NY State Senate Bill 2015-S7868

Archive: Last Bill Status - In Senate Committee Insurance Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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Actions

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jun 03, 2016	print number 7868a
Jun 03, 2016	amend (t) and recommit to insurance
May 18, 2016	referred to insurance

Bill Amendments

Original

A (Active)

2015-S7868 - Details

Current Committee:: Senate Insurance
Law Section:: Financial Services Law
Laws Affected:: Amd §§605 & 608, Fin Serv L
Versions Introduced in Other Legislative Sessions:: 2017-2018: S4241
2019-2020: S3171

2015-S7868 - Summary

Relates to establishing protections from excessive hospital emergency charges; includes hospital charges; extends coverage for members in certain counties.

2015-S7868 - Sponsor Memo

                                 BILL NUMBER:  S7868

 TITLE OF BILL :  An act to amend the financial services law, in
relation to establishing protections from excessive hospital emergency
charges

 PURPOSE :

This bill subjects hospital charges for emergency services to the
independent dispute resolution process established to protect against
excessive emergency charges.

 SUMMARY OF PROVISIONS :

Section one amends section 605 of the financial services law by
including hospital charges in the emergency charges that are subject
to the independent dispute resolution process. It also provides that
if a health insurer submits a dispute regarding the hospital's charge
to dispute resolution, the health insurer shall pay a reasonable
amount for the services directly to the hospital.

Section 2 sets the effective date.

 JUSTIFICATION :

Section 3241 of the insurance law requires health insurers to ensure

that enrollees incur no greater out-of-pocket costs than they would
have incurred with a participating provider when emergency services
are received from a non-participating provider. Recognizing that
emergency physician charges are often excessive, section 605 of the
financial services law establishes an independent dispute resolution
process for physician emergency charges.

The charges billed by hospitals for emergency services when they are
out-of-network are often as excessive as physician charges. This is
particularly true given section 3241 of the insurance law cited above,
which essentially requires health insurers to pay charges to
non-participating hospitals for emergency services to ensure that
members are not balance billed. Hospitals are assured of receiving
their billed charges, notwithstanding how excessive the charges might
be.

Hospital charges for emergency services must be subject to dispute
resolution to ensure that hospitals are not able to take advantage of
section 3241 of the insurance law by charging exorbitant fees which
ultimately drive up the cost of health insurance.

 LEGISLATIVE HISTORY :

New bill.

 FISCAL IMPLICATIONS :

None.

 EFFECTIVE DATE :
Immediately.

2015-S7868 - Bill Text download pdf

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

                                  7868

                            I N  S E N A T E

                              May 18, 2016
                               ___________

Introduced  by  Sen.  SEWARD -- read twice and ordered printed, and when
  printed to be committed to the Committee on Insurance

AN ACT to amend the financial services law, in relation to  establishing
  protections from excessive hospital emergency charges

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

  Section 1. Section 605 of the financial  services  law,  as  added  by
section  26  of  part H of chapter 60 of the laws of 2014, is amended to
read as follows:
  S 605.  Dispute  resolution  for  emergency  services.  (a)  Emergency
services for an insured. (1) When a health care plan receives a bill for
emergency  services  from a non-participating physician OR HOSPITAL, the
health care plan shall pay an amount that it  determines  is  reasonable
for  the  emergency services rendered by the non-participating physician
OR HOSPITAL, in accordance with section three thousand two hundred twen-
ty-four-a of the insurance law, except  for  the  insured's  co-payment,
coinsurance  or  deductible,  if  any, and shall ensure that the insured
shall incur no greater out-of-pocket costs for  the  emergency  services
than  the  insured would have incurred with a participating physician OR
HOSPITAL pursuant to  subsection  (c)  of  section  three  thousand  two
hundred forty-one of the insurance law.
  (2)  A  non-participating  physician OR HOSPITAL or a health care plan
may submit a dispute regarding a fee or payment for  emergency  services
for review to an independent dispute resolution entity. IN CASES WHERE A
HEALTH  CARE  PLAN  SUBMITS  A  DISPUTE REGARDING A FEE FOR PAYMENT OF A
NON-PARTICIPATING HOSPITAL'S EMERGENCY ROOM SERVICES,  THE  HEALTH  CARE
PLAN  SHALL  PAY  THE AMOUNT IT DETERMINES IS REASONABLY DIRECTLY TO THE
NON-PARTICIPATING HOSPITAL.
  (3) The independent dispute resolution entity shall  make  a  determi-
nation within thirty days of receipt of the dispute for review.
  (4)  In  determining  a  reasonable  fee for the services rendered, an
independent dispute resolution entity shall  select  either  the  health
care  plan's  payment or the non-participating physician's OR HOSPITAL'S
fee. The independent dispute resolution  entity  shall  determine  which

