A7699A-2011 Actions

• Jan 4, 2012: referred to health
• May 20, 2011: print number 7699a
• May 20, 2011: amend and recommit to health
• May 16, 2011: referred to health

A7699A-2011 Text

 S T A T E   O F   N E W   Y O R K
 
 7699--A
 2011-2012 Regular Sessions
 I N  ASSEMBLY
 May 16, 2011
 
 Introduced by M. of A. CASTRO -- read once and referred to the Committee
 on  Health -- committee discharged, bill amended, ordered reprinted as
 amended and recommitted to said committee
 

AN ACT to amend the public health law, in relation to providing  quality
 out-patient  specialty  care  for patients of academic medical centers
 regardless of source of  payment  or  insurance  type,  and  providing
 improved  notification to patients regarding their rights to financial
 assistance at hospitals; and to amend  the  social  services  law,  in
 relation  to improving access to specialty care for medical assistance
 recipients
 THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM
 BLY, DO ENACT AS FOLLOWS:

 

Section  1.  Legislative  intent.  The  legislature  hereby finds that
 private academic medical centers operate a two-tiered system of  out-pa
 tient  specialty  care,  in  which  patients are sorted into the medical
 centers' faculty practices or clinics depending  upon  their  source  of
 payment  or  insurance  status. Within this two-tiered system of out-pa
 tient specialty care, privately insured patients are treated at  faculty
 practices  while  Medicaid  and  uninsured  patients  are treated at the
 hospital-based clinics, even if both types of patients are seeking  care
 for the same problem.
 Once  separated into different systems of care, the Medicaid and unin
 sured patients are not given access to the same  services  as  privately
 insured  patients.  For  example, privately insured patients are able to
 see highly experienced faculty physicians to whom they have  twenty-four
 hour access, resulting in continuity of care and good care coordination.
 Medicaid  or uninsured patients, by contrast, only have access to rotat
 ing student doctors, who are less able to provide the continuity of care
 or care coordination that is so critical for patients  who  suffer  from
 chronic  or  serious  medical  conditions.  Furthermore,  these  student
 doctors often lack adequate supervision from attending  physicians,  who
 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
 [ ] is old law to be omitted.
 LBD11059-02-1
 
       A. 7699--A                          2
 are  not  required  by  the academic medical centers to spend sufficient
 time supervising residents and caring for patients in the clinics.    In
 cases  of emergency, Medicaid and uninsured patients only have access to
 the  hospital's emergency room, and not to a 24-hour call service as the
 privately insured patients do, which contributes to emergency room over
 crowding as well as higher health care costs.
 The legislature further finds that the difference in  access  to  care
 experienced  by  patients based on their insurance status contributes to
 disparities in racial and ethnic disparities in health outcomes, partic
 ularly since blacks and  Hispanics  are  disproportionately  represented
 among  Medicaid beneficiaries and the uninsured. In addition, the system
 is economically wasteful, as it allows two systems of  care  to  operate
 within one facility and it causes Medicaid and other state dollars to be
 spent  on  inferior  care.  Finally,  the system runs counter to current
 state health policy, which is increasingly focused  on  patient-centered
 medical  homes and similar innovative strategies to achieve care coordi
 nation for Medicaid beneficiaries and cost  reduction  for  the  state's
 health care system.
 It  is therefore the intent of the legislature to eliminate this sepa
 rate and unequal system of care by requiring private  academic  teaching
 hospitals  to  care  for  all  patients, regardless of insurance type or
 source of payment, in the same place and at the same time. The  legisla
 ture  seeks  to  ensure  that  academic  medical  centers, which receive
 millions of dollars every year through  the  Medicaid  program  and  the
 state's  indigent care pool, do not limit access to care and services to
 patients in whose name those funds are given.
 In addition, the legislature seeks to ensure  that  all  patients  are
 made  aware of hospital financial assistance policies through the hospi
 tal's website and patient referral line.  Lastly, the legislature  seeks
 to require that New York state general hospitals make reasonable efforts
 to  negotiate  with Medicaid managed care plans in their social services
 districts to ensure that all medical service providers employed  by  the
 general hospitals are credentialed by available plans.
 

S  2.  The public health law is amended by adding a new section 2805-u
 to read as follows:

 

