Bill Text: NY A10601 | 2023-2024 | General Assembly | Introduced
Bill Title: Allows for Medicaid accountable care organizations to purchase experience-rated health insurance for their members.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced) 2024-06-20 - referred to insurance [A10601 Detail]
Download: New_York-2023-A10601-Introduced.html
STATE OF NEW YORK ________________________________________________________________________ 10601 IN ASSEMBLY June 20, 2024 ___________ Introduced by COMMITTEE ON RULES -- (at request of M. of A. Lee) -- read once and referred to the Committee on Insurance AN ACT to amend the insurance law, in relation to allowing for Medicaid accountable care organizations to purchase experience-rated health insurance for their members The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Paragraph 1 of subsection (c) of section 4235 of the insur- 2 ance law is amended by adding a new subparagraph (O) as follows: 3 (O) A policy issued to an accountable care organization issued a 4 certificate of authorization pursuant to article twenty-nine-E of the 5 public health law, or to a trustee or trustees of a fund established, 6 created or maintained for the benefit of members of one or more account- 7 able care organizations issued a certificate of authorization pursuant 8 to article twenty-nine-E of the public health law, all of whose eligible 9 members have the same profession, trade or occupation provided or 10 related to the provision of health care, which association or associ- 11 ations have been organized and maintained in good faith for purposes 12 principally other than that of obtaining insurance and have been in 13 active existence for at least two years. The policy shall insure 14 members, or employees of members, of such accountable care organization 15 or organizations for the benefit of persons other than employers and the 16 accountable care organization or organizations, or any officials, repre- 17 sentatives, trustees or agents thereof and shall provide for the issu- 18 ance of a certificate to the persons insured or such beneficiary as 19 evidence of such insurance. The members or employees eligible for the 20 insurance under the policy shall be all the members, or all the members 21 and their employees, or all of any class or classes thereof determined 22 by conditions pertaining to their employment or to the accountable care 23 organization membership or both. The premiums for the policy shall be 24 paid from the accountable care organization or members' funds, or partly 25 from such funds and partly from funds contributed by the insured indi- 26 viduals, or from funds wholly contributed by the insured individuals. A 27 policy on which all or part of the premium is to be derived from funds EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD15655-01-4A. 10601 2 1 contributed by the insured individuals specifically for their insurance 2 must insure at least fifty percent of the then eligible individuals or a 3 minimum of five hundred individuals, whichever is less, excluding any as 4 to whom evidence of individual insurability is not satisfactory to the 5 insurer. A policy on which no part of the premium is to be derived from 6 funds contributed by the insured individuals specifically for their 7 insurance must cover all eligible individuals, excluding any as to whom 8 evidence of individual insurability is not satisfactory to the insurer. 9 In every case the policy must cover at least one hundred individuals at 10 date of issue. The insurance coverage on employees insured under the 11 policy shall be based upon some plan precluding individual selection. 12 However, with respect to such fund, or accountable care organization or 13 accountable care organizations, such a plan may permit a number of 14 selections by the fund, accountable care organization or accountable 15 care organizations if the selections offered utilize consistent plans of 16 coverage so that the resulting plans of coverage are reasonable. 17 Furthermore, such a plan may permit a limited number of selections 18 offered by employees or members if the selections offered utilize 19 consistent plans of coverage for individual group members so that the 20 resulting plans of coverage are reasonable. If a policy dividend is 21 declared or a reduction in rate is made under such a policy, the excess, 22 if any, of the aggregate dividends or rate reductions under the policy 23 over the aggregate expenditure for insurance under such policy made from 24 the accountable care organization or employer funds, including expendi- 25 tures made in connection with administration of such policy, shall be 26 applied by the policyholder for the sole benefit of the insured individ- 27 uals. A policy issued pursuant to this subparagraph shall provide a 28 conversion privilege no less favorable than that provided for in 29 subsection (e) of section three thousand two hundred twenty-one of this 30 chapter. 31 § 2. Subsection (g) of section 3231 of the insurance law, as amended 32 by section 70 of part D of chapter 56 of the laws of 2013, paragraph 1 33 as amended by chapter 12 of the laws of 2016, is amended to read as 34 follows: 35 (g) (1) Unless otherwise described in paragraph three of this 36 subsection: (A) This section shall also apply to policies issued to a 37 group defined in subsection (c) of section four thousand two hundred 38 thirty-five of this chapter, including but not limited to an association 39 or trust of employers, if the group includes one or more member employ- 40 ers or other member groups having one hundred or fewer employees or 41 members exclusive of spouses and dependents. For a policy issued or 42 renewed on or after January first, two thousand fourteen, if the group 43 includes one or more member small group employers eligible for coverage 