S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  5281--A
 
                        2017-2018 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             February 7, 2017
                                ___________
 
 Introduced by M. of A. LAWRENCE -- read once and referred to the Commit-
   tee  on  Insurance  --  recommitted  to  the Committee on Insurance in
   accordance with Assembly Rule 3, sec. 2 -- committee discharged,  bill
   amended,  ordered reprinted as amended and recommitted to said commit-
   tee

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

                                                            LBD00271-03-8

 A. 5281--A                          2
 
 COMMISSION SHALL BE SEATED NO LATER THAN NINETY DAYS AFTER THE EFFECTIVE
 DATE OF THE CHAPTER OF THE LAWS OF TWO THOUSAND EIGHTEEN  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.
   (2) IN EVALUATING EACH MANDATED BENEFIT, THE COMMISSION SHALL:

 A. 5281--A                          3
 
   (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 NINETEEN,
 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.
   § 2. This act shall take effect immediately.