Senate Bill S7335

                                 BILL NUMBER:  S7335

 TITLE OF BILL :

An act to amend the public health law, in relation to patient notice
of care under an alternate payment system

 PURPOSE :

To ensure patients who receive treatment in a hospital participating
in a bundled payment arrangement, system or model are provided with
notice of such arrangements, treatment options and other relevant
information upon admission or immediately following the decision to
schedule surgery whichever occurs later.

 SUMMARY OF PROVISIONS :

Section 1 of this bill amends the public health law by adding a new
section 2805-w-1 entitled Patient notice of care under an alternate
payment. This section requires all general hospitals which participate
in bundled payment arrangements, systems or models which include
coverage of post acute care, to provide patients covered under such
payment arrangements, with an oral and written notice of his or her
inclusion in such an arrangement. The notice shall be provided upon
admission to the participant hospital or immediately following the
decision to schedule surgery whichever occurs later.  The written
              

notice shall include, but not be limited to, a detailed explanation of
the payment model and how it might be expected to affect the patient's
care including post acute care services; notification that the patient
retains freedom of choice to chose providers and services including
impatient and outpatient rehabilitative therapy and services, and that
he or she should contact their insurance plan to better understand the
implications of the payment model; a list of providers and suppliers
with whom the participant hospital has a collaborator agreement; and
an explanation of how patients can access care records and claims data
and share such information with caregivers. The commissioner shall
develop and make available guidance on the notice.

Section 2 provides an effective date of within 90 days of becoming
law.

 JUSTIFICATION :

New federal Medicare rules effective April 1, 2016 require certain
hospitals across the nation to be accountable for all costs related to
hip and knee replacements for 90 days by establishing bundled payment
rates. Patients who go home and recover quickly could save hospitals
money and increase their Medicare payment, while those who have
complications or lengthy stays in rehabilitation facilities could
result in hospitals owing Medicare. As part of the new Medicare rule
hospitals are required to provide notices to Medicare beneficiaries
whose care is being reimbursed under such a payment arrangement.

Several NYC hospitals participated voluntarily in Medicare's bundled
payment program for knee and hip replacements prior to the mandatory
program going into effect April 2016. Bundled payment arrangements are
not unique to this new Medicare model, as any hospital can negotiate
with a payer to provide care in this manner. For example, in April
2016 Mount Sinai announced that it was launching a value-based joint
replacement initiative covering 70,000 New York members of the
services union 32BJ SEIU who are insured by Empire BCBS. Through the
arrangement the hospital expects to reduce unnecessary consultations,
post acute care and readmissions while providing the union member
patients who choose Mount Sinai for their knee or hip replacements
access without any co-payments.

While these arrangements may help in achieve the triple aim of health
care: better care, better health, at lower cost, they can also
incentivize less utilization of post acute care different or less
intensive rehabilitation and care outside of the specified period of
the bundled payment.

Making sure that patients are well aware of the arrangements and their
options will protect against such abuses.

This legislation builds upon the existing notice hospitals must
provide to patients under the Medicare bundled payment program, and
expands such notice requirement to all cases in the state where a
hospital is caring for a patient under similar payment arrangements.
Patients must be informed that such payment arrangement exists, that
the arrangements may affect the patient's care, and that patient's
retain freedom of choice to choose providers and services.

Patient notices will help to maximize the benefit of the new payment
model incentives by safeguarding against any unintended consequences
and ensuring the welfare of patients in New York State.

 LEGISLATIVE HISTORY :

New Bill

 FISCAL IMPLICATIONS :

None to state.

 EFFECTIVE DATE :
90th day after it shall be enacted.