senate Bill S1197

2013-2014 Legislative Session

Requires hospitals to inform emergency care patients whether the attending physician participates in the insured's insurance policy

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Archive: Last Bill Status - In Committee


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

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Assembly Actions - Lowercase
Senate Actions - UPPERCASE
Jan 08, 2014 referred to health
Jan 09, 2013 referred to health

Co-Sponsors

S1197 - Bill Details

See Assembly Version of this Bill:
A7668
Current Committee:
Senate Health
Law Section:
Public Health Law
Laws Affected:
Amd §2805-b, Pub Health L; amd §3216, Ins L
Versions Introduced in 2011-2012 Legislative Session:
S6189

S1197 - Bill Texts

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Requires hospitals to inform emergency care patients whether the attending physician participates in the insured's insurance policy; requires insurance companies to cover the cost of out-of-network care for patients who are unconscious or otherwise unable to provide informed consent.

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BILL NUMBER:S1197

TITLE OF BILL:
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

PURPOSE:
The bill requires hospitals to inform
patients if they are to
be treated by an out-of network doctor. The bill also provides that
in certain circumstances if emergency services provided by an out-of
network provider the cost sharing requirements will be the same if
the services were provided by an in-network provider.

SUMMARY OF PROVISIONS:
Section 1. The bill requires that every general hospital which
patients receive emergency care must adopt regulations requiring its
staff to inform patients whether the attending physician participates
with the patient's insurance policy. The patient can then decide if
they want to be treated by the out-of network physician or request
treatment by an in-network physician.

Section 2. Requires that every policy that provides coverage for
services to treat an emergency condition in a hospital facility that
meets the specified criteria and services are provided by a
non-participating provider, the cost-sharing requirement shall be the
same requirement that would apply if the services were provided by a
participating provider.

JUSTIFICATION:
In 2011, Nathan Roethstein was bite by a dog and sought
medical treatment at a provider hospital. Due to the severity of the
bite his parents were told that he would have to be seen by a plastic
surgeon.
The Roethsteins were not aware that the plastic surgeon on-call at the
time was not an in-network provider. The Roethstein were made aware
of this when Nathan went to the surgeon to get his stitches out and
his parents were presented with a large medical bill, which their
insurance would only cover a small portion off. The Roethsteins are
not the only family in New York whom after receiving emergency care
received a large medical bill because the attending physician that
they saw was out-of network. This bill attempts to solve this
problem. By requiring hospitals to inform patients if the physician
on-call is in their network will provide patients with the choice to
see the physician or to request an in-network physician. This will
help patients to make an informed choice to hopefully decrease the
number of New Yorkers who struggle to pay high medical bills. The
bill will also alleviate this financial burden by requiring that in
certain emergency situations the cost-sharing requirement for
services provided by a non-participating provider be the same


requirement that would apply if the services were provided by a
participating provider.

New York's families are already struggling in this hard economic time.
Many cannot afford the huge medical bills that are associated with
being treated by an out of network doctor in an emergency situation.
This bill takes the necessary steps to try and cut down on cost of
emergency care.

LEGISLATIVE HISTORY:
2011-12 - S.6189 - Referred to Health

FISCAL IMPLICATIONS:
Needs to be determined.

EFFECTIVE DATE:
This law shall take effect on the one hundred twentieth day after it
shall become law.

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

                                  1197

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                               (PREFILED)

                             January 9, 2013
                               ___________

Introduced  by Sen. CARLUCCI -- read twice and ordered printed, and when
  printed to be committed 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
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.
                                                           LBD05326-01-3

S. 1197                             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. 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.

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