S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   6534
 
                        2021-2022 Regular Sessions
 
                             I N  S E N A T E
 
                                May 5, 2021
                                ___________
 
 Introduced  by  Sen.  RIVERA -- read twice and ordered printed, and when
   printed to be committed to the Committee on Health
 
 AN ACT to amend the public health law, in relation to  establishing  the
   primary care reform commission
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:

   Section 1. The article heading of article 29-AA of the  public  health
 law, as added by section 35 of part H of chapter 59 of the laws of 2011,
 is amended to read as follows:
              PATIENT CENTERED MEDICAL HOMES AND PRIMARY CARE
   §  2.  The public health law is amended by adding a new section 2959-b
 to read as follows:
   § 2959-B. PRIMARY CARE REFORM COMMISSION.  1.  (A)  COMMISSION  ESTAB-
 LISHED.  THE PRIMARY CARE REFORM COMMISSION, REFERRED TO IN THIS SECTION
 AS THE "COMMISSION",  IS  HEREBY  ESTABLISHED  IN  THE  DEPARTMENT.  THE
 COMMISSION  SHALL  REVIEW,  EXAMINE,  AND  MAKE FINDINGS ON THE LEVEL OF
 PRIMARY CARE SPENDING BY ALL PAYERS IN THE CONTEXT OF  ALL  HEALTH  CARE
 SPENDING  IN  THE STATE, AND SHALL PUBLISH AN ANNUAL REPORT ON THE FIND-
 INGS. THE COMMISSION SHALL ALSO MAKE  RECOMMENDATIONS  TO  INCREASE  AND
 STRENGTHEN  SPENDING  ON PRIMARY CARE IN THE STATE, TAKING CARE TO AVOID
 INCREASING COSTS TO PATIENTS OR THE TOTAL COST OF HEALTH CARE.
   (B) COMPOSITION AND POWERS. (I) THE COMMISSION SHALL CONSIST OF:
   (1) THE COMMISSIONER AND  THE  SUPERINTENDENT  OF  THE  DEPARTMENT  OF
 FINANCIAL  SERVICES,  WHO  MAY BE REPRESENTED BY THEIR RESPECTIVE DESIG-
 NEES;
   (2) FOUR MEMBERS APPOINTED BY THE GOVERNOR; AND
   (3) TWELVE MEMBERS APPOINTED BY THE GOVERNOR AS FOLLOWS: FOUR  ON  THE
 RECOMMENDATION  OF  THE SPEAKER OF THE ASSEMBLY, FOUR ON THE RECOMMENDA-
 TION OF THE TEMPORARY PRESIDENT OF THE SENATE, TWO ON THE RECOMMENDATION
 OF THE MINORITY LEADER OF THE ASSEMBLY, AND TWO ON THE RECOMMENDATION OF
 THE MINORITY LEADER OF THE SENATE.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD10879-01-1

 S. 6534                             2
 
   (II) ANY VACANCY IN THE MEMBERSHIP OF THE COMMISSION SHALL  BE  FILLED
 IN THE SAME MANNER AS THE MEMBER BEING SUCCEEDED WAS APPOINTED.
   (III) THE COMMISSION SHALL SELECT A CHAIRPERSON FROM AMONG THE MEMBERS
 OF THE COMMISSION.
   (IV)  THE  COMPOSITION  OF  THE  COMMISSION SHALL INCLUDE MEMBERS WITH
 EXPERTISE IN HEALTH CARE FINANCING, REIMBURSEMENT, AND REGULATION,  FROM
 AMONG  THE  FOLLOWING CATEGORIES: PRIMARY CARE PROVIDERS AND ADMINISTRA-
 TORS FROM FEDERALLY QUALIFIED HEALTH CENTERS AND  PROFESSIONAL  PRACTICE
 GROUPS,  AS  WELL  AS REPRESENTATIVES WITH RELEVANT EXPERTISE FROM BUSI-
 NESSES OPERATING WITHIN NEW YORK, PUBLIC AND COMMERCIAL HEALTH INSURANCE
 PLANS, AND PRIMARY  CARE  PROFESSIONAL  AND  ADVOCACY  ORGANIZATIONS.  A
 MEMBER MAY REPRESENT MORE THAN ONE CATEGORY.
   (V)  ANY  DECISION  OR ACTION BY THE COMMISSION SHALL BE BY A MAJORITY
 VOTE. MEMBERS OF THE COMMISSION MAY BE REPRESENTED BY A DESIGNEE.
   2. (A) EACH MEDICAID MANAGED CARE PROVIDER SHALL PROVIDE PRIMARY  CARE
 SPENDING  DATA  AS  REQUESTED  BY THE COMMISSION UNDER THIS SECTION. THE
 INFORMATION SHALL INCLUDE, BUT NOT BE LIMITED TO, PRIMARY CARE SPENDING,
 TOTAL HEALTH CARE SPENDING, AND ALL FURTHER INFORMATION  THE  COMMISSION
 REQUESTS RELATING TO ITS WORK. THE COMMISSIONER SHALL ESTABLISH REQUIRE-
 MENTS  TO  ENSURE COMPLIANCE WITH ALL APPLICABLE LAWS AND TO PROTECT THE
 PRIVACY OF ANY PROPRIETARY INFORMATION THAT IS PROVIDED TO  THE  COMMIS-
 SION UNDER THIS SECTION.
   (B)  EACH INSURANCE ENTITY PROVIDING MANAGED CARE PRODUCTS, INDIVIDUAL
 COMPREHENSIVE ACCIDENT AND HEALTH INSURANCE OR GROUP OR BLANKET  COMPRE-
 HENSIVE  ACCIDENT AND HEALTH INSURANCE, AS DEFINED IN THE INSURANCE LAW,
 CORPORATION ORGANIZED UNDER ARTICLE FORTY-THREE  OF  THE  INSURANCE  LAW
 PROVIDING COMPREHENSIVE HEALTH INSURANCE, AN ENTITY LICENSED UNDER ARTI-
 CLE FORTY-FOUR OF THIS CHAPTER PROVIDING COMPREHENSIVE HEALTH INSURANCE,
 AND EVERY OTHER PLAN OVER WHICH THE DEPARTMENT OF FINANCIAL SERVICES HAS
 JURISDICTION  SHALL  PROVIDE  PRIMARY CARE SPENDING DATA AS REQUESTED BY
 THE COMMISSION UNDER THIS SECTION. THE INFORMATION  SHALL  INCLUDE,  BUT
 NOT  BE  LIMITED  TO, PRIMARY CARE SPENDING, TOTAL HEALTH CARE SPENDING,
 AND ALL FURTHER INFORMATION THE COMMISSION REQUESTS.  THE SUPERINTENDENT
 OF THE DEPARTMENT OF FINANCIAL SERVICES SHALL ESTABLISH REQUIREMENTS  TO
 ENSURE COMPLIANCE WITH ALL APPLICABLE LAWS AND TO PROTECT THE PRIVACY OF
 ANY  PROPRIETARY  INFORMATION  THAT  IS PROVIDED TO THE COMMISSION UNDER
 THIS SECTION. AN ENTITY THAT PROVIDES INFORMATION UNDER PARAGRAPH (A) OF
 THIS SUBDIVISION SHALL NOT BE REQUIRED TO PROVIDE DUPLICATE  INFORMATION
 UNDER THIS PARAGRAPH.
   (C)  FAILURE  OF  ANY  ENTITY TO PROVIDE INFORMATION TO THE COMMISSION
 REQUESTED BY THE COMMISSION UNDER THIS SUBDIVISION SHALL BE CONSIDERED A
 VIOLATION UNDER SECTION TWELVE OF THIS CHAPTER.
   3. THE DEPARTMENT AND  THE  DEPARTMENT  OF  FINANCIAL  SERVICES  SHALL
 PROVIDE  ASSISTANCE  AND  STAFF  TO  THE COMMISSION, AS REQUESTED BY THE
 COMMISSION.  ASSISTANCE SHALL ALSO BE MADE AVAILABLE,  AS  REQUESTED  BY
 THE COMMISSION, FROM OTHER AGENCIES, DEPARTMENTS, AND PUBLIC AUTHORITIES
 OF THE STATE.
   4.  THE  FOLLOWING  TERMS,  WHEN  USED IN THIS SECTION, SHALL HAVE THE
 FOLLOWING MEANINGS:
   (A) "PRIMARY CARE" MEANS THE HEALTH CARE FIELDS  OF  FAMILY  PRACTICE,
 GENERAL PEDIATRICS, PRIMARY CARE INTERNAL MEDICINE, PRIMARY CARE OBSTET-
 RICS,  AND  PRIMARY CARE GYNECOLOGY, PROVIDED IN ALL OUTPATIENT SETTINGS
 INCLUDING, BUT NOT LIMITED TO, HEALTH CARE  PROFESSIONAL  PRACTICES  AND
 HOSPITALS  AS  DEFINED BY ARTICLE TWENTY-EIGHT OF THIS CHAPTER.  PRIMARY
 CARE SHALL NOT INCLUDE INPATIENT SERVICES. PRIMARY CARE INCLUDES, BUT IS
 NOT LIMITED TO, SERVICES PROVIDED IN REGULAR CHECK-UPS,  OFFICE  VISITS,

