S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   4267
 
                        2023-2024 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             February 14, 2023
                                ___________
 
 Introduced by M. of A. ZEBROWSKI, BENEDETTO, THIELE, BURDICK, GUNTHER --
   read once and referred to the Committee on Health
 
 AN  ACT  to amend the public health law, in relation to establishing the
   New York state public health care option program;  and  to  amend  the
   state  finance  law,  in  relation  to establishing the New York state
   public health care option program fund
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  Article 2 of the public health law is amended by adding a
 new title 3-A to read as follows:
                                TITLE III-A
             NEW YORK STATE PUBLIC HEALTH CARE OPTION PROGRAM
 SECTION 245.   DEFINITIONS.
         245-A. PUBLIC OPTION PROGRAM ESTABLISHED.
         245-B. POWERS OF THE COMMISSIONER.
         245-C. MEMBER COSTS; LIMITATIONS.
         245-D. BOARD OF TRUSTEES.
   § 245. DEFINITIONS. AS USED IN THIS TITLE THE  TERMS  SHALL  HAVE  THE
 FOLLOWING MEANINGS:
   1.  "BOARD"  MEANS  THE BOARD OF TRUSTEES OF THE NEW YORK STATE PUBLIC
 HEALTH CARE OPTION PROGRAM.
   2. "COST SHARING EXPENSE"  MEANS  DEDUCTIBLES,  CO-INSURANCE,  CO-PAY-
 MENTS, OR ANY OTHER REQUIRED SIMILAR EXPENSE INCURRED BY A MEMBER. "COST
 SHARING  EXPENSE"  SHALL NOT INCLUDE PREMIUMS OR ANY EXPENSES RELATED TO
 SERVICES OR PROVIDERS THAT ARE OUT OF THE PROGRAM'S NETWORK.
   3. "HEALTH CARE PROVIDER" MEANS ANY INDIVIDUAL OR ENTITY AUTHORIZED TO
 PROVIDE MEDICAL AND/OR HEALTH CARE SERVICES TO MEMBERS OF THE PROGRAM.
   4. "HEALTH CARE SERVICE" MEANS ANY HEALTH CARE SERVICE, INCLUDING CARE
 COORDINATION, INCLUDED AS A BENEFIT UNDER THE PROGRAM.
   5. "MEMBER" MEANS AN INDIVIDUAL WHO IS ENROLLED IN THE PROGRAM.

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD04745-01-3
 A. 4267                             2
              

