LAW: There is no timeline for the seating of the "New York
State Health Care Quality and Cost Containment Commission" and this
commission only may analyze new benefits.

JUSTIFICATION: The "New York State Health Care Quality and Cost
Containment Commission" created a venue for the serious examination of
new health care mandates in a setting isolated from political concerns
and focused solely on healthcare quality and cost. Unfortunately this
commission is yet to be seated. By ensuring that New York does not
mandate healthcare benefits that impose increased costs without
meaningful increases in healthcare quality, businesses and individuals
in the state will see their healthcare premiums decrease.

LEGISLATIVE HISTORY: New Bill

FISCAL IMPLICATIONS: Positive if costly mandated healthcare benefits
are reduced.

LOCAL FISCAL IMPLICATIONS: Positive if costly mandated healthcare
benefits arc reduced.

EFFECTIVE DATE: Immediate

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

                                  3042

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                            January 29, 2013
                               ___________

Introduced  by Sen. GALLIVAN -- read twice and ordered printed, and when
  printed to be committed to the Committee on Insurance

AN ACT to amend the insurance law, in relation to  the  New  York  state
  health care quality and cost containment commission

  THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. Section 213 of the insurance law, as added by section 1  of
part L of chapter 57 of the laws of 2007, is amended to read as follows:
  S 213. New York state health care quality and cost containment commis-
sion.  (a)  There  is hereby established within the department a commis-
sion, to be known as the "New York state health care  quality  and  cost
containment  commission".  The  commission  shall  consist  of  thirteen
members appointed by the governor, one of whom shall be the  superinten-
dent,  one  of whom shall be the commissioner of health, and six of whom
shall be appointed on the recommendation of the legislative leaders, two
on the recommendation of the temporary president of the senate,  two  on
the  recommendation of the speaker of the assembly, one on the recommen-
dation of the minority leader of the senate, and one on the  recommenda-
tion  of the minority leader of the assembly. All members shall serve at
the pleasure of the governor, and vacancies shall be  appointed  in  the
same  manner  as  original appointments. Members of the commission shall
serve without compensation, but shall be reimbursed for reasonable trav-
el expenses. In making appointments  to  the  commission,  the  governor
shall  ensure  that  the interests of health care consumers, small busi-
nesses, the medical community and health plans are  represented  on  the
commission,  AND  THAT  THE COMMISSION INCLUDE AT LEAST ONE ACTUARY, ONE
EXPERT ON HEALTH BENEFITS, HAVING NO LESS THAN FIFTEEN YEARS  OF  DIRECT
EXPERIENCE  WITH  HEALTH BENEFITS, AND ONE PHYSICIAN. ALL MEMBERS OF THE
COMMISSION SHALL BE SEATED NO LATER THAN NINETY DAYS AFTER THE EFFECTIVE
DATE OF THE CHAPTER OF THE LAWS OF 2013 WHICH AMENDED THIS  SECTION  AND
ALL VACANCIES SHALL BE FILLED AS SOON AS PRACTICABLE.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD07566-01-3

S. 3042                             2

  (b)(1) The purpose of the commission shall be to analyze the impact on
health  insurance  costs and quality of proposed legislation which would
mandate that health benefits be offered or made available in  individual
and  group health insurance policies, contracts and comprehensive health
service plans, including legislation that affects the delivery of health
benefits or services or the reimbursement of health care providers.
  (2)  The governor, the chair of the senate insurance committee and the
chair of the assembly insurance committee may request  in  writing  that
the commission evaluate a proposed mandated benefit. Upon receiving such
a  request,  the  commission  [may,  by a majority vote of its members,]
SHALL undertake an evaluation of such proposed mandated benefit.
  (3) In evaluating a proposed mandated benefit, the commission shall:
  (A) investigate the current practices of health plans with  regard  to
the  proposed mandated benefit, and, to the extent possible, self-funded
health benefit plans;
  (B) investigate the potential premium impact of the proposed  mandated
benefits  on all segments of the insurance market, as well as the poten-
tial for avoided costs through early detection and treatment  of  condi-
tions, or more cost-effective delivery of medical services; [and]
  (C)  analyze  the  most  current [medical] AND CREDIBLE EVIDENCE BASED
MEDICINE literature regarding the proposed mandated benefit PUBLISHED IN
PEER REVIEWED MEDICAL LITERATURE GENERALLY RECOGNIZED  BY  THE  RELEVANT
MEDICAL  COMMUNITY  to  determine  THE  EFFECTIVENESS  OF  THE  PROPOSED
MANDATED BENEFIT AND its impact on health care quality[.]; AND
  (D) INVESTIGATE THE POTENTIAL  COST  TO  THE  STATE  OF  THE  PROPOSED
MANDATED BENEFITS IN LIGHT OF THE IMPLEMENTATION OF THE FEDERAL AFFORDA-
BLE CARE ACT.
  (4) In evaluating a proposed mandated benefit, the commission may hold
one  or more public hearings, and shall strive to obtain independent and
verifiable information from diverse sources within the healthcare indus-
try, medical community and among health care consumers  with  regard  to
the proposed mandated benefit.
  (c)  To assist the commission in its duties, and upon the direction of
the commission, the superintendent is authorized to enter  into  one  or
more  contracts  with independent entities and organizations with demon-
strable expertise in health care quality, finance, utilization and actu-
arial services. For the purposes of  this  section,  the  superintendent
shall  not enter into contracts with health plans, entities or organiza-
tions owned or controlled by health plans, or with significant  business
relationships with health plans.
  (d)  Upon  completion of its evaluation of a proposed mandated benefit
pursuant to this section, the commission shall deliver a written  report
of its findings to the chair of the assembly insurance committee and the
chair of the senate insurance committee.
  (E)(1)  BEGINNING  NO  LATER  THAN NINE MONTHS AFTER THE COMMISSION IS
SEATED, AND REOCCURRING NO LESS OFTEN THAN ONCE EVERY THREE  YEARS,  THE
COMMISSION SHALL ANALYZE THE IMPACT ON HEALTH INSURANCE COSTS AND QUALI-
TY  OF  ALL  STATE LAWS WHICH MANDATE THAT HEALTH BENEFITS BE OFFERED OR
MADE AVAILABLE  IN  INDIVIDUAL  AND  GROUP  HEALTH  INSURANCE  POLICIES,
CONTRACTS  AND  COMPREHENSIVE  HEALTH  SERVICE  PLANS, INCLUDING BUT NOT
LIMITED TO LAWS THAT AFFECT THE DELIVERY OF HEALTH BENEFITS OR  SERVICES
OR THE REIMBURSEMENT OF HEALTH CARE PROVIDERS.
  (2) IN EVALUATING EACH MANDATED BENEFIT, THE COMMISSION SHALL:
  (A)  INVESTIGATE  THE CURRENT PRACTICES OF HEALTH PLANS WITH REGARD TO
THE MANDATED BENEFIT, AND, TO THE EXTENT  POSSIBLE,  SELF-FUNDED  HEALTH
BENEFIT  PLANS  INCLUDING BUT NOT LIMITED TO AVOIDED COSTS THROUGH EARLY