S 2805-U. PROHIBITION AGAINST PATIENT  STEERING  BASED  ON  SOURCE  OF
 PAYMENT  AND  INTEGRATION  OF  OUT-PATIENT  CARE. 1. NO GENERAL HOSPITAL
 SHALL REFER, STEER, OR OTHERWISE DIRECT ANY  PATIENT  SEEKING  SPECIALTY
 OUT-PATIENT  HOSPITAL  SERVICES  TO PRIVATE PHYSICIAN PRACTICES THAT ARE
 NOT LICENSED PURSUANT TO THIS ARTICLE,  INCLUDING  BUT  NOT  LIMITED  TO
 UNIVERSITY  FACULTY PRACTICE CORPORATIONS AS DEFINED IN SECTION FOURTEEN
 HUNDRED TWELVE OF THE NOT-FOR-PROFIT CORPORATION LAW, IF  THE  PATIENT'S
 INSURANCE  IS ACCEPTED BY THE GENERAL HOSPITAL AND APPROPRIATELY CREDEN
 TIALED PHYSICIANS ARE AVAILABLE TO TREAT THE PATIENT IN THE  APPROPRIATE
 OUT-PATIENT  CLINIC  OWNED  AND  OPERATED  BY  THE GENERAL HOSPITAL. THE
 PROVISIONS OF THIS SECTION SHALL APPLY REGARDLESS OF WHETHER THE PATIENT
 CONTACTS THE GENERAL HOSPITAL VIA A TELEPHONE-OR  INTERNET-BASED  PHYSI
 CIAN  REFERRAL  SERVICE,  AS A WALK-IN, OR THROUGH THE PATIENT'S PRIMARY
 CARE PHYSICIAN.
 2. EVERY GENERAL HOSPITAL SHALL ENSURE THAT ALL  PATIENTS,  REGARDLESS
 OF  INSURANCE  STATUS, SEEKING SPECIALTY OUT-PATIENT CARE RECEIVE TREAT
 MENT FROM AN INTEGRATED TEAM OF  MEDICAL  PROFESSIONALS,  CONSISTING  OF
 ATTENDING  PHYSICIANS  AND RESIDENTS, WHO RECEIVE ROUTINE ON-SITE SUPER
 VISION FROM ATTENDING  PHYSICIANS.  FURTHERMORE,  SUCH  HOSPITALS  SHALL
 ENSURE  THAT  ALL  PATIENTS SEEN IN THE CLINIC SETTING SHALL HAVE DIRECT
 
       A. 7699--A                          3
 ACCESS TO THE ATTENDING PHYSICIANS SUPERVISING  THEIR  TREATMENT  DURING
 WEEKEND AND EVENING HOURS AND EMERGENCIES.
 3. THE PROVISIONS OF THIS SECTION SHALL NOT APPLY TO THE NEW YORK CITY
 HEALTH  AND  HOSPITALS  CORPORATION, ESTABLISHED PURSUANT TO CHAPTER ONE
 THOUSAND SIXTEEN OF THE LAWS OF NINETEEN SIXTY-NINE, AS AMENDED.
 

S 3. Paragraph (c) of subdivision 9-a of section 2807-k of the  public
 health law, as added by section 39-a of part A of chapter 57 of the laws
 of 2006, is amended to read as follows:

 (c)  Such  policies  and procedures shall be clear, understandable, in
 writing and publicly available in summary form and each general hospital
 participating in the pool shall ensure that every patient is made  aware
 of  the  existence of such policies and procedures and is provided, in a
 timely manner, with a summary  of  such  policies  and  procedures  upon
 request.  Any  summary provided to patients shall, at a minimum, include
 specific information as to income levels used to  determine  eligibility
 for  assistance, a description of the primary service area of the hospi
 tal and the means of applying for assistance. For general hospitals with
 twenty-four hour emergency departments,  such  policies  and  procedures
 shall  require the notification of patients during the intake and regis
 tration process, through the conspicuous posting of language-appropriate
 information in  the  general  hospital,  NOTIFICATION  ON  WEBSITES  AND
 THROUGH THE GENERAL HOSPITAL'S PATIENT REFERRAL LINE, and information on
 bills  and statements sent to patients, that financial aid may be avail
 able to qualified patients and how to obtain  further  information.  For
 specialty hospitals without twenty-four hour emergency departments, such
 notification  shall  take  place  through  written materials provided to
 patients during  the  intake  and  registration  process  prior  to  the
 provision  of  any  health  care services or procedures, NOTIFICATION ON
 WEBSITES AND THROUGH THE SPECIALTY HOSPITAL'S PATIENT REFERRAL LINE, and
 through information on bills  and  statements  sent  to  patients,  that
 financial  aid  may be available to qualified patients and how to obtain
 further information. Application materials shall  include  a  notice  to
 patients  that upon submission of a completed application, including any
 information or documentation needed to determine the patient's eligibil
 ity pursuant to the hospital's financial assistance policy, the  patient
 may  disregard  any  bills until the hospital has rendered a decision on
 the application in accordance with this paragraph.
 