 
   6. "NEW YORK STATE PUBLIC HEALTH CARE OPTION PROGRAM", "PUBLIC  OPTION
 PROGRAM",  AND  "PROGRAM"  MEAN  THE  NEW  YORK STATE PUBLIC HEALTH CARE
 OPTION PROGRAM CREATED BY  SECTION  TWO  HUNDRED  FORTY-FIVE-A  OF  THIS
 TITLE.
   7.  "NEW  YORK STATE PUBLIC HEALTH CARE OPTION PROGRAM FUND" MEANS THE
 NEW YORK STATE PUBLIC HEALTH CARE OPTION PROGRAM FUND ESTABLISHED  UNDER
 SECTION NINETY-NINE-R OF THE STATE FINANCE LAW.
   8.  "PARTICIPATING  PROVIDER" MEANS ANY INDIVIDUAL OR ENTITY THAT IS A
 HEALTH CARE PROVIDER QUALIFIED AND APPROVED BY THE PROGRAMS  TO  PROVIDE
 HEALTH  CARE  SERVICES  TO  MEMBERS  UNDER THE PROGRAM, OR A HEALTH CARE
 ORGANIZATION.
   § 245-A. PUBLIC OPTION PROGRAM ESTABLISHED. THE NEW YORK STATE  PUBLIC
 HEALTH CARE OPTION PROGRAM IS HEREBY ESTABLISHED. THE COMMISSIONER SHALL
 ESTABLISH  AND IMPLEMENT THE PROGRAM PURSUANT TO THIS TITLE. THE PROGRAM
 SHALL PROVIDE A  COMPREHENSIVE  AND  AFFORDABLE  HEALTH  CARE  INSURANCE
 OPTION  FOR  ALL  RESIDENTS  OF  THIS  STATE WHO CHOOSE TO ENROLL IN THE
 PROGRAM. THE COMMISSIONER SHALL ENSURE THAT  COVERAGE  PROVIDED  THROUGH
 THE  PROGRAM  IS  COMPETITIVE  IN  TERMS  OF AFFORDABILITY, BENEFITS AND
 ACCESS TO QUALITY HEALTH CARE PROVIDERS.   EVERY RESIDENT OF  THE  STATE
 SHALL BE ELIGIBLE AND ENTITLED TO ENROLL AS A MEMBER UNDER THE PROGRAM.
   § 245-B. POWERS OF THE COMMISSIONER. IN CARRYING OUT THE PROVISIONS OF
 THIS ACT, THE COMMISSIONER SHALL HAVE THE POWER AND AUTHORITY TO:
   1.  ESTABLISH  PREMIUMS  FOR  WHICH  MEMBERS ARE RESPONSIBLE AND OTHER
 CHARGES FOR ENROLLING IN OR BEING A MEMBER UNDER THE PROGRAM.
   2. ENSURE THAT THE PROGRAM'S PLANS SHALL BE AVAILABLE  FOR  ENROLLMENT
 ON THE MARKETPLACE AS PROVIDED IN TITLE SEVEN OF THIS ARTICLE.
   3.  ESTABLISH  CRITERIA  AND STANDARDS FOR HEALTH CARE PROVIDERS TO BE
 QUALIFIED FOR PARTICIPATION IN THE PROGRAM AND GROUNDS FOR REVOCATION OF
 SUCH PARTICIPATION.
   4. ESTABLISH COVERAGE  FOR  THE  PROGRAM  INCLUDING  ALL  HEALTH  CARE
 SERVICES  THAT  MEMBERS  WOULD  BE  ELIGIBLE  TO RECEIVE AND MAINTAIN AN
 UPDATED LIST OF PARTICIPATING PROVIDERS. SUCH COVERAGE SHALL ENSURE THAT
 ALL PLANS MEET THE REQUIREMENTS  OF  A  QUALIFIED  HEALTH  PLAN  BY  THE
 MARKETPLACE  PURSUANT TO SECTION TWO HUNDRED SIXTY-EIGHT-C OF THIS ARTI-
 CLE.
   5. ESTABLISH AND MAINTAIN PROCEDURES  AND  STANDARDS  FOR  RECOGNIZING
 HEALTH CARE PROVIDERS LOCATED OUT OF THE STATE FOR PURPOSES OF PROVIDING
 COVERAGE UNDER THE PROGRAM FOR OUT-OF-STATE HEALTH CARE SERVICES.
   6.  DEVELOP  PAYMENT  METHODOLOGIES AND RATES FOR HEALTH CARE SERVICES
 PROVIDED BY PARTICIPATING PROVIDERS INCLUDING A METHODOLOGY FOR  REASON-
 ABLE AND CUSTOMARY FEES FOR OUT OF NETWORK HEALTH CARE SERVICES INCURRED
 BY MEMBERS.
   7.  CREATE  AN  ENROLLMENT  PROCESS  FOR  EMPLOYERS WITH LESS THAN ONE
 HUNDRED EMPLOYEES TO  PARTICIPATE  IN  THE  PROGRAM.  ANY  PARTICIPATING
 EMPLOYER  SHALL MEET STANDARDS ESTABLISHED BY THE COMMISSIONER INCLUDING
 BUT NOT LIMITED  TO,  ESTABLISHING  AN  ANNUAL  LIMITATION  ON  EMPLOYEE
 CONTRIBUTIONS  AND  PROVISIONS FOR COMPLIANCE WITH APPLICABLE COLLECTIVE
 BARGAINING AGREEMENTS.  NOTWITHSTANDING ANY PROVISION TO  THE  CONTRARY,
 ANY  EMPLOYEE  OF A PARTICIPATING EMPLOYER MAY ENROLL AS A MEMBER OF THE
 PROGRAM REGARDLESS OF WHETHER THEY ARE A RESIDENT OF THE STATE.
   8. SUBMIT AN IMPLEMENTATION PLAN TO THE GOVERNOR AND STATE LEGISLATURE
 NO LATER THAN TWELVE MONTHS FOLLOWING THE EFFECTIVE DATE OF THIS SECTION
 THAT WILL PROVIDE A DETAILED PLAN ON TIMELINES FOR ENROLLMENT, COVERAGE,
 PREMIUM SCHEDULE, BENEFITS AND OTHER RELEVANT INFORMATION RELATED TO THE
 IMPLEMENTATION OF THE PROGRAM.
 A. 4267                             3
 