S. 3042                             3

DETECTION AND TREATMENT OF CONDITIONS, OR MORE  COST-EFFECTIVE  DELIVERY
OF MEDICAL SERVICES;
  (B) INVESTIGATE THE POTENTIAL PREMIUM IMPACT OF REPEALING AND/OR MODI-
FYING THE MANDATED BENEFITS ON ALL SEGMENTS OF THE INSURANCE MARKET;
  (C)  ANALYZE  THE  MOST  CURRENT  AND CREDIBLE EVIDENCE BASED MEDICINE
LITERATURE REGARDING THE MANDATED BENEFIT  PUBLISHED  IN  PEER  REVIEWED
MEDICAL LITERATURE GENERALLY RECOGNIZED BY THE RELEVANT MEDICAL COMMUNI-
TY TO DETERMINE THE EFFECTIVENESS OF THE MANDATED BENEFIT AND ITS IMPACT
ON HEALTH CARE QUALITY; AND
  (D)  INVESTIGATE  THE  POTENTIAL  COST  TO  THE  STATE OF THE PROPOSED
MANDATED BENEFITS IN LIGHT OF THE IMPLEMENTATION OF THE FEDERAL AFFORDA-
BLE CARE ACT.
  (3) IN EVALUATING MANDATED BENEFITS, THE COMMISSION SHALL HOLD NO LESS
THAN TWO PUBLIC HEARINGS, AND SHALL STRIVE  TO  OBTAIN  INDEPENDENT  AND
VERIFIABLE  INFORMATION  FROM  DIVERSE  SOURCES  WITHIN  THE HEALTH CARE
INDUSTRY, MEDICAL COMMUNITY AND AMONG HEALTH CARE CONSUMERS WITH  REGARD
TO EACH MANDATED BENEFIT.
  (4)(A)  ON  OR BEFORE THE FIRST DAY OF FEBRUARY TWO THOUSAND FOURTEEN,
THE COMMISSION SHALL SUBMIT TO THE LEGISLATURE AND  DISSEMINATE  TO  THE
PUBLIC  RECOMMENDATIONS FOR THE REPEAL AND/OR MODIFICATION OF STATE LAWS
WHICH MANDATE BENEFITS, ALONG WITH A SINGLE PIECE OF LEGISLATION  NECES-
SARY  TO IMPLEMENT SUCH RECOMMENDATIONS. THESE RECOMMENDATIONS SHALL NOT
BE EXPECTED TO INCREASE THE AVERAGE PREMIUM IN THE STATE.  UPON  RECEIPT
OF  SUCH RECOMMENDATIONS, THE IMPLEMENTING LEGISLATION THEREFOR SHALL BE
INTRODUCED IN BOTH HOUSES OF  THE  LEGISLATURE  WITHOUT  ANY  AMENDMENTS
WITHIN FIVE DAYS.
  (B)  THE  LEGISLATION  INTRODUCED PURSUANT TO SUBPARAGRAPH (A) OF THIS
PARAGRAPH SHALL BE VOTED UPON, WITHOUT AMENDMENT, BY BOTH SUCH HOUSES OF
THE LEGISLATURE WITHIN NINETY DAYS, BUT NOT  SOONER  THAN  THIRTY  DAYS,
AFTER  THE COMMISSION SUBMITS ITS RECOMMENDATIONS TO THE LEGISLATURE. IF
APPROVED, THE LEGISLATURE SHALL FORWARD SUCH LEGISLATION TO THE GOVERNOR
WITHIN FIVE DAYS.
  S 2. This act shall take effect immediately.

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