Senate Bill S8614

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   8614
 
                        2025-2026 Regular Sessions
 
                             I N  S E N A T E
 
                             December 12, 2025
                                ___________
 
 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); and to amend the financial services law, in relation
   to consumer protection from health care costs; and to  repeal  certain
   provisions of such law relating thereto (Part B)
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. This act enacts into law components of legislation relating
 to health equity, affordability, and reform.  Each component  is  wholly
 contained  within a Part identified as Parts A through B.  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
 
   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

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD14093-01-5
              

 S. 8614                             2
 
 chapter  56  of  the  laws of 2022 and paragraph (d) of subdivision 3 as
 separately amended by chapter 669 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
 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
 S. 8614                             3

 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 QUALIFIED DEPENDENTS 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] SUCH PERSON:
   (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  A  SMALL
 GROUP  EMPLOYER-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 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,  UNLESS  THE
 INDIVIDUAL OR AN ELIGIBLE SMALL GROUP PURCHASES COVERAGE THROUGH A BASIC
 HEALTH PLAN UNDER THE BASIC HEALTH PROGRAM BUY-IN SET FORTH UNDER SUBDI-
 VISION  ELEVEN  OR TWELVE OF THIS SECTION; 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  noncitizens  lawfully present in the United States with house-
 hold 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 noncitizen
 would be ineligible for medical assistance under title  eleven  of  this
 article due to their immigration status;
 S. 8614                             4
 
   (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]  NONCITIZENS  lawfully
 present  in  the  United  States  with household incomes at or below one
 hundred thirty-three percent of the federal poverty line shall be eligi-
 ble to receive  coverage  for  health  care  services  pursuant  to  the
 provisions  of this title if such [alien] NONCITIZEN 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.
   3-A. BASIC HEALTH PROGRAM BUY-IN.  A PERSON OR AN ELIGIBLE SMALL GROUP
 SHALL BE PERMITTED TO PURCHASE COVERAGE FROM  THE  STATE  TO  ENROLL  AN
 INDIVIDUAL  OR  ANY  QUALIFIED DEPENDENTS IN A BASIC HEALTH PLAN THROUGH
 THE BASIC HEALTH PROGRAM BUY-IN DESCRIBED UNDER SUBDIVISION TEN OF  THIS
 SECTION,  AS LONG AS THE INDIVIDUAL, AND ANY QUALIFIED DEPENDENTS OTHER-
 WISE 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
 S. 8614                             5
 
 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] THEIR 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
 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, OR FAMILY COVER-
 AGE THROUGH THE BASIC HEALTH PROGRAM BUY-IN  UNDER  SUBDIVISION  TEN  OF
 THIS SECTION, OR AN ELIGIBLE SMALL GROUP WHO PURCHASES OR CONTRIBUTES TO
 THE  COST  OF SUCH COVERAGE UNDER SUBDIVISION ELEVEN OF THIS SECTION FOR
 SUCH  INDIVIDUAL  AND  ANY  QUALIFIED  DEPENDENTS,  SHALL  MAKE  MONTHLY
 PAYMENTS  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 TO TAKE  ANY  OTHER  ACTIONS
 NECESSARY  TO  USE  FEDERAL PREMIUM TAX CREDITS COST SHARING REDUCTIONS,
 AND ANY OTHER FEDERAL SUBSIDIES THAT MAY BE AVAILABLE FOR SUCH  INDIVID-
 UALS,  AND  IN THE ABSENCE OF FEDERAL SUBSIDIES, STATE FUNDS, TO FINANCE
 THE PROGRAM AND KEEP THE APPLICABLE PREMIUM PAYMENTS  AND  COST  SHARING
 OWED  FOR  BASIC HEALTH PROGRAM BUY-IN MEMBERS AS AFFORDABLE AS POSSIBLE
 AND CONSISTENT WITH THE COVERAGE AND BENEFIT DESIGN APPLICABLE TO  BASIC
 HEALTH  PROGRAM BENEFICIARIES.   THE COMMISSIONER SHALL BE AUTHORIZED TO
 CREATE VARIABLE PREMIUM  AMOUNTS  AND  PLAN  DESIGNS  BASED  ON  INCOME,
 CONSISTENT  WITH CURRENT PRACTICE, SUCH THAT INDIVIDUALS AT LOWER HOUSE-
 HOLD INCOME LEVELS COULD PAY LOWER PREMIUMS AND HAVE LOWER OR LESS  COST
 SHARING COMPARED TO INDIVIDUALS AT HIGHER INCOME LEVELS.
   (A-2)  ELIGIBLE  SMALL GROUPS THAT PURCHASE COVERAGE FOR AN INDIVIDUAL
 AND ANY QUALIFIED DEPENDENTS UNDER SUBDIVISION ELEVEN  OF  THIS  SECTION
 MAY  BE  REQUIRED  TO  PAY  TO THE STATE OR BASIC HEALTH PLAN, A PREMIUM
 SUPPLEMENT PAYMENT AS DESCRIBED IN SUBPARAGRAPH (II) OF PARAGRAPH  (A-3)
 OF  THIS  SUBDIVISION.    SUCH FUND SHALL BE USED TO HELP ENSURE PROGRAM
 VIABILITY, AND FOR OTHER PURPOSES THAT MAY BE ALLOWED BY  THE  SECRETARY
 OF HEALTH AND HUMAN SERVICES, INCLUDING BUT NOT LIMITED TO, RATE ADEQUA-
 S. 8614                             6

