S T A T E O F N E W Y O R K
________________________________________________________________________
7699
2011-2012 Regular Sessions
I N A S S E M B L Y
May 16, 2011
___________
Introduced by M. of A. CASTRO -- read once and referred to the Committee
on Health
AN ACT to amend the public health 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 providing
improved notification 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. Legislative intent. The legislature hereby finds that
private academic medical centers operate a two-tiered system of out-pa-
tient 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.
Once separated into different systems of care, the Medicaid and unin-
sured 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 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
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD11059-01-1
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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 over-
crowding as well as higher health care costs.
The legislature further finds that 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, partic-
ularly 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 coordi-
nation for Medicaid beneficiaries and cost reduction for the state's
health care system.
It is therefore the intent of the legislature to eliminate this sepa-
rate 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 legisla-
ture seeks 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.
In addition, the legislature seeks to ensure that all patients are
made aware of hospital financial assistance policies through the hospi-
tal's website and patient referral line. Lastly, the legislature seeks
to require that New York City general hospitals make reasonable efforts
to negotiate with Medicaid managed care plans in their social 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 SPECIALTY
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-OR INTERNET-BASED PHYSI-
CIAN 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.
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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 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. 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
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not a major public hospital or facility operated by a major public
hospital; and
(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 TWENTY-EIGHT
HUNDRED ONE OF THE PUBLIC HEALTH LAW, MUST USE BEST EFFORTS TO NEGOTIATE
WITH MANAGED CARE PROVIDERS LICENSED TO OPERATE IN THE SOCIAL SERVICES
DISTRICT IN WHICH SUCH GENERAL HOSPITAL 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
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TO THE DEPARTMENT DESCRIBING THE GENERAL HOSPITAL'S STRATEGIC PLAN TO
MEET THE REQUIREMENTS OF THIS SUBSECTION 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 repealed 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 is
authorized to be made on or before such effective date.