S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   7296
 
                        2021-2022 Regular Sessions
 
                           I N  A S S E M B L Y
 
                                May 4, 2021
                                ___________
 
 Introduced  by  M. of A. ENGLEBRIGHT, COLTON, COOK, McDONOUGH, CAHILL --
   Multi-Sponsored by -- M. of A. GLICK, THIELE -- 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.
   § 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
 PROVIDER  FURNISHING  SUCH  SERVICES  IS  A  PARTICIPATING PROVIDER WITH
 RESPECT TO SUCH SERVICES;
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD11148-01-1
              

 A. 7296                             2
 
   (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. § 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.  §
 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. § 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).
   § 3. This act shall take effect on the one hundred twentieth day after
 it shall have become a law.