 CY  FOR  APPROVED  ORGANIZATIONS AND NETWORK PROVIDERS, AS MAY BE DETER-
 MINED 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
 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 BUDG-
 ET,  EXISTING RATES OF PAYMENT IN EFFECT UNDER THE BASIC HEALTH PROGRAM,
 AND SUBJECT TO APPROVAL BY THE SECRETARY OF HEALTH  AND  HUMAN  SERVICES
 AND  SUBJECT  TO  THE DISCRETION OF THE COMMISSIONER AND THE DIVISION OF
 THE BUDGET ONCE ENROLLMENT  IN  THE  BASIC  HEALTH  PROGRAM  BUY-IN  HAS
 REACHED  MORE  THAN  TWO 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 PAYMENT
 AMOUNTS THAT THE COMMISSIONER, IN CONSULTATION WITH THE DIVISION OF  THE
 BUDGET,  MAY REQUIRE TO BE PAID BY CERTAIN INDIVIDUALS OR ELIGIBLE SMALL
 GROUPS TO INCREASE AVAILABLE FUNDS AND MAINTAIN THE AFFORDABILITY OF THE
 BASIC HEALTH PROGRAM FOR INDIVIDUALS AT LOWER INCOME LEVELS  WHO  OBTAIN
 COVERAGE  UNDER  THE  BUY-IN DESCRIBED IN SUBDIVISIONS TEN AND ELEVEN OF
 THIS SECTION.  THE ANALYSIS MAY CONSIDER ANTICIPATED SAVINGS FOR  ELIGI-
 BLE  SMALL  GROUPS  AND INDIVIDUALS WHO WOULD OTHERWISE HAVE TO PURCHASE
 COVERAGE FROM THE HEALTH INSURANCE EXCHANGES OR THE SMALL GROUP  MARKET,
 AS  APPLICABLE, TO PROVIDE VARYING OPTIONS OF PREMIUM SUPPLEMENTS ACROSS
 HOUSEHOLD INCOME LEVELS AND SMALL GROUP SIZE.
   (A-4) FOR COVERAGE PURCHASED THROUGH SUBDIVISION TEN OR ELEVEN OF THIS
 SECTION, FOR INDIVIDUALS AND QUALIFIED DEPENDENTS WITH HOUSEHOLD INCOMES
 ABOVE FIVE 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, OR ANY ELIGIBLE  SMALL  GROUP
 PURCHASING  OR  CONTRIBUTING  TO  SUCH  COVERAGE ON THEIR BEHALF, IN THE
 DISCRETION OF THE COMMISSIONER AND THE DIVISION OF THE BUDGET, A PREMIUM
 SUPPLEMENT PAYMENT MAY BE REQUIRED BY  EITHER  INDIVIDUALS  OR  ELIGIBLE
 SMALL  GROUPS TO INCREASE STATE SHARE FUNDS FOR THE PROGRAM. THE PREMIUM
 SUPPLEMENT AMOUNT MAY VARY BASED ON INCOME LEVELS AND  SHALL  BE  DETER-
 MINED  BY  THE COMMISSIONER TO ENSURE THE PROGRAM REMAINS AFFORDABLE AND
 DOES NOT PRESENT UNDUE BARRIERS TO PURCHASING COVERAGE.
   (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
 S. 8614                             7
 
 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
 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.
   (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] THEIR immigration
 S. 8614                             8
 
 status if the provisions of section one hundred twenty-two of this chap-
 ter 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-
 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
 COVERED HEALTH CARE SERVICES AVAILABLE TO ANY INDIVIDUAL  IN  THE  BASIC
 HEALTH  PROGRAM. APPROVED ORGANIZATIONS OPERATING BASIC HEALTH PLANS AND
 PROVIDERS SHALL USE GOOD FAITH  EFFORTS  TO  NEGOTIATE  NETWORK  PARTIC-
 IPATION   ARRANGEMENTS  TO  PROVIDE  COVERED  SERVICES  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.
 S. 8614                             9
 
