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

                                  7668

                       2013-2014 Regular Sessions

                          I N  A S S E M B L Y

                              May 30, 2013
                               ___________

Introduced by M. of A. ENGLEBRIGHT, COLTON, ROBERTS, JACOBS, SIMANOWITZ,
  TITONE,  COOK,  SKOUFIS,  ROSA,  McDONOUGH, MAISEL, JAFFEE, DenDEKKER,
  CAHILL, SCARBOROUGH -- Multi-Sponsored by -- M. of A.  ARROYO,  CLARK,
  GLICK, MOSLEY, SKARTADOS, SWEENEY, THIELE, WEISENBERG -- read once and
  referred to the Committee on Health

AN ACT to amend the public health law and the insurance law, in relation
  to  requiring  hospitals to inform emergency care patients whether the
  attending physician participates with the patient's  insurance  policy
  and  requiring insurance companies to cover the cost of out-of-network
  care for patients who are unconscious or otherwise unable  to  provide
  informed consent

  THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. Section 2805-b of the  public  health  law  is  amended  by
adding a new subdivision 1-a to read as follows:
  1-A. EVERY GENERAL HOSPITAL IN WHICH INSURED PATIENTS ARE ADMITTED FOR
EMERGENCY  CARE  SHALL  ADOPT  REGULATIONS REQUIRING ITS STAFF TO INFORM
SUCH PATIENTS WHETHER THE  ATTENDING  PHYSICIAN  PARTICIPATES  WITH  THE
PATIENT'S  INSURANCE  POLICY. IN THE EVENT SUCH ATTENDING PHYSICIAN DOES
NOT PARTICIPATE WITH THE PATIENT'S INSURANCE POLICY, THE  PATIENT  SHALL
BE  PERMITTED  TO  DECIDE  WHETHER  TO  BE TREATED BY THE OUT-OF-NETWORK
ATTENDING PHYSICIAN OR TO REQUEST TREATMENT BY AN IN-NETWORK  PHYSICIAN,
WHO MUST TREAT SUCH PATIENT WITH ALL CONVENIENT SPEED.
  S 2. Subsection (i) of section 3216 of the insurance law is amended by
adding a new paragraph 9-a to read as follows:
  (9-A)(A)  EVERY POLICY THAT PROVIDES COVERAGE FOR SERVICES TO TREAT AN
EMERGENCY CONDITION IN HOSPITAL FACILITIES:
  (I) WITHOUT THE NEED FOR ANY PRIOR AUTHORIZATION DETERMINATION;
  (II) IN THE CASE OF PATIENTS WHO ARE UNCONSCIOUS OR  OTHERWISE  UNABLE
TO  PROVIDE  INFORMED  CONSENT,  REGARDLESS  OF  WHETHER THE HEALTH CARE

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD05326-01-3

              