 S. 6534                             3
 
 TELEMEDICINE,  PREVENTIVE  CARE,  SERVICES  FOR ACUTE AND CHRONIC CONDI-
 TIONS, AND OTHER SERVICES, PROVIDED BY  OR  UNDER  THE  DIRECTION  OF  A
 PHYSICIAN, NURSE PRACTITIONER, PHYSICIAN ASSISTANT, OR MIDWIFE.
   (B)  "PRIMARY  CARE  SPENDING"  MEANS ANY EXPENDITURE OF FUNDS MADE BY
 INSURERS, PUBLIC ENTITIES, OR THE STATE FOR THE  PURPOSE  OF  SUPPORTING
 PRIMARY  CARE PROVIDERS. PRIMARY CARE SPENDING IS INCLUDED REGARDLESS OF
 PAYMENT METHODOLOGY, SUCH AS FEE-FOR-SERVICE, CAPITATION, INCENTIVES, OR
 VALUE-BASED PAYMENTS, ADJUSTED APPROPRIATELY TO EXCLUDE ANY  PORTION  OF
 THE  EXPENDITURE  THAT IS REASONABLY APPORTIONED TO EXCLUDE EXPENSES FOR
 INPATIENT SERVICES OR OTHER NON-PRIMARY CARE SERVICES.
   (C) "MEDICAID MANAGED CARE PROVIDER" MEANS  A  MANAGED  CARE  PROVIDER
 UNDER  ARTICLE  FORTY-FOUR  OF  THIS  CHAPTER  OR  SECTION THREE HUNDRED
 SIXTY-FOUR-J OF THE SOCIAL SERVICES LAW.
   5. (A) THE COMMISSION SHALL PUBLISH AND DELIVER AN  ANNUAL  REPORT  TO
 THE  GOVERNOR,  TEMPORARY  PRESIDENT  OF  THE SENATE, THE SPEAKER OF THE
 ASSEMBLY, AND THE CHAIRPERSON  OF  THE  SENATE  FINANCE  COMMITTEE,  THE
 CHAIRPERSON  OF  THE  ASSEMBLY  WAYS  AND MEANS COMMITTEE AND THE CHAIR-
 PERSONS OF THE SENATE AND ASSEMBLY HEALTH AND INSURANCE COMMITTEES.  THE
 FIRST  REPORT SHALL BE PUBLISHED AND DELIVERED NO LATER THAN MARCH THIR-
 TY-FIRST, TWO THOUSAND TWENTY-TWO.
   (B) THE CONTENT OF THE ANNUAL REPORTS SHALL BE AT  THE  DISCRETION  OF
 THE COMMISSION BUT THE FIRST REPORT SHALL INCLUDE:
   (I)  AN  ANALYSIS  OF  CURRENT  PRIMARY  CARE  SPENDING,  INCLUDING IN
 RELATION TO ALL OTHER HEALTH CARE SPENDING IN THE AGGREGATE.
   (II) RECOMMENDATIONS TO THE LEGISLATURE OF ANY CHANGES  TO  THE  DEFI-
 NITION  OF  "PRIMARY  CARE"  FOR THE PURPOSES OF THE COMMISSION'S FUTURE
 WORK. SUCH RECOMMENDATIONS MAY BE  MADE  TO  THE  LEGISLATURE  PRIOR  TO
 DELIVERY OF THE COMMISSION'S REPORT.
   (III)  RECOMMENDATIONS FOR LEGISLATIVE AND EXECUTIVE ACTION, INCLUDING
 AMENDMENTS TO CURRENT LAW, NEW LEGISLATION, CHANGES TO  REGULATIONS,  OR
 NEW REGULATIONS.
   (IV)  IDENTIFICATION  OF  BARRIERS, INCLUDING PAYMENT METHODOLOGIES BY
 HEALTH CARE PAYORS AND PROVIDERS, TO PROVIDING PRIMARY CARE AND INCREAS-
 ING PRIMARY CARE SPENDING.
   (V) RECOMMENDATIONS TO IMPROVE PROVIDING INCREASED AND  HIGHER-QUALITY
 PRIMARY  CARE  AND  PRIMARY  CARE  SPENDING,  WITH  SPECIAL ATTENTION TO
 INCREASING HEALTH CARE EQUITY, REDUCING  HEALTH  CARE  DISPARITIES,  AND
 AVOIDING INCREASING COSTS TO PATIENTS OR THE TOTAL COST OF HEALTH CARE.
   (VI)  RECOMMENDATIONS  TO  INCREASE  PRIMARY  CARE  SPENDING TO BE THE
 GREATER OF TWELVE PERCENT OR A ONE PERCENT INCREASE YEAR AFTER  YEAR  OF
 OVERALL  HEALTH  CARE  SPENDING BY TWO THOUSAND TWENTY-SIX, EXCLUSIVE OF
 EXPENDITURES ON PRESCRIPTION DRUGS, DENTAL CARE, AND ANY CARE  REQUIRING
 A SPECIALIST.
   § 3. This act shall take effect immediately.