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

                                                           LBD15486-01-6

S. 7868                             2

amount  to  select  based  upon  the conditions and factors set forth in
section six hundred four of this  article.  If  an  independent  dispute
resolution  entity  determines,  based on the health care plan's payment
and  the non-participating physician's OR HOSPITAL'S fee, that a settle-
ment between the health care plan  and  non-participating  physician  OR
HOSPITAL  is  reasonably  likely,  or  that  both the health care plan's
payment and the non-participating physician's OR HOSPITAL'S  fee  repre-
sent  unreasonable  extremes,  then  the  independent dispute resolution
entity may direct both parties to attempt a good faith  negotiation  for
settlement.  The  health  care  plan  and non-participating physician OR
HOSPITAL may be granted up to ten business days  for  this  negotiation,
which  shall  run  concurrently  with  the thirty day period for dispute
resolution.
  (b) Emergency services for a patient that is not  an  insured.  (1)  A
patient  that  is not an insured or the patient's physician may submit a
dispute regarding a fee for emergency services for review  to  an  inde-
pendent dispute resolution entity upon approval of the superintendent.
  (2) An independent dispute resolution entity shall determine a reason-
able fee for the services based upon the same conditions and factors set
forth in section six hundred four of this article.
  (3)  A patient that is not an insured shall not be required to pay the
physician's OR HOSPITAL'S fee in order to  be  eligible  to  submit  the
dispute for review to an independent dispute resolution entity.
  (c)  The  determination  of  an  independent dispute resolution entity
shall be binding on the health care  plan,  physician  OR  HOSPITAL  and
patient,  and  shall  be  admissible in any court proceeding between the
health care plan, physician OR HOSPITAL or patient, or in  any  adminis-
trative proceeding between this state and the physician OR HOSPITAL.
  S  2.  Paragraph  (a) of section 608 of the financial services law, as
added by section 26 of part H of chapter 60 of  the  laws  of  2014,  is
amended to read as follows:
  (a)  For  disputes  involving an insured, when the independent dispute
resolution entity determines the health care plan's payment  is  reason-
able,  payment for the dispute resolution process shall be the responsi-
bility of the non-participating physician OR HOSPITAL.   When the  inde-
pendent  dispute  resolution  entity  determines  the  non-participating
physician's OR HOSPITAL'S fee is reasonable,  payment  for  the  dispute
resolution  process shall be the responsibility of the health care plan.
When a good faith negotiation directed by the independent dispute resol-
ution entity pursuant to paragraph four of subsection (a) of section six
hundred five of this article, or paragraph  six  of  subsection  (a)  of
section  six  hundred  seven  of  this  article  results in a settlement
between the health care plan and non-participating physician, the health
care plan and the non-participating physician OR HOSPITAL  shall  evenly
divide and share the prorated cost for dispute resolution.
  S 3. This act shall take effect immediately.

co-Sponsors

2015-S7868A (ACTIVE) - Details

Current Committee:: Senate Insurance
Law Section:: Financial Services Law
Laws Affected:: Amd §§605 & 608, Fin Serv L
Versions Introduced in Other Legislative Sessions:: 2017-2018: S4241
2019-2020: S3171

2015-S7868A (ACTIVE) - Summary

Relates to establishing protections from excessive hospital emergency charges; includes hospital charges; extends coverage for members in certain counties.

2015-S7868A (ACTIVE) - Sponsor Memo

                                 BILL NUMBER:  S7868A

 TITLE OF BILL :  An act to amend the financial services law, in
relation to establishing protections from excessive hospital emergency
charges; and providing for the repeal of certain provisions upon
expiration thereof

 PURPOSE :

This bill subjects hospital charges for emergency services to the
independent dispute resolution process established to protect against
excessive emergency charges.

 SUMMARY OF PROVISIONS :

Section 1 amends section 605 of the financial services law by
including hospital charges in the emergency charges that are subject
to the independent dispute resolution process. It also provides that
if a health insurer submits a dispute regarding the hospital's charge
to dispute resolution, the health insurer shall pay a reasonable
amount for the services directly to the hospital.

