Senate Bill S9508

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   9508
 
                             I N  S E N A T E
 
                               July 22, 2022
                                ___________
 
 Introduced  by  Sen.  COONEY -- read twice and ordered printed, and when
   printed to be committed to the Committee on Rules
 
 AN ACT to amend the social services law, in relation to the basic health
   program (Part A); to amend the financial services law, in relation  to
   cost  containment and consumer protection; to amend the civil practice
   law and rules, in relation to income execution; and to repeal  certain
   provisions of the financial services law relating thereto (Part B); to
   amend  the public health law and the insurance law, in relation to the
   chronic disease demonstration program (Part C); to  amend  the  public
   health law, in relation to addressing health equity through safety net
   hospital  support  (Part  D);  and  to amend the public health law, in
   relation to providing that the commissioner of health may require  any
   health  care  provider or third-party payer to report additional claim
   or price information not already reported pursuant to section 2816  of
   such  law  to  analyze  all health care expenditures in the state from
   public and private sources (Part E)
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:

   Section  1.  Short title.  This act shall be known and may be cited as
 the "health equity, affordability, and reform act".
   § 2.  This act enacts into law components of legislation  relating  to
 the  health  equity,  affordability, and reform act.   Each component is
 wholly contained within a Part identified as Parts A  through  E.    The
 effective  date for each particular provision contained within such part
 is set forth in the last section of such Part.   Any  provision  in  any
 section  contained  within  a  Part, including the effective date of the
 Part, which makes reference to a section "of this  act",  when  used  in
 connection  with  that particular component, shall be deemed to mean and
 refer to the corresponding section of the Part in  which  it  is  found.
 Section  three of this act sets forth the general effective date of this
 act.

                                  PART A
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD15220-03-2
              

 S. 9508                             2
 
   Section 1. Section 369-gg of the social  services  law,  as  added  by
 section 51 of part C of chapter 60 of the laws of 2014, paragraph (c) of
 subdivision 1 as separately amended by sections 4 of part BBB of chapter
 56 and part P of chapter 57 of the laws of 2022, paragraph (e) of subdi-
 vision  1, and subdivisions 5 and 7 as amended by section 2 of part H of
 chapter 57 of the laws of 2021, subdivision 2 as amended and subdivision
 9 as added by section 28-a, subdivision 6 as added  by  section  28  and
 subdivision  8  as  amended by section 46 of part B of chapter 57 of the
 laws of 2015, paragraph (d) of subdivision 3 as amended by section 2 and
 paragraph (b) of subdivision 5 as amended by section 7-a of part BBB  of
 chapter 56 of the laws of 2022, is amended to read as follows:
   §  369-gg.  Basic health program. 1. Definitions. For purposes of this
 section:
   (a) "Eligible organization" means  an  insurer  licensed  pursuant  to
 article  thirty-two  or forty-two of the insurance law, a corporation or
 an organization under article forty-three of the insurance  law,  or  an
 organization  certified  under  article  forty-four of the public health
 law, including providers  certified  under  section  forty-four  hundred
 three-e of the public health law;
   (b) "Approved organization" means an eligible organization approved by
 the commissioner to underwrite a basic health insurance plan pursuant to
 this title;
   (c)  "Health  care  services"  means  (i) the services and supplies as
 defined by the commissioner in consultation with the  superintendent  of
 financial  services,  and  shall  be  consistent with and subject to the
 essential health benefits as defined by the commissioner  in  accordance
 with  the  provisions  of the patient protection and affordable care act
 (P.L. 111-148) and consistent with the benefits provided by  the  refer-
 ence plan selected by the commissioner for the purposes of defining such
 benefits,  and  shall  include coverage of and access to the services of
 any national cancer institute-designated cancer center licensed  by  the
 department  of  health within the service area of the approved organiza-
 tion that is willing  to  agree  to  provide  cancer-related  inpatient,
 outpatient  and  medical services to all enrollees in approved organiza-
 tions' plans in such cancer center's service area under  the  prevailing
 terms  and  conditions  that the approved organization requires of other
 similar providers to be included in the approved organization's network,
 provided that such terms shall include reimbursement of such  center  at
 no  less  than the fee-for-service medicaid payment rate and methodology
 applicable to the  center's  inpatient  and  outpatient  services;  (ii)
 dental  and vision services as defined by the commissioner, and (iii) as
 defined by the commissioner and subject  to  federal  approval,  certain
 services and supports provided to enrollees eligible pursuant to subpar-
 agraph  one of paragraph (g) of subdivision one of section three hundred
 sixty-six of this article who have functional limitations and/or chronic
 illnesses that have the primary purpose of supporting the ability of the
 enrollee to live or work in the  setting  of  their  choice,  which  may
 include  the  individual's  home,  a  worksite,  or  a provider-owned or
 controlled residential setting;
   (d) "Qualified health plan" means a health plan that meets the  crite-
 ria  for  certification described in § 1311(c) of the Patient Protection
 and Affordable Care Act (P.L. 111-148), and is  offered  to  individuals
 through the health insurance exchange marketplace; [and]
   (e) "Basic health insurance plan" means a standard health plan provid-
 ing  health  care  services,  separate  and  apart from qualified health
 S. 9508                             3
 
 plans, that is issued by  an  approved  organization  and  certified  in
 accordance with this section[.];
   (F)  "ELIGIBLE SMALL GROUP" MEANS ANY EMPLOYER, OR TRUSTEE OR TRUSTEES
 OF A FUND ESTABLISHED BY AN EMPLOYER, MEMBERS OF  A  TRADE  ASSOCIATION,
 LABOR  UNION, FUND ESTABLISHED OR PARTICIPATED IN BY TWO OR MORE EMPLOY-
 ERS OR BY ONE OR MORE LABOR UNIONS, ASSOCIATION, OR  A TRUSTEE OR  TRUS-
 TEES  OF  A  FUND  ESTABLISHED, CREATED OR MAINTAINED FOR THE BENEFIT OF
 MEMBERS OF ONE OR MORE ASSOCIATIONS, CHURCH, OR ANY ENTITY THAT  MAY  BE
 ELIGIBLE  TO  PURCHASE  GROUP COVERAGE UNDER THE INSURANCE LAW, PROVIDED
 THAT ANY OF THE FOREGOING GROUPS IDENTIFIED EMPLOY, REPRESENT, OR  COVER
 ONE HUNDRED OR LESS INDIVIDUALS;
   (G) "QUALIFIED DEPENDENTS" MEAN THE SPOUSE, AND ANY DEPENDENT CHILDREN
 OF  AN INDIVIDUAL SEEKING COVERAGE THROUGH THE BASIC HEALTH PROGRAM BUY-
 IN; AND
   (H) "FAMILY COVERAGE" MEANS THE COST TO BUY-IN  TO  THE  BASIC  HEALTH
 PROGRAM  FOR  AN INDIVIDUAL AND ANY ELIGIBLE PARTNER OR QUALIFIED DEPEN-
 DENTS BASED ON THE PER MEMBER, PER MONTH COST APPLICABLE.
   2. Authorization. If it is in the financial interest of the  state  to
 do  so,  the  commissioner of health is authorized, with the approval of
 the director of the budget, to establish a  basic  health  program.  The
 commissioner's  authority  pursuant  to  this section is contingent upon
 obtaining and maintaining all necessary approvals from the secretary  of
 health  and human services to offer a basic health program in accordance
 with 42 U.S.C. 18051. The commissioner may  take  any  and  all  actions
 necessary to obtain such approvals. Notwithstanding the foregoing, with-
 in  ninety  days of the effective date of [the] PART B OF chapter FIFTY-
 SEVEN of the laws of two thousand fifteen [which amended  this  subdivi-
 sion]  the commissioner shall submit a report to the temporary president
 of the senate and the speaker of the assembly  detailing  a  contingency
 plan  in  the  event  eligibility  rules  or regulations are modified or
 repealed; or in the event federal payment is reduced  from  ninety  five
 percent  of the premium tax credits and cost-sharing reductions pursuant
 to the patient protection and affordable care act  (P.L.  111-148).  The
 contingency  plan  shall  be implemented within ninety days of the above
 stated events or the time period specified in federal law.
   3. Eligibility. A person is eligible to receive  coverage  for  health
 care services pursuant to this title if he or she:
   (a) resides in New York state and is under sixty-five years of age;
   (b)  is not eligible for medical assistance under title eleven of this
 article or for the child health insurance plan described in title  one-A
 of article twenty-five of the public health law;
   (c)  is  not  eligible  for  minimum essential coverage, as defined in
 section 5000A(f) of the Internal Revenue Service Code  of  1986,  or  is
 eligible  for  an  employer-sponsored  plan  that  is not affordable, in
 accordance with section 5000A of such code; PROVIDED, HOWEVER, THAT  THE
 COMMISSIONER  OF  HEALTH MAY SEEK AUTHORITY FROM THE SECRETARY OF HEALTH
 AND HUMAN SERVICES TO PERMIT INDIVIDUALS WHO ARE ELIGIBLE FOR AN EMPLOY-
 ER-SPONSORED PLAN TO PURCHASE COVERAGE THROUGH THE BASIC HEALTH  PROGRAM
 BUY-IN; and
   (d) (i) except as provided by subparagraph (ii) of this paragraph, has
 household  income  at  or below two hundred FIFTY percent of the federal
 poverty line defined and annually revised by the United  States  depart-
 ment  of  health  and  human  services for a household of the same size,
 UNLESS  THE  INDIVIDUAL  OR  ELIGIBLE SMALL GROUP  PURCHASES    COVERAGE
 THROUGH  A  BASIC HEALTH PLAN  UNDER  THE  BASIC  HEALTH  PROGRAM BUY-IN
 SET FORTH UNDER SUBDIVISION ELEVEN OR TWELVE OF THIS  SECTION;  and  has
 S. 9508                             4
 
 household  income  that  exceeds one hundred thirty-three percent of the
 federal poverty line defined and annually revised by the  United  States
 department  of  health  and  human  services for a household of the same
 size;  however,  MAGI  eligible  aliens  lawfully  present in the United
 States with household incomes  at  or  below  one  hundred  thirty-three
 percent  of the federal poverty line shall be eligible to receive cover-
 age for health care services pursuant to the provisions of this title if
 such alien would be ineligible for medical assistance under title eleven
 of this article due to their immigration status; PROVIDED HOWEVER,  THAT
 SUBJECT    TO   APPROVAL   FROM   THE   SECRETARY   OF HEALTH  AND HUMAN
 SERVICES, A PERSON SHALL ALSO BE ELIGIBLE TO RECEIVE COVERAGE FOR HEALTH
 CARE SERVICES UNDER THIS TITLE,  WITHOUT  REGARD  TO FEDERAL   FINANCIAL
 PARTICIPATION,  IF HE OR SHE IS A RESIDENT OF NEW YORK STATE, HAS HOUSE-
 HOLD INCOME BELOW TWO HUNDRED FIFTY PERCENT OF THE FEDERAL POVERTY  LINE
 AS  DEFINED  AND  ANNUALLY  REVISED  BY  THE UNITED STATES DEPARTMENT OF
 HEALTH AND HUMAN SERVICES FOR A HOUSEHOLD OF THE SAME SIZE, AND IS INEL-
 IGIBLE FOR FEDERAL FINANCIAL PARTICIPATION IN THE BASIC  HEALTH  PROGRAM
 UNDER  42  U.S.C.  SECTION 18051 ON THE BASIS OF IMMIGRATION STATUS, BUT
 OTHERWISE MEETS THE ELIGIBILITY REQUIREMENTS IN PARAGRAPHS (A), (B), AND
 (C) OF THIS SUBDIVISION;
   (ii)  subject  to  federal approval and the use of state funds, unless
 the commissioner may use funds under subdivision seven of this  section,
 has household income at or below two hundred fifty percent of the feder-
 al  poverty  line  defined  and  annually  revised  by the United States
 department of health and human services for  a  household  of  the  same
 size;  and  has  household  income that exceeds one hundred thirty-three
 percent of the federal poverty line defined and annually revised by  the
 United States department of health and human services for a household of
 the  same  size;  however,  MAGI eligible aliens lawfully present in the
 United States with household incomes at or  below  one  hundred  thirty-
 three  percent  of the federal poverty line shall be eligible to receive
 coverage for health care services pursuant to  the  provisions  of  this
 title  if  such  alien  would be ineligible for medical assistance under
 title eleven of this article due to their immigration status;
   (iii) subject to federal approval if required and  the  use  of  state
 funds,  unless the commissioner may use funds under subdivision seven of
 this section, a pregnant individual who is eligible  for  and  receiving
 coverage  for health care services pursuant to this title is eligible to
 continue to receive health care services pursuant to this  title  during
 the  pregnancy  and  for  a  period of one year following the end of the
 pregnancy without regard to any change in the income  of  the  household
 that  includes the pregnant individual, even if such change would render
 the pregnant individual  ineligible  to  receive  health  care  services
 pursuant to this title;
   (iv) subject to federal approval, a child born to an individual eligi-
 ble for and receiving coverage for health care services pursuant to this
 title who would be eligible for coverage pursuant to subparagraphs [(2)]
 TWO  or  [(4)]  FOUR  of paragraph (b) of subdivision [1] ONE of section
 three hundred [and] sixty-six of [the social services law] THIS  ARTICLE
 shall  be deemed to have applied for medical assistance and to have been
 found eligible for such assistance on the date  of  such  birth  and  to
 remain eligible for such assistance for a period of one year.
   An  applicant who fails to make an applicable premium payment, if any,
 shall lose eligibility to receive coverage for health care  services  in
 accordance with time frames and procedures determined by the commission-
 er.
 S. 9508                             5
 