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  6534--B
 
                        2021-2022 Regular Sessions
 
                             I N  S E N A T E
 
                                May 5, 2021
                                ___________
 
 Introduced  by Sens. RIVERA, BROUK, MAY -- read twice and ordered print-
   ed, and when printed to be committed to the  Committee  on  Health  --
   committee  discharged,  bill amended, ordered reprinted as amended and
   recommitted to said committee  --  recommitted  to  the  Committee  on
   Health  in  accordance  with  Senate  Rule  6,  sec.  8  --  committee
   discharged, bill amended, ordered reprinted as amended and recommitted
   to said committee
 
 AN ACT to amend the public health law, in relation to  establishing  the
   primary care reform commission
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. The article heading of article 29-AA of the  public  health
 law, as added by section 35 of part H of chapter 59 of the laws of 2011,
 is amended to read as follows:
              PATIENT CENTERED MEDICAL HOMES AND PRIMARY CARE
   §  2.  The public health law is amended by adding a new section 2959-b
 to read as follows:
   § 2959-B. PRIMARY CARE REFORM COMMISSION.  1.  (A)  COMMISSION  ESTAB-
 LISHED.  THE PRIMARY CARE REFORM COMMISSION, REFERRED TO IN THIS SECTION
 AS THE "COMMISSION",  IS  HEREBY  ESTABLISHED  IN  THE  DEPARTMENT.  THE
 COMMISSION  SHALL  REVIEW,  EXAMINE,  AND  MAKE FINDINGS ON THE LEVEL OF
 PRIMARY CARE SPENDING BY ALL PAYERS IN THE CONTEXT OF  ALL  HEALTH  CARE
 SPENDING  IN  THE STATE, AND SHALL PUBLISH AN ANNUAL REPORT ON THE FIND-
 INGS. THE COMMISSION SHALL ALSO MAKE RECOMMENDATIONS TO INCREASE  SPEND-
 ING  ON  PRIMARY  CARE AND STRENGTHEN PRIMARY CARE INFRASTRUCTURE IN THE
 STATE, TAKING CARE TO AVOID INCREASING COSTS TO PATIENTS  OR  THE  TOTAL
 COST OF HEALTH CARE.
   (B) COMPOSITION AND POWERS. (I) THE COMMISSION SHALL CONSIST OF:
   (1)  THE  COMMISSIONER  AND  THE  SUPERINTENDENT  OF THE DEPARTMENT OF
 FINANCIAL SERVICES, WHO MAY BE REPRESENTED BY  THEIR  RESPECTIVE  DESIG-
 NEES;
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD10879-05-1
              