Section 2 amends section 608 of the financial services law by
including hospitals in the payment and settlement provisions with
respect to the cost of the independent dispute resolution process.

Section 3 requires parties to a contract between a commercial health
insurer and a hospital or hospital system to engage in mutually
agreeable third-party mediation for the purposes of settling a
financial dispute.

Section 4 sets the effective date, and sets forth that section 3 of
the bill shall be deemed repealed on January 1, 2017.

 JUSTIFICATION :

Section 3241 of the insurance law requires health insurers to ensure
that enrollees incur no greater out-of-pocket costs than they would
have incurred with a participating provider when emergency services
are received from a non-participating provider. Currently, section 605
of the financial services law establishes an independent dispute
resolution process for physician emergency charges.

The charges billed by hospitals for emergency services when they are
out-of-network are often excessive. This is particularly true given
section 3241 of the insurance law cited above, which essentially
requires health insurers to pay charges to non-participating hospitals
for emergency services to ensure that members are not balance billed.
Hospitals are assured of receiving their billed charges,
notwithstanding how excessive the charges might be.

Hospital charges for emergency services must be subject to dispute
resolution to ensure that hospitals are not able to take advantage of
section 3241 of the insurance law by charging exorbitant fees which
ultimately drive up the cost of health insurance.

 LEGISLATIVE HISTORY :

New bill.

 FISCAL IMPLICATIONS :

None.

 EFFECTIVE DATE :
Immediately.

2015-S7868A (ACTIVE) - Bill Text download pdf

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

                                 7868--A

                            I N  S E N A T E

                              May 18, 2016
                               ___________

Introduced  by  Sen.  SEWARD -- read twice and ordered printed, and when
  printed to be committed to the Committee  on  Insurance  --  committee
  discharged, bill amended, ordered reprinted as amended and recommitted
  to said committee

AN  ACT to amend the financial services law, in relation to establishing
  protections from excessive hospital emergency charges;  and  providing
  for the repeal of certain provisions upon expiration thereof

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

  Section 1. Section 605 of the financial  services  law,  as  added  by
section  26  of  part H of chapter 60 of the laws of 2014, is amended to
read as follows:
  S 605.  Dispute  resolution  for  emergency  services.  (a)  Emergency
services for an insured. (1) When a health care plan receives a bill for
emergency  services  from a non-participating physician OR HOSPITAL, the
health care plan shall pay an amount that it  determines  is  reasonable
for  the  emergency services rendered by the non-participating physician
OR HOSPITAL, in accordance with section three thousand two hundred twen-
ty-four-a of the insurance law, except  for  the  insured's  co-payment,
coinsurance  or  deductible,  if  any, and shall ensure that the insured
shall incur no greater out-of-pocket costs for  the  emergency  services
than  the  insured would have incurred with a participating physician OR
HOSPITAL pursuant to  subsection  (c)  of  section  three  thousand  two
hundred forty-one of the insurance law.
  (2)  A  non-participating  physician OR HOSPITAL or a health care plan
may submit a dispute regarding a fee or payment for  emergency  services
for review to an independent dispute resolution entity. IN CASES WHERE A
HEALTH  CARE  PLAN  SUBMITS  A  DISPUTE REGARDING A FEE FOR PAYMENT OF A
NON-PARTICIPATING HOSPITAL'S EMERGENCY ROOM SERVICES,  THE  HEALTH  CARE
PLAN  SHALL  PAY  THE AMOUNT IT DETERMINES IS REASONABLE DIRECTLY TO THE
NON-PARTICIPATING HOSPITAL.
  (3) The independent dispute resolution entity shall  make  a  determi-
nation within thirty days of receipt of the dispute for review.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD15486-02-6

