Bill Text: NY A11341 | 2017-2018 | General Assembly | Introduced

Bill Title: Relates to the establishment of the New York Health Benefit Exchange.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2018-09-19 - referred to insurance [A11341 Detail]

Download: New_York-2017-A11341-Introduced.html

                STATE OF NEW YORK
                   IN ASSEMBLY
                                   September 19, 2018
        Introduced  by  COMMITTEE  ON RULES -- (at request of M. of A. Rozic) --
          read once and referred to the Committee on Insurance
        AN ACT to amend the public authorities law and the public officers  law,
          in  relation  to  the  establishment  of  the  New York Health Benefit
          The People of the State of New York, represented in Senate and  Assem-
        bly, do enact as follows:
     1    Section  1.  This act shall be known and may be cited as the "New York
     2  Health Benefit Exchange Act".
     3    § 2. The public authorities law is amended by  adding  a  new  article
     4  10-E to read as follows:
     5                                 ARTICLE 10-E
     6                      NEW YORK HEALTH BENEFIT EXCHANGE
     7  Section 3980. Statement of policy and purposes.
     8          3981. Definitions.
     9          3982. Establishment of the New York health benefit exchange.
    10          3983. General powers of the exchange.
    11          3984. Functions of the exchange.
    12          3985. Special  functions  of the exchange related to health plan
    13                   certification and qualified health plan oversight.
    14          3986. Regional advisory committees.
    15          3987. Funding of the exchange.
    16          3988. Tax exemption and tax contract by the state.
    17          3989. Officers and employees.
    18          3990. Limitation of liability; indemnification.
    19          3991. Construction.
    20    § 3980. Statement of policy and purposes. The purpose of this  article
    21  is  to  establish  an American health benefit exchange in New York.  The
    22  exchange shall facilitate enrollment in health  coverage,  the  purchase
    23  and  sale  of  qualified  health  plans in the individual market in this
    24  state, and enroll individuals in health  coverage  for  which  they  are
    25  eligible  in accordance with federal law. The exchange also shall incor-
    26  porate a small business health options program ("SHOP") to assist quali-
    27  fied employers in facilitating the  enrollment  of  their  employees  in
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.

        A. 11341                            2
     1  qualified health plans offered in the group market.  It is the intent of
     2  the  legislature,  through the establishment of the exchange, to promote
     3  quality and affordable health coverage and care, reduce  the  number  of
     4  uninsured  persons, provide a transparent marketplace, educate consumers
     5  and assist individuals with access to coverage, premium  assistance  tax
     6  credits and cost-sharing reductions.
     7    § 3981. Definitions. For purposes of this article, the following defi-
     8  nitions shall apply:
     9    1. "Board" or "board of directors" means the board of directors of the
    10  exchange.
    11    2.  "Regional  advisory  committees" means the New York health benefit
    12  exchange regional advisory committees established pursuant to this arti-
    13  cle.
    14    3. "Commissioner" means the commissioner of health.
    15    4. "Exchange" means the New York health benefit  exchange  established
    16  pursuant to this article.
    17    5.  "Health  plan" means a policy, contract or certificate, offered or
    18  issued by an insurer to provide, deliver, arrange for, pay for or  reim-
    19  burse  any  of  the costs of health care services. Health plan shall not
    20  include the following:
    21    (a) accident insurance or disability income insurance, or any combina-
    22  tion thereof;
    23    (b) coverage issued as a supplement to liability insurance;
    24    (c) liability insurance, including  general  liability  insurance  and
    25  automobile liability insurance;
    26    (d) workers' compensation or similar insurance;
    27    (e) automobile no-fault insurance;
    28    (f) credit insurance;
    29    (g)  other  similar  insurance coverage, as specified in federal regu-
    30  lations, under which benefits for medical care are  secondary  or  inci-
    31  dental to other insurance benefits;
    32    (h)  limited  scope  dental or vision benefits, benefits for long-term
    33  care insurance, nursing home insurance,  home  care  insurance,  or  any
    34  combination  thereof,  or  such  other  similar, limited benefits health
    35  insurance as specified in  federal  regulations,  if  the  benefits  are
    36  provided  under  a separate policy, certificate or contract of insurance
    37  or are otherwise not an integral part of the plan;
    38    (i) coverage only for a specified disease or illness, hospital  indem-
    39  nity, or other fixed indemnity coverage;
    40    (j)  Medicare  supplemental insurance as defined in section 1882(g)(1)
    41  of the federal social security act, coverage supplemental to the  cover-
    42  age  provided under chapter 55 of title 10 of the United States code, or
    43  similar supplemental coverage provided under a group health plan  if  it
    44  is  offered  as a separate policy, certificate or contract of insurance;
    45  or
    46    (k) the medical indemnity fund established pursuant to title  four  of
    47  article twenty-nine-D of the public health law.
    48    6.  "Insurer" means an insurance company subject to article thirty-two
    49  or forty-three of the insurance law, or a health  maintenance  organiza-
    50  tion  certified  pursuant to article forty-four of the public health law
    51  that contracts or offers to contract to provide, deliver,  arrange,  pay
    52  or reimburse any of the costs of health care services.
    53    7.  "Qualified  dental plan" means a limited scope dental plan that is
    54  issued by an insurer and certified in accordance  with  section  thirty-
    55  nine hundred eighty-five of this article.