   3-A.  BASIC  HEALTH  PROGRAM BUY-IN ELIGIBILITY.  A PERSON OR ELIGIBLE
 SMALL GROUP SHALL BE PERMITTED TO PURCHASE COVERAGE FROM A BASIC  HEALTH
 PLAN  ON  BEHALF  OF AN INDIVIDUAL, SPOUSE, AND ANY QUALIFIED DEPENDENTS
 THROUGH THE BASIC HEALTH PROGRAM BUY-IN DESCRIBED UNDER PARAGRAPH ELEVEN
 OR  TWELVE  OF  THIS SECTION, AS LONG AS THE INDIVIDUAL, SPOUSE, AND ANY
 QUALIFIED DEPENDENTS OTHERWISE  MEET  THE  ELIGIBILITY  REQUIREMENTS  IN
 PARAGRAPHS  (A),  (B),  AND (C) OF SUBDIVISION THREE OF THIS SECTION. AN
 APPLICANT WHO FAILS TO MAKE AN APPLICABLE  PREMIUM  PAYMENT  SHALL  LOSE
 ELIGIBILITY  TO  RECEIVE COVERAGE FOR HEALTH CARE SERVICES IN ACCORDANCE
 WITH TIME FRAMES AND PROCEDURES DETERMINED BY THE COMMISSIONER.
   4. Enrollment. (a) Subject to federal approval,  the  commissioner  is
 authorized  to  establish  an  application  and enrollment procedure for
 prospective enrollees.  Such  procedure  shall  include  a  verification
 system for applicants, which shall be consistent with 42 USC § 1320b-7.
   (b) Such procedure shall allow for continuous enrollment for enrollees
 to the basic health program where an individual may apply and enroll for
 coverage at any point.
   (c)  Upon  an applicant's enrollment in a basic health insurance plan,
 coverage for health care services pursuant to  the  provisions  of  this
 title  shall be prospective. Coverage shall begin in a manner consistent
 with the requirements for qualified health  plans  offered  through  the
 health  insurance  exchange  marketplace, as delineated in federal regu-
 lation at 42 CFR 155.420(b)(1) or any successor regulation thereof.
   (d) A person who has enrolled for coverage pursuant to this title, and
 who loses eligibility to enroll in the basic health program for a reason
 other than citizenship status,  lack  of  state  residence,  failure  to
 provide a valid social security number, providing inaccurate information
 that  would affect eligibility when requesting or renewing health cover-
 age pursuant to this title, or failure to  make  an  applicable  premium
 payment, before the end of a twelve month period beginning on the effec-
 tive  date  of  the person's initial eligibility for coverage, or before
 the end of a twelve month period beginning on the date of any subsequent
 determination of eligibility, shall have  his  or  her  eligibility  for
 coverage  continued  until the end of such twelve month period, provided
 that the state receives federal approval for using funds from the  basic
 health  program  trust  fund,  established  under section 97-oooo of the
 state finance law, for the costs associated with such assistance.
   5. Premiums and cost sharing. (a) Subject  to  federal  approval,  the
 commissioner  shall  establish  premium  payments enrollees shall pay to
 approved organizations for coverage of health care services pursuant  to
 this  title.  No  payment  is  required for individuals with a household
 income at or below two hundred  percent  of  the  federal  poverty  line
 defined  and  annually revised by the United States department of health
 and human services for a household of the same size.
   (A-1) FOR AN INDIVIDUAL WITH A  HOUSEHOLD  INCOME  ABOVE  TWO  HUNDRED
 FIFTY  PERCENT  OF THE FEDERAL POVERTY LINE DEFINED AND ANNUALLY REVISED
 BY THE UNITED STATES DEPARTMENT OF  HEALTH  AND  HUMAN  SERVICES  FOR  A
 HOUSEHOLD  OF  THE  SAME  SIZE,  AN INDIVIDUAL WHO PURCHASES INDIVIDUAL,
 COUPLE, OR FAMILY COVERAGE THROUGH THE BASIC HEALTH PROGRAM BUY-IN UNDER
 SUBDIVISION ELEVEN OF THIS SECTION,  OR  AN  ELIGIBLE  SMALL  GROUP  WHO
 PURCHASES  OR CONTRIBUTES TO THE COST OF SUCH COVERAGE UNDER SUBDIVISION
 TWELVE OF THIS SECTION FOR SUCH INDIVIDUAL AND ANY QUALIFIED DEPENDENTS,
 SHALL MAKE AN APPLICABLE PREMIUM PAYMENT  EQUALING  THE  PER  MEMBER-PER
 MONTH PAYMENT RECEIVED BY A BASIC HEALTH PLAN FOR PROVIDING BASIC HEALTH
 PROGRAM  SERVICES  IN  THE REGION WHERE THE INDIVIDUAL RESIDES, PROVIDED
 THAT THE COMMISSIONER SHALL PURSUE ANY FEDERAL WAIVERS AND BE  PERMITTED
 S. 9508                             6

 TO TAKE ANY OTHER ACTIONS NECESSARY TO OFFSET THE PREMIUM PAYMENT TO THE
 MAXIMUM EXTENT POSSIBLE FOR INDIVIDUALS WITH HOUSEHOLD INCOMES LESS THAN
 FIVE HUNDRED PERCENT OF THE FEDERAL POVERTY LINE, AS DEFINED AND ANNUAL-
 LY  REVISED BY THE UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES
 FOR A HOUSEHOLD OF THE SAME SIZE, INCLUDING  SEEKING  AUTHORITY  TO  USE
 FEDERAL PREMIUM TAX CREDITS AND COST SHARING REDUCTIONS, IN AN EFFORT TO
 KEEP  THE  APPLICABLE PREMIUM PAYMENT AS LOW AS POSSIBLE FOR INDIVIDUALS
 AT THESE HOUSEHOLD INCOME LEVELS. THE COMMISSIONER SHALL  BE  AUTHORIZED
 TO ASSIGN VARIABLE PREMIUM AMOUNTS BASED ON INCOME SUCH THAT INDIVIDUALS
 WITH LOWER HOUSEHOLD INCOMES ARE REQUIRED TO PAY LESS PREMIUM.
   (A-2)  ELIGIBLE  SMALL GROUPS THAT PURCHASE COVERAGE FOR AN INDIVIDUAL
 UNDER SUBDIVISION ELEVEN OF THIS SECTION FOR WHICH THE INDIVIDUAL OR THE
 STATE RECEIVES FEDERAL PREMIUM TAX CREDITS AND COST  SHARING  REDUCTIONS
 FOR  INDIVIDUALS TO SUBSIDIZE THAT COVERAGE, SHALL BE REQUIRED TO PAY TO
 THE BASIC HEALTH PLAN, OR PAY DIRECTLY  TO  THE  STATE,  THE  AMOUNT  OF
 PREMIUM  TAX  CREDITS  AND COST SHARING REDUCTIONS RECEIVED BY THE BASIC
 HEALTH PROGRAM TRUST FUND FOR THE INDIVIDUAL, IN ADDITION TO ANY PREMIUM
 SUPPLEMENT THAT MAY APPLY BASED ON THE HOUSEHOLD INCOME OF THE  INDIVID-
 UAL,  AS  SET  FORTH  UNDER  PARAGRAPH (II) OF SUBDIVISION (A-3) OF THIS
 SECTION.  BASIC HEALTH PLANS SHALL REMIT  THESE  AMOUNTS  TO  THE  BASIC
 HEALTH PROGRAM TRUST FUND OR A SEPARATE STATE FUND, AS MAY BE DETERMINED
 BY  THE  COMMISSIONER.  SUCH  FUND  SHALL BE USED TO HELP ENSURE DEFICIT
 NEUTRALITY AND PROGRAM VIABILITY, AND FOR OTHER  PURPOSES  THAT  MAY  BE
 ALLOWED BY THE SECRETARY OF HEALTH AND HUMAN SERVICES, INCLUDING BUT NOT
 LIMITED TO, RATE ADEQUACY FOR APPROVED ORGANIZATIONS AND NETWORK PROVID-
 ERS, AS MAY BE DETERMINED BY THE COMMISSIONER.
   (A-3)  (I) THE COMMISSIONER SHALL CONTRACT WITH AN INDEPENDENT ACTUARY
 TO STUDY AND MAKE RECOMMENDATIONS AROUND PREMIUMS AND COST  SHARING  FOR
 APPROVED  ORGANIZATIONS OPERATING A BASIC HEALTH PLAN, AND FOR ALL INDI-
 VIDUALS PARTICIPATING IN THE BASIC HEALTH PROGRAM BUY-IN.  THE  ANALYSIS
 FOR  DEVELOPING  PREMIUMS  FOR  APPROVED  ORGANIZATIONS SHALL INCLUDE AN
 ANALYSIS OF RATES OF PAYMENT IN RELATION TO THE EXPECTED  POPULATION  TO
 BE  SERVED  ADJUSTED  FOR  CASE  MIX,  THE SCOPE OF HEALTH CARE SERVICES
 APPROVED ORGANIZATIONS MUST PROVIDE, THE PROJECTED UTILIZATION  OF  SUCH
 SERVICES, THE NETWORK OF PROVIDERS REQUIRED TO MEET STATE STANDARDS, AND
 SUBJECT  TO APPROVAL FROM THE SECRETARY OF HEALTH AND HUMAN SERVICES AND
 THE DIVISION OF THE BUDGET, EXISTING RATES OF PAYMENT  IN  EFFECT  UNDER
 THE  BASIC  HEALTH  PROGRAM, AND SUBJECT TO APPROVAL BY THE SECRETARY OF
 HEALTH AND HUMAN SERVICES AND THE  DIVISION  OF  THE  BUDGET,  AND  ONCE
 ENROLLMENT  IN THE BASIC HEALTH PROGRAM BUY-IN HAS REACHED MORE THAN ONE
 HUNDRED THOUSAND ENROLLEES, RATES OF PAYMENT IN  EFFECT  UNDER  MEDICARE
 PART A, B, AND C.
   (II)  PREMIUM SUPPLEMENT PAYMENTS. THE ANALYSIS CONDUCTED BY THE INDE-
 PENDENT ACTUARY SHALL INCLUDE  RECOMMENDED  PREMIUM  SUPPLEMENT  AMOUNTS
 THAT  SHALL  BE REQUIRED FOR CERTAIN INDIVIDUALS AND MAY BE REQUIRED FOR
 ELIGIBLE SMALL GROUPS TO INCREASE AVAILABLE FUNDS FOR THE  BASIC  HEALTH
 PROGRAM.  PREMIUM  SUPPLEMENT PAYMENTS SHALL BE PAID BY INDIVIDUALS THAT
 ENROLL IN THE BASIC HEALTH PROGRAM BUY-IN,  WHO  HAVE  HOUSEHOLD  INCOME
 ABOVE  EIGHT HUNDRED PERCENT OF THE FEDERAL POVERTY LINE, AS DEFINED AND
 ANNUALLY REVISED BY THE UNITED STATES DEPARTMENT  OF  HEALTH  AND  HUMAN
 SERVICES  FOR A HOUSEHOLD OF THE SAME SIZE, AND IN THE DISCRETION OF THE
 COMMISSIONER, MAY BE REQUIRED TO BE PAID BY ELIGIBLE SMALL  GROUPS  THAT
 CONTRIBUTE  TO  COVERAGE FOR ANY INDIVIDUALS QUALIFIED UNDER SUBDIVISION
 TWELVE OF THIS SECTION.
   (A-4) FOR  COVERAGE  PURCHASED  THROUGH  SUBDIVISION  ELEVEN  OF  THIS
 SECTION, FOR INDIVIDUALS AND QUALIFIED DEPENDENTS WITH HOUSEHOLD INCOMES
 S. 9508                             7
 