 S. 6534--B                          2
 
   (2) SEVEN MEMBERS APPOINTED BY THE GOVERNOR; AND
   (3)  EIGHT  MEMBERS APPOINTED BY THE GOVERNOR AS FOLLOWS: THREE ON THE
 RECOMMENDATION OF THE SPEAKER OF THE ASSEMBLY, THREE ON THE  RECOMMENDA-
 TION OF THE TEMPORARY PRESIDENT OF THE SENATE, ONE ON THE RECOMMENDATION
 OF THE MINORITY LEADER OF THE ASSEMBLY, AND ONE ON THE RECOMMENDATION OF
 THE MINORITY LEADER OF THE SENATE.
   (II)  ANY  VACANCY IN THE MEMBERSHIP OF THE COMMISSION SHALL BE FILLED
 IN THE SAME MANNER AS THE MEMBER BEING SUCCEEDED WAS APPOINTED.
   (III) THE COMMISSION SHALL SELECT A CHAIRPERSON FROM AMONG THE MEMBERS
 OF THE COMMISSION.
   (IV) THE COMPOSITION OF THE COMMISSION  SHALL  INCLUDE  AT  LEAST  ONE
 MEMBER WITH EXPERTISE IN HEALTH CARE FINANCING, REIMBURSEMENT, AND REGU-
 LATION, REPRESENTING EACH OF THE FOLLOWING CATEGORIES: PRACTICING PRIMA-
 RY  CARE  PROVIDERS,  FEDERALLY  QUALIFIED  HEALTH CENTERS, PROFESSIONAL
 PRACTICE GROUPS, PRIMARY CARE ADVOCATES,  PRIMARY  CARE  CONSUMER  ADVO-
 CATES,  BUSINESSES,  HEALTH  PLANS,  AND  HOSPITALS  OR  HEALTH SYSTEMS.
 COMMISSION MEMBERS SHALL BE APPOINTED SO AS TO REPRESENT A  GEOGRAPHICAL
 DISTRIBUTION ACROSS THE STATE.
   (V)  MEMBERS OF THE COMMISSION, EXCEPT FOR THOSE REPRESENTING NEW YORK
 STATE DEPARTMENTS, AGENCIES, AUTHORITIES OR COUNCILS, SHALL SERVE FOR  A
 TERM OF FOUR YEARS AND MAY BE REAPPOINTED IN THE SAME MANNER AS PROVIDED
 FOR THEIR INITIAL APPOINTMENT.
   (VI)  A  MAJORITY  OF  THE CURRENT FILLED MEMBERSHIP OF THE COMMISSION
 SHALL CONSTITUTE A QUORUM FOR THE TRANSACTION OF  ANY  BUSINESS  OR  THE
 EXERCISE OF ANY POWER OR FUNCTION OF THE COMMISSION, AND ANY DECISION OR
 ACTION  BY  THE  COMMISSION SHALL BE BY A MAJORITY VOTE OF THOSE PRESENT
 AND VOTING.
   (VII) THE COMMISSION SHALL MEET AT LEAST QUARTERLY AT THE CALL OF  THE
 CHAIRPERSON.  ADDITIONAL  MEETINGS  MAY  BE  CALLED  BY  THE CHAIRPERSON
 SUBJECT TO THE GIVING OF ONE WEEK'S NOTICE, AND SHALL BE CALLED  BY  THE
 CHAIRPERSON  AT  THE REQUEST OF A MAJORITY OF THE MEMBERS OF THE COMMIS-
 SION.
   (VIII) THE MEMBERS OF THE COMMISSION SHALL RECEIVE NO COMPENSATION FOR
 THEIR SERVICES, BUT SHALL BE ALLOWED THEIR ACTUAL AND NECESSARY EXPENSES
 INCURRED IN THE PERFORMANCE OF THEIR DUTIES.
   2. (A) EACH MEDICAID MANAGED CARE PROVIDER UNDER SECTION THREE HUNDRED
 SIXTY-FOUR-J OF THE SOCIAL  SERVICES  LAW  SHALL  PROVIDE  PRIMARY  CARE
 SPENDING  DATA  FOR  THE  FIVE YEARS PRIOR TO THE EFFECTIVE DATE OF THIS
 SECTION AND FOR EACH YEAR THEREAFTER  AS  REQUESTED  BY  THE  COMMISSION
 UNDER  THIS  SECTION.  THE INFORMATION SHALL INCLUDE, BUT NOT BE LIMITED
 TO, PRIMARY CARE SPENDING, TOTAL HEALTH CARE SPENDING, AND  ALL  FURTHER
 INFORMATION THE COMMISSION REQUESTS RELATING TO ITS WORK.  EACH MEDICAID
 MANAGED CARE PROVIDER SHALL ALSO PROVIDE THE TOTAL COST OF CARE PROVIDED
 BY THE PROVIDER ANNUALLY FOR EACH OF THE YEARS.
   (B)  EACH INSURANCE ENTITY PROVIDING MANAGED CARE PRODUCTS, INDIVIDUAL
 COMPREHENSIVE ACCIDENT AND HEALTH INSURANCE OR GROUP OR BLANKET  COMPRE-
 HENSIVE  ACCIDENT AND HEALTH INSURANCE, AS DEFINED IN THE INSURANCE LAW,
 CORPORATION ORGANIZED UNDER ARTICLE FORTY-THREE  OF  THE  INSURANCE  LAW
 PROVIDING  COMPREHENSIVE HEALTH INSURANCE, ENTITY LICENSED UNDER ARTICLE
 FORTY-FOUR OF THIS CHAPTER  PROVIDING  COMPREHENSIVE  HEALTH  INSURANCE,
 EVERY  OTHER  PLAN  OVER  WHICH THE DEPARTMENT OF FINANCIAL SERVICES HAS
 JURISDICTION, AND EVERY  THIRD-PARTY  PAYOR  PROVIDING  HEALTH  COVERAGE
 SHALL PROVIDE PRIMARY CARE SPENDING DATA FOR THE FIVE YEARS PRIOR TO THE
 EFFECTIVE DATE OF THIS SECTION AND FOR EACH YEAR THEREAFTER AS REQUESTED
 BY THE COMMISSION UNDER THIS SECTION. THE INFORMATION SHALL INCLUDE, BUT
 NOT  BE  LIMITED  TO, PRIMARY CARE SPENDING, TOTAL HEALTH CARE SPENDING,
 S. 6534--B                          3
 
