S T A T E   O F   N E W   Y O R K
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                                   1532
 
                        2021-2022 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 11, 2021
                                ___________
 
 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
 STEPS  THAT  CAN  BE TAKEN TO MINIMIZE THE ADVERSE IMPACT OF THE REDUCED
 ADMISSIONS ON THE HOSPITAL.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD04900-01-1

 A. 1532                             2
 
   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.