S T A T E   O F   N E W   Y O R K
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                                  4223

                       2009-2010 Regular Sessions

                          I N  A S S E M B L Y

                            February 2, 2009
                               ___________

Introduced  by  M.  of  A.  CROUCH  --  Multi-Sponsored  by  -- M. of A.
  BACALLES, FINCH -- read once and referred to the Committee  on  Insur-
  ance

AN  ACT  to  amend the insurance law, in relation to creating a New York
  health benefit and cost commission

  THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section  1. Legislative intent. It is the desire of the legislature to
ensure that health coverage provides the  care,  treatment  and  service
that  people  need,  and  to  ensure that the coverage is affordable and
available. The legislature finds that there is a need for  a  comprehen-
sive  review  of all current benefits mandated by statute, and for accu-
rate cost analysis of proposed mandates.
  S 2. The insurance law is amended by adding a new  section  3221-a  to
read as follows:
  S  3221-A. HEALTH BENEFIT AND COST COMMISSION. (A) FOR THE PURPOSES OF
THIS SECTION, "MANDATED HEALTH BENEFIT" SHALL MEAN ANY REQUIREMENT  THAT
INDIVIDUAL,  GROUP  OR BLANKET ACCIDENT AND HEALTH INSURANCE POLICIES OR
CONTRACTS ISSUED BY HOSPITAL OR HEALTH SERVICE CORPORATIONS INCLUDE:
  (1) COVERAGE FOR SPECIFIC HEALTH SERVICES,  TREATMENT,  TESTS,  DRUGS,
SUPPLIES,  OR  EQUIPMENT  TO  DIAGNOSE  OR TREAT A PARTICULAR DISEASE OR
CONDITION; AND
  (2) COVERAGE  FOR  SERVICES  OF  SPECIFIC  PROVIDERS  OF  HEALTH  CARE
SERVICES.
  (B)  THERE IS HEREBY CREATED A COMMISSION WITHIN THE DEPARTMENT, TO BE
KNOWN AS THE "NEW YORK HEALTH BENEFIT AND COST COMMISSION" CONSISTING OF
THIRTEEN MEMBERS TO BE APPOINTED AS FOLLOWS: THREE TO  BE  APPOINTED  BY
THE  GOVERNOR,  THREE  TO BE APPOINTED BY THE TEMPORARY PRESIDENT OF THE
SENATE, THREE TO BE APPOINTED BY THE SPEAKER OF THE  ASSEMBLY,  AND  ONE
EACH TO BE APPOINTED BY THE MINORITY LEADER OF THE SENATE AND THE ASSEM-
BLY.  THE SUPERINTENDENT AND THE COMMISSIONER OF HEALTH, OR THEIR DESIG-