44 subject to this section, then such member employers shall be classified 45 as small groups for rating purposes and the remaining members shall be 46 rated consistent with the rating rules applicable to such remaining 47 members pursuant to paragraph two of this subsection. (B) Subparagraph A 48 of this paragraph shall not apply to either the renewal of a policy 49 issued to a group or the issuance, between January first, two thousand 50 sixteen and December thirty-first, two thousand sixteen, of a policy, 51 and any renewal thereof, to a group, provided that the following three 52 requirements are met: (I) the group had been issued a policy that was in 53 effect on July first, two thousand fifteen; (II) the group had member 54 employers, who, on or after July first, two thousand fifteen, have 55 between fifty-one and one hundred employees, exclusive of spouses and 56 dependents; and (III) the group is either: (i) comprised entirely of oneA. 10601 3 1 or more municipal corporations or districts (as such terms are defined 2 in section one hundred nineteen-n of the general municipal law); or (ii) 3 comprised entirely of nonpublic schools providing education in any grade 4 from pre-kindergarten through twelfth grade. 5 (2) [If] Unless otherwise described in paragraph three of this 6 subsection, if a policy is issued to a group defined in subsection (c) 7 of section four thousand two hundred thirty-five of this chapter, 8 including an association group, that includes one or more individual or 9 individual proprietor members, for rating purposes the insurer shall 10 include such members in its individual pool of risks in establishing 11 premium rates for such members. 12 (3) This subsection shall not apply to a policy issued to a group 13 defined in subparagraph (O) of paragraph one of subsection (c) of 14 section four thousand two hundred thirty-five of this chapter, even if 15 the group includes one or more member employers or other member groups 16 which have one hundred or fewer employees or members exclusive of spous- 17 es and dependents, if the following criteria are met: 18 (A) the group is comprised of at least one hundred fifty member 19 employers; 20 (B) the collective number of individuals insured under the policy 21 exceeds five hundred persons; 22 (C) each employer in the group is enrolled as a provider in the 23 state's Medicaid program; and 24 (D) each employer in the group can demonstrate an annual payer mix in 25 which Medicaid represents sixty percent or more of annual revenues. 26 § 3. Paragraph 1 of subsection (d) of section 4317 of the insurance 27 law, as amended by chapter 12 of the laws of 2016, is amended and a new 28 paragraph 4 is added to read as follows: 29 (1) (A) [This] Unless otherwise described in paragraph four of this 30 subsection, this section shall also apply to a contract issued to a 31 group defined in subsection (c) of section four thousand two hundred 32 thirty-five of this chapter, including but not limited to an association 33 or trust of employers, if the group includes one or more member employ- 34 ers or other member groups having one hundred or fewer employees or 35 members exclusive of spouses and dependents. For a contract issued or 36 renewed on or after January first, two thousand fourteen, if the group 37 includes one or more member small group employers eligible for coverage 38 subject to this section, then such member employers shall be classified 39 as small groups for rating purposes and the remaining members shall be 40 rated consistent with the rating rules applicable to such remaining 41 members pursuant to paragraph two of this subsection. (B) Subparagraph A 42 of this paragraph shall not apply to either the renewal of a contract 43 issued to a group or the issuance, between January first, two thousand 44 sixteen and December thirty-first, two thousand sixteen, of a contract, 45 and any renewal thereof, to a group, provided that the following three 46 requirements are met: (I) the group had been issued a contract that was 47 in effect on July first, two thousand fifteen; (II) the group had member 48 employers, who, on or after July first, two thousand fifteen, have 49 between fifty-one and one hundred employees, exclusive of spouses and 50 dependents; and (III) the group is either: (i) comprised entirely of one 51 or more municipal corporations or districts (as such terms are defined 52 in section one hundred nineteen-n of the general municipal law); or (ii) 53 comprised entirely of nonpublic schools providing education in any grade 54 from pre-kindergarten through twelfth grade. 55 (4) This subsection shall not apply to a policy issued to a group 56 defined in paragraph (O) of subsection (c) of section four thousand twoA. 10601 4 1 hundred thirty-five of this chapter, even if the group includes one or 2 more member employers or other member groups which have one hundred or 3 fewer employees or members exclusive of spouses and dependents, if the 4 following criteria are met: 5 (A) the group is comprised of at least one hundred fifty member 6 employers; 7 (B) the collective number of individuals insured under the policy 8 exceeds five hundred persons; 9 (C) each employer in the group is enrolled as a provider in the 10 state's Medicaid program; and 11 (D) each employer in the group can demonstrate an annual payer mix in 12 which Medicaid represents sixty percent or more of annual revenues. 13 § 4. This act shall take effect on the one hundred eightieth day after 14 it shall have become a law; provided, however, that the amendments to 15 paragraph (1) of subsection (g) of section 3231 and paragraph (1) of 16 subsection (d) of section 4317 of the insurance law made by sections two 17 and three of this act shall not affect the expiration of such paragraphs 18 and shall be deemed to expire therewith.
