S T A T E O F N E W Y O R K
________________________________________________________________________
517
2019-2020 Regular Sessions
I N A S S E M B L Y
(PREFILED)
January 9, 2019
___________
Introduced by M. of A. PERRY -- read once and referred to the Committee
on Health
AN ACT to amend the public health law, in relation to substantial
reductions by health maintenance organizations of inpatient referrals
to a hospital
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. The public health law is amended by adding a new section
4405-c to read as follows:
§ 4405-C. SUBSTANTIAL REDUCTIONS OF REFERRALS TO A HOSPITAL. 1. NO
HEALTH MAINTENANCE ORGANIZATION SHALL MAKE A SUBSTANTIAL REDUCTION IN
INPATIENT REFERRALS TO ANY HOSPITAL, TO WHICH THE HEALTH MAINTENANCE
ORGANIZATION HAS REFERRED NON-EMERGENCY INPATIENTS FOR AT LEAST THREE
YEARS, OR ISSUE ORDERS, DIRECTIVES, INSTRUCTIONS OR SUGGEST IN ANY
MANNER TO ANY PARTICIPANT MEDICAL PRACTITIONER REGISTERED IN THE HEALTH
MAINTENANCE ORGANIZATION PLAN THAT SUCH PRACTITIONER SHOULD REDUCE OR
DISCONTINUE REFERRING PATIENTS TO ANY HOSPITAL, WITHOUT APPROVAL OF THE
COMMISSIONER.
2. FOR THE PURPOSES OF THIS SECTION, ANY REDUCTION IN A HEALTH MAINTE-
NANCE ORGANIZATION'S INPATIENT REFERRALS TO A HOSPITAL SHALL BE CONSID-
ERED SUBSTANTIAL IF SUCH REDUCTION WOULD RESULT IN A DECREASE IN THE
PROJECTED ANNUALIZED DISCHARGES OF THE HOSPITAL THAT EXCEEDS FIVE
PERCENT OF ITS TOTAL DISCHARGES IN THE PRIOR CALENDAR YEAR.
3. A HEALTH MAINTENANCE ORGANIZATION THAT PLANS TO MAKE A SUBSTANTIAL
REDUCTION IN INPATIENT REFERRALS TO A PARTICULAR HOSPITAL SHALL FILE
WITH THE DEPARTMENT AND WITH THE APPROPRIATE HEALTH SYSTEMS AGENCY A
WRITTEN PLAN THAT SHALL INCLUDE: (A) THE PROJECTED NUMBER OF REDUCED
REFERRALS BY SERVICE; (B) THE PLANS TO ASSURE QUALITY AND CONTINUITY OF
SERVICE TO THE HEALTH MAINTENANCE ORGANIZATION ENROLLEES; AND (C) THE
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD05296-01-9
A. 517 2
STEPS THAT CAN BE TAKEN TO MINIMIZE THE ADVERSE IMPACT OF THE REDUCED
ADMISSIONS ON THE HOSPITAL.
4. THE HEALTH SYSTEMS AGENCY SHALL HAVE AN OPPORTUNITY TO GIVE ITS
VIEWS TO THE COMMISSIONER. THE COMMISSIONER SHALL NOT GRANT APPROVAL FOR
THE SUBSTANTIAL REDUCTION IN INPATIENT REFERRALS UNLESS HE OR SHE IS
SATISFIED THAT THE WRITTEN PLAN SUBMITTED BY THE HEALTH MAINTENANCE
ORGANIZATION: (A) ADEQUATELY PROTECTS QUALITY AND ACCESSIBILITY OF
SERVICES TO HEALTH MAINTENANCE ORGANIZATION MEMBERS; (B) REFLECTS ALL
REASONABLE EFFORTS BY THE HEALTH MAINTENANCE ORGANIZATION TO MINIMIZE
THE ADVERSE IMPACT OF THE REDUCTION UPON THE HOSPITAL; AND (C) DOES NOT
UNDULY RISK THE QUALITY OR ACCESSIBILITY OF HOSPITAL SERVICES IN THE
COMMUNITY SERVED BY THE HOSPITAL. TO PROTECT THE PUBLIC INTEREST, THE
COMMISSIONER MAY ESTABLISH A REASONABLE WITHDRAWAL SCHEDULE.
§ 2. This act shall take effect immediately.