S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   7976
 
                        2021-2022 Regular Sessions
 
                           I N  A S S E M B L Y
 
                               June 4, 2021
                                ___________
 
 Introduced  by  M.  of  A.  SEAWRIGHT  --  read once and referred to the
   Committee on Health
 
 AN ACT to amend the public health law and the social  services  law,  in
   relation to assuring more equitable access to specialized cancer care;
   and providing for the repeal of such provisions upon expiration there-
   of

   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Legislative findings and intent. The Legislature finds that
 enhancing access to high quality, specialized cancer care is  an  impor-
 tant  goal,  given the fact that cancer remains the second leading cause
 of death in New York state, and the Legislature further finds that it is
 important to ensure equitable access to cancer care for all New Yorkers,
 regardless of the source of  their  healthcare  coverage.  Evidence  has
 demonstrated  that  patients with cancer who are treated at a comprehen-
 sive cancer center like Memorial Sloan Kettering have better outcomes at
 a comparable or lower total cost of care.
   The Legislature further  finds  that,  while  most  employer-sponsored
 group  health  plans  in  the  downstate  region  include Memorial Sloan
 Kettering in their networks, nearly all health plans that offer coverage
 on an individual basis-such as through the  health  insurance  exchange,
 the  Medicaid  managed  care  program  or  the  Essential  Plan-have not
 contracted with Memorial Sloan Kettering for fear of adverse  selection:
 i.e.,  the  plans  are  concerned that large numbers of individuals with
 cancer will enroll in a plan that includes Memorial Sloan  Kettering  in
 its  network when very few, if any, of the other plans contract with the
 facility.  The purpose of this legislation  is  to  assess  whether,  by
 requiring  all  plans  in the downstate region to contract with Memorial
 Sloan  Kettering,  individuals  who  rely  upon  the  health   insurance
 exchange,  the Medicaid managed care program and the Essential Plan will
 have improved access to state-of-the-art cancer care.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD11279-01-1

