What's happening
This bill requires the state health care quality and cost containment commission to meet annually and issue a report on insurance coverage for long-term and chronic Lyme and tick-borne diseases.
Why it matters
Annual required meetings and reporting. will ensure that long-term and chronic Lyme and tick-borne diseases remain a consistent focus for state health policy, potentially increasing accountability and transparency in how insurance coverage issues are handled.
Mandated analysis of geographic disparities. (such as impacts in the Hudson Valley and Long Island) means the commission will have to address regional differences in disease prevalence and health care needs—important for ensuring policies are responsive to hotspots rather than taking a one-size-fits-all approach.
Evaluation of best practices from other states and detailed cost analysis. (including costs of untreated symptoms) could lead to more evidence-based and economically sound recommendations, possibly influencing future insurance mandates and improving patient outcomes.
Broader inclusion of stakeholders and ongoing oversight. may elevate the issue of Lyme and tick-borne diseases in state policy discussions and could set a precedent for similar commissions to address other chronic or emerging health threats.
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Who cares
Patients with long-term or chronic Lyme disease and other tick-borne diseases
The bill would require a report on proposed coverage requirements, including projected costs of untreated symptoms, rather than mandate coverage itself.
Health insurers
The commission would examine the insurance cost and quality impacts of requiring coverage, including associated costs and coverage practices in other states.
Hudson Valley and Long Island medical providers
The report would consider specific medical impacts in these regions as part of its review of Lyme and other tick-borne disease coverage.
New York State Health Care Quality and Cost Containment Commission
The bill would require an annual January meeting and delivery of the coverage report to specified state leaders by May 1, 2020.
Headline styles
Report on Lyme Coverage Costs
Plain English, a few words. Used as the page title.
Sponsors
History
- Referred to insurance
- Referred to insurance
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
1345
2019-2020 Regular Sessions
IN SENATE
January 14, 2019
Introduced by Sens. SERINO, AKSHAR, HELMING, JACOBS, KENNEDY, O'MARA, RITCHIE -- read twice and ordered printed, and when printed to be committed to the Committee on Insurance
AN ACT to amend the insurance law, in relation to meetings and reports of the New York state health care quality and cost containment commission
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Section 213 of the insurance law, as added by section 1 of part L of chapter 57 of the laws of 2007, is amended to read as follows:
§ 213. New York state health care quality and cost containment commission. (a) There is hereby established within the department a commission, to be known as the "New York state health care quality and cost containment commission". The commission shall consist of thirteen members appointed by the governor, one of whom shall be the superintendent, one of whom shall be the commissioner of health, and six of whom shall be appointed on the recommendation of the legislative leaders, two on the recommendation of the temporary president of the senate, two on the recommendation of the speaker of the assembly, one on the recommendation of the minority leader of the senate, and one on the recommendation of the minority leader of the assembly. All members shall serve at the pleasure of the governor, and vacancies shall be appointed in the same manner as original appointments. Members of the commission shall serve without compensation, but shall be reimbursed for reasonable travel expenses. In making appointments to the commission, the governor shall ensure that the interests of health care consumers, small businesses, the medical community and health plans are represented on the commission. The commission shall be required to meet on the first Monday after the first of January of each calendar year to consider outstanding requests or duties. Any vacancies shall be deemed waived by the appointing authority for the purposes of the first meeting. Nothing
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD00470-02-9
S. 1345 2
in this section shall forfeit the right for an appointment authority to fill vacancies within their statutorily allowed members.
(b)(1) The purpose of the commission shall be to analyze the impact on health insurance costs and quality of proposed legislation which would mandate that health benefits be offered or made available in individual and group health insurance policies, contracts and comprehensive health service plans, including legislation that affects the delivery of health benefits or services or the reimbursement of health care providers.
(2) [The] Notwithstanding any other provision of law, the governor, the chair of the senate insurance committee and the chair of the assembly insurance committee may request in writing that the commission evaluate a proposed mandated benefit. Upon receiving such a request, the commission may, by a majority vote of its members, undertake an evaluation of such proposed mandated benefit.
(3) In evaluating a proposed mandated benefit, the commission shall:
(A) investigate the current practices of health plans with regard to the proposed mandated benefit, and, to the extent possible, self-funded health benefit plans;
(B) investigate the potential premium impact of the proposed mandated benefits on all segments of the insurance market, as well as the potential for avoided costs through early detection and treatment of conditions, or more cost-effective delivery of medical services; and
(C) analyze the most current medical literature regarding the proposed mandated benefit to determine its impact on health care quality.
(4) In evaluating a proposed mandated benefit, the commission may hold one or more public hearings, and shall strive to obtain independent and verifiable information from diverse sources within the healthcare industry, medical community and among health care consumers with regard to the proposed mandated benefit.
(c) To assist the commission in its duties, and upon the direction of the commission, the superintendent is authorized to enter into one or more contracts with independent entities and organizations with demonstrable expertise in health care quality, finance, utilization and actuarial services. For the purposes of this section, the superintendent shall not enter into contracts with health plans, entities or organizations owned or controlled by health plans, or with significant business relationships with health plans.
(d) Upon completion of its evaluation of a proposed mandated benefit pursuant to this section, the commission shall deliver a written report of its findings to the chair of the assembly insurance committee and the chair of the senate insurance committee.
(e) The commission shall issue a report to the governor, the majority leader of the senate, the speaker of the assembly, the chairs of the senate and assembly insurance committees, and the chair of the senate task force on Lyme and tick-borne diseases, considering the impact on health insurance costs and quality of legislation requiring coverage of long-term and chronic Lyme disease and other tick-borne diseases. The commission shall be required to consider issues including, but not limited to, the specific medical impacts to particular geographic areas in the state including the Hudson Valley and Long Island, best practices developed for coverage for long-term and chronic Lyme disease in other states, and the associated costs of mandated coverage in addition to projected costs of untreated symptoms. The commission shall deliver a written report of its findings by May first, two thousand twenty.
§ 2. This act shall take effect immediately.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Sponsor's memo
Title of bill
An act to amend the insurance law, in relation to meetings and reports of the New York state health care quality and cost containment commis- sion
Purpose
To require the New York State Health Care Quality and Cost Containment Commission to meet each year, and to submit a report on the impact of providing insurance coverage for Lyme and other tick-borne related diseases.
Summary of provisions
Section 1: Requires the commission to meet on the first Monday after the first of January of each year to consider any outstanding requests or duties. Also requires that the commission submits a report to the gover- nor and legislature which considers the impact on health insurance costs of requiring coverage of Lyme and other tick-borne diseases by May 1, 2020.
Section 2: Provides the effective date.
Justification
Currently, health insurance companies are not required to cover long term treatment for those who suffer from chronic Lyme or other related diseases, and for many New Yorkers, this is devastating. Those suffer- ing from chronic Lyme can experience extreme fatigue, nausea, depression, joint pain and many other symptoms. Massachusetts, Rhode Island and Connecticut have recognized the toll these diseases take on victims by passing legislation, which requires that Lyme disease be covered by insurance.
This bill is the first major step in establishing a conversation on what can be done to address this issue in New York and figuring out what a solution would look like. No individual should be left with the choice of covering the exorbitant costs needed to combat Lyme disease or sacri- ficing their quality of life because they cannot afford the necessary treatment.
Legislative history
2017-18: S.2168A Passed Senate 2016: S.7777A Passed Senate
Fiscal implications
None.
Effective date
This act shall take effect immediately.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.