senate Bill S5785

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

download pdf

Sponsor

Bill Status


  • Introduced
  • In Committee
  • On Floor Calendar
    • Passed Senate
    • Passed Assembly
  • Delivered to Governor
  • Signed/Vetoed by Governor
view actions

actions

  • 16 / Jun / 2011
    • REFERRED TO RULES
  • 04 / Jan / 2012
    • REFERRED TO HEALTH

Summary

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.

do you support this bill?

Bill Details

Versions:
S5785
Legislative Cycle:
2011-2012
Current Committee:
Senate Health
Law Section:
Public Health Law
Laws Affected:
Add §2805-u, amd §2807-k, Pub Health L; amd §364-j, Soc Serv L

Sponsor 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.

view bill text
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  5785

                       2011-2012 Regular Sessions

                            I N  S E N A T E

                              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

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD13158-01-1

S. 5785                             2

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.

S. 5785                             3

  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

S. 5785                             4

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.

Comments

Open Legislation comments facilitate discussion of New York State legislation. All comments are subject to moderation. Comments deemed off-topic, commercial, campaign-related, self-promotional; or that contain profanity or hate speech; or that link to sites outside of the nysenate.gov domain are not permitted, and will not be published. Comment moderation is generally performed Monday through Friday.

By contributing or voting you agree to the Terms of Participation and verify you are over 13.