S T A T E O F N E W Y O R K
________________________________________________________________________
6669
2015-2016 Regular Sessions
I N A S S E M B L Y
March 30, 2015
___________
Introduced by M. of A. ENGLEBRIGHT, COLTON, ROBERTS, SIMANOWITZ, TITONE,
COOK, SKOUFIS, McDONOUGH, JAFFEE, DenDEKKER, CAHILL, SCARBOROUGH, MOYA
-- Multi-Sponsored by -- M. of A. ARROYO, CLARK, GLICK, MOSLEY, SCHI-
MEL, SKARTADOS, 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.
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
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD05003-01-5
A. 6669 2
PROVIDER FURNISHING SUCH SERVICES IS A PARTICIPATING PROVIDER WITH
RESPECT TO SUCH SERVICES;
(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.