S 4. Paragraph (a) of subdivision 4 of section  364-j  of  the  social
 services  law,  as  amended by section 14 of part C of chapter 58 of the
 laws of 2004, clause (E) of subparagraph (iii) as added and  clause  (F)
 of  subparagraph  (iii) as relettered by chapter 37 of the laws of 2010,
 is amended to read as follows:

 (a) (i) a managed care  provider  shall  arrange  for  access  to  and
 enrollment  of  primary  care  practitioners  and other medical services
 providers. Each managed care provider shall possess  the  expertise  and
 sufficient  resources  to assure the delivery of quality medical care to
 participants in an appropriate and timely manner and may include  physi
 cians,  nurse  practitioners,  county  health  departments, providers of
 comprehensive health service plans licensed pursuant to  article  forty
 four  of  the public health law, and hospitals and diagnostic and treat
 ment centers licensed pursuant to article  twenty-eight  of  the  public
 health  law or otherwise authorized by law to offer comprehensive health
 services or facilities licensed pursuant to articles sixteen, thirty-one
 and thirty-two of the mental hygiene law.
 (ii) provided, however, if a major public hospital, as defined in  the
 public  health  law,  is  designated  by the commissioner of health as a
 
       A. 7699--A                          4
 managed care provider in a social services district the commissioner  of
 health shall designate at least one other managed care provider which is
 not  a  major  public  hospital  or  facility operated by a major public
 hospital; and
 (iii)  under  a  managed  care program, not all managed care providers
 must be required to provide the same set of medical assistance services.
 The managed  care  program  shall  establish  procedures  through  which
 participants  will  be assured access to all medical assistance services
 to which they are otherwise entitled, other  than  through  the  managed
 care provider, where:

 (A)  the  service  is  not reasonably available directly or indirectly
 from the managed care provider,
 (B) it is necessary because of emergency or geographic unavailability,
 or
 (C) the services provided are family planning services; or
 (D) the services are dental services and are provided by a  diagnostic
 and  treatment  center licensed under article twenty-eight of the public
 health law which is affiliated with an academic dental center and  which
 has  been  granted  an operating certificate pursuant to article twenty
 eight of the public health law to provide such  dental  services.    Any
 diagnostic  and  treatment  center providing dental services pursuant to
 this clause shall prior to June first of each year report to the  gover
 nor,  temporary  president  of the senate and speaker of the assembly on
 the following: the total number of visits  made  by  medical  assistance
 recipients during the immediately preceding calendar year; the number of
 visits  made  by  medical  assistance  recipients during the immediately
 preceding calendar year by recipients who were enrolled in managed  care
 programs;  the  number  of  visits made by medical assistance recipients
 during the immediately preceding calendar year by  recipients  who  were
 enrolled  in  managed  care  programs  that provide dental benefits as a
 covered service; and the number of visits made by the  uninsured  during
 the immediately preceding calendar year; or
 (E)  the  services  are optometric services, as defined in article one
 hundred forty-three of the education law, and are provided by a diagnos
 tic and treatment center licensed  under  article  twenty-eight  of  the
 public  health  law which is affiliated with the college of optometry of
 the state university of New York and which has been granted an operating
 certificate pursuant to article twenty-eight of the public health law to
 provide such optometric services. Any diagnostic  and  treatment  center
 providing  optometric  services  pursuant  to this clause shall prior to
 June first of each year report to the governor, temporary  president  of
 the  senate  and  speaker  of  the assembly on the following:  the total
 number of visits made by medical assistance recipients during the  imme
 diately  preceding  calendar  year; the number of visits made by medical
 assistance recipients during the immediately preceding calendar year  by
 recipients  who  were  enrolled  in managed care programs; the number of
 visits made by medical  assistance  recipients  during  the  immediately
 preceding  calendar year by recipients who were enrolled in managed care
 programs that provide optometric benefits as a covered service; and  the
 number  of visits made by the uninsured during the immediately preceding
 calendar year; or
 (F) other services as defined by the commissioner of health; AND
 (IV) EVERY  GENERAL  HOSPITAL,  AS  DEFINED  BY  SECTION  TWENTY-EIGHT
 HUNDRED ONE OF THE PUBLIC HEALTH LAW, MUST USE BEST EFFORTS TO NEGOTIATE
 WITH  MANAGED  CARE PROVIDERS LICENSED TO OPERATE IN THE SOCIAL SERVICES
 DISTRICT IN WHICH SUCH GENERAL HOSPITAL IS  LOCATED  TO  CREDENTIAL  ALL
 
       A. 7699--A                          5
 MEDICAL  SERVICES  PROVIDERS  EMPLOYED  BY  SUCH  GENERAL HOSPITAL. EACH
 GENERAL HOSPITAL SUBJECT TO THIS SUBSECTION MUST SUBMIT AN ANNUAL REPORT
 TO THE DEPARTMENT DESCRIBING THE GENERAL HOSPITAL'S  STRATEGIC  PLAN  TO
 MEET THE REQUIREMENTS OF THIS SUBSECTION AND THE EFFORTS MADE TO FULFILL
 THE STRATEGIC PLAN.
 

S  5.  This  act  shall  take effect on the two hundred seventieth day
 after it shall have become a law, provided however, that the  amendments
 to  subdivision  4  of section 364-j of the social services law, made by
 section four of this act shall not affect the repeal of such section and
 shall be deemed repealed therewith,  provided  further,  that  effective
 immediately,  the addition, amendment and/or repeal of any rule or regu
 lation necessary for implementation of this act on its effective date is
 authorized to be made on or before such effective date.

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