S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   6010
 
                        2019-2020 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             February 26, 2019
                                ___________
 
 Introduced by M. of A. LAWRENCE -- read once and referred to the Commit-
   tee 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:
   § 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 TWO THOUSAND NINETEEN 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.
              

                                                            LBD02710-01-9

 A. 6010                             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

 A. 6010                             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 TWENTY,
 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.