Bill Text: NY A04267 | 2023-2024 | General Assembly | Introduced
Bill Title: Establishes the New York state public health care option program to provide a comprehensive and affordable health care insurance option for all residents of this state; establishes the New York state public health care option program fund.
Spectrum: Partisan Bill (Democrat 6-0)
Status: (Introduced) 2024-07-15 - enacting clause stricken [A04267 Detail]
Download: New_York-2023-A04267-Introduced.html
STATE OF NEW YORK ________________________________________________________________________ 4267 2023-2024 Regular Sessions IN ASSEMBLY 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: 1 Section 1. Article 2 of the public health law is amended by adding a 2 new title 3-A to read as follows: 3 TITLE III-A 4 NEW YORK STATE PUBLIC HEALTH CARE OPTION PROGRAM 5 Section 245. Definitions. 6 245-a. Public option program established. 7 245-b. Powers of the commissioner. 8 245-c. Member costs; limitations. 9 245-d. Board of trustees. 10 § 245. Definitions. As used in this title the terms shall have the 11 following meanings: 12 1. "Board" means the board of trustees of the New York state public 13 health care option program. 14 2. "Cost sharing expense" means deductibles, co-insurance, co-pay- 15 ments, or any other required similar expense incurred by a member. "Cost 16 sharing expense" shall not include premiums or any expenses related to 17 services or providers that are out of the program's network. 18 3. "Health care provider" means any individual or entity authorized to 19 provide medical and/or health care services to members of the program. 20 4. "Health care service" means any health care service, including care 21 coordination, included as a benefit under the program. 22 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. LBD04745-01-3A. 4267 2 1 6. "New York state public health care option program", "public option 2 program", and "program" mean the New York state public health care 3 option program created by section two hundred forty-five-a of this 4 title. 5 7. "New York state public health care option program fund" means the 6 New York state public health care option program fund established under 7 section ninety-nine-r of the state finance law. 8 8. "Participating provider" means any individual or entity that is a 9 health care provider qualified and approved by the programs to provide 10 health care services to members under the program, or a health care 11 organization. 12 § 245-a. Public option program established. The New York state public 13 health care option program is hereby established. The commissioner shall 14 establish and implement the program pursuant to this title. The program 15 shall provide a comprehensive and affordable health care insurance 16 option for all residents of this state who choose to enroll in the 17 program. The commissioner shall ensure that coverage provided through 18 the program is competitive in terms of affordability, benefits and 19 access to quality health care providers. Every resident of the state 20 shall be eligible and entitled to enroll as a member under the program. 21 § 245-b. Powers of the commissioner. In carrying out the provisions of 22 this act, the commissioner shall have the power and authority to: 23 1. Establish premiums for which members are responsible and other 24 charges for enrolling in or being a member under the program. 25 2. Ensure that the program's plans shall be available for enrollment 26 on the Marketplace as provided in title seven of this article. 27 3. Establish criteria and standards for health care providers to be 28 qualified for participation in the program and grounds for revocation of 29 such participation. 30 4. Establish coverage for the program including all health care 31 services that members would be eligible to receive and maintain an 32 updated list of participating providers. Such coverage shall ensure that 33 all plans meet the requirements of a qualified health plan by the 34 Marketplace pursuant to section two hundred sixty-eight-c of this arti- 35 cle. 36 5. Establish and maintain procedures and standards for recognizing 37 health care providers located out of the state for purposes of providing 38 coverage under the program for out-of-state health care services. 39 6. Develop payment methodologies and rates for health care services 40 provided by participating providers including a methodology for reason- 41 able and customary fees for out of network health care services incurred 42 by members. 43 7. Create an enrollment process for employers with less than one 44 hundred employees to participate in the program. Any participating 45 employer shall meet standards established by the commissioner including 46 but not limited to, establishing an annual limitation on employee 47 contributions and provisions for compliance with applicable collective 48 bargaining agreements. Notwithstanding any provision to the contrary, 49 any employee of a participating employer may enroll as a member of the 50 program regardless of whether they are a resident of the state. 51 8. Submit an implementation plan to the governor and state legislature 52 no later than twelve months following the effective date of this section 53 that will provide a detailed plan on timelines for enrollment, coverage, 54 premium schedule, benefits and other relevant information related to the 55 implementation of the program.A. 4267 3 1 9. Seek all applicable federal waivers or other federal approvals for 2 the operations of the program including federal approval to authorize 3 the use of premium tax credits for applicable members for enrollment in 4 the program. 