 AND ALL FURTHER INFORMATION THE COMMISSION REQUESTS.  EACH ENTITY  SHALL
 ALSO  PROVIDE THE TOTAL COST OF CARE PROVIDED BY THE ENTITY ANNUALLY FOR
 EACH OF THE YEARS.  AN ENTITY THAT PROVIDES INFORMATION UNDER  PARAGRAPH
 (A)  OF  THIS  SUBDIVISION  SHALL  NOT  BE REQUIRED TO PROVIDE DUPLICATE
 INFORMATION UNDER THIS PARAGRAPH.
   (C) FAILURE OF ANY ENTITY TO PROVIDE  INFORMATION  TO  THE  COMMISSION
 REQUESTED  BY  THE  COMMISSION  UNDER THIS SECTION SHALL BE CONSIDERED A
 VIOLATION UNDER SECTION TWELVE OF THIS CHAPTER.
   (D) THE COMMISSIONER, AND THE  SUPERINTENDENT  OF  THE  DEPARTMENT  OF
 FINANCIAL SERVICES WITH RESPECT TO ENTITIES REGULATED BY THE SUPERINTEN-
 DENT,  SHALL ESTABLISH REQUIREMENTS TO ENSURE COMPLIANCE WITH ALL APPLI-
 CABLE LAWS AND TO PROTECT THE CONFIDENTIALITY OF ANY PROPRIETARY  INFOR-
 MATION THAT IS PROVIDED TO THE COMMISSION UNDER THIS SECTION.
   3.  THE  DEPARTMENT  AND  THE  DEPARTMENT  OF FINANCIAL SERVICES SHALL
 PROVIDE ASSISTANCE AND STAFF TO THE  COMMISSION,  AS  REQUESTED  BY  THE
 COMMISSION.    ASSISTANCE  SHALL ALSO BE MADE AVAILABLE, AS REQUESTED BY
 THE COMMISSION, FROM OTHER AGENCIES, DEPARTMENTS, AND PUBLIC AUTHORITIES
 OF THE STATE.   THE COMMISSION MAY ACCEPT FUNDING  OR  GRANTS  FROM  THE
 STATE  OR  FEDERAL  GOVERNMENT,  OR ANY OTHER GOVERNMENT AGENCY OR OTHER
 SOURCE DETERMINED BY THE COMMISSION, TO AID IN THE COMMISSION'S WORK.
   4. THE FOLLOWING TERMS, WHEN USED IN  THIS  SECTION,  SHALL  HAVE  THE
 FOLLOWING MEANINGS:
   (A)  "PRIMARY  CARE"  MEANS THE HEALTH CARE FIELDS OF FAMILY PRACTICE,
 GENERAL PEDIATRICS, PRIMARY CARE INTERNAL MEDICINE, PRIMARY CARE OBSTET-
 RICS, AND PRIMARY CARE GYNECOLOGY, PROVIDED IN ALL  OUTPATIENT  SETTINGS
 INCLUDING,  BUT  NOT  LIMITED TO, HEALTH CARE PROFESSIONAL PRACTICES AND
 HOSPITALS AS DEFINED BY ARTICLE TWENTY-EIGHT OF THIS CHAPTER.    PRIMARY
 CARE SHALL NOT INCLUDE INPATIENT SERVICES. PRIMARY CARE INCLUDES, BUT IS
 NOT  LIMITED  TO, PRIMARY CARE SERVICES FOR ACUTE AND CHRONIC CONDITIONS
 AND PREVENTIVE CARE, SERVICES  PROVIDED  IN  REGULAR  CHECK-UPS,  OFFICE
 VISITS,  TELEMEDICINE,  AND  OTHER  SERVICES,  PROVIDED  BY OR UNDER THE
 DIRECTION OF A PHYSICIAN, NURSE PRACTITIONER,  PHYSICIAN  ASSISTANT,  OR
 MIDWIFE.    THE  COMMISSION  SHALL CONSIDER EXPANDING THIS DEFINITION TO
 INCLUDE PRIMARY CARE SERVICES PROVIDED  BY  OTHER  HEALTH  CARE  PROFES-
 SIONALS.
   (B)  "PRIMARY  CARE  SPENDING"  MEANS ANY EXPENDITURE OF FUNDS MADE BY
 THIRD PARTY PAYORS, PUBLIC ENTITIES, OR THE STATE  FOR  THE  PURPOSE  OF
 PAYING  FOR  PRIMARY  CARE OR SUPPORTING PRIMARY CARE PROVIDERS. PRIMARY
 CARE SPENDING IS INCLUDED REGARDLESS OF  PAYMENT  METHODOLOGY,  SUCH  AS
 FEE-FOR-SERVICE,  CAPITATION,  INCENTIVES, VALUE-BASED PAYMENTS OR OTHER
 METHODOLOGIES, ADJUSTED APPROPRIATELY TO  EXCLUDE  ANY  PORTION  OF  THE
 EXPENDITURE THAT IS REASONABLY APPORTIONED TO EXCLUDE EXPENSES FOR INPA-
 TIENT SERVICES OR OTHER NON-PRIMARY CARE SERVICES.
   5. (A) THE COMMISSION SHALL PUBLISH, POST ON THE DEPARTMENT'S WEBSITE,
 AND DELIVER AN ANNUAL REPORT TO THE GOVERNOR, THE TEMPORARY PRESIDENT OF
 THE  SENATE,  THE SPEAKER OF THE ASSEMBLY, THE CHAIRPERSON OF THE SENATE
 FINANCE COMMITTEE, THE  CHAIRPERSON  OF  THE  ASSEMBLY  WAYS  AND  MEANS
 COMMITTEE AND THE CHAIRS OF THE SENATE AND ASSEMBLY HEALTH AND INSURANCE
 COMMITTEES.  THE  FIRST REPORT SHALL BE PUBLISHED AND DELIVERED NO LATER
 THAN MARCH THIRTY-FIRST OF THE YEAR FOLLOWING THE EFFECTIVE DATE OF THIS
 SECTION.
   (B) THE CONTENT OF THE ANNUAL REPORTS SHALL BE AT  THE  DISCRETION  OF
 THE COMMISSION BUT THE FIRST REPORT SHALL INCLUDE:
   (I)  AN  ANALYSIS  OF  CURRENT  PRIMARY  CARE  SPENDING,  INCLUDING BY
 GEOGRAPHIC REGION, IN RELATION TO ALL OTHER HEALTH CARE SPENDING IN  THE
 AGGREGATE.
 S. 6534--B                          4
 