 ABOVE  EIGHT HUNDRED PERCENT OF THE FEDERAL POVERTY LINE, AS DEFINED AND
 ANNUALLY REVISED BY THE UNITED STATES DEPARTMENT  OF  HEALTH  AND  HUMAN
 SERVICES  FOR A HOUSEHOLD OF THE SAME SIZE, A PREMIUM SUPPLEMENT PAYMENT
 SHALL BE PAID TO INCREASE STATE SHARE FUNDS FOR THE PROGRAM. THE PREMIUM
 SUPPLEMENT  SHALL  BE  DETERMINED BY THE COMMISSIONER IN ACCORDANCE WITH
 PRINCIPLES OF EQUITY AND FAIRNESS, INCREASING COMMENSURATE  WITH  HOUSE-
 HOLD  INCOME,  AND  MAY  CONSIDER  ASSUMED  SAVINGS  FOR  THE INDIVIDUAL
 COMPARED TO TRADITIONAL INSURANCE COVERAGE, PROVIDED THE PREMIUM SUPPLE-
 MENT AMOUNT SHALL BE STRUCTURED IN A WAY TO  MAXIMIZE  AFFORDABILITY  AT
 LOWER APPLICABLE HOUSEHOLD INCOME LEVELS, AND SHALL NOT RESULT IN COVER-
 AGE  BEING  MORE  EXPENSIVE  UNDER  THE BASIC HEALTH PROGRAM BUY-IN THAN
 UNDER A SILVER LEVEL METALLIC PLAN OFFERED BY A  QUALIFIED  HEALTH  PLAN
 UNDER  THE  NEW  YORK  HEALTH BENEFITS EXCHANGES FOR COMPARABLE COVERAGE
 UNTIL HOUSEHOLD INCOME OF AN INDIVIDUAL MEETS OR EXCEEDS FIFTEEN HUNDRED
 PERCENT OF THE FEDERAL POVERTY LINE, DEFINED AND ANNUALLY REVISED BY THE
 UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES FOR A HOUSEHOLD OF
 THE SAME SIZE.
   (A-5) ONCE ENROLLMENT IN THE BASIC HEALTH PROGRAM BUY-IN  HAS  REACHED
 ONE HUNDRED THOUSAND INDIVIDUALS, THE COMMISSIONER SHALL HAVE DISCRETION
 TO  DETERMINE  WHETHER  ELIGIBLE  SMALL  GROUPS SHALL BE REQUIRED TO PAY
 PREMIUM SUPPLEMENT PAYMENTS FOR ANY INDIVIDUAL AND QUALIFIED  DEPENDENTS
 WHO  THEY CONTRIBUTE COVERAGE COSTS FOR UNDER SUBDIVISION TWELVE OF THIS
 SECTION, IF IT BECOMES NECESSARY TO INCREASE STATE SHARE FUNDS  FOR  THE
 PROGRAM  A  PREMIUM  SUBSIDY  AMOUNT  CAN BE APPLIED WITHOUT UNDERMINING
 VIABILITY AND AFFORDABILITY OF THE PROGRAM. THE PREMIUM SUPPLEMENT  THAT
 WOULD  BE  OWED  BY  AN  ELIGIBLE SMALL GROUP SHALL BE DETERMINED BY THE
 COMMISSIONER, BUT SHALL COMPRISE A PER PERSON AMOUNT THAT  IS  DEVELOPED
 TO  ENSURE  MAXIMUM  FAIRNESS  FOR  ELIGIBLE SMALL GROUPS, AND TAKE INTO
 CONSIDERATION THE SIZE, AGE, AND REVENUE OF THE  ELIGIBLE  SMALL  GROUP,
 THE HOUSEHOLD INCOME OF THE COVERED INDIVIDUAL, AND THE COST SAVINGS FOR
 THE  ELIGIBLE SMALL GROUP UNDER THE BASIC HEALTH PROGRAM BUY-IN COMPARED
 TO TRADITIONAL SMALL GROUP INSURANCE COVERAGE, AS APPLICABLE.
   (b) The commissioner shall  establish  cost  sharing  obligations  for
 enrollees,  subject  to federal approval. There shall be no cost-sharing
 obligations for enrollees for dental and vision services as  defined  in
 subparagraph  (ii)  of paragraph (c) of subdivision one of this section;
 services and supports as defined in subparagraph (iii) of paragraph  (c)
 of  subdivision one of this section; and health care services authorized
 under subparagraphs (iii) and (iv) of paragraph (d) of subdivision three
 of this section. SUCH COST SHARING SHALL: (I)  NOT  INCLUDE  DEDUCTIBLES
 FOR  INDIVIDUALS   AT ANY HOUSEHOLD INCOME LEVEL; (II) SUBJECT TO AVAIL-
 ABLE FUNDS, NOT REQUIRE ANY  COST  SHARING  FOR  HOUSEHOLD  INCOMES  NOT
 EXCEEDING FIVE HUNDRED PERCENT OF THE FEDERAL POVERTY LINE  DEFINED  AND
 ANNUALLY  REVISED  BY  THE  UNITED STATES DEPARTMENT OF HEALTH AND HUMAN
 SERVICES FOR A HOUSEHOLD OF THE SAME SIZE, BUT IF THIS IS NOT  POSSIBLE,
 THEN  SUCH  COST  SHARING SHALL BE SET AS LOW AS POSSIBLE FOR THE LOWEST
 HOUSEHOLD  INCOMES;  AND  (III) NOT  BE  ESTABLISHED  AS  A   PERCENTAGE
 OF   THE COST OF THE SERVICE AND COMPRISE A FIXED COST INTENDED TO BE AS
 AFFORDABLE AS POSSIBLE  AND  NOT ACT  AS  A  BARRIER   TO   CARE,   THAT
 IN  NO  EVENT  SHALL  BE  MORE  THAN TWO HUNDRED DOLLARS FOR ANY COVERED
 HEALTH CARE SERVICE. COST  SHARING   OWED FOR   SERVICES   ABOVE    FIVE
 HUNDRED   PERCENT OF THE FEDERAL POVERTY LINE SHALL VARY BASED ON INCOME
 TO PROMOTE EQUITY AND FAIRNESS.
   6. Rates of payment.  (a) The commissioner shall select  the  contract
 with   an   independent  actuary  to  study  and  recommend  appropriate
 reimbursement methodologies for the cost of health care service coverage
 S. 9508                             8
 
 pursuant to this title. Such independent actuary shall review  and  make
 recommendations concerning appropriate actuarial assumptions relevant to
 the  establishment  of  reimbursement  methodologies,  including but not
 limited  to;  the  adequacy of rates of payment in relation to the popu-
 lation to be served adjusted for case mix,  the  scope  of  health  care
 services  approved  organizations  must provide, the utilization of such
 services and the network of providers required to meet state  standards,
 EXISTING  RATES OF PAYMENT IN EFFECT UNDER THE BASIC HEALTH PROGRAM, AND
 SUBJECT TO APPROVAL BY THE SECRETARY OF HEALTH AND  HUMAN  SERVICES  AND
 THE  DIVISION  OF  THE  BUDGET,  AND ONCE ENROLLMENT IN THE BASIC HEALTH
 PROGRAM BUY-IN HAS REACHED MORE THAN  ONE  HUNDRED  THOUSAND  ENROLLEES,
 RATES OF PAYMENT IN EFFECT UNDER MEDICARE PART A, B, AND C.
   (b)  Upon  consultation  with  the  independent  actuary  and entities
 representing approved  organizations,  the  commissioner  shall  develop
 reimbursement  methodologies  and fee schedules for determining rates of
 payment, which rate shall be approved by the director of the division of
 the budget, to be made by the department to approved  organizations  for
 the  cost  of health care services coverage pursuant to this title. Such
 reimbursement methodologies and fee schedules may include provisions for
 capitation arrangements. PROVIDERS AND APPROVED ORGANIZATIONS  SHALL  BE
 PERMITTED  TO  NEGOTIATE  RATES  OF PAYMENT, PROVIDED, HOWEVER, THAT THE
 COMMISSIONER SHALL BE AUTHORIZED TO ESTABLISH MANDATORY RATES OF PAYMENT
 TO ENSURE AFFORDABILITY AND VIABILITY OF THE PROGRAM.
   (c) The commissioner shall have  the  authority  to  promulgate  regu-
 lations,  including  emergency  regulations, necessary to effectuate the
 provisions of this subdivision.
   (d) The department shall  require  the  independent  actuary  selected
 pursuant  to  paragraph  (a)  of  this subdivision to provide a complete
 actuarial report, along with all  actuarial  assumptions  made  and  all
 other data, materials and methodologies used in the development of rates
 for  the  basic  health  plan authorized under this section. Such report
 shall be provided annually to the temporary president of the senate  and
 the speaker of the assembly.
   7. Any funds transferred by the secretary of health and human services
 to the state pursuant to 42 U.S.C. 18051(d) shall be deposited in trust.
 Funds from the trust shall be used for providing health benefits through
 [an  approved  organization]  A  BASIC HEALTH PLAN, which, at a minimum,
 shall  include  essential  health  benefits  as  defined  in  42  U.S.C.
 18022(b);  to  reduce  the premiums, if any, and cost sharing of partic-
 ipants in the basic health program; or for such other purposes as may be
 allowed by the secretary of health and human services.  Health  benefits
 available  through  the basic health program shall be provided by one or
 more approved organizations pursuant to an agreement with the department
 of health and shall meet the  requirements  of  applicable  federal  and
 state laws and regulations.
   8.  An  individual  who  is lawfully admitted for permanent residence,
 permanently residing in the United States under color of law, or who  is
 a  non-citizen  in  a  valid nonimmigrant status, as defined in 8 U.S.C.
 1101(a)(15), and who would be ineligible for  medical  assistance  under
 title eleven of this article due to his or her immigration status if the
 provisions  of  section  one  hundred  twenty-two  of  this chapter were
 applied, shall be considered to be ineligible for medical assistance for
 purposes of paragraphs (b) and (c) of subdivision three of this section.
   9. Reporting. The commissioner shall submit a report to the  temporary
 president  of  the  senate  and  the speaker of the assembly annually by
 December thirty-first. The report shall include, at a minimum, an analy-
 S. 9508                             9
 
 sis of the basic health program and its impact on the financial interest
 of the state; its  impact  on  the  health  benefit  exchange  including
 enrollment  and premiums; its impact on the number of uninsured individ-
 uals  in the state; its impact on the Medicaid global cap; ITS IMPACT ON
 HEALTH CARE AFFORDABILITY FOR MIDDLE CLASS NEW YORKERS;  ITS  IMPACT  ON
 SMALL BUSINESS AND ECONOMIC ACTIVITY; ITS IMPACT ON POPULATION TRENDS IN
 THE  STATE; THE IMPACT OF BASIC HEALTH PROGRAM PAYMENT RATES ON HOSPITAL
 FINANCES AND FINANCIAL SUSTAINABILITY, AND  RECOMMENDATIONS  TO  ADDRESS
 ANY  POTENTIAL CONCERNS BASED ON MIGRATION FROM THE COMMERCIAL INSURANCE
 MARKET TO THE BASIC HEALTH PROGRAM; and the demographics of basic health
 program enrollees including age and immigration status.
   10. NETWORK PARTICIPATION. ANY PROVIDER LICENSED  OR  CERTIFIED  UNDER
 ARTICLE  THIRTY-ONE  OR  THIRTY-TWO  OF  THE MENTAL HYGIENE LAW, AND ANY
 HOSPITAL LICENSED UNDER ARTICLE TWENTY-EIGHT OF THE PUBLIC  HEALTH  LAW,
 INCLUDING ANY CLINIC, PHYSICIAN OR SPECIALIST GROUP, OUTPATIENT FACILITY
 OR  PRACTICE,  AMBULATORY CARE SETTING OR OTHER OFFICE-BASED SETTING, OR
 OTHER HEALTH CARE SETTING OWNED IN  WHOLE  OR  IN  PART  BY  A  HOSPITAL
 LICENSED UNDER ARTICLE TWENTY-EIGHT OF THE PUBLIC HEALTH LAW, AS WELL AS
 ANY  SINGLE  OR MULTI-SPECIALTY FREE-STANDING AMBULATORY SURGERY CENTERS
 LICENSED UNDER ARTICLE TWENTY-EIGHT OF THE PUBLIC HEALTH LAW, SHALL MAKE
 HEALTH CARE SERVICES AVAILABLE TO ANY INDIVIDUAL  IN  THE  BASIC  HEALTH
 PROGRAM. APPROVED ORGANIZATIONS OPERATING BASIC HEALTH PLANS AND PROVID-
 ERS  SHALL  USE  GOOD  FAITH  EFFORTS TO NEGOTIATE NETWORK PARTICIPATION
 ARRANGEMENTS FOR INDIVIDUALS ENROLLED IN THE BASIC HEALTH PROGRAM.
   11. BASIC HEALTH PROGRAM BUY-IN FOR INDIVIDUALS.  ANY  INDIVIDUAL  WHO
 MEETS THE ELIGIBILITY REQUIREMENTS OF PARAGRAPHS (A) AND (B) OF SUBDIVI-
 SION  THREE  OF THIS SECTION SHALL BE PERMITTED TO PURCHASE BASIC HEALTH
 PROGRAM COVERAGE FOR THEMSELVES AND ANY QUALIFIED DEPENDENTS WHO  OTHER-
 WISE  MEET  THE  ELIGIBILITY  REQUIREMENTS  OF PARAGRAPHS (A) AND (B) OF
 SUBDIVISION THREE OF THIS SECTION,  THROUGH  THE  BASIC  HEALTH  PROGRAM
 BUY-IN.  SUBJECT  TO APPROVAL FROM THE UNITED STATES SECRETARY OF HEALTH
 AND HUMAN SERVICES, THE BASIC HEALTH PROGRAM BUY-IN SHALL ALLOW ELIGIBLE
 INDIVIDUALS TO PAY THE REGIONAL PER MEMBER, PER MONTH  PREMIUM  THAT  IS
 PAID  TO  A BASIC HEALTH PLAN FOR ELIGIBLE INDIVIDUALS IN THE REGION, OR
 ANY SUBSIDIZED PREMIUM BASED ON THE AVAILABILITY  OF  FEDERAL  OR  STATE
 SUBSIDIES  AS  BASIC HEALTH PROGRAM FUNDS PERMIT, FOR THEMSELVES AND ANY
 QUALIFIED  DEPENDENTS,  AND  GAIN  COVERAGE  THROUGH  THE  BASIC  HEALTH
 PROGRAM.
   12.  BASIC HEALTH PROGRAM BUY-IN FOR ELIGIBLE SMALL GROUPS. ANY ELIGI-
 BLE SMALL GROUP MAY PAY TO A BASIC  HEALTH  PLAN  THE  FULL  OR  PARTIAL
 AMOUNT OF THE PREMIUM COSTS FOR AN INDIVIDUAL AND THEIR QUALIFIED DEPEN-
 DENTS  TO  BUY-IN TO THE BASIC HEALTH PROGRAM AS A BENEFIT TO MEMBERS OF
 THE ELIGIBLE SMALL GROUP.  THE COMMISSIONER SHALL  ESTABLISH  PROCEDURES
 THROUGH  WHICH  ELIGIBLE SMALL GROUPS CAN PAY VOLUNTARY PREMIUM CONTRIB-
 UTIONS, AND IF CONTRIBUTIONS ARE MADE, ANY APPLICABLE  REQUIRED  SUBSIDY
 EQUIVALENCY PAYMENTS AND PREMIUM SUPPLEMENTS FOR COVERED INDIVIDUALS AND
 THEIR QUALIFIED DEPENDENTS, DIRECTLY TO A BASIC HEALTH PLAN ON AN AGGRE-
 GATE, MONTHLY BASIS.
   13.  THE  COMMISSIONER  SHALL SEEK ANY FEDERAL WAIVERS, APPROVALS, AND
 TAKE ANY AND ALL ACTIONS NECESSARY TO IMPLEMENT THIS SECTION,  INCLUDING
 BUT  NOT  LIMITED TO FEDERAL WAIVERS AND APPROVALS, AND PURSUE ANY STATE
 STATUTORY OR REGULATORY CHANGES NECESSARY TO IMPLEMENT THIS ACT, INCLUD-
 ING ESTABLISHING PENALTIES, FINES, AND OVERSIGHT AUTHORITY, IN  CONJUNC-
 TION  WITH  THE  DEPARTMENT OF TAXATION AND FINANCE, TO CAPTURE ACCURATE
 INFORMATION FROM INDIVIDUALS  AND  ELIGIBLE  SMALL  GROUPS,  AND  ENSURE
 S. 9508                            10
 
