STATE OF NEW YORK ________________________________________________________________________ 4498 2025-2026 Regular Sessions IN ASSEMBLY February 4, 2025 ___________ Introduced by M. of A. JENSEN -- read once and referred to the Committee on Insurance 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: 1 Section 1. Section 213 of the insurance law, as added by section 1 of 2 part L of chapter 57 of the laws of 2007, is amended to read as follows: 3 § 213. New York state health care quality and cost containment commis- 4 sion. (a) There is hereby established within the department a commis- 5 sion, to be known as the "New York state health care quality and cost 6 containment commission". The commission shall consist of thirteen 7 members appointed by the governor, one of whom shall be the superinten- 8 dent, one of whom shall be the commissioner of health, and six of whom 9 shall be appointed on the recommendation of the legislative leaders, two 10 on the recommendation of the temporary president of the senate, two on 11 the recommendation of the speaker of the assembly, one on the recommen- 12 dation of the minority leader of the senate, and one on the recommenda- 13 tion of the minority leader of the assembly. All members shall serve at 14 the pleasure of the governor, and vacancies shall be appointed in the 15 same manner as original appointments. Members of the commission shall 16 serve without compensation, but shall be reimbursed for reasonable trav- 17 el expenses. In making appointments to the commission, the governor 18 shall ensure that the interests of health care consumers, small busi- 19 nesses, the medical community and health plans are represented on the 20 commission, and that the commission include at least one actuary, one 21 expert on health benefits, having no less than fifteen years of direct 22 experience with health benefits, and one physician. All members of the 23 commission shall be seated no later than ninety days after the effective 24 date of the chapter of the laws of two thousand twenty-five which EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD02869-01-5
A. 4498 2 1 amended this section and all vacancies shall be filled as soon as prac- 2 ticable. 3 (b)(1) The purpose of the commission shall be to analyze the impact on 4 health insurance costs and quality of proposed legislation which would 5 mandate that health benefits be offered or made available in individual 6 and group health insurance policies, contracts and comprehensive health 7 service plans, including legislation that affects the delivery of health 8 benefits or services or the reimbursement of health care providers. 9 (2) The governor, the chair of the senate insurance committee and the 10 chair of the assembly insurance committee may request in writing that 11 the commission evaluate a proposed mandated benefit. Upon receiving such 12 a request, the commission [may, by a majority vote of its members,] 13 shall undertake an evaluation of such proposed mandated benefit. 14 (3) In evaluating a proposed mandated benefit, the commission shall: 15 (A) investigate the current practices of health plans with regard to 16 the proposed mandated benefit, and, to the extent possible, self-funded 17 health benefit plans; 18 (B) investigate the potential premium impact of the proposed mandated 19 benefits on all segments of the insurance market, as well as the poten- 20 tial for avoided costs through early detection and treatment of condi- 21 tions, or more cost-effective delivery of medical services; [and] 22 (C) analyze the most current [medical] and credible evidence based 23 medicine literature regarding the proposed mandated benefit published in 24 peer reviewed medical literature generally recognized by the relevant 25 medical community to determine the effectiveness of the proposed 26 mandated benefit and its impact on health care quality[.]; and 27 (D) investigate the potential cost to the state of the proposed 28 mandated benefits in light of the implementation of the federal afforda- 29 ble care act. 30 (4) In evaluating a proposed mandated benefit, the commission may hold 31 one or more public hearings, and shall strive to obtain independent and 32 verifiable information from diverse sources within the healthcare indus- 33 try, medical community and among health care consumers with regard to 34 the proposed mandated benefit. 35 (c) To assist the commission in its duties, and upon the direction of 36 the commission, the superintendent is authorized to enter into one or 37 more contracts with independent entities and organizations with demon- 38 strable expertise in health care quality, finance, utilization and actu- 39 arial services. For the purposes of this section, the superintendent 40 shall not enter into contracts with health plans, entities or organiza- 41 tions owned or controlled by health plans, or with significant business 42 relationships with health plans. 43 (d) Upon completion of its evaluation of a proposed mandated benefit 44 pursuant to this section, the commission shall deliver a written report 45 of its findings to the chair of the assembly insurance committee and the 46 chair of the senate insurance committee. 47 (e)(1) Beginning no later than nine months after the commission is 48 seated, and reoccurring no less often than once every three years, the 49 commission shall analyze the impact on health insurance costs and quali- 50 ty of all state laws which mandate that health benefits be offered or 51 made available in individual and group health insurance policies, 52 contracts and comprehensive health service plans, including but not 53 limited to laws that affect the delivery of health benefits or services 54 or the reimbursement of health care providers. 55 (2) In evaluating each mandated benefit, the commission shall:
A. 4498 3 1 (A) investigate the current practices of health plans with regard to 2 the mandated benefit, and, to the extent possible, self-funded health 3 benefit plans including but not limited to avoided costs through early 4 detection and treatment of conditions, or more cost-effective delivery 5 of medical services; 6 (B) investigate the potential premium impact of repealing and/or modi- 7 fying the mandated benefits on all segments of the insurance market; 8 (C) analyze the most current and credible evidence based medicine 9 literature regarding the mandated benefit published in peer reviewed 10 medical literature generally recognized by the relevant medical communi- 11 ty to determine the effectiveness of the mandated benefit and its impact 12 on health care quality; and 13 (D) investigate the potential cost to the state of the proposed 14 mandated benefits in light of the implementation of the federal afforda- 15 ble care act. 16 (3) In evaluating mandated benefits, the commission shall hold no less 17 than two public hearings, and shall strive to obtain independent and 18 verifiable information from diverse sources within the health care 19 industry, medical community and among health care consumers with regard 20 to each mandated benefit. 21 (4)(A) On or before the first day of February, two thousand twenty- 22 six, the commission shall submit to the legislature and disseminate to 23 the public recommendations for the repeal and/or modification of state 24 laws which mandate benefits, along with a single piece of legislation 25 necessary to implement such recommendations. These recommendations shall 26 not be expected to increase the average premium in the state. Upon 27 receipt of such recommendations, the implementing legislation therefor 28 shall be introduced in both houses of the legislature without any amend- 29 ments within five days. 30 (B) The legislation introduced pursuant to subparagraph (A) of this 31 paragraph shall be voted upon, without amendment, by both such houses of 32 the legislature within ninety days, but not sooner than thirty days, 33 after the commission submits its recommendations to the legislature. If 34 approved, the legislature shall forward such legislation to the governor 35 within five days. 36 § 2. This act shall take effect immediately.