5 10. Utilize any funds from the New York state public health care 6 option program fund for purposes supporting the operations of the 7 program. 8 § 245-c. Member costs; limitations. 1. The commissioner shall estab- 9 lish a base rate for enrollment in the program. The rates for enrollment 10 shall include a formula that adjusts premiums based on household size 11 and income. The premium schedule and formula shall ensure that the 12 program remains viable, but at the lowest possible cost to members. The 13 commissioner shall establish benchmark goals for premiums that should 14 seek to be below comparable commercially available plans. 15 2. The commissioner shall determine other deductibles, co-payments or 16 co-insurance under the program in a manner that ensures the program 17 remains viable but is affordable for members. 18 3. The commissioner shall establish an annual limitation for cost 19 sharing expenses for members and annually update such limitation. Such 20 limitation shall be based on cost growth factor established by the 21 commissioner. 22 4. The commissioner shall ensure that eligible members can receive any 23 applicable premium tax credits. 24 § 245-d. Board of trustees. 1. The board of the New York State public 25 health care option program is hereby established within the department. 26 2. The board shall, at the request of the commissioner, develop and 27 submit recommendations related to the implementation of this title. The 28 commissioner may propose regulations under this title for consideration 29 by the board. The board shall have power to establish and amend regu- 30 lations to effectuate the provisions of this title which shall be 31 subject to approval by the commissioner. 32 3. The board shall be comprised of thirteen trustees to be appointed 33 as follows: 34 a. the commissioner of health and the superintendent of the department 35 of financial services shall serve as ex-officio trustees; 36 b. five trustees shall be appointed by the governor; 37 c. two trustees shall be appointed by the temporary president of the 38 senate; 39 d. two trustees shall be appointed by the speaker of the assembly; 40 e. one trustee shall be appointed by the minority leader of the 41 senate; and 42 f. one trustee shall be appointed by the minority leader of the assem- 43 bly. 44 4. The board shall meet at least four times each calendar year. Meet- 45 ings shall be held upon the call of the chair and as provided by the 46 board. A majority of the appointed trustees shall constitute a quorum of 47 the board. Actions may be taken, and motions and resolutions adopted by 48 the board with the affirmative vote of at least seven trustees. The 49 board may establish an executive committee to exercise any powers or 50 duties of the board as it may provide, and other committees to assist 51 the board or the executive committee. The chair of the board shall chair 52 the executive committee and shall appoint the chair and trustees of all 53 other committees. The board may appoint one or more advisory committees. 54 Members of advisory committees need not be trustees of the board.A. 4267 4 1 5. The trustees of the board shall serve terms of four years. Subse- 2 quent appointments upon the expiration of term shall be filled in the 3 same manner as the original appointment. 4 6. The trustees of the board shall elect one of their trustees to 5 serve as chairperson during his or her appointment term or for a period 6 of four years, whichever is shorter. 7 7. Trustees of the board shall serve without compensation but shall be 8 allowed their actual and necessary expenses incurred in the performance 9 of their duties. 10 8. The board and its committees and advisory committees may request 11 and receive the assistance of the department and any other state or 12 local governmental entity in exercising its powers and duties. 13 9. The board, in consultation with the commissioner, may submit recom- 14 mendations to the governor and legislature related to the provisions of 15 this article. 16 10. Within twelve months from the enactment of this title, the board, 17 in consultation with the commissioner, shall make a recommendation to 18 the governor and legislature on whether any additional revenue, taxes or 19 assessments are necessary to implement the program. 20 § 2. The state finance law is amended by adding a new section 99-r to 21 read as follows: 22 § 99-r. New York state public health care option program fund. 1. 23 There is hereby established in the joint custody of the comptroller and 24 the commissioner of taxation and finance a debt service fund to be known 25 as the "New York state public health care option program fund". 26 2. Such fund shall consist of all revenues received through premiums, 27 co-insurance or other related fees from members enrolled in the New York 28 state public health care option program pursuant to title three-A of 29 article two of the public health law, any federal payments received for 30 such purpose, state funds transferred to the fund for the purposes of 31 support for the New York state public health care option program or any 32 other revenue generated that is dedicated towards the purpose of 33 supporting the New York state public health care option program. Nothing 34 contained in this section shall prevent the state from receiving grants, 35 gifts or bequests for the purposes of the fund as defined in this 36 section and depositing them into the fund according to law. 37 3. The moneys in such fund shall be expended and transferred for the 38 purposes of operating the New York state public health care option 39 program and any reasonable expenses related thereto. 40 § 3. This act shall take effect on the one hundred eightieth day after 41 it shall have become a law.