        A. 11341                            3
     1    8. "Qualified employer" means a small employer that elects to make its
     2  full-time  employees  eligible  for  one  or more qualified health plans
     3  through the exchange.
     4    9.  "Qualified  health  plan" means a health plan that is issued by an
     5  insurer and certified in accordance  with  section  thirty-nine  hundred
     6  eighty-five of this article.
     7    10.  "Qualified  individual"  means  an individual, including a minor,
     8  who:
     9    (a) is seeking to enroll in a qualified health plan offered  to  indi-
    10  viduals through the exchange;
    11    (b) resides in this state;
    12    (c)  at the time of enrollment, is not incarcerated, other than incar-
    13  ceration pending the disposition of charges; and
    14    (d) is, and is reasonably expected to be, for the  entire  period  for
    15  which  enrollment  is sought, a citizen or national of the United States
    16  or an alien lawfully present in the United States.
    17    11. "SHOP" means the small business health options program designed to
    18  assist qualified employers in this state in facilitating the  enrollment
    19  of their employees in qualified health plans offered in the group market
    20  in this state.
    21    12. "Small employer" means, for plan years prior to January first, two
    22  thousand  sixteen,  an employer that employed an average of at least one
    23  but not more than fifty employees on business days during the  preceding
    24  calendar  year. For plan years beginning on and after January first, two
    25  thousand sixteen, small employer means  an  employer  that  employed  an
    26  average of at least one but not more than one hundred employees on busi-
    27  ness  days during the preceding calendar year. For purposes of the defi-
    28  nition of small employer:
    29    (a) all persons treated as a single  employer  under  subsection  (b),
    30  (c),  (m)  or  (o)  of  section 414 of the Internal Revenue Code of 1986
    31  shall be treated as a single employer;
    32    (b) an employer and any predecessor employer shall  be  treated  as  a
    33  single employer;
    34    (c)  all employees shall be counted, including part-time employees and
    35  employees who are not eligible for coverage through the employer;
    36    (d) if an employer was  not  in  existence  throughout  the  preceding
    37  calendar  year,  then  the  determination  of whether that employer is a
    38  small employer shall be based upon the average number of employees  that
    39  the  employer  reasonably  expects  to  employ  on  business days in the
    40  current calendar year;
    41    (e) if a qualified employer that makes enrollment in qualified  health
    42  plans  available  to  its  employees through the exchange ceases to be a
    43  small employer by reason of an increase in the number of its  employees,
    44  then  the  employer shall continue to be treated as a qualified employer
    45  for purposes of this article for the period beginning with the  increase
    46  and  ending  with the first day on which the employer does not make such
    47  enrollment available to its employees; and
    48    (f) notwithstanding paragraphs (a) through (e) of this subdivision, an
    49  employer also shall be considered a small employer if  the  coverage  it
    50  offers  would be considered small group coverage under the insurance law
    51  and regulations promulgated thereunder.
    52    13. "Small group market" means the health insurance market under which
    53  individuals receive health insurance coverage on  behalf  of  themselves
    54  and  their  dependents through a group health plan maintained by a small
    55  employer.
    56    14. "Superintendent" means the superintendent of financial services.

        A. 11341                            4
     1    § 3982. Establishment of the New York health  benefit  exchange.    1.
     2  There  is hereby created a public benefit corporation to be known as the
     3  New York health benefit exchange.  Such  corporation  shall  be  a  body
     4  corporate and politic.
     5    2.  The purpose of the exchange is to facilitate the purchase and sale
     6  of qualified health plans, assist qualified  employers  in  facilitating
     7  the  enrollment of their employees in qualified health plans through the
     8  small business health options  program,  enroll  individuals  in  health
     9  coverage  for which they are eligible in accordance with federal law and
    10  carry out other functions set forth in this article.
    11    3. (a) The exchange shall be governed by a board of directors consist-
    12  ing of nine voting directors, including the commissioner and the  super-
    13  intendent, who shall serve as ex officio directors.
    14    (b)  Seven  directors  shall be appointed by the governor, two of whom
    15  shall be appointed upon the recommendation of the temporary president of
    16  the senate and two of whom shall be appointed upon the recommendation of
    17  the speaker of the assembly.  Each person appointed as a director pursu-
    18  ant to this paragraph shall have expertise in one or more of the follow-
    19  ing areas:
    20    (i) Individual health care coverage;
    21    (ii) Small employer health care coverage;
    22    (iii) Health benefits administration;
    23    (iv) Health care finance;
    24    (v) Public or private health care delivery systems; and
    25    (vi) Purchasing health plan coverage.
    26    (c) Recommendations and appointments shall take into consideration the
    27  expertise of other directors recommended and appointed pursuant to  this
    28  subdivision, so that the board composition reflects a diversity of expe-
    29  rience.
    30    (d)  Recommendations  by the temporary president of the senate and the
    31  speaker of the assembly shall be made within sixty days of the effective
    32  date of this article, within sixty days of the occurrence of  a  vacancy
    33  or within sixty days prior to the expiration of a term.
    34    4.  The  governor  shall  appoint  a chair of the board from among the
    35  directors who shall be subject to the advice and consent of the  senate.
    36  Any  director  appointed by the governor as chair of the board may serve
    37  as acting chair until such time as a vote for confirmation is  taken  by
    38  the  senate.  No  director  appointed  as chair shall serve as chair, or
    39  continue to serve as acting chair,  if  the  senate  has  voted  not  to
    40  confirm such director as chair.
    41    5.  (a)  The  terms of the directors, other than the ex officio direc-
    42  tors, shall be three years, provided, however, that the initial terms of
    43  one of the directors appointed  upon  recommendation  of  the  temporary
    44  president of the senate, one of the directors appointed upon recommenda-
    45  tion  of the speaker of the assembly, and one of the directors appointed
    46  by the governor without recommendation shall be for two years.
    47    (b) Vacancies occurring otherwise than by expiration of term of office
    48  shall be filled for the  unexpired  term  in  the  manner  provided  for
    49  original appointment.
    50    6. The directors shall not receive any compensation for their services
    51  as directors.
    52    7.  (a)  Each  director shall have the responsibility and duty to meet
    53  the requirements of this article and all applicable  state  and  federal
    54  laws and regulations to serve the public interest of the individuals and
    55  small  businesses  seeking  health  care  coverage through the exchange,

