Www.cidny.org



August 5, 2011

Sen. Dean Skelos

New York State Senate Majority Leader

Legislative Office Building, Room 909

Albany, NY 12247

Sen. James Seward

172 State Street, Room 430

The Capitol

Albany, NY 12247

Sen. Kemp Hannon

172 State Street, Room 420

The Capitol

Albany, NY 12247

Re: Establishment of a State Exchange under the Affordable Care Act

Dear Majority Leader Skelos, Senator Seward, and Senator Hannon,

HCFANY has reviewed the Proposed Rule published by the Department of Health and Human Services ("HHS") on July 15, 2011, with respect to State establishment of Exchanges, 45 C.F.R. Parts 155 and 156.  The Proposed Rule confirms the need for swift action by the Senate to approve A. 8514 / S5849 ("the Exchange Bill").

If the Exchange is to begin operation on January 1, 2014, it must be certified by HHS no later than January 1, 2013.  As New York has chosen a public benefit corporation as a governance structure, this new agency requires sufficient time to become established and operational (legal requirements, staffing, location, etc). In addition, there are complex operational issues requiring legislative decision, such as "active purchaser" and market merger, be thoroughly studied and decided upon in the legislative session ending June, 2012.  If the Exchange Bill is not enacted this summer, the careful studies (13 separate ones are enumerated) mandated in the bill in order to inform further legislative decision-making cannot be adequately or properly accomplished by the April 1, 2012 deadline. 

The proposed regulations also lay out a set of requirements that the exchange must meet in order to adhere to the certification deadlines. Thus, in addition to the operational complexities of a new state authority and the policy (study) issues, there are functional issues the exchange has to provide such as their interaction with other state agencies and programs (most notably public insurance) and the IT infrastructure, to name a few. Further, the federal window for significant amounts of multi-year federal funding will be lost to New York absent the adoption of an Exchange bill. This funding window closes in June 2012.

The governance and functional provisions of the Exchange Bill do not appear to contradict or violate any material provision of the Proposed Rule.  In some respects, the requirements of the Proposed Rule go beyond the provisions of the Exchange Bill.  For example, the Proposed Rule, at 45 C.F.R. 155.110(c) explicitly prohibits an Exchange governing board in which health insurance issuers and brokers or other sellers of insurance form a majority of members.  While we advocated for a similar rule to be explicitly incorporated in the Exchange Bill, the Proposed Rule makes clear that the governance structure will be considered in compliance if it is established through an Exchange by-law.  The Exchange Bill gives the Exchange more than adequate authority to adopt such provisions through its own by-laws.

We urge the Senate to act at its earliest opportunity to pass the Exchange Bill in the form agreed upon by leadership during the regular legislative session and passed by the Assembly, so that the Exchange can begin the hard work of forming itself and undertaking the complex studies the legislature will need to make its further decisions.

Very truly yours,

[pic]

Elisabeth R. Benjamin, MSPH, JD

Health Care For All New York

cc: Governor Andrew Cuomo

James Introne, Secretary for Health and Human Services

Benjamin Lawsky, Superintendent of the Department of Financial Services

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download