 ELIGIBLE  SMALL  GROUPS  ARE  COMPLYING  WITH  THE  REQUIREMENTS OF THIS
 SECTION.
   § 2. This act shall take effect on the one hundred eightieth day after
 it shall have become a law.  Effective immediately, the addition, amend-
 ment and/or repeal of any rule or regulation necessary for the implemen-
 tation  of  this act on its effective date are authorized to be made and
 completed on or before such effective date; provided, further, that  the
 amendments  to paragraphs (c) and (e) of subdivision 1, paragraph (d) of
 subdivision 3, and subdivisions 5 and 7 of section 369-gg of the  social
 services  law made by section one of this act shall not affect the expi-
 ration of such paragraphs and subdivisions and shall be deemed to expire
 therewith.

                                  PART B
 
   Section 1. Legislative intent. The legislature finds and declares  all
 of the following:
   Medical  care should never result in financial hardship or bankruptcy;
 that out-of-network service reimbursement should be  fair  to  providers
 but  put consumers first; and that hospitals should not be able to place
 liens on their patients' homes to secure payment of out-of-pocket costs.
   For too many New Yorkers, an unexpected medical emergency or diagnosis
 carries both life-altering health and financial consequences.  An  indi-
 vidual should not need to substantially modify theirs and their family's
 future  by liquidating college or retirement savings or need to start an
 online fundraiser to afford the bills from a  medical  emergency.    For
 those  who  have experienced a medical travesty and cannot work, ongoing
 costs they cannot afford compound the trauma.
   As a result of the Affordable Care Act, health insurance  plans  today
 are required to establish out-of-pocket payment maximums that attempt to
 limit  one's  out-of-pocket  cost liability for health care. While these
 are certainly preferred over no coverage, they offer  little  protection
 against  debt and bankruptcy because they exclude out-of-network care as
 well as premium contributions paid by an individual. This means that the
 sum of premium payments a person makes for their health  care  does  not
 count  towards the out-of-pocket cap, meaning the cap is not account for
 what could be a substantial amount  of  available  resources  that  have
 already  been  devoted  to  pay  for one's health care. In addition, the
 out-of-pocket maximum does not account  for  an  individual's  household
 income,  exacerbating equity issues by failing to consider one's ability
 to actually afford their out-of-pocket maximum, or if it  is  an  amount
 that would inevitably lead to debt and bankruptcy.
   While  there  are  many  contributing  factors  to  health  care  cost
 increases, one of the drivers continues to  be  out-of-network  charges.
 While  New  York  has  led the way in protecting consumers from surprise
 bills, studies have shown  New  York's  Independent  Dispute  Resolution
 process  and  its  reliance  on  health care charges to resolve disputes
 incentivizes out-of-network  providers  to  continually  increase  their
 "charges", as charges are part of the criteria used to determine payment
 of  a  disputed  out-of-network  charge. Higher charges result in higher
 awards and more costs being built into premiums in subsequent years.  As
 long as the state maintains a health care system that permits and incen-
 tivizes this behavior, the system will continue to incentivize such cost
 increases  while encouraging those who do not participate in networks to
 continue to do so, with consumers caught in between. It is essential  to
 address  out-of-network  charges  in a way that is fair to providers but
 S. 9508                            11
 
 takes patients completely out of the middle of health plan and  provider
 disputes.
   §  2.  Article  6  of the financial services law is REPEALED and a new
 article 6 is added to read as follows:
                                 ARTICLE 6
                 COST CONTAINMENT AND CONSUMER PROTECTIONS
 SECTION 601. APPLICABILITY.
         602. DEFINITIONS.
         603. RATES OF PAYMENT FOR NON-PARTICIPATING SERVICES.
         604. ANNUAL LIMIT ON CONSUMER HEALTH CARE EXPENDITURES.
         605. SERVICE LEVEL CAPS ON HIGH HEALTH CARE COSTS.
         606. COST GROWTH CAPS.
   § 601. APPLICABILITY. THIS ARTICLE SHALL  NOT  APPLY  TO  HEALTH  CARE
 SERVICES, INCLUDING EMERGENCY SERVICES, WHERE PHYSICIAN FEES ARE SUBJECT
 TO  SCHEDULES OR OTHER MONETARY LIMITATIONS UNDER ANY OTHER LAW, INCLUD-
 ING THE WORKERS' COMPENSATION LAW AND ARTICLE FIFTY-ONE OF THE INSURANCE
 LAW, AND SHALL NOT PREEMPT ANY SUCH LAW.
   § 602. DEFINITIONS. FOR PURPOSES OF THIS ARTICLE:
   (A) "EMERGENCY  HEALTH  CARE  SERVICES"  MEANS  HEALTH  CARE  SERVICES
 RENDERED TO AN INSURED EXPERIENCING AN "EMERGENCY CONDITION".
   (B)  "EMERGENCY  CONDITION" MEANS MEDICAL OR BEHAVIORAL CONDITION THAT
 MANIFESTS ITSELF BY ACUTE SYMPTOMS  OF  SUFFICIENT  SEVERITY,  INCLUDING
 SEVERE  PAIN, SUCH THAT A PRUDENT LAYPERSON, POSSESSING AN AVERAGE KNOW-
 LEDGE OF MEDICINE AND HEALTH, COULD REASONABLY  EXPECT  THE  ABSENCE  OF
 IMMEDIATE  MEDICAL ATTENTION TO RESULT IN: (1) PLACING THE HEALTH OF THE
 PERSON AFFLICTED WITH SUCH CONDITION IN SERIOUS JEOPARDY, OR IN THE CASE
 OF A BEHAVIORAL CONDITION PLACING THE HEALTH OF SUCH PERSON OR OTHERS IN
 SERIOUS JEOPARDY; (2) SERIOUS IMPAIRMENT TO SUCH PERSON'S  BODILY  FUNC-
 TIONS;  (3)  SERIOUS  DYSFUNCTION  OF  ANY  BODILY ORGAN OR PART OF SUCH
 PERSON; (4) SERIOUS DISFIGUREMENT OF SUCH PERSON;  OR  (5)  A  CONDITION
 DESCRIBED  IN  CLAUSE (I), (II) OR (III) OF SECTION 1867(E)(1)(A) OF THE
 SOCIAL SECURITY ACT 42 U.S.C. 1395DD.
   (C) "HEALTH CARE PLAN" MEANS AN INSURER LICENSED TO WRITE ACCIDENT AND
 HEALTH INSURANCE PURSUANT TO ARTICLE THIRTY-TWO OF THE INSURANCE LAW;  A
 CORPORATION  ORGANIZED  PURSUANT TO ARTICLE FORTY-THREE OF THE INSURANCE
 LAW; A MUNICIPAL COOPERATIVE HEALTH BENEFIT PLAN CERTIFIED  PURSUANT  TO
 ARTICLE FORTY-SEVEN OF THE INSURANCE LAW; A HEALTH MAINTENANCE ORGANIZA-
 TION  CERTIFIED PURSUANT TO ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH LAW;
 OR A STUDENT HEALTH PLAN ESTABLISHED OR MAINTAINED PURSUANT  TO  SECTION
 ONE THOUSAND ONE HUNDRED TWENTY-FOUR OF THE INSURANCE LAW.
   (D) "INSURED" MEANS A PATIENT COVERED UNDER A HEALTH CARE PLAN'S POLI-
 CY OR CONTRACT.
   (E)  "NONEMERGENCY  HEALTH  CARE  SERVICES" MEANS HEALTH CARE SERVICES
 RENDERED TO AN INSURED EXPERIENCING A MEDICAL CONDITION  OTHER  THAN  AN
 EMERGENCY CONDITION.
   (F)  "IN-NETWORK CONTRACTED RATE" MEANS THE RATE CONTRACTED BETWEEN AN
 INSURED'S HEALTH CARE PLAN AND A PARTICIPATING HEALTH CARE PROVIDER  FOR
 THE  REIMBURSEMENT OF HEALTH CARE SERVICES DELIVERED BY THAT HEALTH CARE
 PROVIDER TO THE INSURED.
   (G) "MEDIAN, IN-NETWORK CONTRACTED  RATE"  MEANS  THE  MEDIAN  ALLOWED
 AMOUNT PAID TO IN-NETWORK PROVIDERS FOR A SPECIFIC SERVICE BY A SPECIFIC
 HEALTH PLAN.
   (H)  "NON-PARTICIPATING  COMMERCIAL RATE FOR EMERGENCY SERVICES" MEANS
 THE AMOUNT SET PURSUANT TO THIS SECTION, AND USED TO DETERMINE THE  RATE
 OF  PAYMENT  TO  A  HEALTH  CARE PROVIDER FOR THE PROVISION OF EMERGENCY
 S. 9508                            12
 