        A. 11341                            5
     1  consistent with section twenty-eight hundred twenty-four of  this  chap-
     2  ter.
     3    (b)  Each  director  shall  be  a  state  officer  or employee for the
     4  purposes of sections seventy-three and seventy-four of the public  offi-
     5  cers law.
     6    (c) No director may be employed or otherwise retained by the exchange.
     7    8.  (a) The board may create such committees as the board deems neces-
     8  sary. The first meeting of the board shall be held  within  thirty  days
     9  after  all  directors  are initially appointed.  At the first meeting of
    10  the board, and at the first meeting in each subsequent year,  the  board
    11  shall  elect  from  among  its  members a secretary and a treasurer. The
    12  board also shall elect such other officers as it shall  deem  necessary.
    13  The  officers  so  elected  shall  have  such  powers  and duties as are
    14  assigned by the by-laws and this chapter.
    15    (b) The board, and any committee thereof, may hold meetings  by  elec-
    16  tronic means consistent with article seven of the public officers law.
    17    §  3983.  General  powers of the exchange. The exchange shall have the
    18  following powers to be used in furtherance of its corporate purposes:
    19    1. to sue and be sued and to participate in actions  and  proceedings,
    20  whether judicial, administrative, arbitrative or otherwise;
    21    2.  to  have a corporate seal, and to alter such seal at pleasure, and
    22  to use it by causing it or a facsimile to be  affixed  or  impressed  or
    23  reproduced in any other manner;
    24    3.  to  purchase,  receive,  take  by  grant, gift, devise, bequest or
    25  otherwise, lease, or otherwise acquire, own, hold, improve, employ,  use
    26  and otherwise deal in and with, real or personal property, or any inter-
    27  est therein, wherever situated;
    28    4. to sell, convey, lease, exchange, transfer or otherwise dispose of,
    29  or  mortgage  or pledge, or create a security interest in, all or any of
    30  its property, or any interest therein, wherever situated;
    31    5. to make contracts,  give  guarantees  and  incur  liabilities,  and
    32  borrow  money;  provided,  however,  that  the  exchange shall not issue
    33  bonds;
    34    6. to invest and reinvest its  funds,  and  take  and  hold  real  and
    35  personal  property  as  security  for  the payment of funds so loaned or
    36  invested;
    37    7. to make and alter by-laws for its organization and management;
    38    8. to make and alter rules and regulations as necessary  to  implement
    39  the  provisions  of this article, subject to the provisions of the state
    40  administrative procedure act;
    41    9. to hire employees,  consistent  with  section  thirty-nine  hundred
    42  eighty-nine of this article;
    43    10. to designate the depositories of its money;
    44    11. to establish its fiscal year;
    45    12. to insure or otherwise provide for the insurance of the exchange's
    46  property  or operations and against such other risks as the exchange may
    47  deem advisable;
    48    13. to receive and spend money for any of its  corporate  purposes  in
    49  accordance with this article; and
    50    14.  to  apply for, accept the award of, and spend any available grant
    51  money.
    52    § 3984. Functions of the exchange.  The exchange shall:
    53    1. (a) make available qualified health plans to qualified  individuals
    54  and  qualified employers beginning on or before January first, two thou-
    55  sand eighteen, provided that coverage under such qualified  plans  shall

