Bill S5785-2011

Provides quality out-patient specialty care for patients of academic medical centers regardless of source of payment or insurance type and improving access to specialty care

Provides quality out-patient specialty care for patients of academic medical centers regardless of source of payment or insurance type and improving access to specialty care for medical assistance recipients.

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  • Jan 4, 2012: REFERRED TO HEALTH
  • Jun 16, 2011: REFERRED TO RULES

Memo

BILL NUMBER:S5785

TITLE OF BILL: An act to amend the public health law and the social services 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 improving access to specialty care for medical assistance recipients

PURPOSE: The purpose of the bill is to ensure that all patients receive quality medical care, regardless of source of payment or insurance type in New York's private teaching hospitals.

SUMMARY OF PROVISIONS: Section 2 creates a new sub-section in the public health law that prohibits general hospitals from referring, steering or otherwise directing patients to private physicians' practices, including faculty practice corporations, that are not licensed by the Department of Health, unless the general hospital does not accept the patient's insurance. This section also requires that outpatient specialty care be provided by integrated teams of medical professionals, consisting of both attending physicians and resident doctors receiving on-site supervision from faculty physicians. This section will not apply to the New York City Health and Hospitals Corporation.

Section 3 requires that patients be informed about the availability of hospital financial assistance through a notification on the hospital's website and through its physician referral line.

Section 4 requires general hospitals to make best efforts to negotiate with Medicaid managed care plans in their social service district to ensure that all medical service providers employed by the general hospital are credentialed by the available plans. Section 4 also requires hospitals to submit a strategic plan describing their goals and efforts to meet the requirements of this section.

Section 5 provides for an effective date 270 days after enactment and gives the department the power to promulgate regulations.

JUSTIFICATION: This bill requires private academic medical centers to implement an integrated system of outpatient specialty care. Under this integrated system, academic medical centers will be required to treat all patients who contact the hospital for specialty outpatient care in the same place and at the same time, regardless of insurance type or source of payment.

Currently, academic medical centers operate a two-tiered system of out-patient 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-patient 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 uninsured 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 rotating 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 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 overcrowding as well as higher health care costs.

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, particularly 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 coordination for Medicaid beneficiaries and cost reduction for the state's health care system.

It is therefore the intent of this bill to eliminate this separate 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 objective is 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.

Lastly, this bill will ensure that all patients are made aware of hospital financial assistance policies through the hospital's website and patient referral line and require that New York 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.

LEGISLATIVE HISTORY: S.7807 in the 2009-10 Legislative Session

FISCAL IMPLICATIONS:

None to the state.

EFFECTIVE DATE: On the two hundred and seventieth day after it shall have become law.


Text

STATE OF NEW YORK ________________________________________________________________________ 5785 2011-2012 Regular Sessions IN SENATE June 16, 2011 ___________
Introduced by Sen. RIVERA -- read twice and ordered printed, and when printed to be committed to the Committee on Rules AN ACT to amend the public health law and the social services law, in relation to providing quality out-patient specialty care for patients of academic medical centers regardless of source of payment or insur- ance type and improving access to specialty care for medical assist- ance 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: a. Private academic medical centers operate a two-tiered system of out-patient 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. b. Once separated into different systems of care, the Medicaid and uninsured patients are not given access to the same services as private- ly 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 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 twenty-four hour call service as the privately insured patients do, which contributes to emer- gency room overcrowding as well as higher health care costs. c. The difference in access to care experienced by patients based on their insurance status contributes to racial and ethnic disparities in health outcomes, particularly since African-Americans and Hispanics are disproportionately represented among Medicaid beneficiaries and the uninsured. d. The system is economically wasteful, as it allows two systems of care to operate within one facility and it causes Medicaid and other state funds to be spent on inferior care. e. The system runs counter to current state health policy, which is increasingly focused on patient-centered medical homes and similar inno- vative strategies to achieve care coordination for Medicaid benefici- aries and cost reduction for the state's health care system. The legislature intends to eliminate this separate 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 legislature further intends to ensure that academic medical centers, which receive millions of dollars every year though the Medi- caid 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. The legislature further intends to ensure that all patients are made aware of hospital financial assistance policies through the hospital's website and patient referral line. The legislature also intends 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 SPECIALITY 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-BASED OR INTERNET-BASED PHYSICIAN 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 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 HUNDRED 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. Subparagraph (ii) and clause (F) of subparagraph (iii) of para- graph (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 and clause (F) of subparagraph (iii) as relettered by chapter 37 of the laws of 2010, are amended and a new subparagraph (iv) is added to read as follows: (ii) provided, however, if a major public hospital, as defined in the public health law, is designated by the commissioner of health as a 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]. (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 THE BEST EFFORTS TO NEGO- TIATE WITH MANAGED CARE PROVIDERS LICENSED TO OPERATE IN THE SOCIAL SERVICES DISTRICT IN WHICH SUCH GENERAL HOSPITAL IS LOCATED TO CREDEN- TIAL ALL MEDICAL SERVICES PROVIDERS EMPLOYED BY SUCH GENERAL HOSPITAL. EACH GENERAL HOSPITAL SUBJECT TO THIS SUBDIVISION MUST SUBMIT AN ANNUAL REPORT TO THE DEPARTMENT DESCRIBING THE GENERAL HOSPITAL'S STRATEGIC
PLAN TO MEET THE REQUIREMENTS OF THIS SUBDIVISION 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 to repeal 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 are authorized and directed to be made and completed on or before such effective date.

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