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

                                 3042--A

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                            January 29, 2013
                               ___________

Introduced  by  Sens. GALLIVAN, LARKIN, SEWARD -- read twice and ordered
  printed, and when printed to be committed to the Committee  on  Insur-
  ance  --  recommitted to the Committee on Insurance in accordance with
  Senate Rule 6, sec. 8 -- committee discharged, bill  amended,  ordered
  reprinted as amended and recommitted to said committee

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:

  Section  1. Section 213 of the insurance law, as added by section 1 of
part L of chapter 57 of the laws of 2007, is amended to read as follows:
  S 213. New York state health care quality and cost containment commis-
sion. (a) There is hereby established within the  department  a  commis-
sion,  to  be  known as the "New York state health care quality and cost
containment  commission".  The  commission  shall  consist  of  thirteen
members  appointed by the governor, one of whom shall be the superinten-
dent, one of whom shall be the commissioner of health, and six  of  whom
shall be appointed on the recommendation of the legislative leaders, two
on  the  recommendation of the temporary president of the senate, two on
the recommendation of the speaker of the assembly, one on the  recommen-
dation  of the minority leader of the senate, and one on the recommenda-
tion of the minority leader of the assembly. All members shall serve  at
the  pleasure  of  the governor, and vacancies shall be appointed in the
same manner as original appointments. Members of  the  commission  shall
serve without compensation, but shall be reimbursed for reasonable trav-
el  expenses.  In  making  appointments  to the commission, the governor
shall ensure that the interests of health care  consumers,  small  busi-
nesses,  the  medical  community and health plans are represented on the
commission, AND THAT THE COMMISSION INCLUDE AT LEAST  ONE  ACTUARY,  ONE
EXPERT  ON  HEALTH BENEFITS, HAVING NO LESS THAN FIFTEEN YEARS OF DIRECT
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.
                                                           LBD07566-02-4
              

S. 3042--A                          2

COMMISSION SHALL BE SEATED NO LATER THAN NINETY DAYS AFTER THE EFFECTIVE
DATE  OF  THE CHAPTER OF THE LAWS OF TWO THOUSAND FOURTEEN WHICH AMENDED
THIS SECTION AND ALL VACANCIES SHALL BE FILLED AS SOON AS PRACTICABLE.
  (b)(1) The purpose of the commission shall be to analyze the impact on
health  insurance  costs and quality of proposed legislation which would
mandate that health benefits be offered or made available in  individual
and  group health insurance policies, contracts and comprehensive health
service plans, including legislation that affects the delivery of health
benefits or services or the reimbursement of health care providers.
  (2) The governor, the chair of the senate insurance committee and  the
chair  of  the  assembly insurance committee may request in writing that
the commission evaluate a proposed mandated benefit. Upon receiving such
a request, the commission [may, by a  majority  vote  of  its  members,]
SHALL undertake an evaluation of such proposed mandated benefit.
  (3) In evaluating a proposed mandated benefit, the commission shall:
  (A)  investigate  the current practices of health plans with regard to
the proposed mandated benefit, and, to the extent possible,  self-funded
health benefit plans;
  (B)  investigate the potential premium impact of the proposed mandated
benefits on all segments of the insurance market, as well as the  poten-
tial  for  avoided costs through early detection and treatment of condi-
tions, or more cost-effective delivery of medical services; [and]
  (C) analyze the most current [medical]  AND  CREDIBLE  EVIDENCE  BASED
MEDICINE literature regarding the proposed mandated benefit PUBLISHED IN
PEER  REVIEWED  MEDICAL  LITERATURE GENERALLY RECOGNIZED BY THE RELEVANT
MEDICAL  COMMUNITY  to  determine  THE  EFFECTIVENESS  OF  THE  PROPOSED
MANDATED BENEFIT AND its impact on health care quality[.]; AND
  (D)  INVESTIGATE  THE  POTENTIAL  COST  TO  THE  STATE OF THE PROPOSED
MANDATED BENEFITS IN LIGHT OF THE IMPLEMENTATION OF THE FEDERAL AFFORDA-
BLE CARE ACT.
  (4) In evaluating a proposed mandated benefit, the commission may hold
one or more public hearings, and shall strive to obtain independent  and
verifiable information from diverse sources within the healthcare indus-
try,  medical  community  and among health care consumers with regard to
the proposed mandated benefit.
  (c) To assist the commission in its duties, and upon the direction  of
the  commission,  the  superintendent is authorized to enter into one or
more contracts with independent entities and organizations  with  demon-
strable expertise in health care quality, finance, utilization and actu-
arial  services.  For  the  purposes of this section, the superintendent
shall not enter into contracts with health plans, entities or  organiza-
tions  owned or controlled by health plans, or with significant business
relationships with health plans.
  (d) Upon completion of its evaluation of a proposed  mandated  benefit
pursuant  to this section, the commission shall deliver a written report
of its findings to the chair of the assembly insurance committee and the
chair of the senate insurance committee.
  (E)(1) BEGINNING NO LATER THAN NINE MONTHS  AFTER  THE  COMMISSION  IS
SEATED,  AND  REOCCURRING NO LESS OFTEN THAN ONCE EVERY THREE YEARS, THE
COMMISSION SHALL ANALYZE THE IMPACT ON HEALTH INSURANCE COSTS AND QUALI-
TY OF ALL STATE LAWS WHICH MANDATE THAT HEALTH BENEFITS  BE  OFFERED  OR
MADE  AVAILABLE  IN  INDIVIDUAL  AND  GROUP  HEALTH  INSURANCE POLICIES,
CONTRACTS AND COMPREHENSIVE HEALTH  SERVICE  PLANS,  INCLUDING  BUT  NOT
LIMITED  TO LAWS THAT AFFECT THE DELIVERY OF HEALTH BENEFITS OR SERVICES
OR THE REIMBURSEMENT OF HEALTH CARE PROVIDERS.
  (2) IN EVALUATING EACH MANDATED BENEFIT, THE COMMISSION SHALL:

S. 3042--A                          3

  (A) INVESTIGATE THE CURRENT PRACTICES OF HEALTH PLANS WITH  REGARD  TO
THE  MANDATED  BENEFIT,  AND, TO THE EXTENT POSSIBLE, SELF-FUNDED HEALTH
BENEFIT PLANS INCLUDING BUT NOT LIMITED TO AVOIDED COSTS  THROUGH  EARLY
DETECTION  AND  TREATMENT OF CONDITIONS, OR MORE COST-EFFECTIVE DELIVERY
OF MEDICAL SERVICES;
  (B) INVESTIGATE THE POTENTIAL PREMIUM IMPACT OF REPEALING AND/OR MODI-
FYING THE MANDATED BENEFITS ON ALL SEGMENTS OF THE INSURANCE MARKET;
  (C)  ANALYZE  THE  MOST  CURRENT  AND CREDIBLE EVIDENCE BASED MEDICINE
LITERATURE REGARDING THE MANDATED BENEFIT  PUBLISHED  IN  PEER  REVIEWED
MEDICAL LITERATURE GENERALLY RECOGNIZED BY THE RELEVANT MEDICAL COMMUNI-
TY TO DETERMINE THE EFFECTIVENESS OF THE MANDATED BENEFIT AND ITS IMPACT
ON HEALTH CARE QUALITY; AND
  (D)  INVESTIGATE  THE  POTENTIAL  COST  TO  THE  STATE OF THE PROPOSED
MANDATED BENEFITS IN LIGHT OF THE IMPLEMENTATION OF THE FEDERAL AFFORDA-
BLE CARE ACT.
  (3) IN EVALUATING MANDATED BENEFITS, THE COMMISSION SHALL HOLD NO LESS
THAN TWO PUBLIC HEARINGS, AND SHALL STRIVE  TO  OBTAIN  INDEPENDENT  AND
VERIFIABLE  INFORMATION  FROM  DIVERSE  SOURCES  WITHIN  THE HEALTH CARE
INDUSTRY, MEDICAL COMMUNITY AND AMONG HEALTH CARE CONSUMERS WITH  REGARD
TO EACH MANDATED BENEFIT.
  (4)(A)  ON  OR BEFORE THE FIRST DAY OF FEBRUARY, TWO THOUSAND FIFTEEN,
THE COMMISSION SHALL SUBMIT TO THE LEGISLATURE AND  DISSEMINATE  TO  THE
PUBLIC  RECOMMENDATIONS FOR THE REPEAL AND/OR MODIFICATION OF STATE LAWS
WHICH MANDATE BENEFITS, ALONG WITH A SINGLE PIECE OF LEGISLATION  NECES-
SARY  TO IMPLEMENT SUCH RECOMMENDATIONS. THESE RECOMMENDATIONS SHALL NOT
BE EXPECTED TO INCREASE THE AVERAGE PREMIUM IN THE STATE.  UPON  RECEIPT
OF  SUCH RECOMMENDATIONS, THE IMPLEMENTING LEGISLATION THEREFOR SHALL BE
INTRODUCED IN BOTH HOUSES OF  THE  LEGISLATURE  WITHOUT  ANY  AMENDMENTS
WITHIN FIVE DAYS.
  (B)  THE  LEGISLATION  INTRODUCED PURSUANT TO SUBPARAGRAPH (A) OF THIS
PARAGRAPH SHALL BE VOTED UPON, WITHOUT AMENDMENT, BY BOTH SUCH HOUSES OF
THE LEGISLATURE WITHIN NINETY DAYS, BUT NOT  SOONER  THAN  THIRTY  DAYS,
AFTER  THE COMMISSION SUBMITS ITS RECOMMENDATIONS TO THE LEGISLATURE. IF
APPROVED, THE LEGISLATURE SHALL FORWARD SUCH LEGISLATION TO THE GOVERNOR
WITHIN FIVE DAYS.
  S 2. This act shall take effect immediately.