S. 7868--A                          2

  (4)  In  determining  a  reasonable  fee for the services rendered, an
independent dispute resolution entity shall  select  either  the  health
care  plan's  payment or the non-participating physician's OR HOSPITAL'S
fee. The independent dispute resolution  entity  shall  determine  which
amount  to  select  based  upon  the conditions and factors set forth in
section six hundred four of this  article.  If  an  independent  dispute
resolution  entity  determines,  based on the health care plan's payment
and the non-participating physician's OR HOSPITAL'S fee, that a  settle-
ment  between  the  health  care plan and non-participating physician OR
HOSPITAL is reasonably likely, or  that  both  the  health  care  plan's
payment  and  the non-participating physician's OR HOSPITAL'S fee repre-
sent unreasonable extremes,  then  the  independent  dispute  resolution
entity  may  direct both parties to attempt a good faith negotiation for
settlement. The health care  plan  and  non-participating  physician  OR
HOSPITAL  may  be  granted up to ten business days for this negotiation,
which shall run concurrently with the  thirty  day  period  for  dispute
resolution.
  (b)  Emergency  services  for  a patient that is not an insured. (1) A
patient that is not an insured or the patient's physician may  submit  a
dispute  regarding  a  fee for emergency services for review to an inde-
pendent dispute resolution entity upon approval of the superintendent.
  (2) An independent dispute resolution entity shall determine a reason-
able fee for the services based upon the same conditions and factors set
forth in section six hundred four of this article.
  (3) A patient that is not an insured shall not be required to pay  the
physician's  OR  HOSPITAL'S  fee  in  order to be eligible to submit the
dispute for review to an independent dispute resolution entity.
  (c) The determination of  an  independent  dispute  resolution  entity
shall  be  binding  on  the  health care plan, physician OR HOSPITAL and
patient, and shall be admissible in any  court  proceeding  between  the
health  care  plan, physician OR HOSPITAL or patient, or in any adminis-
trative proceeding between this state and the physician OR HOSPITAL.
  S 2. Subdivision (a) of section 608 of the financial services law,  as
added  by  section  26  of  part H of chapter 60 of the laws of 2014, is
amended to read as follows:
  (a) For disputes involving an insured, when  the  independent  dispute
resolution  entity  determines the health care plan's payment is reason-
able, payment for the dispute resolution process shall be the  responsi-
bility  of  the non-participating physician OR HOSPITAL.  When the inde-
pendent  dispute  resolution  entity  determines  the  non-participating
physician's  OR  HOSPITAL'S  fee  is reasonable, payment for the dispute
resolution process shall be the responsibility of the health care  plan.
When a good faith negotiation directed by the independent dispute resol-
ution  entity pursuant to paragraph four of [subsection] SUBDIVISION (a)
of section six hundred  five  of  this  article,  or  paragraph  six  of
[subsection]  SUBDIVISION (a) of section six hundred seven of this arti-
cle results in a settlement between the health care plan and  non-parti-
cipating  physician,  the  health  care  plan  and the non-participating
physician OR HOSPITAL shall evenly divide and share  the  prorated  cost
for dispute resolution.
  S  3.    A contract between a hospital or hospital system located in a
county with a population greater than 178,000 and less than 182,000  and
a  commercial  health  insurer  providing  coverage or benefits for both
fully insured and self-insured members is subject to expire or is  being
terminated  on  or  after May 31, 2016, shall automatically be extended,
under the same terms and  conditions,  for  an  additional  ninety  days

S. 7868--A                          3

during  which  time  the parties to the contract shall engage a mutually
agreeable independent and qualified third party to mediate the financial
terms in dispute between the parties. In selecting the third party medi-
ator, such parties shall act reasonably and in good faith.
  S  4.  This  act  shall take effect immediately; provided that section
three of this act shall expire and be  deemed  repealed  on  January  1,
2017.

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Senate Bill S7868

Sponsored By

Archive: Last Bill Status - In Senate Committee Insurance Committee

Bill Amendments

2015-S7868 - Details

2015-S7868 - Summary

2015-S7868 - Sponsor Memo

2015-S7868 - Bill Text download pdf

co-Sponsors

2015-S7868A (ACTIVE) - Details

2015-S7868A (ACTIVE) - Summary

2015-S7868A (ACTIVE) - Sponsor Memo

2015-S7868A (ACTIVE) - Bill Text download pdf

Comments

Senate Bill S7868

Share this bill

Sponsored By

James L. Seward

Archive: Last Bill Status - In Senate Committee Insurance Committee

Bill Amendments

2015-S7868 - Details

2015-S7868 - Summary

2015-S7868 - Sponsor Memo

2015-S7868 - Bill Text download pdf

co-Sponsors

George Amedore

2015-S7868A (ACTIVE) - Details

2015-S7868A (ACTIVE) - Summary

2015-S7868A (ACTIVE) - Sponsor Memo

2015-S7868A (ACTIVE) - Bill Text download pdf

Comments