Bill Text: NY A05281 | 2017-2018 | General Assembly | Amended


Bill Title: Provides that the New York state health care quality and cost containment commission shall: evaluate each mandated benefit; investigate current practices of health plans with regard to the mandated benefit; investigate the potential premium impact of repealing and/or modifying the mandated benefits on all segments of the insurance market; hold at least two public hearings; submit a report to the legislature; makes related provisions.

Spectrum: Partisan Bill (Republican 1-0)

Status: (Introduced - Dead) 2018-05-30 - held for consideration in insurance [A05281 Detail]

Download: New_York-2017-A05281-Amended.html


                STATE OF NEW YORK
        ________________________________________________________________________
                                         5281--A
                               2017-2018 Regular Sessions
                   IN ASSEMBLY
                                    February 7, 2017
                                       ___________
        Introduced by M. of A. LAWRENCE -- read once and referred to the Commit-
          tee  on  Insurance  --  recommitted  to  the Committee on Insurance in
          accordance with Assembly Rule 3, sec. 2 -- committee discharged,  bill
          amended,  ordered reprinted as amended and recommitted to said commit-
          tee
        AN ACT to amend the insurance law, in relation to  the  New  York  state
          health care quality and cost containment commission
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
     1    Section 1. Section 213 of the insurance law, as added by section 1  of
     2  part L of chapter 57 of the laws of 2007, is amended to read as follows:
     3    § 213. New York state health care quality and cost containment commis-
     4  sion.  (a)  There  is hereby established within the department a commis-
     5  sion, to be known as the "New York state health care  quality  and  cost
     6  containment  commission".  The  commission  shall  consist  of  thirteen
     7  members appointed by the governor, one of whom shall be the  superinten-
     8  dent,  one  of whom shall be the commissioner of health, and six of whom
     9  shall be appointed on the recommendation of the legislative leaders, two
    10  on the recommendation of the temporary president of the senate,  two  on
    11  the  recommendation of the speaker of the assembly, one on the recommen-
    12  dation of the minority leader of the senate, and one on the  recommenda-
    13  tion  of the minority leader of the assembly. All members shall serve at
    14  the pleasure of the governor, and vacancies shall be  appointed  in  the
    15  same  manner  as  original appointments. Members of the commission shall
    16  serve without compensation, but shall be reimbursed for reasonable trav-
    17  el expenses. In making appointments  to  the  commission,  the  governor
    18  shall  ensure  that  the interests of health care consumers, small busi-
    19  nesses, the medical community and health plans are  represented  on  the
    20  commission,  and  that  the commission include at least one actuary, one
    21  expert on health benefits, having no less than fifteen years  of  direct
    22  experience  with  health benefits, and one physician. All members of the
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD00271-03-8