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD06908-01-9
              

A. 4223                             2

NATED REPRESENTATIVES, SHALL ALSO SERVE AS MEMBERS  OF  THE  COMMISSION.
THE MEMBERS SHALL ELECT A PERSON TO SERVE AS CHAIR.
  (C)  EACH MEMBER SHALL SERVE FOR A TERM OF FOUR YEARS. VACANCIES SHALL
BE APPOINTED IN THE SAME MANNER AS ORIGINAL APPOINTMENTS. THE MEMBERS OF
THE COMMISSION SHALL RECEIVE NO  COMPENSATION  FOR  THEIR  SERVICES  BUT
SHALL  BE ALLOWED ACTUAL AND NECESSARY EXPENSES INCURRED IN THE PERFORM-
ANCE OF THEIR DUTIES. THE COMMISSION MAY REQUEST AND SHALL RECEIVE  FROM
ANY  DEPARTMENT,  BOARD,  BUREAU,  COMMISSION,  OFFICE,  AGENCY OR OTHER
INSTRUMENTALITY OF THE STATE, SUCH FACILITIES, ASSISTANCE AND DATA AS IT
DEEMS NECESSARY OR DESIRABLE FOR THE PROPER EXECUTION OF ITS POWERS  AND
DUTIES. THE COMMISSION MAY SEEK THE ASSISTANCE AND ADVICE OF ANY PERSON,
ORGANIZATION  OR  ENTITY AS MAY BE RELEVANT OR NECESSARY AND MAY HIRE OR
CONTRACT WITH ANY SUCH PERSON, ORGANIZATION OR  ENTITY.  THE  COMMISSION
SHALL  HAVE  THE  POWER TO HOLD PUBLIC HEARINGS AND SOLICIT TESTIMONY ON
ANY MATTER IT DEEMS RELEVANT TO CARRYING OUT ITS MISSION.
  (D) THE COMMISSION SHALL, UPON THE WRITTEN REQUEST  OF  THE  GOVERNOR,
THE  TEMPORARY  PRESIDENT  OF THE SENATE OR THE SPEAKER OF THE ASSEMBLY,
CONDUCT A REVIEW AND PUBLIC COMMENT PERIOD, AND ISSUE A REPORT  RELATING
TO  SPECIFIED  LEGISLATION  WHICH WOULD ENACT A MANDATED HEALTH BENEFIT.
SUCH ISSUANCE SHALL:
  (1) CONSIDER AND SUMMARIZE ALL  PUBLIC  COMMENT  AND  ALL  SCIENTIFIC,
MEDICAL,  AND ACTUARIAL DATA AND INFORMATION PROVIDED OR OBTAINED RELAT-
ING TO THE PROPOSED MANDATED HEALTH BENEFIT;
  (2) REPORT ON PUBLIC AND PATIENT HEALTH ISSUES, INCLUDING:
  (I) THE EXTENT TO WHICH THE PROPOSED MANDATED HEALTH BENEFIT IS AVAIL-
ABLE AND UTILIZED BY THE STATE'S POPULATION  AND  THE  LEVEL  OF  PUBLIC
DEMAND FOR THE BENEFIT;
  (II)  THE  EXTENT  TO  WHICH  THE  PROPOSED MANDATED HEALTH BENEFIT IS
ALREADY A COVERED HEALTH BENEFIT;
  (III) IF COVERAGE IS NOT GENERALLY AVAILABLE, THE EXTENT TO WHICH  THE
LACK  OF  COVERAGE  RESULTS  IN PERSONS BEING UNABLE TO OBTAIN NECESSARY
HEALTH CARE AND RESULTS IN FINANCIAL HARDSHIP  FOR  THOSE  NEEDING  SUCH
CARE;
  (IV)  PROJECTED  UTILIZATION  RATES  AND ACCESS TO SERVICE WHICH WOULD
RESULT FROM THE PROPOSED MANDATED HEALTH BENEFIT;
  (V) WHETHER THE PROPOSED MANDATED HEALTH BENEFIT IS  A  MEDICAL  OR  A
BROADER SOCIAL NEED AND WHETHER IT IS CONSISTENT WITH THE ROLE OF HEALTH
INSURANCE AND MANAGED HEALTH CARE; AND
  (VI)  THE  EXTENT  TO  WHICH  THE  PROPOSED MANDATED HEALTH BENEFIT IS
GENERALLY RECOGNIZED BY THE MEDICAL COMMUNITY  AS  BEING  EFFECTIVE  AND
EFFICACIOUS, INCLUDING APPROPRIATE REVIEW BY SCIENTIFIC AND MEDICAL PEER
REVIEW LITERATURE;
  (3) REPORT ON ACCESS TO COVERAGE AND ECONOMIC ISSUES INCLUDING:
  (I)  THE IMPACT ON PREMIUMS, RATES AND COSTS OF HEALTH COVERAGE IN ALL
AFFECTED MARKETS;
  (II) THE IMPACT THAT THE PROPOSED MANDATED HEALTH BENEFIT MAY HAVE  ON
THE AVAILABILITY OF OTHER BENEFITS; AND
  (III) THE IMPACT THAT THE PROPOSED MANDATED HEALTH BENEFIT MAY HAVE ON
THE  AVAILABILITY  OF  HEALTH  COVERAGE IN EACH AFFECTED MARKET, AND THE
IMPACT ON THE NUMBER OF PERSONS COVERED THROUGH SELF-INSURED PLANS; AND
  (4) REPORT ON ANY OTHER MATTER, QUESTION  OR  CONCERN  RELATING  TO  A
MANDATED  HEALTH BENEFIT AS MAY BE DETERMINED RELEVANT BY THE COMMISSION
OR BY THE PERSON HAVING ISSUED THE REQUEST.
  (E) THE COMMISSION, UPON RECEIPT OF A REQUEST, SHALL  ALLOW  A  THIRTY
DAY  PUBLIC  COMMENT PERIOD AND SHALL ISSUE A REPORT TO THE GOVERNOR AND
THE LEGISLATURE WITHIN NINETY DAYS AFTER RECEIPT OF A  WRITTEN  REQUEST.

A. 4223                             3

THE  COMMISSION  MAY  EXTEND  ITS  REVIEW PERIOD AND REPORTING TIME UPON
CONSENT OF THE PERSON HAVING ISSUED THE REQUEST.
  (F)  THE  COMMISSION  SHALL  REVIEW  AND  REPORT ON UTILIZATION RATES,
PUBLIC AND PATIENT HEALTH EFFECTS, AND IMPACT ON PREMIUMS AND ACCESS  TO
HEALTH CARE AND HEALTH COVERAGE OF ALL MANDATED HEALTH BENEFITS EXISTING
ON THE EFFECTIVE DATE OF THIS SECTION.
  S 3. This act shall take effect immediately.