   9. SEEK ALL APPLICABLE FEDERAL WAIVERS OR OTHER FEDERAL APPROVALS  FOR
 THE  OPERATIONS  OF  THE PROGRAM INCLUDING FEDERAL APPROVAL TO AUTHORIZE
 THE USE OF PREMIUM TAX CREDITS FOR APPLICABLE MEMBERS FOR ENROLLMENT  IN
 THE PROGRAM.
   10.  UTILIZE  ANY  FUNDS  FROM  THE  NEW YORK STATE PUBLIC HEALTH CARE
 OPTION PROGRAM FUND  FOR  PURPOSES  SUPPORTING  THE  OPERATIONS  OF  THE
 PROGRAM.
   §  245-C.  MEMBER COSTS; LIMITATIONS. 1. THE COMMISSIONER SHALL ESTAB-
 LISH A BASE RATE FOR ENROLLMENT IN THE PROGRAM. THE RATES FOR ENROLLMENT
 SHALL INCLUDE A FORMULA THAT ADJUSTS PREMIUMS BASED  ON  HOUSEHOLD  SIZE
 AND  INCOME.  THE  PREMIUM  SCHEDULE  AND  FORMULA SHALL ENSURE THAT THE
 PROGRAM REMAINS VIABLE, BUT AT THE LOWEST POSSIBLE COST TO MEMBERS.  THE
 COMMISSIONER  SHALL  ESTABLISH  BENCHMARK GOALS FOR PREMIUMS THAT SHOULD
 SEEK TO BE BELOW COMPARABLE COMMERCIALLY AVAILABLE PLANS.
   2. THE COMMISSIONER SHALL DETERMINE OTHER DEDUCTIBLES, CO-PAYMENTS  OR
 CO-INSURANCE  UNDER  THE  PROGRAM  IN  A MANNER THAT ENSURES THE PROGRAM
 REMAINS VIABLE BUT IS AFFORDABLE FOR MEMBERS.
   3. THE COMMISSIONER SHALL ESTABLISH  AN  ANNUAL  LIMITATION  FOR  COST
 SHARING  EXPENSES  FOR MEMBERS AND ANNUALLY UPDATE SUCH LIMITATION. SUCH
 LIMITATION SHALL BE BASED ON  COST  GROWTH  FACTOR  ESTABLISHED  BY  THE
 COMMISSIONER.
   4. THE COMMISSIONER SHALL ENSURE THAT ELIGIBLE MEMBERS CAN RECEIVE ANY
 APPLICABLE PREMIUM TAX CREDITS.
   §  245-D. BOARD OF TRUSTEES. 1. THE BOARD OF THE NEW YORK STATE PUBLIC
 HEALTH CARE OPTION PROGRAM IS HEREBY ESTABLISHED WITHIN THE DEPARTMENT.
   2. THE BOARD SHALL, AT THE REQUEST OF THE  COMMISSIONER,  DEVELOP  AND
 SUBMIT  RECOMMENDATIONS RELATED TO THE IMPLEMENTATION OF THIS TITLE. THE
 COMMISSIONER MAY PROPOSE REGULATIONS UNDER THIS TITLE FOR  CONSIDERATION
 BY  THE  BOARD.  THE BOARD SHALL HAVE POWER TO ESTABLISH AND AMEND REGU-
 LATIONS TO EFFECTUATE THE  PROVISIONS  OF  THIS  TITLE  WHICH  SHALL  BE
 SUBJECT TO APPROVAL BY THE COMMISSIONER.
   3.  THE  BOARD SHALL BE COMPRISED OF THIRTEEN TRUSTEES TO BE APPOINTED
 AS FOLLOWS:
   A. THE COMMISSIONER OF HEALTH AND THE SUPERINTENDENT OF THE DEPARTMENT
 OF FINANCIAL SERVICES SHALL SERVE AS EX-OFFICIO TRUSTEES;
   B. FIVE TRUSTEES SHALL BE APPOINTED BY THE GOVERNOR;
   C. TWO TRUSTEES SHALL BE APPOINTED BY THE TEMPORARY PRESIDENT  OF  THE
 SENATE;
   D. TWO TRUSTEES SHALL BE APPOINTED BY THE SPEAKER OF THE ASSEMBLY;
   E.  ONE  TRUSTEE  SHALL  BE  APPOINTED  BY  THE MINORITY LEADER OF THE
 SENATE; AND
   F. ONE TRUSTEE SHALL BE APPOINTED BY THE MINORITY LEADER OF THE ASSEM-
 BLY.
   4. THE BOARD SHALL MEET AT LEAST FOUR TIMES EACH CALENDAR YEAR.  MEET-
 INGS SHALL BE HELD UPON THE CALL OF THE CHAIR AND  AS  PROVIDED  BY  THE
 BOARD. A MAJORITY OF THE APPOINTED TRUSTEES SHALL CONSTITUTE A QUORUM OF
 THE  BOARD. ACTIONS MAY BE TAKEN, AND MOTIONS AND RESOLUTIONS ADOPTED BY
 THE BOARD WITH THE AFFIRMATIVE VOTE OF  AT  LEAST  SEVEN  TRUSTEES.  THE
 BOARD  MAY  ESTABLISH  AN  EXECUTIVE COMMITTEE TO EXERCISE ANY POWERS OR
 DUTIES OF THE BOARD AS IT MAY PROVIDE, AND OTHER  COMMITTEES  TO  ASSIST
 THE BOARD OR THE EXECUTIVE COMMITTEE. THE CHAIR OF THE BOARD SHALL CHAIR
 THE  EXECUTIVE COMMITTEE AND SHALL APPOINT THE CHAIR AND TRUSTEES OF ALL
 OTHER COMMITTEES. THE BOARD MAY APPOINT ONE OR MORE ADVISORY COMMITTEES.
 MEMBERS OF ADVISORY COMMITTEES NEED NOT BE TRUSTEES OF THE BOARD.
 A. 4267                             4
 