 HEALTH CARE SERVICES TO AN INSURED WHEN THE HEALTH CARE PROVIDER IS  NOT
 IN THE INSURER'S NETWORK.
   (I)  "NONCONTRACTED  COMMERCIAL  RATE FOR NONEMERGENCY SERVICES" MEANS
 THE AMOUNT SET PURSUANT TO THIS SECTION, AND USED TO DETERMINE THE  RATE
 OF  PAYMENT  TO A HEALTH CARE PROVIDER FOR THE PROVISION OF NONEMERGENCY
 HEALTH CARE SERVICES TO AN INSURED WHEN THE HEALTH CARE PROVIDER IS  NOT
 IN THE INSURER'S NETWORK.
   (J)  "RELATIVE  PRICE"  MEANS THE NEGOTIATED ALLOWED AMOUNT PAID FOR A
 MEDICAL SERVICE BY A HEALTH CARE PLAN, INCLUDING AMOUNTS PAID FROM  BOTH
 THE  HEALTH  CARE  PLAN  AND  THE INSURED, COMPARED AGAINST THE MEDICARE
 REIMBURSEMENT RATE FOR THE SAME PROCEDURE AND FACILITY.
   (K) "CORE CPI" MEANS THE CONSUMER PRICE INDEX FOR ALL URBAN CONSUMERS,
 ALL ITEMS LESS FOOD & ENERGY, DEVELOPED BY THE UNITED STATES  BUREAU  OF
 LABOR STATISTICS.
   §  603.  RATES  OF  PAYMENT FOR NON-PARTICIPATING SERVICES. ALL HEALTH
 CARE PLANS SHALL PAY NON-PARTICIPATING PROVIDERS OF EMERGENCY  AND  NON-
 EMERGENCY  HEALTH  CARE  SERVICES PROVIDED TO AN INSURED AT THE INSURERS
 MEDIAN, IN-NETWORK RATE FOR THE SERVICE  PROVIDED.  PROVIDERS  SHALL  BE
 PROHIBITED  FROM  BALANCE  BILLING  AN  INSURED FOR ANY AMOUNT ABOVE THE
 MEDIAN, IN-NETWORK RATE PAID FOR THE HEALTH  CARE  SERVICE.  THE  SUPER-
 INTENDENT   MAY  PROMULGATE  REGULATIONS  NECESSARY  TO  IMPLEMENT  THIS
 SECTION.
   § 604. ANNUAL LIMIT ON CONSUMER HEALTH CARE EXPENDITURES. (A) NOTWITH-
 STANDING ANY OUT-OF-POCKET MAXIMUMS THAT MAY  EXIST  TODAY,  THE  SUPER-
 INTENDENT  SHALL ESTABLISH ANNUAL LIMITS ON THE OVERALL FINANCIAL AMOUNT
 AN INSURED SHALL BE RESPONSIBLE FOR IN THE  STATE  REGULATED  COMMERCIAL
 HEALTH  INSURANCE  MARKET,  FOR  PAYMENT  OF  HEALTH  CARE COSTS UNDER A
 CONTRACT WITH A NEW YORK STATE REGULATED HEALTH  PLAN,  WHICH  SHALL  BE
 INCLUSIVE  OF  ALL PREMIUM CONTRIBUTIONS MADE DIRECTLY BY THE INDIVIDUAL
 FOR INDIVIDUAL OR FAMILY COVERAGE, AS WELL AS ANY AMOUNTS  PAID  TOWARDS
 COPAYS, COINSURANCE, AND DEDUCTIBLES, FOR ALL MEDICALLY NECESSARY HEALTH
 CARE  SERVICES,  IRRESPECTIVE  OF  WHETHER THE SERVICE IS PROVIDED BY AN
 IN-NETWORK OR OUT-OF-NETWORK PROVIDER, SUCH THAT WHEN THE  TOTAL  AMOUNT
 OF HEALTH CARE COSTS PAID BY AN INDIVIDUAL REACHES THE APPLICABLE LIMIT,
 THE  CONSUMER  IS  NO  LONGER FINANCIALLY RESPONSIBLE TO THE INSURER FOR
 PAYMENT OF OUT-OF-POCKET COSTS. FOR PURPOSES OF THIS SECTION, ANY FINAN-
 CIAL CONTRIBUTIONS TOWARD THE PREMIUM MADE BY  AN  EMPLOYER  FOR  HEALTH
 INSURANCE  COVERAGE  SHALL  NOT  COUNT  TOWARDS THE ANNUAL OUT-OF-POCKET
 MAXIMUM.
   (B) IN IMPLEMENTING SUBSECTION (A) OF THIS SECTION, THE SUPERINTENDENT
 MAY USE THE IRS EMPLOYER HEALTH PLAN AFFORDABILITY THRESHOLD AS A  BASE-
 LINE,  BUT  SHALL  ESTABLISH  CAP  AMOUNTS  AT  VARIOUS HOUSEHOLD INCOME
 LEVELS, SUCH THAT  INDIVIDUALS  WITH  LESS  HOUSEHOLD  INCOME  SHALL  BE
 SUBJECT  TO  A  LOWER  ANNUAL  PAYMENT  CAP, AND INDIVIDUALS WITH HIGHER
 HOUSEHOLD INCOME SHALL BE SUBJECT TO A HIGHER  ANNUAL  CAP,  BUT  IN  NO
 EVENT  SHALL  THE  ANNUAL OUT-OF-POCKET MAXIMUM CAP MORE THAN DOUBLE THE
 IRS EMPLOYER HEALTH PLAN AFFORDABILITY THRESHOLD FOR INDIVIDUALS AT  ANY
 INCOME  LEVEL.  THE  SUPERINTENDENT  SHALL BE PERMITTED TO APPLY FOR ANY
 FEDERAL WAIVERS AND PURSUE ANY REINSURANCE OPTIONS FOR INSURERS  OR  THE
 STATE  AND  TAKE OTHER ACTIONS CONSISTENT WITH THIS SECTION TO IMPLEMENT
 ITS INTENT.
   (C) INSURERS SHALL BE  PROHIBITED  FROM  INCREASING  HEALTH  INSURANCE
 PREMIUMS  TO  ACCOUNT  FOR  THE  OUT-OF-POCKET LIMITS, AND THE ACTUARIAL
 VALUE OF THE INSURANCE PRODUCT SHALL BE REGARDED AS  IF  THE  UNDERLYING
 INSURANCE PRODUCT DID NOT INCLUDE ANY REVISED OUT-OF-POCKET LIMIT.
 S. 9508                            13
 
   (D)  THE  COMMISSIONER  OF  HEALTH SHALL WORK WITH THE COMMISSIONER OF
 TAXATION AND FINANCE TO ESTABLISH APPROPRIATE PENALTIES  AND  SAFEGUARDS
 TO ENSURE PROPER IMPLEMENTATION OF THIS ARTICLE.
   §  605.  SERVICE  LEVEL  CAPS ON HIGH HEALTH CARE COSTS. (A) NO HEALTH
 CARE PLAN SHALL BE PERMITTED TO REIMBURSE ANY  INPATIENT  OR  OUTPATIENT
 HOSPITAL  LICENSED  UNDER ARTICLE TWENTY-EIGHT OF THE PUBLIC HEALTH LAW,
 AND ANY  SINGLE  OR  MULTI-SPECIALTY  FREE-STANDING  AMBULATORY  SURGERY
 CENTERS  LICENSED  UNDER  ARTICLE TWENTY-EIGHT OF THE PUBLIC HEALTH LAW,
 MORE THAN TWO HUNDRED FORTY PERCENT OF THE MEDICARE BENCHMARK  RATE  FOR
 THE SERVICE.
   (B)  ANY  PROVIDER  SUBJECT TO THIS PARAGRAPH SHALL BE PROHIBITED FROM
 BALANCE BILLING AN INSURED FOR COSTS ABOVE THE BENCHMARK RATE OR COST UP
 TO THE BENCHMARK RATE IF THE PROVIDER HAS NEGOTIATED A LOWER CHARGE  FOR
 THE SERVICE FROM THE HEALTH CARE PLAN.
   (C) ANY RATE FILINGS THAT MAY BE REQUIRED SHALL BE SUBJECT TO PRESUMP-
 TIVE  DISAPPROVAL  IF  IT INCLUDES ANY PAYMENT TO PROVIDERS THAT IS MORE
 THAN TWO HUNDRED FORTY PERCENT OF THE MEDICARE BENCHMARK RATE.
   (D) THE SUPERINTENDENT SHALL ASSESS THE IMPACT OF  THIS  PROVISION  ON
 HEALTH  CARE  COSTS IN CONSULTATION WITH THE COMMISSIONER OF HEALTH, AND
 MAY RECOMMEND MODIFICATIONS TO THE SERVICE LEVEL  CAPS,  INCLUDING,  BUT
 NOT  LIMITED  TO, REVISING THE METHODOLOGY TO ESTABLISH NEW CAPS, ESTAB-
 LISHING REGIONAL CAPS, OR LOWERING OR RAISING CAPS AS MAY  BE  NECESSARY
 BASED ON HEALTH CARE UTILIZATION, PRICE, AND TREND ANALYSIS CONDUCTED BY
 THE COMMISSIONER OF HEALTH.
   § 606. COST GROWTH CAPS. ANY RATE FILINGS SUBMITTED TO THE SUPERINTEN-
 DENT  MAY  NOT  INCLUDE  AGGREGATE UNIT PRICE GROWTH FOR NONPROFESSIONAL
 SERVICES THAT EXCEED THE FOLLOWING:
   (A) ONE YEAR AFTER THE ANALYSIS ON HEALTH CARE COST GROWTH AND  TRENDS
 IS  COMPLETED BY THE COMMISSIONER OF HEALTH UNDER SECTION TWENTY HUNDRED
 SIXTEEN OF THE PUBLIC HEALTH  LAW,  THE  COMMISSIONER  OF  HEALTH  SHALL
 ESTABLISH  THREE  TIERS OF HOSPITALS BASED ON HEALTH CARE PRICES PAID BY
 HEALTH CARE PLANS TO INPATIENT AND  OUTPATIENT  HOSPITALS  AND  HOSPITAL
 SYSTEMS,  AND ALL AMBULATORY SURGERY CENTERS LICENSED OR CERTIFIED UNDER
 ARTICLE TWENTY-EIGHT OF THE PUBLIC HEALTH LAW, SUCH THAT:
   (1) THE FIRST TIER SHALL CONSIST OF THOSE FACILITIES IN THE STATE THAT
 FALL BELOW THE MEDIAN OF ALL FACILITIES IN TERMS OF RELATIVE  REIMBURSE-
 MENT  RECEIVED BY HEALTH CARE PLANS FOR SERVICES; HOSPITALS IN THIS TIER
 SHALL BE PERMITTED TO NEGOTIATE INCREASES  TO  THEIR  REIMBURSEMENT  AND
 HEALTH CARE PLANS ARE PERMITTED TO PAY INCREASES WITHOUT LIMITATION;
   (2)  THE  SECOND  TIER  SHALL  CONSIST OF THOSE FACILITIES BETWEEN THE
 MEDIAN AND NINETY-FIFTH PERCENTILE OF ALL FACILITIES IN TERMS  OF  RELA-
 TIVE REIMBURSEMENT RECEIVED BY HEALTH CARE PLANS FOR SERVICES; BEGINNING
 FOR  POLICIES  THAT TAKE EFFECT JANUARY FIRST, TWO THOUSAND TWENTY-FOUR,
 THE SUPERINTENDENT SHALL PERMIT HEALTH CARE PLANS TO SUBMIT RATE FILINGS
 THAT ALLOW UNIT PRICE GROWTH FOR THESE FACILITIES THAT DOES  NOT  EXCEED
 THE GREATER OF 2.5 PERCENT OR CORE CPI PLUS 1 PERCENT; AND,
   (3)  THE  THIRD TIER SHALL CONSIST OF THOSE FACILITIES ABOVE THE NINE-
 TY-FIFTH PERCENTILE OF ALL FACILITIES IN TERMS OF RELATIVE REIMBURSEMENT
 RECEIVED BY HEALTH CARE PLANS FOR SERVICES; BEGINNING FOR POLICIES  THAT
 TAKE  EFFECT JANUARY FIRST, TWO THOUSAND TWENTY-FOUR, THE SUPERINTENDENT
 SHALL NOT PERMIT ANY RATE FILINGS THAT ALLOW UNIT PRICE GROWTH FOR THESE
 FACILITIES.
   (B) ANY RATE FILINGS SUBMITTED BY A HEALTH  CARE  PLAN  THAT  VIOLATES
 THESE  REQUIREMENTS  SHALL  BE SUBJECT TO PRESUMPTIVE DISAPPROVAL BY THE
 SUPERINTENDENT.
 S. 9508                            14
 
   (C) THE SUPERINTENDENT IS PERMITTED TO TAKE OTHER ACTIONS  TO  ENFORCE
 THE REQUIREMENTS OF THIS SECTION, AND SHALL IMPLEMENT REGULATIONS NECES-
 SARY TO CARRY OUT ITS INTENT.
   §  3.  Subdivision  (b)  of section 5201 of the civil practice law and
 rules is amended to read as follows:
   (b) Property against which a money judgment may be enforced.  A  money
 judgment may be enforced against any property which could be assigned or
 transferred,  whether it consists of a present or future right or inter-
 est and whether or not it is vested, unless it is exempt  from  applica-
 tion  to the satisfaction of the judgment. A money judgment entered upon
 a joint liability of two or more persons may be enforced  against  indi-
 vidual  property  of  those  persons summoned and joint property of such
 persons with any other persons against whom the judgment is entered.  NO
 PROPERTY  LIEN  SHALL BE ENTERED AGAINST A DEBTOR'S PRIMARY RESIDENCE IN
 ACTIONS BROUGHT BY A HOSPITAL LICENSED UNDER ARTICLE TWENTY-EIGHT OF THE
 PUBLIC HEALTH LAW OR A HEALTH CARE PROFESSIONAL AUTHORIZED  UNDER  TITLE
 EIGHT OF THE EDUCATION LAW.
   §  4.  Subdivision  (b)  of section 5231 of the civil practice law and
 rules, as amended by chapter 575 of the laws of 2008, is amended to read
 as follows:
   (b) Issuance. Where a judgment debtor is  receiving  or  will  receive
 money from any source, an income execution for installments therefrom of
 not  more  than  ten  percent thereof may be issued and delivered to the
 sheriff of the county in which the judgment debtor resides or, where the
 judgment debtor is a non-resident, the county in which he  is  employed;
 provided,  however,  that (i) no amount shall be withheld from the judg-
 ment debtor's earnings pursuant to an  income  execution  for  any  week
 unless  the  disposable  earnings  of  the judgment debtor for that week
 exceed the greater of thirty  times  the  federal  minimum  hourly  wage
 prescribed  in  the Fair Labor Standards Act of 1938 or thirty times the
 state minimum hourly wage prescribed in section six hundred fifty-two of
 the labor law as in effect at the time the earnings  are  payable;  (ii)
 the  amount  withheld from the judgment debtor's earnings pursuant to an
 income execution for any week shall not exceed  twenty-five  percent  of
 the  disposable  earnings  of the judgment debtor for that week, or, the
 amount by which the disposable earnings of the judgment debtor for  that
 week  exceed the greater of thirty times the federal minimum hourly wage
 prescribed by the Fair Labor Standards Act of 1938 or thirty  times  the
 state minimum hourly wage prescribed in section six hundred fifty-two of
 the  labor law as in effect at the time the earnings are payable, which-
 ever is less; (iii) if the earnings of  the  judgment  debtor  are  also
 subject  to  deductions  for  alimony, support or maintenance for family
 members or former spouses pursuant to section five thousand two  hundred
 forty-one  or  section five thousand two hundred forty-two of this arti-
 cle, the amount withheld from the judgment debtor's earnings pursuant to
 this section shall not exceed the amount by which twenty-five percent of
 the disposable earnings of the judgment debtor for that week exceeds the
 amount deducted from the judgment debtor's earnings in  accordance  with
 section five thousand two hundred forty-one or section five thousand two
 hundred  forty-two  of this article; AND (IV) NO AMOUNT SHALL BE IMPOSED
 IN JUDGMENTS ARISING FROM A MEDICAL DEBT ACTION BROUGHT  BY  A  HOSPITAL
 LICENSED UNDER ARTICLE TWENTY-EIGHT OF THE PUBLIC HEALTH LAW OR A HEALTH
 CARE  PROFESSIONAL  AUTHORIZED  UNDER  TITLE EIGHT OF THE EDUCATION LAW.
 Nothing in this section shall be construed to modify, abrogate,  impair,
 or affect any exemption from the satisfaction of a money judgment other-
 wise granted by law.
 S. 9508                            15
 
   §  5.   This act shall take effect immediately, provided however, that
 it shall apply to all health care plan policies beginning on January  1,
 2024.  Effective  immediately,  the addition, amendment and/or repeal of
 any rule or regulation necessary for the implementation of this  act  on
 its  effective date are authorized to be made and completed on or before
 such effective date.
 
