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Gov. proposes Health Benefit Exchange

Gov. Andrew M. Cuomo is proposing a new health benefit exchange be set up to comply with the Patient Protection and Affordable Care Act passed by Congress in 2010.

He said 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,” Cuomo said Monday. “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 exchange would be established as a public benefit corporation managed by a board of directors. It will make available health plans, including certain qualified dental plans, to individuals and employers by Jan. 1, 2014.

Under the legislation, the exchange will establish the minimum requirements an insurer shall meet 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 it on the basis of relative quality and price, in accordance with the PPACA.

While the PPACA requires each exchange to be “self-sustaining” by Jan. 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 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.