        A. 11341                            6
     1  not become effective prior to such date and shall not make available any
     2  health plan that is not a qualified health plan;
     3    (b) make available qualified dental plans to qualified individuals and
     4  qualified  employers  beginning on or before January first, two thousand
     5  eighteen, provided that coverage under such qualified dental plans shall
     6  not become effective  prior  to  such  date,  either  separately  or  in
     7  conjunction  with  a qualified health plan, if such plan provides pedia-
     8  tric dental benefits;
     9    2. assign a rating to each qualified health plan offered  through  the
    10  exchange, and determine each qualified health plan's level of coverage;
    11    3. utilize a standardized format for presenting health benefit options
    12  in  the  exchange,  including the use of the uniform outline of coverage
    13  established under section 2715 of the federal public health service act;
    14    4. provide for enrollment  periods  pursuant  to  the  insurance  law,
    15  whichever is in the best interest of qualified individuals and qualified
    16  employers;
    17    5.  implement  procedures  for  the certification, recertification and
    18  decertification of health plans as qualified  health  plans,  consistent
    19  with guidelines developed by the superintendent;
    20    6.  require  qualified health plans to offer those benefits determined
    21  by the superintendent to be essential health  benefits  and  such  addi-
    22  tional benefits as may be required pursuant to the insurance law;
    23    7.  ensure that insurers offering health plans through the exchange do
    24  not charge an individual a fee or penalty for termination of coverage;
    25    8. provide for the operation  of  a  toll-free  telephone  hotline  to
    26  respond to requests for assistance;
    27    9.  maintain  an internet website through which enrollees and prospec-
    28  tive enrollees of qualified health plans may obtain standardized compar-
    29  ative information on such plans and public health programs;
    30    10. establish and make available by electronic means a  calculator  to
    31  determine  the  actual  cost  of  coverage  after the application of any
    32  premium tax credit under section 36B of the  Internal  Revenue  Code  of
    33  1986 and any cost-sharing reduction;
    34    11.  establish  a  program  under  which the exchange awards grants to
    35  entities to serve as navigators;
    36    12. inform individuals of eligibility requirements  for  the  medicaid
    37  program  under  title  XIX  of  the  social security act, the children's
    38  health insurance program (CHIP) under title XXI of the  social  security
    39  act or any applicable state or local public health insurance program and
    40  if,  through  screening of the application by the exchange, the exchange
    41  determines that such individuals are  eligible  for  any  such  program,
    42  enroll such individuals in such program;
    43    13.    grant a certification attesting that, for purposes of the indi-
    44  vidual responsibility penalty under section 5000A of the Internal Reven-
    45  ue Code of 1986, an individual is exempt from the  individual  responsi-
    46  bility requirement or from the penalty imposed by that section because:
    47    (a) there is no affordable qualified health plan available through the
    48  exchange or the individual's employer, covering the individual; or
    49    (b) the individual meets the requirements for any other such exemption
    50  from the individual responsibility requirement or penalty;
    51    14. transmit to the comptroller:
    52    (a)  a  list of the individuals to whom the exchange granted a certif-
    53  ication under subdivision thirteen of this section, including  the  name
    54  and taxpayer identification number of each individual;
    55    (b) the name and taxpayer identification number of each individual who
    56  was an employee of an employer who was determined to be eligible for the

        A. 11341                            7
     1  premium  tax  credit  under  section 36B of the Internal Revenue Code of
     2  1986 because:
     3    (i)  the employer did not provide minimum essential coverage as deter-
     4  mined by the superintendent; or
     5    (ii) the employer provided the minimum essential  coverage  as  deter-
     6  mined  by  the  superintendent,  but  it  was  determined  under section
     7  36B(c)(2)(C) of the Internal Revenue Code of 1986 to either be unafford-
     8  able to the employee or to not provide the  required  minimum  actuarial
     9  value; and
    10    (c) the name and taxpayer identification number of:
    11    (i)  each  individual  who  notifies  the  exchange that he or she has
    12  changed employers; and
    13    (ii) each individual who ceases coverage under a qualified health plan
    14  during a plan year and the effective date of that cessation;
    15    15. provide to each employer the name of each employee of the employer
    16  described in paragraph (b) of subdivision fourteen of this  section  who
    17  ceases coverage under a qualified health plan during a plan year and the
    18  effective date of the cessation;
    19    16.  operate  a small business health options program ("SHOP") through
    20  which qualified employers access coverage for their employees, and may:
    21    (a) permit qualified employers to specify a level of coverage so their
    22  employees may enroll in any qualified health plan  offered  through  the
    23  SHOP  at the specified level of coverage or provide a specific amount or
    24  other payment formulated to be used as part of an employee choice  plan;
    25  and
    26    (b) provide premium aggregation and other related services to minimize
    27  administrative burdens for qualified employers;
    28    17.  enter  into  agreements  as necessary with: (a) federal and state
    29  agencies and other state exchanges to  carry  out  its  responsibilities
    30  under   this   article,   provided   such  agreements  include  adequate
    31  protections with respect to the confidentiality of any information to be
    32  shared and comply with all state and federal laws and regulations; and
    33    (b) local departments of social services to coordinate  enrollment  in
    34  other social services programs, as appropriate, provided such agreements
    35  include  adequate protections with respect to the confidentiality of any
    36  information to be shared and comply with all state and federal laws  and
    37  regulations;
    38    18.  perform duties required by the superintendent or the secretary of
    39  the United States department of  the  treasury  related  to  determining
    40  eligibility for premium tax credits, reduced cost-sharing, or individual
    41  responsibility requirement exemptions;
    42    19. meet financial integrity requirements of this chapter, including:
    43    (a)  keeping  an  accurate accounting of all activities, receipts, and
    44  expenditures and annually submitting  to  the  superintendent  a  report
    45  concerning  such accountings, with a copy of such report provided to the
    46  governor, the temporary president of the senate and the speaker  of  the
    47  assembly; and
    48    (b)  fully  cooperating with any investigation conducted by the super-
    49  intendent pursuant to his or her authority and allowing the  superinten-
    50  dent to:
    51    (i) investigate the affairs of the exchange;
    52    (ii) examine the properties and records of the exchange; and
    53    (iii) require periodic reports in relation to the activities undertak-
    54  en by the exchange;
    55    20.  (a)  consult  with  the  regional advisory committees established
    56  pursuant to section thirty-nine hundred eighty-six of this article; and

