Assembly Bill A10988

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

                                  10988

                          I N  A S S E M B L Y

                               May 6, 2010
                               ___________

Introduced by M. of A. BENJAMIN, MAISEL -- read once and referred to the
  Committee on Health

AN  ACT to amend the public health law, in relation to providing quality
  out-patient care for patients of academic medical  centers  regardless
  of source of payment or insurance type, and providing improved notifi-
  cation  to  patients regarding their rights to financial assistance at
  hospitals; and to amend  the  social  services  law,  in  relation  to
  improving access to specialty care for medical assistance recipients

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

  Section 1. 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. EVERY  GENERAL  HOSPITAL
LOCATED  IN A CITY WITH A POPULATION OF ONE MILLION OR MORE SHALL ENSURE
THAT EVERY PATIENT SEEKING OUT-PATIENT HOSPITAL SERVICES, REGARDLESS  OF
SOURCE  OF  PAYMENT,  SHALL RECEIVE CARE IN THE OUT-PATIENT CLINIC OWNED
AND OPERATED BY THE GENERAL HOSPITAL PURSUANT TO THIS ARTICLE.
  2. NO GENERAL HOSPITAL LOCATED IN A CITY  WITH  A  POPULATION  OF  ONE
MILLION  OR  MORE  SHALL  REFER,  STEER, OR OTHERWISE DIRECT ANY PATIENT
SEEKING OUT-PATIENT HOSPITAL   SERVICES TO PRIVATE  PHYSICIAN  PRACTICES
THAT ARE NOT LICENSED PURSUANT TO THIS ARTICLE, INCLUDING BUT NOT LIMIT-
ED  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 APPROPRIATE-
LY  CREDENTIALED  PHYSICIANS  ARE  AVAILABLE TO TREAT THE PATIENT IN THE
APPROPRIATE OUT-PATIENT CLINIC OWNED AND OPERATED BY THE GENERAL  HOSPI-
TAL.  THE  PROVISIONS  OF THIS SECTION SHALL APPLY REGARDLESS OF WHETHER
THE PATIENT CONTACTS THE GENERAL HOSPITAL VIA A TELEPHONE- OR  INTERNET-
BASED PHYSICIAN REFERRAL SERVICE, AS A WALK-IN, OR THROUGH THE PATIENT'S
PRIMARY CARE PHYSICIAN.
  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.

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

                                                           LBD17091-01-0

A. 10988                            2

  S 2. 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 3. Paragraph (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, clause E of subparagraph (iii) as added and  clause  F  of
subparagraph  (iii)  as relettered by chapter 37 of the laws of 2010, is
amended to read as follows:
  (a) (i) a managed care  provider  shall  arrange  for  access  to  and
enrollment  of  primary  care  practitioners  and other medical services
providers. Each managed care provider shall possess  the  expertise  and
sufficient  resources  to assure the delivery of quality medical care to
participants in an appropriate and timely manner and may include  physi-
cians,  nurse  practitioners,  county  health  departments, providers of
comprehensive health service plans licensed pursuant to  article  forty-
four  of  the public health law, and hospitals and diagnostic and treat-
ment centers licensed pursuant to article  twenty-eight  of  the  public
health  law or otherwise authorized by law to offer comprehensive health
services or facilities licensed pursuant to articles sixteen, thirty-one
and thirty-two of the mental hygiene law.
  (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]

A. 10988                            3

  (iii) under a managed care program, not  all  managed  care  providers
must be required to provide the same set of medical assistance services.
The  managed  care  program  shall  establish  procedures  through which
participants will be assured access to all medical  assistance  services
to  which  they  are  otherwise entitled, other than through the managed
care provider, where:
  (A) the service is not reasonably  available  directly  or  indirectly
from the managed care provider,
  (B) it is necessary because of emergency or geographic unavailability,
or
  (C) the services provided are family planning services; or
  (D)  the services are dental services and are provided by a diagnostic
and treatment center licensed under article twenty-eight of  the  public
health  law which is affiliated with an academic dental center and which
has been granted an operating certificate pursuant  to  article  twenty-
eight  of  the  public  health law to provide such dental services.  Any
diagnostic and treatment center providing dental  services  pursuant  to
this  clause shall prior to June first of each year report to the gover-
nor, temporary president of the senate and speaker of  the  assembly  on
the  following:  the  total  number of visits made by medical assistance
recipients during the immediately preceding calendar year; the number of
visits made by medical  assistance  recipients  during  the  immediately
preceding  calendar year by recipients who were enrolled in managed care
programs; the number of visits made  by  medical  assistance  recipients
during  the  immediately  preceding calendar year by recipients who were
enrolled in managed care programs that  provide  dental  benefits  as  a
covered  service;  and the number of visits made by the uninsured during
the immediately preceding calendar year; or
  (E) the services are optometric services, as defined  in  article  one
hundred forty-three of the education law, and are provided by a diagnos-
tic  and  treatment  center  licensed  under article twenty-eight of the
public health law which is affiliated with the college of  optometry  of
the state university of New York and which has been granted an operating
certificate pursuant to article twenty-eight of the public health law to
provide  such  optometric  services. Any diagnostic and treatment center
providing optometric services pursuant to this  clause  shall  prior  to
June  first  of each year report to the governor, temporary president of
the senate and speaker of the assembly on  the  following:    the  total
number  of visits made by medical assistance recipients during the imme-
diately preceding calendar year; the number of visits  made  by  medical
assistance  recipients during the immediately preceding calendar year by
recipients who were enrolled in managed care  programs;  the  number  of
visits  made  by  medical  assistance  recipients during the immediately
preceding calendar year by recipients who were enrolled in managed  care
programs  that provide optometric benefits as a covered service; and the
number of visits made by the uninsured during the immediately  preceding
calendar year; or
  (F) other services as defined by the commissioner of health; AND
  (IV)  EVERY GENERAL HOSPITAL, AS DEFINED BY SECTION 2801 OF THE PUBLIC
HEALTH LAW, LOCATED IN A CITY WITH A POPULATION OF ONE MILLION  OR  MORE
MUST  USE BEST EFFORTS TO NEGOTIATE WITH MANAGED CARE PROVIDERS LICENSED
TO OPERATE IN THE SOCIAL SERVICES DISTRICT IN WHICH SUCH GENERAL  HOSPI-
TAL  IS LOCATED TO CREDENTIAL ALL MEDICAL SERVICES PROVIDERS EMPLOYED BY
SUCH GENERAL HOSPITAL. EACH GENERAL HOSPITAL SUBJECT TO THIS  SUBSECTION
MUST  SUBMIT  AN  ANNUAL REPORT TO THE DEPARTMENT DESCRIBING THE GENERAL

A. 10988                            4

HOSPITAL'S STRATEGIC PLAN TO MEET THE REQUIREMENTS  OF  THIS  SUBSECTION
AND THE EFFORTS MADE TO FULFILL THE STRATEGIC PLAN.
  S  4.  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 three of this act shall not affect the repeal  of  such  section
and shall be deemed repealed therewith, provided further, that effective
immediately,  the addition, amendment and/or repeal of any rule or regu-
lation necessary for the implementation of this  act  on  its  effective
date  are  authorized  and directed to be made and computed on or before
such effective date.