                                  PART C

   Section 1. Legislative intent. The legislature finds and declares  all
 of the following:
   The widening gap in health and life expectancy of New Yorkers based on
 income  is  a disturbing phenomenon. One of the many reasons why this is
 occurring is because those with lower incomes tend to be  disproportion-
 ately impacted by multiple disparities, including higher rates of chron-
 ic illness and disease, and the ongoing costs of treatment create barri-
 ers  to  access  and  proper  self-care.  Countless  studies  have shown
 individuals are more likely to go without needed care when a  deductible
 is  involved,  while  lower  income individuals are more likely to avoid
 care because  of  out-of-pocket  costs.  Thus,  individuals  with  lower
 incomes  do  not  manage chronic conditions as well as those with higher
 incomes, and tend to live shorter lives as a result.    In  addition  to
 disproportionately  impacting  individuals  from  lower  economic  back-
 grounds, chronic diseases have also  been  found  to  disproportionately
 effect  people  of  color,  who  face higher rates of diabetes, obesity,
 stroke, heart disease, and cancer, than caucasians.  The impacts of poor
 health effect more than the  individual,  as  studies  have  shown  poor
 health  can  impact  the well-being and future of the entire family when
 one member has a chronic condition. Economic  advancement  is  typically
 more  challenging for those with chronic illnesses, as not only does the
 disease impact work and productivity, but treatments and medications can
 account for a significant portion of available resources for those  with
 lower incomes, making it difficult to survive on fixed incomes and forc-
 ing many to forgo needed care. Families with less income do not have the
 ability  to  outsource help and end up taking on more responsibility for
 family members impacted by disease, which impacts  their  own  education
 and work opportunities. Thus, in many respects, chronic diseases exacer-
 bate  existing health and socioeconomic disparities, making it difficult
 for individuals and families from low-income backgrounds to overcome the
 burden.
   It is imperative that life-saving services,  treatments,  and  medica-
 tions be made available to all New Yorkers without cost sharing, so cost
 is  not  a  barrier  for accessing preventive services and care. This is
 essential as a matter of public policy to address disparities in  equity
 and  access; however, there is also evidence that improved adherence and
 chronic disease management will reduce health care costs in  the  aggre-
 gate  and  could lead to improved health outcomes and other benefits for
 the individual and their family.
   § 2. The public health law is amended by adding a new section 2703  to
 read as follows:
   §  2703.  CHRONIC  DISEASE  DEMONSTRATION  PROGRAM.  1. THERE SHALL BE
 ESTABLISHED A CHRONIC DISEASE DEMONSTRATION PROGRAM WITHIN  THE  DEPART-
 MENT. SUCH PROGRAM SHALL RECOMMEND COST SHARING ELIMINATIONS FOR TARGET-
 ED  HIGH-VALUE SERVICES, TREATMENTS AND PRESCRIPTION DRUGS USED TO TREAT
 CERTAIN CHRONIC CONDITIONS. IN ORDER  TO  IMPLEMENT  SUCH  PROGRAM,  THE
 COMMISSIONER,  IN  CONSULTATION  WITH  THE  SUPERINTENDENT  OF FINANCIAL
 S. 9508                            16
 
 SERVICES,  SHALL  IDENTIFY  ONE  TO  THREE  SERVICES,  TREATMENTS,   AND
 PRESCRIPTION  DRUGS IN TOTAL USED TO TREAT EACH OF THE FOLLOWING CHRONIC
 CONDITIONS: DIABETES, ASTHMA,  CHRONIC  OBSTRUCTIVE  PULMONARY  DISEASE,
 HYPERTENSION,  CORONARY ARTERY DISEASE, CONGESTIVE HEART FAILURE, OPIOID
 USE DISORDER, BIPOLAR DISORDER, AND  SCHIZOPHRENIA.    THE  COMMISSIONER
 MAY,  BY  REGULATION, INCLUDE ANY OTHER CHRONIC CONDITIONS DEEMED NECES-
 SARY.  IN DETERMINING THE TARGETED HIGH-VALUE SERVICES, TREATMENTS,  AND
 PRESCRIPTION   DRUGS,   THE   COMMISSIONER  SHALL  CONSIDER  APPROPRIATE
 SERVICES, TREATMENTS AND PRESCRIPTION DRUGS THAT ARE:
   (A) OUT-PATIENT OR AMBULATORY  SERVICES,  INCLUDING  MEDICATIONS,  LAB
 TESTS,  PROCEDURES,  AND OFFICE VISITS, GENERALLY OFFERED IN THE PRIMARY
 CARE OR MEDICAL HOME SETTING;
   (B) OF CLEAR BENEFIT, STRONGLY SUPPORTED BY CLINICAL  EVIDENCE  TO  BE
 COST-EFFECTIVE;
   (C)  LIKELY TO REDUCE HOSPITALIZATIONS OR EMERGENCY DEPARTMENT VISITS,
 OR REDUCE FUTURE EXACERBATIONS OF ILLNESS PROGRESSION, OR IMPROVE QUALI-
 TY OF LIFE;
   (D) RELATIVELY LOW COST WHEN COMPARED TO THE COST OF AN ACUTE  ILLNESS
 OR INCIDENT PREVENTED OR DELAYED BY THE USE OF THE SERVICE, TREATMENT OR
 DRUG; AND
   (E)  AT  LOW  RISK FOR OVERUTILIZATION, ABUSE, ADDICTION, DIVERSION OR
 FRAUD.
   THE COMMISSIONER AND THE  SUPERINTENDENT  OF  FINANCIAL  SERVICES  MAY
 FURTHER  TAKE  INTO  CONSIDERATION OTHER INDEPENDENT RESOURCES OR MODELS
 PROVEN EFFECTIVE IN REDUCING FINANCIAL BARRIERS TO HIGH-VALUE CARE.
   2. EVERY FIVE YEARS, THE COMMISSIONER AND THE SUPERINTENDENT OF FINAN-
 CIAL SERVICES SHALL EVALUATE THE EFFECT OF THIS SECTION. SUCH EVALUATION
 SHALL INCLUDE THE IMPACT ON TREATMENT ADHERENCE,  INCIDENCE  OF  RELATED
 ACUTE  EVENTS,  PREMIUMS  AND  COST  SHARING,  OVERALL HEALTH, LONG-TERM
 HEALTH COSTS, AND OTHER ISSUES THAT THE SUPERINTENDENT AND  COMMISSIONER
 DEEM NECESSARY. THE SUPERINTENDENT OF FINANCIAL SERVICES MAY COLLABORATE
 WITH  AN  INDEPENDENT  RESEARCH ORGANIZATION TO CONDUCT SUCH EVALUATION.
 THE SUPERINTENDENT OF FINANCIAL SERVICES SHALL PUBLISH A  PUBLIC  REPORT
 ON ITS FINDINGS, AND SHALL MAKE SUCH REPORT AVAILABLE ON ITS WEBSITE.
   3.  SUCH PROGRAM SHALL BE IMPLEMENTED NO LATER THAN JANUARY FIRST, TWO
 THOUSAND TWENTY-THREE.
   § 3. Subsection (i) of section 3216 of the insurance law is amended by
 adding a new paragraph 37 to read as follows:
   (37) ANY POLICY, CONTRACT OR CERTIFICATE OF INSURANCE ISSUED  PURSUANT
 TO  THIS  SECTION  SHALL  PROVIDE  COVERAGE FOR THE IDENTIFIED SERVICES,
 TREATMENTS AND PRESCRIPTION DRUGS OF THE CHRONIC  DISEASE  DEMONSTRATION
 PROGRAM ESTABLISHED UNDER ARTICLE TWENTY-SEVEN OF THE PUBLIC HEALTH LAW,
 AT  NO  COST SHARING TO THE MEMBER, INCLUDING CO-PAYMENTS, CO-INSURANCE,
 AND SUCH COVERAGE SHALL NOT BE SUBJECT TO  ANY  DEDUCTIBLE.  THE  SUPER-
 INTENDENT AND THE COMMISSIONER OF HEALTH MAY ADOPT ANY WRITTEN POLICIES,
 PROCEDURES OR REGULATIONS NECESSARY TO IMPLEMENT SUCH PROGRAM.
   §  4.  Section  3221  of  the insurance law is amended by adding a new
 subsection (u) to read as follows:
   (U) ANY POLICY, CONTRACT OR CERTIFICATE OF INSURANCE  ISSUED  PURSUANT
 TO  THIS  SECTION  SHALL  PROVIDE  COVERAGE FOR THE IDENTIFIED SERVICES,
 TREATMENTS AND PRESCRIPTION DRUGS OF THE CHRONIC  DISEASE  DEMONSTRATION
 PROGRAM ESTABLISHED UNDER ARTICLE TWENTY-SEVEN OF THE PUBLIC HEALTH LAW,
 AT  NO  COST SHARING TO THE MEMBER, INCLUDING CO-PAYMENTS, CO-INSURANCE,
 AND SUCH COVERAGE SHALL NOT BE SUBJECT TO  ANY  DEDUCTIBLE.  THE  SUPER-
 INTENDENT AND THE COMMISSIONER OF HEALTH MAY ADOPT ANY WRITTEN POLICIES,
 PROCEDURES OR REGULATIONS NECESSARY TO IMPLEMENT SUCH PROGRAM.
 S. 9508                            17
 
   §  5.  Section  4303  of  the insurance law is amended by adding a new
 subsection (tt) to read as follows:
   (TT)  EVERY  CONTRACT  WHICH PROVIDES PRESCRIPTION DRUGS, OR PHYSICIAN
 SERVICES, MEDICAL, MAJOR MEDICAL OR SIMILAR COMPREHENSIVE-TYPE COVERAGE,
 SHALL PROVIDE COVERAGE  FOR  THE  IDENTIFIED  SERVICES,  TREATMENTS  AND
 PRESCRIPTION  DRUGS  OF THE CHRONIC DISEASE DEMONSTRATION PROGRAM ESTAB-
 LISHED UNDER ARTICLE TWENTY-SEVEN OF THE PUBLIC HEALTH LAW, AT  NO  COST
 SHARING  TO  THE  MEMBER,  INCLUDING CO-PAYMENTS, CO-INSURANCE, AND SUCH
 COVERAGE SHALL NOT BE SUBJECT TO ANY DEDUCTIBLE. THE SUPERINTENDENT  AND
 COMMISSIONER  OF  HEALTH  MAY  ADOPT ANY WRITTEN POLICIES, PROCEDURES OR
 REGULATIONS NECESSARY TO IMPLEMENT SUCH PROGRAM.
   § 6. This act shall take effect immediately, provided however, that it
 shall apply to all health care plan policies  beginning  on  January  1,
 2024.  Effective  immediately,  the addition, amendment and/or repeal of
 any rule or regulation necessary for the implementation of this  act  on
 its  effective date are authorized to be made and completed on or before
 such effective date.
 
