Cuomo Bill Seeks to Establish New Health Benefit Exchange

Proposed Legislation Would Set Up Health Insurance Exchange to Comply with Federal Health Care Law

Governor Andrew Cuomo has submitted a Governor's program bill that would establish a new Health Benefit Exchange in order to comply with the Affordable Care Act passed by Congress and signed into law by President Barack Obama in 2010.

New York will operate its own exchange, rather than have the federal government operate one for the state, given the complexity and diversity of the insurance market in New York.

"This legislation would fulfill New York's commitment to the federal government to set up a health benefit exchange that will enhance access to affordable quality health care for all New Yorkers," Governor Cuomo said.

"This is a dynamic and flexible proposal that will protect consumers and help bring down the cost of health care for families, businesses, and taxpayers."

The purpose of this legislation is to establish a single Exchange in New York – a centralized, customer-service oriented marketplace where individuals and small groups will be able to purchase qualified health plans, receive eligibility and subsidy determinations, and be enrolled in a range of coverage options, including public health coverage programs.

The Exchange will be established as a public benefit corporation managed by a Board of Directors. Four of the seven members of the Board will have expertise in relevant areas, including individual health care coverage, small employer health care coverage, health benefits administration, health care finance, public or private health care delivery systems, and purchasing health plan coverage.

The Superintendent of Insurance (or after October 3, 2011, the Superintendent of the Department of Financial Services), the Commissioner of Health, and the State Medicaid Director will serve as ex officio members of the board.

The Board will consult with an Advisory Committee, comprised of 18 representatives of stakeholders and sectors that will be impacted by the operation of the Exchange, including health care consumers, small businesses, the medical community, and insurers.

The Committee's advice to the Board will reflect findings about regional variations regarding the availability of health insurance coverage and other issues deemed necessary by the Committee and the Board.

The Exchange will make available health plans, including certain qualified dental plans, to individuals and employers beginning on or before January 1, 2014.

Under this legislation, the Exchange will establish the minimum requirements an insurer shall meet to be considered for participation in the Exchange and will implement procedures for the certification, recertification, and decertification of health plans as qualified health plans.

The Exchange will also assign ratings to qualified health plans offered through the Exchange on the basis of relative quality and price, in accordance with the ACA.

The bill also provides critical protections meant to assist individuals in using the Exchange. For example, the bill provides that the Exchange will operate a toll-free telephone line to assist consumers and an Internet website containing standardized comparative information on qualified health plans.

The website will also feature a calculator allowing individuals to determine the actual cost of coverage. The bill also requires the Exchange to establish a program to award grants to entities to serve as "navigators" to help educate consumers and facilitate enrollment.

In addition, the Exchange will include a Small Business Health Options Program (SHOP), which will assist small employers in facilitating the enrollment of their employees in qualified health plans offered in the group market.

While the ACA requires each Exchange to be "self-sustaining" by January 1, 2015, federal funds will support the planning, implementation, and operation of the Exchange through December 2014. New York has already been selected to receive funding under an Early Innovator Grant ($27 million) and an Exchange Planning Grant ($1 million).

In June, the New York State Department of Health expects to apply for a Level 1 Establishment Grant, which makes a year's worth of funding available to states that have made some progress under their Exchange Planning Grant.

With the enactment of this legislation, assuming other applicable criteria are met, New York will qualify to apply for additional federal funding to support Exchange planning and establishment through December 31, 2014.

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