S T A T E O F N E W Y O R K
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2844
2019-2020 Regular Sessions
I N A S S E M B L Y
January 25, 2019
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Introduced by M. of A. CROUCH, FINCH -- Multi-Sponsored by -- M. of A.
HAWLEY -- read once and referred to the Committee on Insurance
AN ACT to amend the insurance law, in relation to creating a New York
health benefit and cost commission
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Legislative intent. It is the desire of the legislature to
ensure that health coverage provides the care, treatment and service
that people need, and to ensure that the coverage is affordable and
available. The legislature finds that there is a need for a comprehen-
sive review of all current benefits mandated by statute, and for accu-
rate cost analysis of proposed mandates.
§ 2. The insurance law is amended by adding a new section 3221-a to
read as follows:
§ 3221-A. HEALTH BENEFIT AND COST COMMISSION. (A) FOR THE PURPOSES OF
THIS SECTION, "MANDATED HEALTH BENEFIT" SHALL MEAN ANY REQUIREMENT THAT
INDIVIDUAL, GROUP OR BLANKET ACCIDENT AND HEALTH INSURANCE POLICIES OR
CONTRACTS ISSUED BY HOSPITAL OR HEALTH SERVICE CORPORATIONS INCLUDE:
(1) COVERAGE FOR SPECIFIC HEALTH SERVICES, TREATMENT, TESTS, DRUGS,
SUPPLIES, OR EQUIPMENT TO DIAGNOSE OR TREAT A PARTICULAR DISEASE OR
CONDITION; AND
(2) COVERAGE FOR SERVICES OF SPECIFIC PROVIDERS OF HEALTH CARE
SERVICES.
(B) THERE IS HEREBY CREATED A COMMISSION WITHIN THE DEPARTMENT, TO BE
KNOWN AS THE "NEW YORK HEALTH BENEFIT AND COST COMMISSION" CONSISTING OF
THIRTEEN MEMBERS TO BE APPOINTED AS FOLLOWS: THREE TO BE APPOINTED BY
THE GOVERNOR, THREE TO BE APPOINTED BY THE TEMPORARY PRESIDENT OF THE
SENATE, THREE TO BE APPOINTED BY THE SPEAKER OF THE ASSEMBLY, AND ONE
EACH TO BE APPOINTED BY THE MINORITY LEADER OF THE SENATE AND THE ASSEM-
BLY. THE SUPERINTENDENT AND THE COMMISSIONER OF HEALTH, OR THEIR DESIG-
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD02894-01-9
A. 2844 2
NATED REPRESENTATIVES, SHALL ALSO SERVE AS MEMBERS OF THE COMMISSION.
THE MEMBERS SHALL ELECT A PERSON TO SERVE AS CHAIR.
(C) EACH MEMBER SHALL SERVE FOR A TERM OF FOUR YEARS. VACANCIES SHALL
BE APPOINTED IN THE SAME MANNER AS ORIGINAL APPOINTMENTS. THE MEMBERS OF
THE COMMISSION SHALL RECEIVE NO COMPENSATION FOR THEIR SERVICES BUT
SHALL BE ALLOWED ACTUAL AND NECESSARY EXPENSES INCURRED IN THE PERFORM-
ANCE OF THEIR DUTIES. THE COMMISSION MAY REQUEST AND SHALL RECEIVE FROM
ANY DEPARTMENT, BOARD, BUREAU, COMMISSION, OFFICE, AGENCY OR OTHER
INSTRUMENTALITY OF THE STATE, SUCH FACILITIES, ASSISTANCE AND DATA AS IT
DEEMS NECESSARY OR DESIRABLE FOR THE PROPER EXECUTION OF ITS POWERS AND
DUTIES. THE COMMISSION MAY SEEK THE ASSISTANCE AND ADVICE OF ANY PERSON,
ORGANIZATION OR ENTITY AS MAY BE RELEVANT OR NECESSARY AND MAY HIRE OR
CONTRACT WITH ANY SUCH PERSON, ORGANIZATION OR ENTITY. THE COMMISSION
SHALL HAVE THE POWER TO HOLD PUBLIC HEARINGS AND SOLICIT TESTIMONY ON
ANY MATTER IT DEEMS RELEVANT TO CARRYING OUT ITS MISSION.
(D) THE COMMISSION SHALL, UPON THE WRITTEN REQUEST OF THE GOVERNOR,
THE TEMPORARY PRESIDENT OF THE SENATE OR THE SPEAKER OF THE ASSEMBLY,
CONDUCT A REVIEW AND PUBLIC COMMENT PERIOD, AND ISSUE A REPORT RELATING
TO SPECIFIED LEGISLATION WHICH WOULD ENACT A MANDATED HEALTH BENEFIT.
