NY Pub Health L § 268-C (2021)
2021 New York Laws PBH - Public Health Article 2 - The Department of Health Title 7 - Ny State of Health 268-C - Functions of the Marketplace.

§ 268-c. Functions of the Marketplace. The Marketplace shall:   1.  (a)  Perform  eligibility  determinations  for  federal  and state insurance  affordability  programs  including  medical   assistance   in accordance  with  section three hundred sixty-six of the social services law, child health plus in accordance with  section  twenty-five  hundred eleven  of  this  chapter,  the  basic health program in accordance with section three hundred sixty-nine-gg of the social services law,  premium tax  credits  and  cost-sharing reductions and qualified health plans in accordance with applicable law and other health  insurance  programs  as determined by the commissioner;  (b)  certify  and  make  available to qualified individuals, qualified health plans, including  dental  plans,  certified  by  the  Marketplace pursuant  to  applicable  law,  provided  that coverage under such plans shall not become effective prior to certification  by  the  Marketplace; and  (c)  certify  and/or  make  available  to eligible individuals, health plans certified by the Marketplace pursuant to  applicable  law,  and/or participating   in   an  insurance  affordability  program  pursuant  to applicable law, provided that coverage under such plans shall not become effective prior to certification by the Marketplace, and/or approval  by the commissioner.   2.  Assign  an  actuarial  value  to  each  Marketplace certified plan offered  through  the  Marketplace  in  accordance  with  the   criteria developed by the secretary pursuant to federal law or the superintendent pursuant  to  the  insurance  law  and/or  requirements developed by the Marketplace, and determine each  health  plan's  level  of  coverage  in accordance  with regulations issued by the secretary pursuant to federal law or the superintendent pursuant to the insurance law.   3. Utilize a standardized format for presenting health benefit options in the Marketplace, including the use of the uniform outline of coverage established under section 2715 of the federal public health service  act or the insurance law.   4.  Standardize the benefits available through the Marketplace at each level of coverage defined by the superintendent in the insurance law.   5. Maintain enrollment periods  in  the  best  interest  of  qualified individuals consistent with federal and state law.   6.  Implement  procedures  for  the certification, recertification and decertification of health plans as  qualified  health  plans  or  health plans  approved  for  sale  by  the  department of financial services or department of health and certified by the Marketplace,  consistent  with guidelines developed by the secretary pursuant to section 1311(c) of the federal act and requirements developed by the Marketplace.   7.  Contract for health care coverage offered to qualified individuals through the Marketplace, and in doing so shall seek  to  provide  health care  coverage  choices  that  offer  the optimal combination of choice, value, quality, and service.   8. Contract for health  care  coverage  offered  to  certain  eligible individuals  through  the  Marketplace,  pursuant  to  health  insurance programs as determined by the commissioner, and in doing so  shall  seek to   provide  health  care  coverage  choices  that  offer  the  optimal combination of choice, value, quality, and service;   9.  Provide  the  minimum  requirements  an  insurer  shall  meet   to participate  in  the  Marketplace,  in  the  best  interest of qualified individuals or eligible individuals;   10. Require qualified health plans and/or other health plans certified by the Marketplace to offer those benefits determined  to  be  essential health benefits pursuant to state law or as required by the Marketplace.    11. Ensure that insurers offering health plans through the Marketplace do not charge an individual enrollee a fee or penalty for termination of coverage.   12.  Provide  for  the  operation  of a toll-free telephone hotline to respond to requests for assistance.   13.  Maintain  an  internet  website  through  which   enrollees   and prospective  enrollees  of  qualified  health  plans  and  health  plans certified  by  the  Marketplace  may  obtain  standardized   comparative information on such plans and insurance affordability programs.   14.  Make  available by electronic means a calculator to determine the actual cost of coverage after the application of any premium tax  credit under  section  36B  of  the Internal Revenue Code of 1986 or applicable state law and any cost-sharing reduction  under  federal  or  applicable state law.   15.  Operate  a  program  under which the Marketplace awards grants to entities to serve as navigators in accordance  with  applicable  federal law and regulations adopted thereunder, and/or a program under which the Marketplace  awards  grants  to  entities  to  provide  community  based enrollment assistance in accordance with requirements developed  by  the Marketplace;  and/or a program under which the Marketplace certifies New York  state  licensed  producers  to  provide  assistance  to   eligible individuals and/or small employers pursuant to federal or state law.   16.  In  accordance  with  applicable  federal  and  state law, inform individuals of eligibility requirements for the Medicaid  program  under title  XIX  of  the social security act and the social services law, the children's health insurance program (CHIP) under title XXI of the social security act and this chapter, the basic health  program  under  section three   hundred  sixty-nine-gg  of  the  social  services  law,  or  any applicable state or  local  public  health  insurance  program  and  if, through screening of the application by the Marketplace, the Marketplace determines  that  such  individuals  are  eligible for any such program, enroll such individuals in such program.   17. Grant a certification  that  an  individual  is  exempt  from  the requirement  to  maintain minimum essential coverage pursuant to federal or state law  and  from  any  penalties  imposed  by  such  requirements because:  (a)  there  is  no  affordable  health  plan  available  covering  the individual, as defined by applicable law; or  (b) the individual meets the requirements for any other such exemption from the requirement to maintain minimum essential coverage  or  to  pay the penalty pursuant to applicable federal or state law.   18.  Operate a small business health options program ("SHOP") pursuant to section 1311 of the federal act and  applicable  state  law,  through which   eligible   small   employers  may  select  marketplace-certified qualified health plans offered in the small group  market,  and  through which  eligible small employers may receive assistance in qualifying for small business tax credits available pursuant to federal and state law.   19. Enter into agreements as necessary with federal and state agencies and other state Marketplaces to carry  out  its  responsibilities  under this  title,  provided such agreements include adequate protections with respect to the confidentiality of  any  information  to  be  shared  and comply with all state and federal laws and regulations.   20.  Perform  duties  required  by the secretary, the secretary of the United States department of the treasury or the commissioner related  to determining  eligibility for premium tax credits or reduced cost-sharing under applicable federal or state law.   21.  Meet  program  integrity  requirements  under   applicable   law, including  keeping  an  accurate accounting of receipts and expenditures  and providing reports to the  secretary  regarding  Marketplace  related activities in accordance with applicable law.   22.   Submit   information  provided  by  Marketplace  applicants  for verification as required by section  1411(c)  of  the  federal  act  and applicable state law.   23.  Establish  rules  and  regulations  that  do not conflict with or prevent the application of regulations promulgated by the secretary.   24. Determine eligibility, provide notices, and provide  opportunities for  appeal  and  redetermination in accordance with the requirements of federal and state law.