        A. 11341                            8
     1    (b) consult with stakeholders relevant to carrying out the  activities
     2  required under this article, including but not limited to:
     3    (i) health care consumers who are enrollees in health plans;
     4    (ii)  individuals and entities with experience in facilitating enroll-
     5  ment in health plans;
     6    (iii) representatives of small businesses and  self-employed  individ-
     7  uals;
     8    (iv)  state  medicaid  offices,  including local departments of social
     9  services;
    10    (v) advocates for enrolling hard to reach populations;
    11    (vi) health care providers; and
    12    (vii) insurers;
    13    21. submit information provided by exchange applicants  for  verifica-
    14  tion;
    15    22.  establish rules and regulations, pursuant to subdivision eight of
    16  section thirty-nine hundred eighty-three of this article,  that  do  not
    17  conflict  with  or prevent the application of regulations promulgated by
    18  the superintendent; and
    19    23. determine eligibility, provide notices, and provide  opportunities
    20  for appeal and redetermination.
    21    §  3985.  Special  functions  of  the  exchange related to health plan
    22  certification and qualified health plan  oversight.    1.  Health  plans
    23  certified by the exchange shall meet the following requirements:
    24    (a) the insurer offering the health plan:
    25    (i) is licensed or certified by the superintendent or commissioner;
    26    (ii)  offers  at least one qualified health plan in each of the silver
    27  and gold levels;
    28    (iii) has filed with and received approval from the superintendent  of
    29  its premium rates and policy or contract forms pursuant to the insurance
    30  law and the public health law;
    31    (iv)  does  not charge any cancellation fees or penalties in violation
    32  of subdivision seven of section thirty-nine hundred eighty-four of  this
    33  article; and
    34    (v)  complies with the regulations developed by the superintendent and
    35  such other requirements as the exchange may establish;
    36    (b) the health plan: (i) provides the essential health benefits  pack-
    37  age and includes such additional benefits as may be required pursuant to
    38  the  insurance law, except that the health plan shall not be required to
    39  provide essential benefits that duplicate the minimum benefits of quali-
    40  fied dental plans if:
    41    (A) the exchange has determined that at  least  one  qualified  dental
    42  plan is available to supplement the health plan's coverage; and
    43    (B)  the  insurer makes prominent disclosure at the time it offers the
    44  health plan, in a form approved by the exchange, that the plan does  not
    45  provide  the full range of essential pediatric benefits, and that quali-
    46  fied dental plans providing those benefits and other dental benefits not
    47  covered by the plan are offered through the exchange;
    48    (ii) provides at least a bronze level of coverage, unless the plan  is
    49  certified as a qualified catastrophic plan, and shall only be offered to
    50  individuals eligible for catastrophic coverage;
    51    (iii)  has  cost-sharing requirements, including deductibles, which do
    52  not exceed the limits established and any requirements of the exchange;
    53    (iv) complies with  regulations  promulgated  by  the  superintendent,
    54  which  include  minimum  standards  in the areas of marketing practices,
    55  network adequacy, essential community providers  in  underserved  areas,
    56  accreditation,   quality   improvement,  uniform  enrollment  forms  and