SUCH ISSUANCE SHALL:
(1) CONSIDER AND SUMMARIZE ALL PUBLIC COMMENT AND ALL SCIENTIFIC,
MEDICAL, AND ACTUARIAL DATA AND INFORMATION PROVIDED OR OBTAINED RELAT-
ING TO THE PROPOSED MANDATED HEALTH BENEFIT;
(2) REPORT ON PUBLIC AND PATIENT HEALTH ISSUES, INCLUDING:
(I) THE EXTENT TO WHICH THE PROPOSED MANDATED HEALTH BENEFIT IS AVAIL-
ABLE AND UTILIZED BY THE STATE'S POPULATION AND THE LEVEL OF PUBLIC
DEMAND FOR THE BENEFIT;
(II) THE EXTENT TO WHICH THE PROPOSED MANDATED HEALTH BENEFIT IS
ALREADY A COVERED HEALTH BENEFIT;
(III) IF COVERAGE IS NOT GENERALLY AVAILABLE, THE EXTENT TO WHICH THE
LACK OF COVERAGE RESULTS IN PERSONS BEING UNABLE TO OBTAIN NECESSARY
HEALTH CARE AND RESULTS IN FINANCIAL HARDSHIP FOR THOSE NEEDING SUCH
CARE;
(IV) PROJECTED UTILIZATION RATES AND ACCESS TO SERVICE WHICH WOULD
RESULT FROM THE PROPOSED MANDATED HEALTH BENEFIT;
(V) WHETHER THE PROPOSED MANDATED HEALTH BENEFIT IS A MEDICAL OR A
BROADER SOCIAL NEED AND WHETHER IT IS CONSISTENT WITH THE ROLE OF HEALTH
INSURANCE AND MANAGED HEALTH CARE; AND
(VI) THE EXTENT TO WHICH THE PROPOSED MANDATED HEALTH BENEFIT IS
GENERALLY RECOGNIZED BY THE MEDICAL COMMUNITY AS BEING EFFECTIVE AND
EFFICACIOUS, INCLUDING APPROPRIATE REVIEW BY SCIENTIFIC AND MEDICAL PEER
REVIEW LITERATURE;
(3) REPORT ON ACCESS TO COVERAGE AND ECONOMIC ISSUES INCLUDING:
(I) THE IMPACT ON PREMIUMS, RATES AND COSTS OF HEALTH COVERAGE IN ALL
AFFECTED MARKETS;
(II) THE IMPACT THAT THE PROPOSED MANDATED HEALTH BENEFIT MAY HAVE ON
THE AVAILABILITY OF OTHER BENEFITS; AND
(III) THE IMPACT THAT THE PROPOSED MANDATED HEALTH BENEFIT MAY HAVE ON
THE AVAILABILITY OF HEALTH COVERAGE IN EACH AFFECTED MARKET, AND THE
IMPACT ON THE NUMBER OF PERSONS COVERED THROUGH SELF-INSURED PLANS; AND
(4) REPORT ON ANY OTHER MATTER, QUESTION OR CONCERN RELATING TO A
MANDATED HEALTH BENEFIT AS MAY BE DETERMINED RELEVANT BY THE COMMISSION
OR BY THE PERSON HAVING ISSUED THE REQUEST.
(E) THE COMMISSION, UPON RECEIPT OF A REQUEST, SHALL ALLOW A THIRTY
DAY PUBLIC COMMENT PERIOD AND SHALL ISSUE A REPORT TO THE GOVERNOR AND
THE LEGISLATURE WITHIN NINETY DAYS AFTER RECEIPT OF A WRITTEN REQUEST.
A. 2844 3
THE COMMISSION MAY EXTEND ITS REVIEW PERIOD AND REPORTING TIME UPON
CONSENT OF THE PERSON HAVING ISSUED THE REQUEST.
(F) THE COMMISSION SHALL REVIEW AND REPORT ON UTILIZATION RATES,
PUBLIC AND PATIENT HEALTH EFFECTS, AND IMPACT ON PREMIUMS AND ACCESS TO
HEALTH CARE AND HEALTH COVERAGE OF ALL MANDATED HEALTH BENEFITS EXISTING
ON THE EFFECTIVE DATE OF THIS SECTION.
§ 3. This act shall take effect immediately.