The New York State Senate

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

                                 139--A

                       2015-2016 Regular Sessions

                            I N  S E N A T E

                               (PREFILED)

                             January 7, 2015
                               ___________

Introduced  by Sen. GALLIVAN -- read twice and ordered printed, and when
  printed to be committed to the Committee on Insurance  --  recommitted
  to the Committee on Insurance in accordance with Senate Rule 6, sec. 8
  --  committee  discharged,  bill amended, ordered reprinted as amended
  and recommitted to said committee

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

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

                                                           LBD01044-02-6

S. 139--A                           2

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 TWO THOUSAND  SIXTEEN  WHICH  AMENDED
THIS SECTION AND ALL VACANCIES SHALL BE FILLED AS SOON AS PRACTICABLE.
  (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.

S. 139--A                           3

  (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
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 SEVENTEEN,
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.