        A. 11341                            9
     1  descriptions of coverage and information on quality measures for  health
     2  benefit plan performance;
     3    (v) complies with the insurance law and the public health law require-
     4  ments  applicable to health insurance issued in this state and any regu-
     5  lations promulgated pursuant  thereto  that  do  not  conflict  with  or
     6  prevent the application of federal requirements; and
     7    (c)  the  exchange  determines  that  making the health plan available
     8  through the exchange is in the interest  of  qualified  individuals  and
     9  qualified employers in this state.
    10    2. The exchange shall not exclude a health plan:
    11    (a) on the basis that the health plan is a fee-for-service plan;
    12    (b)  through the imposition of premium price controls by the exchange;
    13  or
    14    (c) on the basis that the health plan provides treatments necessary to
    15  prevent patients' deaths in circumstances the  exchange  determines  are
    16  inappropriate or too costly.
    17    3.  The  exchange  shall  require  each  insurer  certified or seeking
    18  certification of a health plan as a qualified health plan to:
    19    (a) submit a justification for any premium increase  to  the  exchange
    20  prior to implementation of such increase.  The insurer shall prominently
    21  post the information on its internet website; provided, however, that if
    22  information  submitted  to  the  superintendent as a justification for a
    23  premium rate adjustment pursuant to the insurance  law,  or  information
    24  posted  to  an  insurer's  internet  website,  otherwise  meets  federal
    25  requirements, then submission of a copy of the same justification to the
    26  exchange or use of the same posting shall be deemed sufficient  to  meet
    27  the requirements of this section.  The exchange shall take this informa-
    28  tion,  and  the  information  and  the  recommendations  provided to the
    29  exchange by the superintendent relating  to  patterns  or  practices  of
    30  excessive  or  unjustified  premium  increases,  into consideration when
    31  determining whether to allow the insurer to make health plans  available
    32  through the exchange.  Such rate increases shall be subject to the prior
    33  approval of the superintendent pursuant to the insurance law;
    34    (b)(i) make available to the public and submit to the exchange and the
    35  superintendent, accurate and timely disclosure of:
    36    (A) claims payment policies and practices;
    37    (B) periodic financial disclosures;
    38    (C) data on enrollment and disenrollment;
    39    (D) data on the number of claims that are denied;
    40    (E) data on rating practices;
    41    (F)  information on cost-sharing and payments with respect to any out-
    42  of-network coverage;
    43    (G) information on enrollee and participant rights; and
    44    (H) other information as determined appropriate by the superintendent;
    45    (ii) the information shall be provided in plain language and in  guid-
    46  ance  jointly  issued  thereunder  by the superintendent and the federal
    47  secretary of labor; and
    48    (c) provide to individuals, in a timely manner upon the request of the
    49  individual, the amount of cost-sharing,  including  deductibles,  copay-
    50  ments,  and  coinsurance, under the individual's health plan or coverage
    51  that the individual would be responsible for paying with respect to  the
    52  furnishing of a specific item or service by a participating provider. At
    53  a  minimum,  this  information shall be made available to the individual
    54  through an internet website and  through  other  means  for  individuals
    55  without access to the internet.

        A. 11341                           10
     1    4.  (a)  The provisions of this article that apply to qualified health
     2  plans also shall apply to the extent relevant to qualified dental  plans
     3  except  as  modified in accordance with the provisions of paragraphs (b)
     4  and (c) of this subdivision or otherwise required by the exchange.
     5    (b)  The  qualified  dental  plan  shall be limited to dental and oral
     6  health benefits, without substantially duplicating the benefits typical-
     7  ly offered by health benefit plans without dental  coverage,  and  shall
     8  include,   at   a  minimum,  the  essential  pediatric  dental  benefits
     9  prescribed by the superintendent and such other dental benefits  as  the
    10  exchange or the superintendent may specify in regulations.
    11    (c)  Insurers  may  jointly  offer  a  comprehensive  plan through the
    12  exchange in which an insurer provides  the  dental  benefits  through  a
    13  qualified dental plan and an insurer provides the other benefits through
    14  a  qualified  health plan, provided that the plans are priced separately
    15  and also are made available for purchase separately at the same price.
    16    § 3986. Regional advisory committees. 1. There are hereby created  the
    17  New York health benefit exchange regional advisory committees ("advisory
    18  committees"). One regional advisory committee shall be established with-
    19  in  each  of  five  regions,  to be known as the "New York City region,"
    20  "metropolitan suburban region," "northern region," "central region"  and
    21  "western  region."  The  board shall determine the counties that make up
    22  such regions.
    23    2. Each regional advisory committee shall be comprised of five members
    24  appointed by the governor, one of  whom  shall  be  appointed  upon  the
    25  recommendation  of the temporary president of the senate and one of whom
    26  shall be appointed upon the recommendation of the speaker of the  assem-
    27  bly.
    28    3.  Terms  shall  be  three  years.    Members shall serve until their
    29  successors are appointed. Members may serve up to two consecutive terms.
    30    4. Vacancies shall be filled in the same manner as  original  appoint-
    31  ments,  and  successors  shall  serve for the remainder of the unexpired
    32  term to which they are appointed.
    33    5. Recommendations by the temporary president of the  senate  and  the
    34  speaker of the assembly shall be made within sixty days of the effective
    35  date  of  this  article  or the occurrence of a vacancy, or within sixty
    36  days prior to the expiration of a term.
    37    6. The members of each regional advisory committee shall include:
    38    (a) representatives from the following categories, but not  more  than
    39  two from any single category:
    40    (i) health plan consumer advocates;
    41    (ii) small business consumer representatives;
    42    (iii) health care provider representatives;
    43    (iv) representatives of the health insurance industry;
    44    (b)  representatives  from the following categories, but not more than
    45  one from either category:
    46    (i) licensed insurance producers; and
    47    (ii) representatives of labor organizations.
    48    7. The board shall select the chair of each regional advisory  commit-
    49  tee  from  among  the  members  of such committee. The board shall adopt
    50  rules for the governance of the regional advisory  committees  and  each
    51  regional advisory committee shall meet at least once each quarter and at
    52  such other times as determined by the board to be necessary.
    53    8.  Members  of  the  regional advisory committees shall serve without
    54  compensation.
    55    9. The regional advisory committees shall make findings and  recommen-
    56  dations  regarding regional variations in the operation of the exchange,