        A. 5281--A                          2
     1  commission shall be seated no later than ninety days after the effective
     2  date of the chapter of the laws of two thousand eighteen  which  amended
     3  this section and all vacancies shall be filled as soon as practicable.
     4    (b)(1) The purpose of the commission shall be to analyze the impact on
     5  health  insurance  costs and quality of proposed legislation which would
     6  mandate that health benefits be offered or made available in  individual
     7  and  group health insurance policies, contracts and comprehensive health
     8  service plans, including legislation that affects the delivery of health
     9  benefits or services or the reimbursement of health care providers.
    10    (2) The governor, the chair of the senate insurance committee and  the
    11  chair  of  the  assembly insurance committee may request in writing that
    12  the commission evaluate a proposed mandated benefit. Upon receiving such
    13  a request, the commission [may, by a  majority  vote  of  its  members,]
    14  shall undertake an evaluation of such proposed mandated benefit.
    15    (3) In evaluating a proposed mandated benefit, the commission shall:
    16    (A)  investigate  the current practices of health plans with regard to
    17  the proposed mandated benefit, and, to the extent possible,  self-funded
    18  health benefit plans;
    19    (B)  investigate the potential premium impact of the proposed mandated
    20  benefits on all segments of the insurance market, as well as the  poten-
    21  tial  for  avoided costs through early detection and treatment of condi-
    22  tions, or more cost-effective delivery of medical services; [and]
    23    (C) analyze the most current [medical]  and  credible  evidence  based
    24  medicine literature regarding the proposed mandated benefit published in
    25  peer  reviewed  medical  literature generally recognized by the relevant
    26  medical  community  to  determine  the  effectiveness  of  the  proposed
    27  mandated benefit and its impact on health care quality[.]; and
    28    (D)  investigate  the  potential  cost  to  the  state of the proposed
    29  mandated benefits in light of the implementation of the federal afforda-
    30  ble care act.
    31    (4) In evaluating a proposed mandated benefit, the commission may hold
    32  one or more public hearings, and shall strive to obtain independent  and
    33  verifiable information from diverse sources within the healthcare indus-
    34  try,  medical  community  and among health care consumers with regard to
    35  the proposed mandated benefit.
    36    (c) To assist the commission in its duties, and upon the direction  of
    37  the  commission,  the  superintendent is authorized to enter into one or
    38  more contracts with independent entities and organizations  with  demon-
    39  strable expertise in health care quality, finance, utilization and actu-
    40  arial  services.  For  the  purposes of this section, the superintendent
    41  shall not enter into contracts with health plans, entities or  organiza-
    42  tions  owned or controlled by health plans, or with significant business
    43  relationships with health plans.
    44    (d) Upon completion of its evaluation of a proposed  mandated  benefit
    45  pursuant  to this section, the commission shall deliver a written report
    46  of its findings to the chair of the assembly insurance committee and the
    47  chair of the senate insurance committee.
    48    (e)(1) Beginning no later than nine months  after  the  commission  is
    49  seated,  and  reoccurring no less often than once every three years, the
    50  commission shall analyze the impact on health insurance costs and quali-
    51  ty of all state laws which mandate that health benefits  be  offered  or
    52  made  available  in  individual  and  group  health  insurance policies,
    53  contracts and comprehensive health  service  plans,  including  but  not
    54  limited  to laws that affect the delivery of health benefits or services
    55  or the reimbursement of health care providers.
    56    (2) In evaluating each mandated benefit, the commission shall:

        A. 5281--A                          3
     1    (A) investigate the current practices of health plans with  regard  to
     2  the  mandated  benefit,  and, to the extent possible, self-funded health
     3  benefit plans including but not limited to avoided costs  through  early
     4  detection  and  treatment of conditions, or more cost-effective delivery
     5  of medical services;
     6    (B) investigate the potential premium impact of repealing and/or modi-
     7  fying the mandated benefits on all segments of the insurance market;
     8    (C)  analyze  the  most  current  and credible evidence based medicine
     9  literature regarding the mandated benefit  published  in  peer  reviewed
    10  medical literature generally recognized by the relevant medical communi-
    11  ty to determine the effectiveness of the mandated benefit and its impact
    12  on health care quality; and
    13    (D)  investigate  the  potential  cost  to  the  state of the proposed
    14  mandated benefits in light of the implementation of the federal afforda-
    15  ble care act.
    16    (3) In evaluating mandated benefits, the commission shall hold no less
    17  than two public hearings, and shall strive  to  obtain  independent  and
    18  verifiable  information  from  diverse  sources  within  the health care
    19  industry, medical community and among health care consumers with  regard
    20  to each mandated benefit.
    21    (4)(A)  On or before the first day of February, two thousand nineteen,
    22  the commission shall submit to the legislature and  disseminate  to  the
    23  public  recommendations for the repeal and/or modification of state laws
    24  which mandate benefits, along with a single piece of legislation  neces-
    25  sary  to implement such recommendations. These recommendations shall not
    26  be expected to increase the average premium in the state.  Upon  receipt
    27  of  such recommendations, the implementing legislation therefor shall be
    28  introduced in both houses of  the  legislature  without  any  amendments
    29  within five days.
    30    (B)  The  legislation  introduced pursuant to subparagraph (A) of this
    31  paragraph shall be voted upon, without amendment, by both such houses of
    32  the legislature within ninety days, but not  sooner  than  thirty  days,
    33  after  the commission submits its recommendations to the legislature. If
    34  approved, the legislature shall forward such legislation to the governor
    35  within five days.
    36    § 2. This act shall take effect immediately.
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