   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
 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:
   The  medical  care  a person requires should never result in financial
 hardship or bankruptcy, yet for too  many  New  Yorkers,  an  unexpected
 medical  emergency  or  diagnosis  carries both life-altering health and
 financial consequences. An individual should not need  to  substantially
 modify  theirs  and  their  family's  future  by  liquidating college or
 retirement savings or need to create a "Go-Fund Me" to afford the  bills
 from a medical emergency.
   As  a  result of the Affordable Care Act, health insurance plans today
 are required  to  establish  out-of-pocket  payment  maximums  that  are
 intended  to  limit  one's  out-of-pocket cost liability for health care
 expenses. However, the  out-of-pocket  maximum  excludes  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. It also means what is
 often the most expensive health care services that may be  rendered  for
 an  individual,  out-of-network  health care services are not subject to
 the maximum cap, and even if a plan offers an out-of-network  cap,  this
 may be so high that it offers no relief for the consumer.
   While there are many contributing factors as to why individuals under-
 going  treatment  receive  unaffordable  medical  bills,  out-of-network
 charges continue to top that list.    New  York  has  tried  to  protect
 consumers  from  out-of-network  bills  through  the Independent Dispute
 Resolution process. Unfortunately, it  has  not  been  able  to  protect
 consumers  from  experiencing crushing financial burdens associated with
 costly medical care, and has created an incentive for costs to increase.
 Specifically, studies have shown New York's Independent  Dispute  Resol-
 ution  process  and  its  ultimate  reliance  on providers' own charges,
 instead of what providers are actually reimbursed from commercial health
 insurers  for  the  services  provided,  has  deeply  harmed  consumers,
 contributing  more than anything else to the severe financial burden New
 Yorkers' experience and associate when they are undergoing treatment  or
 experience  a medical crisis. The Independent Dispute Resolution process
 S. 8614                            10

 creates a financial incentive for providers to remain out-of-network and
 consistently increase their "charges", as charges are part of the crite-
 ria used to determine payment of a disputed out-of-network charge. High-
 er  charges  also result in higher Independent Dispute Resolution awards
 and more costs being built into premiums in subsequent  years,  creating
 an  annual  spiral of increasing costs that burden us all.  It is essen-
 tial to address health care costs in a way that is fair to our providers
 but ultimately puts consumers first.
   § 2. Article 6 of the financial services law is  REPEALED  and  a  new
 article 6 is added to read as follows:
                                 ARTICLE 6
                CONSUMER PROTECTION FROM HEALTH CARE COSTS
 SECTION 601. APPLICABILITY.
         602. DEFINITIONS.
         603. RATES OF PAYMENT FOR NON-PARTICIPATING SERVICES.
         604. ANNUAL LIMIT ON CONSUMER HEALTH CARE EXPENDITURES.
   § 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, ANY PROGRAM FOR INDIVIDUALS
 COVERED BY ARTICLE FIVE OF THE SOCIAL SERVICES LAW, ARTICLE  TWENTY-FIVE
 OF  THE  PUBLIC  HEALTH  LAW,  TITLES XVIII, XIX, AND XXI OF THE FEDERAL
 SOCIAL SECURITY ACT, OR CHAPTER 89 OF TITLE 5 OF THE UNITED STATES CODE.
   § 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.
 S. 8614                            11
 
   (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
 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.
   §  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, INCLUDING ESTABLISHING A DEFAULT  OUT-OF-NETWORK  REIMBURSEMENT
 RATE  FOR BOTH EMERGENCY AND NON-EMERGENCY SERVICES, WHICH SHALL ACCOUNT
 FOR THE ACTUAL AVERAGE IN-NETWORK REIMBURSED AMOUNT FOR THE  CLAIM,  AND
 MAY  BE  SET  AS  A PERCENTAGE OF THE MEDICARE FEE SCHEDULE RATE FOR THE
 SERVICE.
   § 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 HEALTH CARE SERVICES, IRRE-
 SPECTIVE 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 FINANCIAL  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) 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.
 S. 8614                            12
 
   § 3.  This act shall take effect immediately, provided  however,  that
 it  shall apply to all health care plan policies beginning on January 1,
 2027. 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.
   § 2. 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.
   § 3. This act shall take effect immediately; provided,  however,  that
 the  applicable effective date of Parts A through B of this act shall be
 as specifically set forth in the last section of such Parts.