        A. 11341                           11
     1  which shall be submitted to  the  board  of  directors,  posted  on  the
     2  website  of  the  exchange,  and considered by the board in a reasonably
     3  timely fashion. Such findings and recommendations shall be  made  on  an
     4  annual basis, on a date determined by the board, and at such other times
     5  as the board or any regional advisory committee deems appropriate.
     6    § 3987. Funding of the exchange.  1. The exchange shall be financially
     7  self-sufficient by January first, two thousand nineteen.
     8    2. The exchange shall conduct or cause to be conducted a study of, and
     9  shall  report  its  findings  and  recommendations  upon, the options to
    10  generate funding for the ongoing operation of the exchange.
    11    3.  The exchange shall publish on its internet website  the  fees  and
    12  any  other  payments  required  by  the exchange, and the administrative
    13  costs of the exchange, to educate consumers on such costs and the amount
    14  of monies lost to waste, fraud and abuse.
    15    4. The exchange shall not utilize any funds intended for the  adminis-
    16  trative  and  operational  expenses  of the exchange for staff retreats,
    17  promotional giveaways, excessive executive compensation, or promotion of
    18  federal or state legislative and regulatory modifications.
    19    5. The moneys of the exchange shall, except as otherwise  provided  in
    20  this  section,  be  deposited  in  a general account called the New York
    21  health benefit exchange account and such other accounts as the  exchange
    22  may  deem necessary, pursuant to resolution of the board, for the trans-
    23  action of its business and shall be paid out as authorized by the  chair
    24  of  the board or by such other person or persons as the chair may desig-
    25  nate.
    26    6. No funds of the exchange shall be transferred to the  general  fund
    27  or  any special revenue fund or shall be used for any purpose other than
    28  the purposes set forth in this article.  No funds shall  be  transferred
    29  from  the general fund or any special revenue fund to the exchange with-
    30  out an appropriation.
    31    7. The accounts of the exchange shall be subject to supervision of the
    32  comptroller and such  accounts  shall  include  receipts,  expenditures,
    33  contracts and other matters which pertain to the fiscal soundness of the
    34  exchange.
    35    8.  Notwithstanding  any  law  to the contrary, and in accordance with
    36  section four of the state finance law, upon request of the  director  of
    37  the  budget,  in  consultation with the commissioner, the superintendent
    38  and the chair of the board, the comptroller  is  hereby  authorized  and
    39  directed to suballocate or transfer special revenue federal funds appro-
    40  priated  to the department of health for planning and implementing vari-
    41  ous healthcare and insurance reform initiatives  authorized  by  federal
    42  legislation to the New York state health benefit exchange. Moneys subal-
    43  located or transferred pursuant to this section shall be paid out of the
    44  fund  upon audit and warrant of the state comptroller on vouchers certi-
    45  fied or approved by the exchange.
    46    § 3988. Tax exemption and tax contract by the state.  1. It is  hereby
    47  determined  that the creation of the exchange and the fulfillment of its
    48  corporate purposes is in all respects for the benefit of the  people  of
    49  this  state  and is a public purpose. Accordingly, the exchange shall be
    50  regarded as performing an essential governmental function in  the  exer-
    51  cise  of  the powers conferred upon it by this article, and the exchange
    52  shall not be required to pay any fees, taxes, special ad valorem  levies
    53  or  assessments  of  any kind, whether state or local, including but not
    54  limited to fees, taxes, special ad valorem levies or assessments on real
    55  property, franchise taxes, sales taxes, transfer taxes,  mortgage  taxes
    56  or  other  taxes,  upon  or  with respect to any property owned by it or