   5. THE TRUSTEES OF THE BOARD SHALL SERVE TERMS OF FOUR YEARS.   SUBSE-
 QUENT  APPOINTMENTS  UPON  THE EXPIRATION OF TERM SHALL BE FILLED IN THE
 SAME MANNER AS THE ORIGINAL APPOINTMENT.
   6.  THE  TRUSTEES  OF  THE  BOARD SHALL ELECT ONE OF THEIR TRUSTEES TO
 SERVE AS CHAIRPERSON DURING HIS OR HER APPOINTMENT TERM OR FOR A  PERIOD
 OF FOUR YEARS, WHICHEVER IS SHORTER.
   7. TRUSTEES OF THE BOARD SHALL SERVE WITHOUT COMPENSATION BUT SHALL BE
 ALLOWED  THEIR ACTUAL AND NECESSARY EXPENSES INCURRED IN THE PERFORMANCE
 OF THEIR DUTIES.
   8. THE BOARD AND ITS COMMITTEES AND ADVISORY  COMMITTEES  MAY  REQUEST
 AND  RECEIVE  THE  ASSISTANCE  OF  THE DEPARTMENT AND ANY OTHER STATE OR
 LOCAL GOVERNMENTAL ENTITY IN EXERCISING ITS POWERS AND DUTIES.
   9. THE BOARD, IN CONSULTATION WITH THE COMMISSIONER, MAY SUBMIT RECOM-
 MENDATIONS TO THE GOVERNOR AND LEGISLATURE RELATED TO THE PROVISIONS  OF
 THIS ARTICLE.
   10.  WITHIN TWELVE MONTHS FROM THE ENACTMENT OF THIS TITLE, THE BOARD,
 IN CONSULTATION WITH THE COMMISSIONER, SHALL MAKE  A  RECOMMENDATION  TO
 THE GOVERNOR AND LEGISLATURE ON WHETHER ANY ADDITIONAL REVENUE, TAXES OR
 ASSESSMENTS ARE NECESSARY TO IMPLEMENT THE PROGRAM.
   §  2. The state finance law is amended by adding a new section 99-r to
 read as follows:
   § 99-R. NEW YORK STATE PUBLIC HEALTH CARE OPTION  PROGRAM  FUND.    1.
 THERE  IS HEREBY ESTABLISHED IN THE JOINT CUSTODY OF THE COMPTROLLER AND
 THE COMMISSIONER OF TAXATION AND FINANCE A DEBT SERVICE FUND TO BE KNOWN
 AS THE "NEW YORK STATE PUBLIC HEALTH CARE OPTION PROGRAM FUND".
   2. SUCH FUND SHALL CONSIST OF ALL REVENUES RECEIVED THROUGH  PREMIUMS,
 CO-INSURANCE OR OTHER RELATED FEES FROM MEMBERS ENROLLED IN THE NEW YORK
 STATE  PUBLIC  HEALTH  CARE  OPTION PROGRAM PURSUANT TO TITLE THREE-A OF
 ARTICLE TWO OF THE PUBLIC HEALTH LAW, ANY FEDERAL PAYMENTS RECEIVED  FOR
 SUCH  PURPOSE,  STATE  FUNDS TRANSFERRED TO THE FUND FOR THE PURPOSES OF
 SUPPORT FOR THE NEW YORK STATE PUBLIC HEALTH CARE OPTION PROGRAM OR  ANY
 OTHER  REVENUE  GENERATED  THAT  IS  DEDICATED  TOWARDS  THE  PURPOSE OF
 SUPPORTING THE NEW YORK STATE PUBLIC HEALTH CARE OPTION PROGRAM. NOTHING
 CONTAINED IN THIS SECTION SHALL PREVENT THE STATE FROM RECEIVING GRANTS,
 GIFTS OR BEQUESTS FOR THE PURPOSES  OF  THE  FUND  AS  DEFINED  IN  THIS
 SECTION AND DEPOSITING THEM INTO THE FUND ACCORDING TO LAW.
   3.  THE  MONEYS IN SUCH FUND SHALL BE EXPENDED AND TRANSFERRED FOR THE
 PURPOSES OF OPERATING THE NEW  YORK  STATE  PUBLIC  HEALTH  CARE  OPTION
 PROGRAM AND ANY REASONABLE EXPENSES RELATED THERETO.
   § 3. This act shall take effect on the one hundred eightieth day after
 it shall have become a law.