The New York State Senate

 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   1197
 
                        2023-2024 Regular Sessions
 
                             I N  S E N A T E
 
                             January 10, 2023
                                ___________
 
 Introduced  by Sens. RIVERA, BROUK, COONEY, MAY, MYRIE, RAMOS, SEPULVEDA
   -- 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  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;
   (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
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD03591-01-3

 S. 1197                             2
 
 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,
 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
 S. 1197                             3
 
 (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.
   (II) RECOMMENDATIONS TO THE GOVERNOR AND THE LEGISLATURE OF ANY CHANG-
 ES TO THE DEFINITION OF "PRIMARY CARE" FOR THE PURPOSES OF  THE  COMMIS-
 S. 1197                             4
 
 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.