        A. 11341                           12
     1  under its jurisdiction, control or supervision, or upon the uses  there-
     2  of,  or upon or with respect to its activities or operations in further-
     3  ance of the powers conferred upon it by this article, or  upon  or  with
     4  respect  to any fares, tolls, rentals, rates, charges, fees, revenues or
     5  other income received by the exchange.
     6    2. The exchange may pay, or may enter into agreements with any  county
     7  or  municipality  to  pay,  a  sum  or  sums annually or otherwise or to
     8  provide other considerations with respect to real property owned by  the
     9  exchange located within such county or municipality.
    10    § 3989. Officers  and  employees. 1. The board shall have the power to
    11  appoint employees to serve as senior managerial staff of the exchange as
    12  necessary, who shall be designated to be in the exempt  class  of  civil
    13  service. The board shall also have the power to fix the salaries of such
    14  employees.
    15    2.  Any  newly  hired  employees  who  are not designated to be in the
    16  exempt class of civil  service  pursuant  to  subdivision  one  of  this
    17  section  and who are not subject to the transfer provisions set forth in
    18  subdivisions four, five and six of this section shall be considered  for
    19  purposes  of  article  fourteen  of  the  civil service law to be public
    20  employees in the civil service of the state, and shall  be  assigned  to
    21  the  appropriate  collective bargaining unit by the exchange in the same
    22  manner and consistent with those employees described in subdivision  six
    23  of this section.
    24    3.  Any  public  officer  or employee of a state department, agency or
    25  commission may be transferred to the exchange  without  examination  and
    26  without  loss  of  any  civil  service  status or rights to a comparable
    27  office, position or employment with the exchange; provided, however,  no
    28  such transfer may be made without the consent of the head of the depart-
    29  ment,  agency or commission.  Transfers shall be made pursuant to subdi-
    30  vision two of section seventy of the civil service law.
    31    4. The salary or compensation of any such officer or  employee,  after
    32  such transfer, shall be paid by the exchange.
    33    5.  Any  officer  or  employee transferred to the exchange pursuant to
    34  this section, who are members of or benefit under any  existing  pension
    35  or  retirement fund or system, shall continue to have all rights, privi-
    36  leges, obligations and status with respect to such fund or system as are
    37  now prescribed by law, but during the period of their employment by  the
    38  exchange,  all  contributions to such funds or systems to be paid by the
    39  employer on account of such officers or employees shall be paid  by  the
    40  exchange.
    41    6. A transferred employee shall remain in the same collective bargain-
    42  ing unit as was the case prior to his or her transfer; successor employ-
    43  ees  to the positions held by such transferred employees shall, consist-
    44  ent with the provisions of article fourteen of the civil service law, be
    45  included in the same unit as their predecessors.  Employees  serving  in
    46  positions  in newly created titles shall be assigned to the same collec-
    47  tive bargaining unit as they would  have  been  assigned  to  were  such
    48  titles  created  prior  to  the  establishment  of the exchange. Nothing
    49  contained in this article shall be construed (a) to diminish the  rights
    50  of  employees  pursuant  to  a collective bargaining agreement or (b) to
    51  affect existing law with respect to an application to the public employ-
    52  ment relations board seeking a designation by  the  board  that  certain
    53  persons are managerial or confidential.
    54    § 3990. Limitation  of  liability; indemnification.  The provisions of
    55  sections seventeen and nineteen of the  public  officers  law  shall  be
    56  applicable  to  exchange  employees, as such term is defined in sections

        A. 11341                           13
     1  seventeen and nineteen of the public officers  law;  provided,  however,
     2  that nothing contained within this section shall be deemed to permit the
     3  exchange  to extend the provisions of sections seventeen and nineteen of
     4  the public officers law upon any independent contractor.
     5    § 3991. Construction.  Nothing in this article, and no action taken by
     6  the exchange pursuant hereto, shall be construed to:
     7    1.  preempt  or  supersede  the authority of the superintendent or the
     8  commissioner; or
     9    2. exempt insurers, insurance producers or qualified health plans from
    10  the public health law or the insurance law and  regulations  promulgated
    11  thereunder.
    12    § 3. Subdivision 1 of section 17 of the public officers law is amended
    13  by adding a new paragraph (z) to read as follows:
    14    (z)  For  purposes  of this section, the term "employee" shall include
    15  directors, officers  and  employees  of  the  New  York  health  benefit
    16  exchange established pursuant to article ten-E of the public authorities
    17  law.
    18    § 4. Subdivision 1 of section 19 of the public officers law is amended
    19  by adding a new paragraph (k) to read as follows:
    20    (k)  For  purposes  of this section, the term "employee" shall include
    21  directors, officers  and  employees  of  the  New  York  health  benefit
    22  exchange established pursuant to article ten-E of the public authorities
    23  law.
    24    §  5.  If any provision or application of this act shall be held to be
    25  invalid, or to violate or be inconsistent with  any  applicable  federal
    26  law  or  regulation,  that shall not affect other provisions or applica-
    27  tions of this act which can be given effect without  that  provision  or
    28  application;  and  to  that end, the provisions and applications of this
    29  act are severable.
    30    § 6. The superintendent of the department  of  financial  services  is
    31  authorized to promulgate rules and regulations, and may promulgate emer-
    32  gency regulations, necessary for the implementation of the provisions of
    33  this act on or before its effective date.
    34    § 7. This act shall take effect upon the occurrence of the earlier of:
    35    (a)  the  repeal of the Patient Protection and Affordable Care Act, 42
    36  U.S.C. § 18001 et seq. (2010); or
    37    (b) the rescinding of Executive Order {Cuomo} No. 42 {9  NYCRR  8.42},
    38  Establishing the New York Health Benefit Exchange;
    39  provided  that  the  governor  of the state of New York shall notify the
    40  legislative bill drafting commission upon the occurrence of the rescind-
    41  ing of Executive Order {Cuomo} No. 42 {9 NYCRR 8.42},  Establishing  the
    42  New  York Health Benefit Exchange in order that the commission may main-
    43  tain an accurate and timely effective data base of the official text  of
    44  the  laws  of  the  state  of  New  York in furtherance of effecting the
    45  provisions of section 44 of the legislative law and section 70-b of  the
    46  public officers law.