                                  PART D
 
   Section 1. Legislative intent. The legislature finds and declares  all
 of the following:
   The  COVID-19  pandemic  magnified many longstanding health inequities
 and disparities that disproportionately impact  many  black  and  latinx
 communities.  Examples of such racial and ethnic barriers include access
 to safe and secure housing, quality education, economic opportunity, and
 access to quality health care. Access to high quality health care has  a
 positive  effect not only on one's own health outcomes but significantly
 impacts how they approach decision-making about their own healthcare.
   We have the finest medical institutions in the country right  here  in
 this  state,  but  access  to  care  and the quality of care received is
 unevenly experienced. Numerous studies have shown that when it comes  to
 health, where you live has a greater impact on your life expectancy than
 your  own  genetic  code. A baby born in one zip code may be expected to
 live an entire generation longer than a baby born in a  neighboring  zip
 code.  In  every  major city of our state, there are well-known, vibrant
 institutions that attract patients who would accept medical care  at  no
 lesser  institution. At the same time, there are hospitals that predomi-
 nantly serve the poor and uninsured, whose patients have  accepted  this
 is  where they go when they need care. If given the choice, most commer-
 cially insured in this state would not choose to receive their  care  at
 one of the financially distressed institutions.
   Acute  care  hospitals  that serve a higher proportion of Medicaid and
 Medicare patients tend to serve higher percentages of racial and  ethnic
 minorities, people of color, and communities that are disproportionately
 impacted  by the social determinants of health and other disparities. It
 is also well known that these hospitals receive lower reimbursement  for
 the  services  they  provide.  While this is mostly because Medicaid and
 Medicare pay these hospitals less than commercial  insurance  would  for
 the  same  procedure,  it  is  also  true  that  these hospitals receive
 substantially less in  commercial  insurance  reimbursement,  even  when
 their  patients do have commercial coverage. This is due to market posi-
 tion and negotiating leverage with insurers. While hospital price dereg-
 ulation and consolidation has allowed some hospital systems to grow  and
 establish  dominant  market  positions with payers, safety net hospitals
 that serve poorer communities have no leverage to negotiate  price  with
 S. 9508                            18
 
 insurers.  As  a  result,  the  reimbursement  they  receive tends to be
 significantly lower than more affluent hospitals, which means an identi-
 cal medical procedure can be reimbursed drastically different for hospi-
 tals  located  on  the same city block. Right now in this state, we have
 world renown hospitals  funding  massive  capital  projects  by  issuing
 investment  grade  bonds  on  the capital markets, and at the same time,
 there are hospitals that are  so  financially  destitute  they  rely  on
 millions of dollars in taxpayer funds every year for capital funding and
 their  very survival. In fiscal year 2019, 28 hospitals across the state
 received more than $700 million in government  support  funds  from  the
 commissioner  of  health just to maintain operations. The divide between
 successful and struggling hospitals is wide  and  growing.  Yet  despite
 this,  every  hospital in the state is a 501 (c)(3) charitable organiza-
 tion, required by law to operate exclusively for charitable purposes.
   A hospital's financial wherewithal has a direct effect on its  quality
 of care, and the quality of the patient experience. Prosperous hospitals
 attract  top  physicians, invest in their physical capacity, and contin-
 ually raise funds to grow operations and improve services, which  allows
 them  to  improve  their  reputational  standing and continue to attract
 commercially insured and affluent  patients,  which  helps  them  remain
 prosperous.  Conversely,  safety  net  hospitals  cannot do any of these
 things. They rely on state and federal grants for  operational  improve-
 ments, and Medicaid cash assistance to prevent multimillion-dollar oper-
 ating  losses.  They struggle to exist and do the best they can with the
 minimum reimbursement they receive,  from  patients  beset  by  multiple
 disparities.  With  large hospital systems now located not far from many
 of these safety net hospitals, it is naive to think  safety  net  insti-
 tutions  could  ever compete with their more esteemed neighbors, even if
 improvements are made.
   In order to meaningfully address health equity, we must do  more  than
 ensure  our  safety hospitals survive. We need to invest in these hospi-
 tals so they can provide care that is on  par  with  other  institutions
 throughout  the state. As a first step, we need to ensure limited hospi-
 tal support dollars are allocated to safety net hospitals that need  the
 funds  most, and are not allocated to those institutions who do not need
 the funds, and take other steps to make our health care delivery  system
 more  equitable,  so safety net hospitals have the resources and ongoing
 support they need to improve care and operations.
   § 2. Section 2807-c of the public health law is amended  by  adding  a
 new subdivision 36 to read as follows:
    36. ADDRESSING HEALTH EQUITY THROUGH SAFETY NET HOSPITAL SUPPORT. (A)
 (I) "SAFETY NET HOSPITAL" MEANS THOSE HOSPITALS THAT PREDOMINANTLY SERVE
 COMMUNITIES  THAT  EXPERIENCE  SIGNIFICANT  RACIAL, ECONOMIC, AND HEALTH
 DISPARITIES THAT HAVE A MEDICAID PAYER MIX AS OF THE MOST RECENT  FISCAL
 YEAR AT OR ABOVE TWENTY-FIVE PERCENT, AND TWENTY-FIVE PERCENT OR LESS OF
 DISCHARGED  PATIENTS  ARE  COMMERCIALLY  INSURED. THE COMMISSIONER SHALL
 ANNUALLY PROMULGATE A LIST OF THOSE HOSPITALS THAT QUALIFY AS SAFETY NET
 HOSPITALS.
   (II) "HEALTH EQUITY POOL" MEANS A NEW TRUST TO BE ADMINISTERED BY  THE
 COMMISSIONER  TO  SUPPORT  SAFETY  NET  HOSPITALS,  PROMOTE  HEALTH CARE
 ACCESS, AND HEALTH EQUITY FOR COMMUNITIES  THAT  EXPERIENCE  SIGNIFICANT
 HEALTH DISPARITIES.
   (III) "COMMERCIAL AVERAGE RELATIVE PRICE" MEANS THE AVERAGE COMMERCIAL
 REIMBURSEMENT  RATE  FOR  EACH  SPECIFIC  SERVICE,  FOR EACH INSURER, BY
 REGION, FOR ALL HOSPITAL INPATIENT AND OUTPATIENT PROCEDURES.
 S. 9508                            19
 
   (IV) "COMMERCIAL HEALTH INSURER" MEANS ENTITIES AUTHORIZED TO  PROVIDE
 HEALTH  INSURANCE PURSUANT TO ARTICLES THIRTY-TWO AND FORTY-THREE OF THE
 INSURANCE LAW, A MUNICIPAL COOPERATIVE HEALTH BENEFIT  PLAN  ESTABLISHED
 PURSUANT  TO  ARTICLE FORTY-SEVEN OF THE INSURANCE LAW, AN ENTITY CERTI-
 FIED  PURSUANT  TO ARTICLE FORTY-FOUR OF THIS CHAPTER, AN INSTITUTION OF
 HIGHER EDUCATION CERTIFIED PURSUANT TO SECTION ONE THOUSAND ONE  HUNDRED
 TWENTY-FOUR  OF THE INSURANCE LAW, THE STATE INSURANCE FUND, AND THE NEW
 YORK STATE HEALTH INSURANCE PLAN ESTABLISHED UNDER ARTICLE ELEVEN OF THE
 CIVIL SERVICE LAW. HOWEVER, THE TERM COMMERCIAL HEALTH INSURER SHALL NOT
 INCLUDE ANY OF THESE ENTITIES ACTING AS A MANAGED CARE PROVIDER PURSUANT
 TO TITLE ELEVEN OF ARTICLE FIVE OF THE SOCIAL  SERVICES  LAW  AND  TITLE
 ONE-A  OF  ARTICLE  TWENTY-FIVE  OF  THIS CHAPTER, OR ENTITIES PROVIDING
 BASIC HEALTH PLANS PURSUANT TO THE BASIC HEALTH  PROGRAM  UNDER  SECTION
 THREE HUNDRED SIXTY-NINE-GG OF THE SOCIAL SERVICES LAW.
   (B) TO PROMOTE HEALTH EQUITY THROUGH COMMERCIAL RATE EQUITY FOR SAFETY
 NET  HOSPITALS  THAT  PREDOMINANTLY  SERVE  COMMUNITIES  THAT EXPERIENCE
 HEALTH DISPARITIES BECAUSE OF RACE, ETHNICITY, SOCIOECONOMIC  STATUS  OR
 OTHER STATUS:
   (I)  ALL  COMMERCIAL HEALTH INSURERS SHALL REIMBURSE SAFETY NET HOSPI-
 TALS FOR EVERY INPATIENT AND OUTPATIENT SERVICE  AT  NO  LESS  THAN  THE
 EIGHTIETH  PERCENTILE  OF THE INSURERS COMMERCIAL RELATIVE PRICE FOR THE
 SERVICE. ANY RATE FILING THAT MAY BE  REQUIRED  TO  BE  SUBMITTED  BY  A
 COMMERCIAL  HEALTH  INSURER THAT DOES NOT REIMBURSE SAFETY NET HOSPITALS
 IN ACCORDANCE WITH THIS SECTION SHALL BE SUBJECT TO  PRESUMPTIVE  DISAP-
 PROVAL BY THE SUPERINTENDENT OF FINANCIAL SERVICES.
   (II)  ANY  HOSPITAL  LICENSED  UNDER THIS ARTICLE WITH MORE THAN THREE
 BILLION DOLLARS IN NET PATIENT REVENUE ON ITS YEAR END COST REPORT SHALL
 CONTRIBUTE FUNDS MINIMALLY EQUALING TWO PERCENT OF THEIR ANNUAL  REVENUE
 TO  THE HEALTH EQUITY POOL TO BE USED TO SUPPORT THOSE SAFETY NET HOSPI-
 TALS WITHIN THE SAME GEOGRAPHIC REGION. HOSPITALS SUBJECT TO THIS  PARA-
 GRAPH  SHALL  BE  PROHIBITED  FROM NEGOTIATING FOR INCREASES TO RATES OF
 PAYMENT FROM COMMERCIAL  INSURERS  AND  OTHER  HEALTH  PLANS  TO  OFFSET
 PAYMENTS TO THE HEALTH EQUITY POOL.
   (III)  THE  COMMISSIONER  SHALL REVISE THE INDIGENT CARE POOL DISTRIB-
 UTION FORMULA ESTABLISHED IN REGULATIONS  PURSUANT  TO  SECTION  TWENTY-
 EIGHT HUNDRED SEVEN-K OF THIS ARTICLE TO PRIORITIZE ANNUAL DISTRIBUTIONS
 FOR  SAFETY NET HOSPITALS THAT ENSURES NO LESS THAN SEVENTY-FIVE PERCENT
 OF AVAILABLE FUNDS ARE DISTRIBUTED ANNUALLY TO THOSE SAFETY  NET  HOSPI-
 TALS  WITH  THE  GREATEST FINANCIAL NEED.  THE REVISED METHODOLOGY SHALL
 FURTHER ENSURE A MORE EQUITABLE DISTRIBUTION OF  DISPROPORTIONATE  SHARE
 HOSPITAL  FUNDS  SUCH  THAT  NO FUNDS ARE DISTRIBUTED TO THOSE HOSPITALS
 THAT REGARDLESS OF THEIR REPORTED PAYER MIX  OR  REPORTED  UNCOMPENSATED
 CARE NEED, ARE IN THE DISCRETION OF THE COMMISSIONER, FINANCIALLY STABLE
 HOSPITALS  THAT  DO NOT REQUIRE DISPROPORTIONATE SHARE HOSPITAL FUNDS TO
 MAINTAIN OPERATIONS.
   (C) THE COMMISSIONER SHALL REQUIRE THAT ALL PRIVATE  NONPROFIT  HOSPI-
 TALS  LICENSED  UNDER  THIS  ARTICLE PROVIDE CHARITY CARE AND MAKE OTHER
 INVESTMENTS BENEFITTING THE COMMUNITY EQUALING 5.9%  OF  THE  HOSPITAL'S
 OVERALL  EXPENDITURES.  ANY  HOSPITAL PAYMENTS TO THE HEALTH EQUITY POOL
 SHALL COUNT TOWARDS THE 5.9%  THRESHOLD.  ANY  HOSPITAL  THAT  DOES  NOT
 CONTRIBUTE THE REQUIRED 5.9% SHALL BE REQUIRED TO MAKE PAYMENT UP TO THE
 5.9% AMOUNT TO THE HEALTH EQUITY POOL.
   (D) THE COMMISSIONER SHALL PROVIDE AN ANNUAL ANALYSIS ON THE IMPACT OF
 THIS SUBDIVISION ON SAFETY NET HOSPITALS AND HEALTH EQUITY NO LATER THAN
 JANUARY FIRST, TWO THOUSAND TWENTY-FOUR.
 S. 9508                            20
 
   § 3. This act shall take effect on January 1, 2024, and shall apply to
 all  health  care  plan policies beginning on January 1, 2024. Effective
 immediately, the addition, amendment and/or repeal of any rule or  regu-
 lation  necessary  for  the  implementation of this act on its effective
 date are authorized to be made and completed on or before such effective
 date.
 