   (II) RECOMMENDATIONS TO THE GOVERNOR AND THE LEGISLATURE OF ANY CHANG-
 ES  TO  THE DEFINITION OF "PRIMARY CARE" FOR THE PURPOSES OF THE COMMIS-
 SION'S FUTURE WORK. SUCH RECOMMENDATIONS MAY BE MADE PRIOR  TO  DELIVERY
 OF THE COMMISSION'S REPORT.
   (III) RECOMMENDATIONS FOR LEGISLATIVE AND EXECUTIVE ACTION.
   (IV)  IDENTIFICATION  OF  BARRIERS, INCLUDING PAYMENT METHODOLOGIES BY
 HEALTH CARE PAYORS AND PROVIDERS, TO PROVIDING PRIMARY CARE AND INCREAS-
 ING PRIMARY CARE SPENDING.
   (V) RECOMMENDATIONS TO IMPROVE PROVIDING INCREASED AND  HIGHER-QUALITY
 PRIMARY  CARE  AND  PRIMARY  CARE  SPENDING,  WITH  SPECIAL ATTENTION TO
 INCREASING HEALTH CARE EQUITY, REDUCING  HEALTH  CARE  DISPARITIES,  AND
 AVOIDING INCREASING COSTS TO PATIENTS OR THE TOTAL COST OF HEALTH CARE.
   (VI)  RECOMMENDATIONS  TO  INCREASE  PRIMARY  CARE SPENDING, TO BE THE
 GREATER OF TWELVE PERCENT OR A ONE PERCENT INCREASE YEAR AFTER  YEAR  OF
 OVERALL  HEALTH CARE SPENDING BY FIVE YEARS FOLLOWING THE EFFECTIVE DATE
 OF THIS SECTION.
   § 3. This act shall take effect immediately.

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  6534--C
     Cal. No. 596
 
                        2021-2022 Regular Sessions
 
                             I N  S E N A T E
 
                                May 5, 2021
                                ___________
 
 Introduced  by Sens. RIVERA, BROUK, MAY, MYRIE -- read twice and ordered
   printed, and when printed to be committed to the Committee  on  Health
   --  committee  discharged,  bill amended, ordered reprinted as amended
   and recommitted to said committee -- recommitted to the  Committee  on
   Health  in  accordance  with  Senate  Rule  6,  sec.  8  --  committee
   discharged, bill amended, ordered reprinted as amended and recommitted
   to said committee  --  reported  favorably  from  said  committee  and
   committed  to the Committee on Finance -- reported favorably from said
   committee, ordered to first and second  report,  ordered  to  a  third
   reading,  amended  and  ordered  reprinted, retaining its place in the
   order of third reading
 
 AN ACT to amend the public health law, in relation to  establishing  the
   primary care reform commission
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. The article heading of article 29-AA of the  public  health
 law, as added by section 35 of part H of chapter 59 of the laws of 2011,
 is amended to read as follows:
              PATIENT CENTERED MEDICAL HOMES AND PRIMARY CARE
   §  2.  The public health law is amended by adding a new section 2959-b
 to read as follows:
   § 2959-B. PRIMARY CARE REFORM COMMISSION.  1.  (A)  COMMISSION  ESTAB-
 LISHED.  THE PRIMARY CARE REFORM COMMISSION, REFERRED TO IN THIS SECTION
 AS THE "COMMISSION",  IS  HEREBY  ESTABLISHED  IN  THE  DEPARTMENT.  THE
 COMMISSION  SHALL  REVIEW,  EXAMINE,  AND  MAKE FINDINGS ON THE LEVEL OF
 PRIMARY CARE SPENDING BY ALL PAYERS IN THE CONTEXT OF  ALL  HEALTH  CARE
 SPENDING  IN  THE STATE, AND SHALL PUBLISH AN ANNUAL REPORT ON THE FIND-
 INGS. THE COMMISSION SHALL ALSO MAKE RECOMMENDATIONS TO INCREASE  SPEND-
 ING  ON  PRIMARY  CARE AND STRENGTHEN PRIMARY CARE INFRASTRUCTURE IN THE
 STATE, TAKING CARE TO AVOID INCREASING COSTS TO PATIENTS  OR  THE  TOTAL
 COST OF HEALTH CARE.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD10879-07-2
 S. 6534--C                          2
 