A. 7668                             2

PROVIDER FURNISHING SUCH  SERVICES  IS  A  PARTICIPATING  PROVIDER  WITH
RESPECT TO SUCH SERVICES;
  (III)  IF  THE  EMERGENCY SERVICES ARE PROVIDED BY A NON-PARTICIPATING
PROVIDER, WITHOUT IMPOSING ANY ADMINISTRATIVE REQUIREMENT OR  LIMITATION
ON  COVERAGE  THAT  IS MORE RESTRICTIVE THAN THE REQUIREMENTS OR LIMITA-
TIONS THAT APPLY  TO  EMERGENCY  SERVICES  RECEIVED  FROM  PARTICIPATING
PROVIDERS; AND
  (IV)  IF  THE  EMERGENCY  SERVICES ARE PROVIDED BY A NON-PARTICIPATING
PROVIDER, THE COST-SHARING REQUIREMENT  (EXPRESSED  AS  A  COPAYMENT  OR
COINSURANCE)  SHALL  BE  THE  SAME  REQUIREMENT THAT WOULD APPLY IF SUCH
SERVICES WERE PROVIDED BY A PARTICIPATING PROVIDER.
  (B) ANY REQUIREMENTS OF SECTION 2719A(B) OF THE PUBLIC HEALTH  SERVICE
ACT,  42 U.S.C. S 300GG19A(B) AND REGULATIONS THEREUNDER THAT EXCEED THE
REQUIREMENTS OF THIS PARAGRAPH WITH RESPECT  TO  COVERAGE  OF  EMERGENCY
SERVICES SHALL BE APPLICABLE TO EVERY POLICY SUBJECT TO THIS PARAGRAPH.
  (C)  FOR  PURPOSES OF THIS PARAGRAPH, AN "EMERGENCY CONDITION" MEANS A
MEDICAL OR BEHAVIORAL CONDITION THAT MANIFESTS ITSELF BY ACUTE  SYMPTOMS
OF  SUFFICIENT  SEVERITY,  INCLUDING  SEVERE  PAIN,  SUCH THAT A PRUDENT
LAYPERSON, POSSESSING AN AVERAGE KNOWLEDGE OF MEDICINE AND HEALTH, COULD
REASONABLY EXPECT THE ABSENCE OF IMMEDIATE MEDICAL ATTENTION  TO  RESULT
IN (I) PLACING THE HEALTH OF THE PERSON AFFLICTED WITH SUCH CONDITION IN
SERIOUS  JEOPARDY,  OR IN THE CASE OF A BEHAVIORAL CONDITION PLACING THE
HEALTH OF SUCH PERSON  OR  OTHERS  IN  SERIOUS  JEOPARDY;  (II)  SERIOUS
IMPAIRMENT  TO SUCH PERSON'S BODILY FUNCTIONS; (III) SERIOUS DYSFUNCTION
OF ANY BODILY  ORGAN OR PART OF SUCH PERSON; (IV) SERIOUS  DISFIGUREMENT
OF  SUCH  PERSON;  OR  (V)  A CONDITION DESCRIBED IN CLAUSE (I), (II) OR
(III) OF SECTION 1867(E)(1)(A) OF THE SOCIAL SECURITY ACT.
  (D) FOR PURPOSES OF THIS PARAGRAPH, "EMERGENCY SERVICES"  MEANS,  WITH
RESPECT  TO  AN EMERGENCY CONDITION: (I) A MEDICAL SCREENING EXAMINATION
AS REQUIRED UNDER SECTION 1867 OF THE SOCIAL SECURITY ACT, 42  U.S.C.  S
1395DD,  WHICH IS WITHIN THE CAPABILITY OF THE EMERGENCY DEPARTMENT OF A
HOSPITAL, INCLUDING ANCILLARY SERVICES ROUTINELY AVAILABLE TO THE  EMER-
GENCY  DEPARTMENT TO EVALUATE SUCH EMERGENCY MEDICAL CONDITION; AND (II)
WITHIN THE CAPABILITIES OF THE STAFF AND  FACILITIES  AVAILABLE  AT  THE
HOSPITAL, SUCH FURTHER MEDICAL EXAMINATION AND TREATMENT AS ARE REQUIRED
UNDER  SECTION  1867  OF THE SOCIAL SECURITY ACT, 42 U.S.C. S 1395DD, TO
STABILIZE THE PATIENT.
  (E) FOR PURPOSES OF THIS PARAGRAPH, "TO STABILIZE" MEANS, WITH RESPECT
TO AN EMERGENCY CONDITION, TO PROVIDE  SUCH  MEDICAL  TREATMENT  OF  THE
CONDITION AS MAY BE NECESSARY TO ASSURE, WITHIN REASONABLE MEDICAL PROB-
ABILITY,  THAT  NO  MATERIAL DETERIORATION OF THE CONDITION IS LIKELY TO
RESULT FROM OR OCCUR DURING THE TRANSFER OF THE INSURED FROM A  FACILITY
OR TO DELIVER A NEWBORN CHILD (INCLUDING THE PLACENTA).
  S 3. This act shall take effect on the one hundred twentieth day after
it shall have become a law.