Relates to eligibility for health benefits.
Ayes (60): Addabbo, Avella, Ball, Bonacic, Boyle, Breslin, Carlucci, DeFrancisco, Diaz, Dilan, Espaillat, Farley, Felder, Flanagan, Gallivan, Gianaris, Gipson, Golden, Griffo, Grisanti, Hannon, Hassell-Thomps, Hoylman, Kennedy, Klein, Krueger, Lanza, Larkin, Latimer, LaValle, Little, Marcellino, Marchione, Martins, Maziarz, Montgomery, Nozzolio, O'Brien, O'Mara, Parker, Peralta, Perkins, Ranzenhofer, Ritchie, Rivera, Robach, Sampson, Sanders, Savino, Serrano, Seward, Skelos, Smith, Squadron, Stavisky, Stewart-Cousins, Tkaczyk, Valesky, Young, Zeldin
Excused (1): Libous
TITLE OF BILL: An act to amend the civil service law, in relation to eligibility for health benefits; and to repeal certain provisions of such law relating thereto
PURPOSE: This bill is a chapter amendment to Chapter 547 of the Laws of 2013, and has been agreed to by the Senate, Assembly and Executive. Like Chapter 547, this bill would provide public employers participating in New York State Health Insurance Program (NYSHIP) with important utilization information relating to their benefits, claims and premium payments. The chapter amendment makes appropriate changes to streamline implementation.
SUMMARY OF PROVISIONS:
Section 1: Repeals subdivision 9 of section 162 of the civil service law (as added by Chapter 547 of the Laws of 2013) relating to transparency in health insurance claims data for public employers participating in NYSHIP. Adds a new subdivision 9 requiring the department of civil service, upon request, to provide a standard report (no more frequently than semi-annually) to any participating employer containing data on the use of benefits by persons covered under the employer's plan. The report shall include premiums paid by month for each month covered in the report and paid claims by month, delineated by specific categories of services. Such report shall also contain individual claimant information, to the extent allowed by state and federal privacy laws, for those claims in excess of $50,000 paid in any of the months covered by the report. Sets forth a timeframe for the Department of Civil Service to provide a report requested by a participating employer.
Section 2: Establishes the effective date.
JUSTIFICATION: Local governments and school districts participating in the New York State Health Insurance Program (NYSHIP) are often not provided timely, meaningful claims information about their own claims and experience, even if they request it. This makes it difficult for them to calculate current and future health care costs. This legislation requires the Department of Civil Service, upon request, to provide NYSHIP participants with information relating to benefits, claims and premium payments, but no more frequently than semi-annually. The overall goal is to make NYSHIP more transparent for local governments and school districts participating in the program. This chapter amendment makes necessary changes to streamline implementation of Chapter 547 of the Laws of 2013.
LEGISLATIVE HISTORY: 2013: S.3788/A.481 - Passed both houses unanimously and approved (Chapter 547, L. 2013) 2012: S 7499-A/A.10333-A - Senate: Rules Committee, Assembly: Passed
FISCAL IMPLICATIONS: None
EFFECTIVE DATE: This act shall take effect immediately, provided however, it shall be deemed to have been in full force and effect on January 1, 2014.
STATE OF NEW YORK ________________________________________________________________________ 6253 IN SENATE (PREFILED) January 8, 2014 ___________Introduced by Sen. FLANAGAN -- read twice and ordered printed, and when printed to be committed to the Committee on Civil Service and Pensions AN ACT to amend the civil service law, in relation to eligibility for health benefits; and to repeal certain provisions of such law relating thereto THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. Subdivision 9 of section 162 of the civil service law, as added by chapter 547 of the laws of 2013 is REPEALED and a new subdivi- sion 9 is added to read as follows: 9. AS SOON AS IS PRACTICABLE, BUT NO LATER THAN THE FIRST OF SEPTEM- BER, TWO THOUSAND FOURTEEN, THE DEPARTMENT SHALL, UPON REQUEST, BUT NO MORE FREQUENTLY THAN SEMI-ANNUALLY, PROVIDE TO ANY PARTICIPATING EMPLOY- ER A STANDARD REPORT WHICH CONTAINS DATA RELATING TO THE USE OF BENEFITS BY PERSONS COVERED UNDER THE PLAN BY SUCH EMPLOYER. SUCH REPORT SHALL INCLUDE: PREMIUMS PAID BY MONTH FOR EACH MONTH COVERED IN THE REPORT AND PAID CLAIMS BY MONTH FOR THE FOLLOWING CATEGORIES OF SERVICES: INPA- TIENT HOSPITAL, OUTPATIENT HOSPITAL, IN NETWORK MEDICAL, OUT OF NETWORK MEDICAL, PRESCRIPTION DRUGS, AND TREATMENT OF BEHAVIORAL CONDITIONS, EACH REPORTED SEPARATELY. TO THE EXTENT ALLOWED BY STATE AND FEDERAL PRIVACY LAWS, SUCH REPORT SHALL ALSO CONTAIN CLAIMS INFORMATION FOR INDIVIDUAL CLAIMANTS FOR CLAIMS IN EXCESS OF FIFTY THOUSAND DOLLARS THAT WERE PAID IN ANY OF THE MONTHS COVERED BY THE REPORT. THE DEPARTMENT SHALL PROVIDE SUCH REPORTS TO ANY PARTICIPATING EMPLOY- ER, UPON REQUEST SUBMITTED ON OR AFTER THE FIRST OF APRIL FOR DATA FROM THE FIRST OF JANUARY THROUGH THE THIRTY-FIRST OF DECEMBER OF THE PRIOR YEAR, AND ON OR AFTER THE FIRST OF SEPTEMBER FOR DATA FROM THE FIRST OF JUNE OF THE PRIOR YEAR THROUGH THE THIRTY-FIRST OF MAY OF THE CURRENT YEAR, WITHIN THIRTY DAYS OF RECEIPT OF SAID REQUEST. HOWEVER, REQUESTS SUBMITTED IN THE TWO THOUSAND FOURTEEN CALENDAR YEAR SHALL BE PROVIDED AS SOON AS PRACTICABLE, BUT NO LATER THAN THE FIRST OF SEPTEMBER TWO THOUSAND FOURTEEN, OR WITHIN THIRTY DAYS AFTER SAID REQUEST IF REQUEST IS SUBMITTED ON OR AFTER THE FIRST OF AUGUST TWO THOUSAND FOURTEEN. S 2. This act shall take effect immediately and shall be deemed to be in full force and effect on and after January 1, 2014.EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD01514-03-4