S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  5817--A
 
                        2023-2024 Regular Sessions
 
                           I N  A S S E M B L Y
 
                              March 23, 2023
                                ___________
 
 Introduced  by  M.  of  A. SOLAGES, RIVERA, HEVESI, SANTABARBARA -- read
   once and referred  to  the  Committee  on  Governmental  Employees  --
   reported  and referred to the Committee on Ways and Means -- committee
   discharged, bill amended, ordered reprinted as amended and recommitted
   to said committee

 AN ACT to amend the civil service law, in relation  to  certain  reports
   relating to health benefits for state and retired state employees
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Subdivision 9 of section 162 of the civil service  law,  as
 added by chapter 147 of the laws of 2014, is amended to read as follows:
   9.  (A)  (I) As soon as is practicable, but no later than the first of
 September, two thousand fourteen, the department  shall,  upon  request,
 but  no more frequently than semi-annually, provide to any participating
 employer a standard report which contains data relating to  the  use  of
 benefits by persons covered under the plan by such employer. Such report
 shall  include:  premiums  paid  by  month for each month covered in the
 report and  paid  claims  by  month  for  the  following  categories  of
 services:  inpatient  hospital, outpatient hospital, in network medical,
 out of network medical, prescription drugs, and treatment of  behavioral
 conditions, each reported separately. To the extent allowed by state and
 federal  privacy laws, such report shall also contain claims information
 for individual claimants for claims in excess of fifty thousand  dollars
 that were paid in any of the months covered by the report.
   (II)  The  department  shall provide such reports to any participating
 employer, upon request submitted on or after the first of April for data
 from the first of January through the thirty-first of  December  of  the
 prior  year,  and  on  or after the first of September for data from the
 first of June of the prior year through the thirty-first of May  of  the
 current  year,  within  thirty days of receipt of said request. However,
 requests submitted in the two thousand fourteen calendar year  shall  be
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD08351-06-3
              