                                  PART E

   Section  1. Legislative intent. The legislature finds and declares all
 of the following:
   While there is a general awareness that the United  States  pays  more
 for  prescription  drugs  than any other nation, there is less awareness
 that we also pay substantially more for hospital and physician services.
 This is particularly true in New York, where we spend more on per-person
 health care costs than  nearly  any  other  state,  with  spending  that
 exceeds the national average, year after year. Health care costs direct-
 ly  effect  health  insurance premiums, and the cost of health insurance
 has grown significantly faster in New York than  inflation  and  wages--
 compounding  at  an  annual rate of 6.5% per year between 1996 and 2019,
 turning a family premium of $5,300 in 1996 into $22,874 in 2019--without
 any end in sight.
   Higher health care costs have also led to the growth  in  adoption  of
 health  benefit designs that not in the best interest of the health care
 consumer, like high deductible plans and plans with  high  out-of-pocket
 cost  sharing.  In  2019, the average New Yorker with employer-sponsored
 health coverage paid $5,149 in premiums and $2,899 in deductibles before
 their health insurance contributed at all to the  cost  of  their  care.
 These  changes  were  designed to provide lower premium options and make
 consumers more responsible for their own costs, but too often  they  end
 up dissuading necessary health care utilization because of cost.
   Yet,  despite  the  overall  cost growth this state has seen, numerous
 studies show that the growth in costs is not  uniform  across-the-board.
 Market  power  remains  a  key driver of price, resulting in significant
 variation in prices charged for the very same medical services, even  in
 the  same geographic region, as some entities are able to demand regular
 cost increases due to their name and status as an organization.
   It is clear that health care costs, and the  underlying  factors  that
 contribute  to  cost  growth, is an issue that can no longer be ignored,
 must be better understood, and cannot simply  be  left  to  the  private
 market  to  resolve. This has become much more than a health care issue,
 as critical services like education,  childcare,  social  services,  and
 economic growth will continue to see resources shifted as long as health
 care  cost  growth continues to outpace wages, inflation, or any measure
 of rational economic output.
   § 2. Section 2816 of the public health law is amended by adding a  new
 subdivision 9-a to read as follows:
   9-A.  (A)  THE  COMMISSIONER  MAY  REQUIRE ANY HEALTH CARE PROVIDER OR
 THIRD-PARTY PAYER TO REPORT ADDITIONAL CLAIM OR  PRICE  INFORMATION  NOT
 ALREADY  REPORTED  PURSUANT  TO  THIS SECTION TO ANALYZE ALL HEALTH CARE
 EXPENDITURES IN THE STATE FROM PUBLIC AND  PRIVATE  SOURCES,  INCLUDING:
 (I)  ALL  CATEGORIES  OF  MEDICAL  EXPENSES  AND  ALL NON-CLAIMS RELATED
 PAYMENTS TO PROVIDERS; (II) ALL PATIENT COST SHARING AMOUNTS,  SUCH  AS,
 DEDUCTIBLES  AND  COPAYMENTS;  AND  (III) THE NET COST OF PRIVATE HEALTH
 INSURANCE, OR AS OTHERWISE DEFINED IN  REGULATIONS  PROMULGATED  BY  THE
 CENTER.
 S. 9508                            21
 
   (B)  THE  COMMISSIONER  SHALL  PUBLISH  AN  ANNUAL REPORT BASED ON THE
 INFORMATION SUBMITTED PURSUANT TO THIS SECTION  CONCERNING  HEALTH  CARE
 PROVIDERS,  THIRD-PARTY  PAYER  COSTS  AND COST TRENDS. THE COMMISSIONER
 SHALL COMPARE THE COSTS AND COST TRENDS BY REGION, AND SHALL DETAIL:
   (I)  BASELINE  INFORMATION  ABOUT  HEALTH  CARE  COST, PRICE, QUALITY,
 UTILIZATION, AND MARKET POWER IN THE STATE'S HEALTH  CARE  SYSTEM;  (II)
 COST  GROWTH  TRENDS  BY  PROVIDER SECTOR, INCLUDING BUT NOT LIMITED TO,
 HOSPITALS,  HOSPITAL  SYSTEMS,  NON-ACUTE  PROVIDERS,   PHARMACEUTICALS,
 MEDICAL  DEVICES  AND DURABLE MEDICAL EQUIPMENT; PROVIDED, HOWEVER, THAT
 ANY DETAILED COST  GROWTH  TREND  IN  THE  PHARMACEUTICAL  SECTOR  SHALL
 CONSIDER  THE  EFFECT OF DRUG REBATES AND OTHER PRICE CONCESSIONS IN THE
 AGGREGATE WITHOUT DISCLOSURE OF  ANY  PRODUCT  OR  MANUFACTURER-SPECIFIC
 REBATE  OR  PRICE CONCESSION INFORMATION, AND WITHOUT LIMITING OR OTHER-
 WISE AFFECTING THE CONFIDENTIAL OR PROPRIETARY NATURE OF ANY  REBATE  OR
 PRICE CONCESSION AGREEMENT; (III) FACTORS THAT CONTRIBUTE TO COST GROWTH
 WITHIN THE STATE'S HEALTH CARE SYSTEM, INCLUDING PROVIDER CONSOLIDATION,
 HOSPITAL  ACQUISITIONS  OF  PHYSICIAN PRACTICES, AND TO THE RELATIONSHIP
 BETWEEN PROVIDER COSTS AND THIRD-PARTY PAYER  PREMIUM  RATES;  (IV)  THE
 IMPACT  OF  ANY  ASSESSMENTS  INCLUDING,  BUT  NOT  LIMITED TO, THE HCRA
 SURCHARGE ON HEALTH INSURANCE PREMIUMS; (V)  TRENDS  IN  UTILIZATION  OF
 HIGH-COST,  UNNECESSARY, OR DUPLICATIVE SERVICES, WITH PARTICULAR EMPHA-
 SIS ON IMAGING AND OTHER HIGH-COST SERVICES; (VI)  THE  DEVELOPMENT  AND
 STATUS  OF PROVIDER ORGANIZATIONS, INCLUDING, BUT NOT LIMITED TO, ACQUI-
 SITIONS, MERGERS, CONSOLIDATIONS AND  ANY  EVIDENCE  OF  EXCESS  CONSOL-
 IDATION  OR  ANTI-COMPETITIVE  BEHAVIOR BY PROVIDER ORGANIZATIONS; (VII)
 THE IMPACT OF HEALTH CARE PAYMENT AND DELIVERY REFORM ON THE QUALITY  OF
 CARE  DELIVERED  IN  THE  STATE;  AND  (VIII)  ANY OTHER INFORMATION THE
 COMMISSIONER DEEMS NECESSARY.
   (C) AS PART OF SUCH REPORT, THE COMMISSIONER  SHALL  REPORT  ON  PRICE
 VARIATION  OF  INPATIENT  AND  OUTPATIENT MEDICAL SERVICES. THE   REPORT
 SHALL INCLUDE: (I) BASELINE INFORMATION ABOUT PRICE VARIATION, IDENTIFY-
 ING HOSPITAL INPATIENT AND OUTPATIENT PRICES RELATIVE TO MEDICARE;  (II)
 THE  ANNUAL  CHANGE  IN PRICE VARIATION OF HOSPITAL INPATIENT AND OUTPA-
 TIENT PRICES; (III) FACTORS THAT CONTRIBUTE TO PRICE  VARIATION  IN  THE
 HEALTH  CARE  SYSTEM;  (IV) THE IMPACT OF PRICE VARIATIONS ON SAFETY NET
 HOSPITALS AND HEALTH INSURANCE PREMIUMS; AND (V) ANY RECOMMENDATIONS  TO
 ADDRESS  COST GROWTH TO MAKE HEALTH CARE AS AFFORDABLE AND ACCESSIBLE AS
 POSSIBLE IN THIS STATE.
   (D) THE COMMISSIONER MAY CONTRACT WITH AN  OUTSIDE  ORGANIZATION  WITH
 EXPERTISE  IN  REVIEWING  DATA AND PREPARING SUCH REPORTS TO CONDUCT THE
 ANALYSIS AND PREPARE  THE  REPORT  REQUIRED.  THE  SUPERINTENDENT  SHALL
 PUBLISH  THE  REPORT  AND PROVIDE THE REPORT TO THE LEGISLATURE AT LEAST
 THIRTY DAYS BEFORE THE PUBLIC HEARING REQUIRED UNDER  PARAGRAPH  (E)  OF
 THIS SECTION.
   (E) NOT LATER THAN OCTOBER FIRST OF EVERY YEAR, THE COMMISSIONER SHALL
 HOLD A PUBLIC HEARING WHICH SHALL EXAMINE HEALTH CARE PROVIDER, PROVIDER
 ORGANIZATION  AND  THIRD-PARTY PAYER COSTS, PRICES AND COST TRENDS, WITH
 PARTICULAR ATTENTION TO FACTORS THAT CONTRIBUTE TO  COST  GROWTH  WITHIN
 THE STATE. PUBLIC NOTICE OF ANY HEARING SHALL BE PROVIDED AT LEAST SIXTY
 DAYS  PRIOR  TO  SUCH HEARING DATE.   THE COMMISSIONER SHALL IDENTIFY AS
 WITNESSES FOR THE PUBLIC HEARING A REPRESENTATIVE SAMPLE OF HEALTH  CARE
 PROVIDERS,  THIRD-PARTY  PAYERS  AND  OTHER  RELEVANT PERSONS. WITNESSES
 SHALL PROVIDE TESTIMONY UNDER OATH AND BE SUBJECT TO  QUESTIONING  BY  A
 PANEL  THAT  SHALL  CONSIST  OF  THE COMMISSIONER, THE SUPERINTENDENT OF
 FINANCIAL SERVICES OR A DESIGNEE,  THREE  APPOINTEES  BY  THE  GOVERNOR,
 THREE  APPOINTEES  BY  THE  TEMPORARY  PRESIDENT  OF  THE  SENATE, THREE
 S. 9508                            22
 
 APPOINTEES BY THE SPEAKER OF THE ASSEMBLY, TWO APPOINTEES OF THE  ATTOR-
 NEY  GENERAL,  AND  TWO  APPOINTEES  OF THE STATE COMPTROLLER. WITNESSES
 SHALL BE INSTRUCTED ON WHICH TOPICS THEY SHOULD BE PREPARED TO  DISCUSS,
 WHICH  MAY  INCLUDE: (I) IN THE CASE OF PROVIDERS AND PROVIDER ORGANIZA-
 TIONS, TESTIMONY CONCERNING PAYMENT SYSTEMS, CARE DELIVERY MODELS, PAYER
 MIX, COST STRUCTURES, ADMINISTRATIVE AND LABOR COSTS, CAPITAL AND  TECH-
 NOLOGY  COST,  ADEQUACY  OF  PUBLIC  PAYER REIMBURSEMENT LEVELS, RESERVE
 LEVELS, UTILIZATION TRENDS,  RELATIVE  PRICE,  QUALITY  IMPROVEMENT  AND
 CARE-COORDINATION STRATEGIES, INVESTMENTS IN HEALTH INFORMATION TECHNOL-
 OGY,  THE RELATION OF PRIVATE PAYER REIMBURSEMENT LEVELS TO PUBLIC PAYER
 REIMBURSEMENTS FOR SIMILAR SERVICES, EFFORTS TO IMPROVE  THE  EFFICIENCY
 OF  THE DELIVERY SYSTEM, EFFORTS TO REDUCE THE INAPPROPRIATE OR DUPLICA-
 TIVE USE OF TECHNOLOGY AND THE IMPACT OF PRICE TRANSPARENCY  ON  PRICES;
 AND  (II) IN THE CASE OF PRIVATE AND PUBLIC PAYERS, TESTIMONY CONCERNING
 FACTORS UNDERLYING PREMIUM COST AND  RATE  INCREASES,  THE  RELATION  OF
 RESERVES  TO  PREMIUM  COSTS,  THE  PAYER'S  EFFORTS  TO DEVELOP BENEFIT
 DESIGN, NETWORK DESIGN AND PAYMENT POLICIES THAT ENHANCE PRODUCT AFFORD-
 ABILITY AND ENCOURAGE EFFICIENT USE OF HEALTH RESOURCES  AND  TECHNOLOGY
 INCLUDING  UTILIZATION  OF ALTERNATIVE PAYMENT METHODOLOGIES, EFFORTS BY
 THE PAYER TO  INCREASE  CONSUMER  ACCESS  TO  HEALTH  CARE  INFORMATION,
 EFFORTS  BY  THE  PAYER TO PROMOTE THE STANDARDIZATION OF ADMINISTRATIVE
 PRACTICES, THE IMPACT OF PRICE TRANSPARENCY, THE EXTENT OF  PRICE  VARI-
 ATION  BETWEEN THE PAYER'S PARTICIPATING PROVIDERS AND EFFORTS TO REDUCE
 SUCH PRICE VARIATION, AND ANY OTHER MATTERS AS DETERMINED BY THE COMMIS-
 SIONER.
   § 3. This act shall take effect immediately; provided,  however,  that
 the  amendments to section 2816 of the public health law made by section
 two of this act shall not affect the  expiration  of  such  section  and
 shall expire therewith.
   § 3. Severability clause. If any clause, sentence, paragraph, subdivi-
 sion, section or part of this act shall be adjudged by a court of compe-
 tent jurisdiction to be invalid, such judgment shall not affect, impair,
 or invalidate the remainder thereof, but shall be confined in its opera-
 tion  to  the  clause, sentence, paragraph, subdivision, section or part
 thereof directly involved in the  controversy  in  which  such  judgment
 shall  have been rendered. It is hereby declared to be the intent of the
 legislature that this act would have been enacted even if  such  invalid
 provision had not been included herein.
   §  4.  This act shall take effect immediately; provided, however, that
 the applicable effective date of Parts A through E of this act shall  be
 as specifically set forth in the last section of such Parts.