 A. 7976                             2
 
   § 2. This act shall be known and  may  be  cited  as  the  "access  to
 comprehensive  cancer  enhanced services strategy (ACCESS) demonstration
 project."
   §  3.  Subparagraph  (vi) of paragraph (b) of subdivision 1 of section
 268-d of the public health law, as added by section 2 of part T of chap-
 ter 57 of the laws of 2019, is amended to read as follows:
   (vi) IF IT PROVIDES COVERAGE TO PERSONS RESIDING  IN  A  CITY  OF  ONE
 MILLION OR MORE OR IN ITS CONTIGUOUS COUNTIES, CONTRACTS WITH A NATIONAL
 CANCER  INSTITUTE-DESIGNATED COMPREHENSIVE CANCER HOSPITAL AS DEFINED IN
 PARAGRAPH (E)  OF  SUBDIVISION  FOUR  OF  SECTION  TWENTY-EIGHT  HUNDRED
 SEVEN-C  OF THIS CHAPTER FOR SERVICES FOR SUCH PERSONS, PROVIDED, HOWEV-
 ER, IF THE HEALTH PLAN AND SUCH HOSPITAL ARE UNABLE TO  REACH  AGREEMENT
 ON  REIMBURSEMENT OR RATES, THE HEALTH PLAN SHALL REIMBURSE THE HOSPITAL
 AT NO LESS THAN AND IN  ACCORDANCE  WITH  THE  FEE-FOR-SERVICE  MEDICAID
 PAYMENT  RATE AND METHODOLOGY APPLICABLE TO THE HOSPITAL'S INPATIENT AND
 OUTPATIENT SERVICES AND AT NO LESS THAN AND IN ACCORDANCE WITH THE  FEE-
 FOR-SERVICE  MEDICARE  PAYMENT  RATE  AND  METHODOLOGY APPLICABLE TO THE
 HOSPITAL-AFFILIATED PHYSICIAN SERVICES; AND
   (VII) complies with the insurance law and  this  chapter  requirements
 applicable  to health insurance issued in this state and any regulations
 promulgated pursuant thereto that do not conflict with  or  prevent  the
 application of federal requirements; and
   §  4.    Subdivision  4 of section 364-j of the social services law is
 amended by adding a new paragraph (w) to read as follows:
   (W) A MANAGED CARE PROVIDER THAT PROVIDES COVERAGE TO PERSONS RESIDING
 IN A CITY OF ONE MILLION OR MORE OR IN  ITS  CONTIGUOUS  COUNTIES  SHALL
 PROVIDE  OR  ARRANGE, DIRECTLY OR INDIRECTLY  (INCLUDING  BY  REFERRAL),
 FOR ACCESS TO AND THE PROVISION OF SERVICES BY A NATIONAL CANCER  INSTI-
 TUTE-DESIGNATED  COMPREHENSIVE  CANCER  HOSPITAL AS DEFINED IN PARAGRAPH
 (E) OF SUBDIVISION FOUR OF SECTION TWENTY-EIGHT HUNDRED SEVEN-C  OF  THE
 PUBLIC  HEALTH  LAW FOR SERVICES FOR SUCH PERSONS, PROVIDED, HOWEVER, IF
 THE MANAGED CARE PROVIDER AND SUCH HOSPITAL ARE UNABLE TO  REACH  AGREE-
 MENT  ON  REIMBURSEMENT  FOR  THESE  SERVICES, THE MANAGED CARE PROVIDER
 SHALL REIMBURSE THE HOSPITAL AT NO LESS THAN AND IN ACCORDANCE WITH  THE
 FEE-FOR-SERVICE MEDICAID PAYMENT RATE AND METHODOLOGY APPLICABLE TO SUCH
 HOSPITAL'S  INPATIENT AND OUTPATIENT SERVICES AND AT NO LESS THAN AND IN
 ACCORDANCE WITH THE FEE-FOR-SERVICE MEDICARE PAYMENT RATE AND  METHODOL-
 OGY APPLICABLE TO THE HOSPITAL-AFFILIATED PHYSICIAN SERVICES.
   §  5.  Paragraph  (c) of subdivision 1 of section 369-gg of the social
 services law, as amended by section 2 of part H of  chapter  57  of  the
 laws of 2021, is amended to read as follows:
   (c)  "Health  care  services"  means  (i) the services and supplies as
 defined by the commissioner in consultation with the  superintendent  of
 financial  services,  and  shall  be  consistent with and subject to the
 essential health benefits as defined by the commissioner  in  accordance
 with  the  provisions  of the patient protection and affordable care act
 (P.L. 111-148) and consistent with the benefits provided by  the  refer-
 ence plan selected by the commissioner for the purposes of defining such
 benefits,  AND  SHALL INCLUDE, FOR ENROLLEES WHO RESIDE IN A CITY OF ONE
 MILLION OR MORE OR IN ITS CONTIGUOUS COUNTIES, COVERAGE OF THE  SERVICES
 OF  A NATIONAL CANCER INSTITUTE-DESIGNATED COMPREHENSIVE CANCER HOSPITAL
 AS DEFINED IN PARAGRAPH (E) OF SUBDIVISION FOUR OF SECTION  TWENTY-EIGHT
 HUNDRED  SEVEN-C  OF  THIS  CHAPTER  FOR  SERVICES  FOR  SUCH ENROLLEES,
 PROVIDED, HOWEVER, IF THE APPROVED ORGANIZATION AND  SUCH  HOSPITAL  ARE
 UNABLE  TO  REACH  AGREEMENT  ON  REIMBURSEMENT  FOR THESE SERVICES, THE
 APPROVED ORGANIZATION SHALL REIMBURSE THE HOSPITAL AT NO LESS  THAN  AND

 A. 7976                             3
 
 IN ACCORDANCE WITH THE FEE-FOR-SERVICE MEDICAID PAYMENT RATE AND METHOD-
 OLOGY  APPLICABLE  TO  SUCH HOSPITAL'S INPATIENT AND OUTPATIENT SERVICES
 AND AT NO LESS THAN AND IN ACCORDANCE WITH THE FEE-FOR-SERVICE  MEDICARE
 PAYMENT  RATE  AND  METHODOLOGY  APPLICABLE  TO  THE HOSPITAL-AFFILIATED
 PHYSICIAN SERVICES, and (ii) dental and vision services  as  defined  by
 the commissioner;
   §  6. This act shall take effect on the first of January next succeed-
 ing the date on which it shall have become a law and shall apply to  all
 coverage  or  policies issued or renewed on or after such effective date
 and shall expire and be deemed repealed  five  years  after  such  date;
 provided, however, that the amendments to subdivision 4 of section 364-j
 of  the  social  services law made by section four of this act shall not
 affect the repeal of such section and shall be  deemed  repealed  there-
 with;  provided, further, that the amendments to paragraph (c) of subdi-
 vision 1 of section 369-gg of the social services law  made  by  section
 five  of  this act shall not affect the expiration of such paragraph and
 shall be deemed to expire therewith.