 A. 5817--A                          2
 
 provided  as soon as practicable, but no later than the first of Septem-
 ber, two thousand fourteen, or within thirty days after said request  if
 request is submitted on or after the first of August, two thousand four-
 teen.
   (B)  AS SOON AS PRACTICABLE, BUT NOT LATER THAN DECEMBER FIRST OF EACH
 YEAR, THE DEPARTMENT SHALL COLLECT AND ANALYZE HEALTH CARE  CLAIMS  DATA
 TO DEVELOP, AND MAKE PUBLICLY AVAILABLE, A NEW YORK STATE HEALTH BENEFIT
 PLAN  HOSPITAL  PRICING  REPORT.  THE PRESIDENT MUST COLLECT HEALTH CARE
 CLAIMS DATA FROM BOTH HEALTH INSURERS AND HEALTH  MAINTENANCE  ORGANIZA-
 TIONS  RELATING  TO  THE  "IN-NETWORK  NEGOTIATED  RATE" AS SUCH TERM IS
 DEFINED IN, AND LIMITED BY, THE TRANSPARENCY IN COVERAGE FINAL  RULE  OR
 SUCCESSOR  FEDERAL LAW, AS PREPARED FOR MACHINE-READABLE FILES, AS LIKE-
 WISE DEFINED BY THE TRANSPARENCY IN COVERAGE  FINAL  RULE  OR  SUCCESSOR
 FEDERAL  LAW,  AND UTILIZATION OF HOSPITAL SERVICES BY ACTIVE EMPLOYEES,
 RETIRED EMPLOYEES, AND THEIR  DEPENDENTS  RECEIVING  BENEFITS  FROM  THE
 PRIOR  STATE FISCAL YEAR, IN ACCORDANCE WITH PROVISIONS UNDER THIS ARTI-
 CLE.   THE REPORT, WHICH SHALL NOT IDENTIFY  THE  PLAN  BY  NAME,  SHALL
 INCLUDE,  BUT NOT BE LIMITED TO, A COMPARATIVE ANALYSIS OF ACTUAL HOSPI-
 TAL IN-NETWORK NEGOTIATED RATES AND OUT-OF-NETWORK ALLOWED  AMOUNTS,  AS
 SUCH TERMS ARE DEFINED IN THIS PARAGRAPH, BY THE PLAN, FOR EACH HOSPITAL
 FACILITY  IDENTIFIED  BY  NAME  AND  CMS  CERTIFICATION  NUMBER (CCN) OR
 SUCCESSOR IDENTIFIER, BASED ON THE  FOLLOWING  SERVICE  CATEGORIES:  (I)
 INPATIENT  HOSPITAL,  (II)  OUTPATIENT  HOSPITAL,  (III)  EMERGENCY ROOM
 SERVICES, AND (IV) PHYSICIAN SERVICES  PROVIDED  AT  THE  HOSPITAL.  THE
 REPORT SHALL ALSO INCLUDE THE IN-NETWORK NEGOTIATED RATE AND OUT-OF-NET-
 WORK  ALLOWED AMOUNT PER SERVICE AS SUCH TERMS ARE DEFINED IN THIS PARA-
 GRAPH PER HOSPITAL FACILITY ON THE TOP TWENTY SERVICES BY VOLUME  WITHIN
 EACH OF THE FOLLOWING SERVICE CATEGORIES: (A) INPATIENT, (B) OUTPATIENT,
 (C)  EMERGENCY ROOM SERVICES, AND (D) PHYSICIAN SERVICES PROVIDED AT THE
 HOSPITAL. THE REPORT SHALL COMPARE THE IN-NETWORK NEGOTIATED  RATES  AND
 OUT-OF-NETWORK ALLOWED AMOUNTS TO THE PROCESS FOR SIMILAR SERVICES REIM-
 BURSED  UNDER  TITLE  EIGHTEEN  OF  THE SOCIAL SECURITY ACT. SUCH REPORT
 SHALL ALSO INCLUDE A COMPREHENSIVE ANALYSIS OF THE PRIOR FIVE  YEARS  OF
 HOSPITAL  IN-NETWORK NEGOTIATED RATES AND OUT-OF-NETWORK ALLOWED AMOUNTS
 FOR SUCH SERVICES TO ESTABLISH TRENDS IN  HOSPITAL  PRICES.  THE  REPORT
 SHALL ALSO INCLUDE AN ALL-PLAN AGGREGATED TOTAL YEARLY SPEND BY HOSPITAL
 FACILITY  IDENTIFIED  BY  NAME  AND  CMS  CERTIFICATION  NUMBER (CCN) OR
 SUCCESSOR IDENTIFIER. IN PREPARING THE REPORT, THE PRESIDENT SHALL  TAKE
 APPROPRIATE  STEPS  TO ENSURE THAT INDIVIDUAL INSURER'S OR HEALTH PLAN'S
 CONFIDENTIAL PROPRIETARY PRICING INFORMATION IS MAINTAINED AS  CONFIDEN-
 TIAL TO THE EXTENT PERMISSIBLE BY LAW. SUCH REPORT SHALL BE DELIVERED TO
 THE  LEGISLATIVE FISCAL COMMITTEES, THE CHAIRS OF THE LEGISLATIVE HEALTH
 CARE COMMITTEES, THE CHAIR OF THE  SENATE  CIVIL  SERVICE  AND  PENSIONS
 COMMITTEE,  AND  THE  CHAIR  OF  THE  ASSEMBLY COMMITTEE ON GOVERNMENTAL
 EMPLOYEES, ON OR BEFORE DECEMBER THIRTY-FIRST OF  EACH  YEAR,  AND  SUCH
 REPORT SHALL BE POSTED ON THE DEPARTMENT'S WEBSITE NO LATER THAN JANUARY
 FIRST  OF THE FOLLOWING CALENDAR YEAR. FOR PURPOSES OF THIS SUBDIVISION,
 "HEALTH CARE CLAIMS DATA" MEANS ANY CLAIMS FOR INPATIENT, OUTPATIENT, OR
 AMBULATORY SURGICAL SERVICES OR OTHER  SERVICES  NORMALLY  PAID  BY  THE
 THIRD-PARTY PAYER ON FORM UB-04 OR SUCCESSOR FORMS, WITH UB-04 BEING THE
 BILLING  FORM  IDENTIFIED  BY  THE  CENTERS  FOR  MEDICARE  AND MEDICAID
 SERVICES.
   § 2. This act shall take effect immediately.