   (B) COMPOSITION AND POWERS. (I) THE COMMISSION SHALL CONSIST OF:
   (1)  THE  COMMISSIONER  AND  THE  SUPERINTENDENT  OF THE DEPARTMENT OF
 FINANCIAL SERVICES, WHO MAY BE REPRESENTED BY  THEIR  RESPECTIVE  DESIG-
 NEES;
   (2) SEVEN MEMBERS APPOINTED BY THE GOVERNOR; AND
   (3)  EIGHT  MEMBERS APPOINTED BY THE GOVERNOR AS FOLLOWS: THREE ON THE
 RECOMMENDATION OF THE SPEAKER OF THE ASSEMBLY, THREE ON THE  RECOMMENDA-
 TION OF THE TEMPORARY PRESIDENT OF THE SENATE, ONE ON THE RECOMMENDATION
 OF THE MINORITY LEADER OF THE ASSEMBLY, AND ONE ON THE RECOMMENDATION OF
 THE MINORITY LEADER OF THE SENATE.
   (II)  ANY  VACANCY IN THE MEMBERSHIP OF THE COMMISSION SHALL BE FILLED
 IN THE SAME MANNER AS THE MEMBER BEING SUCCEEDED WAS APPOINTED.
   (III) THE COMMISSION SHALL SELECT A CHAIRPERSON FROM AMONG THE MEMBERS
 OF THE COMMISSION.
   (IV) THE COMPOSITION OF THE COMMISSION  SHALL  INCLUDE  AT  LEAST  ONE
 MEMBER WITH EXPERTISE IN HEALTH CARE FINANCING, REIMBURSEMENT, AND REGU-
 LATION, REPRESENTING EACH OF THE FOLLOWING CATEGORIES: PRACTICING PRIMA-
 RY  CARE  PROVIDERS,  FEDERALLY  QUALIFIED  HEALTH CENTERS, PROFESSIONAL
 PRACTICE GROUPS, PRIMARY CARE ADVOCATES,  PRIMARY  CARE  CONSUMER  ADVO-
 CATES,  BUSINESSES,  HEALTH  PLANS,  AND  HOSPITALS  OR  HEALTH SYSTEMS.
 COMMISSION MEMBERS SHALL BE APPOINTED SO AS TO REPRESENT A  GEOGRAPHICAL
 DISTRIBUTION ACROSS THE STATE.
   (V)  MEMBERS OF THE COMMISSION, EXCEPT FOR THOSE REPRESENTING NEW YORK
 STATE DEPARTMENTS, AGENCIES, AUTHORITIES OR COUNCILS, SHALL SERVE FOR  A
 TERM OF FOUR YEARS AND MAY BE REAPPOINTED IN THE SAME MANNER AS PROVIDED
 FOR THEIR INITIAL APPOINTMENT.
   (VI)  A  MAJORITY  OF  THE CURRENT FILLED MEMBERSHIP OF THE COMMISSION
 SHALL CONSTITUTE A QUORUM FOR THE TRANSACTION OF  ANY  BUSINESS  OR  THE
 EXERCISE OF ANY POWER OR FUNCTION OF THE COMMISSION, AND ANY DECISION OR
 ACTION  BY  THE  COMMISSION SHALL BE BY A MAJORITY VOTE OF THOSE PRESENT
 AND VOTING.
   (VII) THE COMMISSION SHALL MEET AT LEAST QUARTERLY AT THE CALL OF  THE
 CHAIRPERSON.  ADDITIONAL  MEETINGS  MAY  BE  CALLED  BY  THE CHAIRPERSON
 SUBJECT TO THE GIVING OF ONE WEEK'S NOTICE, AND SHALL BE CALLED  BY  THE
 CHAIRPERSON  AT  THE REQUEST OF A MAJORITY OF THE MEMBERS OF THE COMMIS-
 SION.
   (VIII) THE MEMBERS OF THE COMMISSION SHALL RECEIVE NO COMPENSATION FOR
 THEIR SERVICES, BUT SHALL BE ALLOWED THEIR ACTUAL AND NECESSARY EXPENSES
 INCURRED IN THE PERFORMANCE OF THEIR DUTIES.
   2. (A) EACH MEDICAID MANAGED CARE PROVIDER UNDER SECTION THREE HUNDRED
 SIXTY-FOUR-J OF THE SOCIAL  SERVICES  LAW  SHALL  PROVIDE  PRIMARY  CARE
 SPENDING  DATA  FOR  THE  FIVE YEARS PRIOR TO THE EFFECTIVE DATE OF THIS
 SECTION AND FOR EACH YEAR THEREAFTER  AS  REQUESTED  BY  THE  COMMISSION
 UNDER  THIS  SECTION.  THE INFORMATION SHALL INCLUDE, BUT NOT BE LIMITED
 TO, PRIMARY CARE SPENDING, TOTAL HEALTH CARE SPENDING, AND  ALL  FURTHER
 INFORMATION THE COMMISSION REQUESTS RELATING TO ITS WORK.  EACH MEDICAID
 MANAGED CARE PROVIDER SHALL ALSO PROVIDE THE TOTAL COST OF CARE PROVIDED
 BY THE PROVIDER ANNUALLY FOR EACH OF THE YEARS.
   (B)  EACH INSURANCE ENTITY PROVIDING MANAGED CARE PRODUCTS, INDIVIDUAL
 COMPREHENSIVE ACCIDENT AND HEALTH INSURANCE OR GROUP OR BLANKET  COMPRE-
 HENSIVE  ACCIDENT AND HEALTH INSURANCE, AS DEFINED IN THE INSURANCE LAW,
 CORPORATION ORGANIZED UNDER ARTICLE FORTY-THREE  OF  THE  INSURANCE  LAW
 PROVIDING  COMPREHENSIVE HEALTH INSURANCE, ENTITY LICENSED UNDER ARTICLE
 FORTY-FOUR OF THIS CHAPTER  PROVIDING  COMPREHENSIVE  HEALTH  INSURANCE,
 EVERY  OTHER  PLAN  OVER  WHICH THE DEPARTMENT OF FINANCIAL SERVICES HAS
 JURISDICTION, AND EVERY  THIRD-PARTY  PAYOR  PROVIDING  HEALTH  COVERAGE
 S. 6534--C                          3
 
 SHALL PROVIDE PRIMARY CARE SPENDING DATA FOR THE FIVE YEARS PRIOR TO THE
 EFFECTIVE DATE OF THIS SECTION AND FOR EACH YEAR THEREAFTER AS REQUESTED
 BY THE COMMISSION UNDER THIS SECTION. THE INFORMATION SHALL INCLUDE, BUT
 NOT  BE  LIMITED  TO, PRIMARY CARE SPENDING, TOTAL HEALTH CARE SPENDING,
 AND ALL FURTHER INFORMATION THE COMMISSION REQUESTS.  EACH ENTITY  SHALL
 ALSO  PROVIDE THE TOTAL COST OF CARE PROVIDED BY THE ENTITY ANNUALLY FOR
 EACH OF THE YEARS.  AN ENTITY THAT PROVIDES INFORMATION UNDER  PARAGRAPH
 (A)  OF  THIS  SUBDIVISION  SHALL  NOT  BE REQUIRED TO PROVIDE DUPLICATE
 INFORMATION UNDER THIS PARAGRAPH.
   (C) FAILURE OF ANY ENTITY TO PROVIDE  INFORMATION  TO  THE  COMMISSION
 REQUESTED  BY  THE  COMMISSION  UNDER THIS SECTION SHALL BE CONSIDERED A
 VIOLATION UNDER SECTION TWELVE OF THIS CHAPTER.
   (D) THE COMMISSIONER, AND THE  SUPERINTENDENT  OF  THE  DEPARTMENT  OF
 FINANCIAL SERVICES WITH RESPECT TO ENTITIES REGULATED BY THE SUPERINTEN-
 DENT,  SHALL ESTABLISH REQUIREMENTS TO ENSURE COMPLIANCE WITH ALL APPLI-
 CABLE LAWS AND TO PROTECT THE CONFIDENTIALITY OF ANY PROPRIETARY  INFOR-
 MATION THAT IS PROVIDED TO THE COMMISSION UNDER THIS SECTION.
   3.  THE  DEPARTMENT  AND  THE  DEPARTMENT  OF FINANCIAL SERVICES SHALL
 PROVIDE ASSISTANCE AND STAFF TO THE  COMMISSION,  AS  REQUESTED  BY  THE
 COMMISSION.    ASSISTANCE  SHALL ALSO BE MADE AVAILABLE, AS REQUESTED BY
 THE COMMISSION, FROM OTHER AGENCIES, DEPARTMENTS, AND PUBLIC AUTHORITIES
 OF THE STATE.   THE COMMISSION MAY ACCEPT FUNDING  OR  GRANTS  FROM  THE
 STATE  OR  FEDERAL  GOVERNMENT,  OR ANY OTHER GOVERNMENT AGENCY OR OTHER
 SOURCE DETERMINED BY THE COMMISSION, TO AID IN THE COMMISSION'S WORK.
   4. THE FOLLOWING TERMS, WHEN USED IN  THIS  SECTION,  SHALL  HAVE  THE
 FOLLOWING MEANINGS:
   (A)  "PRIMARY  CARE"  MEANS THE HEALTH CARE FIELDS OF FAMILY PRACTICE,
 GENERAL PEDIATRICS, PRIMARY CARE INTERNAL MEDICINE, PRIMARY CARE OBSTET-
 RICS, AND PRIMARY CARE GYNECOLOGY, PROVIDED IN ALL  OUTPATIENT  SETTINGS
 INCLUDING,  BUT  NOT  LIMITED TO, HEALTH CARE PROFESSIONAL PRACTICES AND
 HOSPITALS AS DEFINED BY ARTICLE TWENTY-EIGHT OF THIS CHAPTER.    PRIMARY
 CARE SHALL NOT INCLUDE INPATIENT SERVICES. PRIMARY CARE INCLUDES, BUT IS
 NOT  LIMITED  TO, PRIMARY CARE SERVICES FOR ACUTE AND CHRONIC CONDITIONS
 AND PREVENTIVE CARE, SERVICES  PROVIDED  IN  REGULAR  CHECK-UPS,  OFFICE
 VISITS,  TELEMEDICINE,  AND  OTHER  SERVICES,  PROVIDED  BY OR UNDER THE
 DIRECTION OF A PHYSICIAN, NURSE PRACTITIONER,  PHYSICIAN  ASSISTANT,  OR
 MIDWIFE.    THE  COMMISSION  SHALL CONSIDER EXPANDING THIS DEFINITION TO
 INCLUDE PRIMARY CARE SERVICES PROVIDED  BY  OTHER  HEALTH  CARE  PROFES-
 SIONALS.
   (B)  "PRIMARY  CARE  SPENDING"  MEANS ANY EXPENDITURE OF FUNDS MADE BY
 THIRD PARTY PAYORS, PUBLIC ENTITIES, OR THE STATE  FOR  THE  PURPOSE  OF
 PAYING  FOR  PRIMARY  CARE OR SUPPORTING PRIMARY CARE PROVIDERS. PRIMARY
 CARE SPENDING IS INCLUDED REGARDLESS OF  PAYMENT  METHODOLOGY,  SUCH  AS
 FEE-FOR-SERVICE,  CAPITATION,  INCENTIVES, VALUE-BASED PAYMENTS OR OTHER
 METHODOLOGIES, ADJUSTED APPROPRIATELY TO  EXCLUDE  ANY  PORTION  OF  THE
 EXPENDITURE THAT IS REASONABLY APPORTIONED TO EXCLUDE EXPENSES FOR INPA-
 TIENT SERVICES OR OTHER NON-PRIMARY CARE SERVICES.
   5. (A) THE COMMISSION SHALL PUBLISH, POST ON THE DEPARTMENT'S WEBSITE,
 AND DELIVER AN ANNUAL REPORT TO THE GOVERNOR, THE TEMPORARY PRESIDENT OF
 THE  SENATE,  THE SPEAKER OF THE ASSEMBLY, THE CHAIRPERSON OF THE SENATE
 FINANCE COMMITTEE, THE  CHAIRPERSON  OF  THE  ASSEMBLY  WAYS  AND  MEANS
 COMMITTEE AND THE CHAIRS OF THE SENATE AND ASSEMBLY HEALTH AND INSURANCE
 COMMITTEES.  THE  FIRST REPORT SHALL BE PUBLISHED AND DELIVERED NO LATER
 THAN MARCH THIRTY-FIRST OF THE YEAR FOLLOWING THE EFFECTIVE DATE OF THIS
 SECTION.
 S. 6534--C                          4
 
   (B) THE CONTENT OF THE ANNUAL REPORTS SHALL BE AT  THE  DISCRETION  OF
 THE COMMISSION BUT THE FIRST REPORT SHALL INCLUDE:
   (I)  AN  ANALYSIS  OF  CURRENT  PRIMARY  CARE  SPENDING,  INCLUDING BY
 GEOGRAPHIC REGION, IN RELATION TO ALL OTHER HEALTH CARE SPENDING IN  THE
 AGGREGATE.
   (II) RECOMMENDATIONS TO THE GOVERNOR AND THE LEGISLATURE OF ANY CHANG-
 ES  TO  THE DEFINITION OF "PRIMARY CARE" FOR THE PURPOSES OF THE COMMIS-
 SION'S FUTURE WORK. SUCH RECOMMENDATIONS MAY BE MADE PRIOR  TO  DELIVERY
 OF THE COMMISSION'S REPORT.
   (III) RECOMMENDATIONS FOR LEGISLATIVE AND EXECUTIVE ACTION.
   (IV)  IDENTIFICATION  OF  BARRIERS, INCLUDING PAYMENT METHODOLOGIES BY
 HEALTH CARE PAYORS AND PROVIDERS, TO PROVIDING PRIMARY CARE AND INCREAS-
 ING PRIMARY CARE SPENDING.
   (V) RECOMMENDATIONS TO IMPROVE PROVIDING INCREASED AND  HIGHER-QUALITY
 PRIMARY  CARE  AND  PRIMARY  CARE  SPENDING,  WITH  SPECIAL ATTENTION TO
 INCREASING HEALTH CARE EQUITY, REDUCING  HEALTH  CARE  DISPARITIES,  AND
 AVOIDING INCREASING COSTS TO PATIENTS OR THE TOTAL COST OF HEALTH CARE.
   (VI) RECOMMENDATIONS TO INCREASE PRIMARY CARE SPENDING.
   § 3. This act shall take effect immediately.