NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A2922
SPONSOR: Peoples-Stokes TITLE OF BILL: An act to amend the insurance law and the public
health law, in relation to establishing a health care disparities data
collection system
PURPOSE OR GENERAL IDEA OF BILL: To mandate that the Superintendent
of financial services include data as to the health disparities records
of HMOs in the state consumer guides to health insurance that it
currently produces, using the data collected under the new health care
disparities data collection system created by this legislation.
SUMMARY OF SPECIFIC PROVISIONS:
Sections 1 and 2 of the bill amend §§ 210 and 4323 of the Insurance Law
to mandate that the Superintendent of Financial Services (i.e., the head
of the new state agency that is the merger of the Insurance and Banking
Departments) include data as to the health disparities records of HMOs
in the state in the state consumer guides to health insurance that it
currently produces, using the data collected under the new health care
disparities data collection system created by this bill.
Section 3 adds a new subdivision (c) to Public Health Law § 206 to clar-
ify that administration and enforcement of the disparities data
collection system is a duty of the New York State Health Commissioner.
Section 245 of new Title 2-G sets forth the legislative intent, noting
that substantial disparities exist as to health care outcomes based on
race and the other factors in the bill. It expresses the legislative
intent that the State Department of Health (SDOH) incorporate the
disparities data that will be collected under the federal Patient
Protection and Affordable Care Act and pursuant to other state and
federal laws and regulations into a comprehensive data collection system
administered by SDOH that will disseminate data on health disparities to
the public in an easily accessible form at no charge.
The data collection system operated by SDOH will have data sets disag-
gregated by race and ethnicity broken down by the U.S. Census catego-
ries, gender, primary language, disability status, and sexual orien-
tation.
JUSTIFICATION: This bill would create a comprehensive system of
reporting and public dissemination of health care outcomes by race and
ethnicity, gender and other factors, building on the federal Affordable
Care Act (ACA) and existing state efforts. Here in New York, the state
already collects data by race and ethnicity on the records of public
health care plans as to certain measures of quality like child asthma
management and managing diabetes.
Data has consistently shown disparities as to health outcomes based on
race, ethnicity and gender. For example, African American and Hispanic
New Yorkers die prematurely at rates nearly twice that of whites, the
infant mortality rate among African Americans is nearly 2.5 times higher
than that of whites and cardiovascular disease is disproportionately
prevalent among African Americans. Hispanic New Yorkers die from
diabetes at a rate almost 50% higher than whites, and 55% of those dying
from cardiovascular disease in New York City are women.
State policymakers and health advocates need access to data on health
care disparities to develop solutions and to hold health plans and
health care institutions accountable. Clear data will also give policy-
makers guidance in determining which programs are the most effective, so
that scarce state resources are used wisely,
PRIOR LEGISLATIVE HISTORY: A.8278 of 2011/2012; A.5426 of 2013/2014.
FISCAL IMPLICATIONS: To be determined.
EFFECTIVE DATE: This act shall take effect 3 months after the effec-
tive date of regulations implementing Title XXXI of the patient
protection and affordable care act (42 U.S.C. 300k) or July 1, 2012
whichever is later.
STATE OF NEW YORK
________________________________________________________________________
2922
2015-2016 Regular Sessions
IN ASSEMBLY
January 20, 2015
___________
Introduced by M. of A. PEOPLES-STOKES -- read once and referred to the
Committee on Mental Health
AN ACT to amend the insurance law and the public health law, in relation
to establishing a health care disparities data collection system
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Subsections (d) and (e) of section 210 of the insurance
2 law, as added by chapter 579 of the laws of 1998, are amended to read as
3 follows:
4 (d) Beginning no later than September first of the year following the
5 effective date of the rules and regulations establishing the health care
6 disparities data collection system, pursuant to title three-A of article
7 two of the public health law, and on September first of the preceding
8 year if practicable, in addition to the information required in
9 subsections (a), (b) and (c) of this section, the superintendent shall
10 include in such guide and selection of the data applicable to each
11 insurer or entity from the health care disparities data collection
12 system. Such data shall include data collected or compiled in regard to
13 health care quality and health outcomes pursuant to section two thousand
14 nine hundred ninety-five-c of the public health law or other data that
15 is generally recognized as authoritative and reliable.
16 (e) Health insurers and entities certified pursuant to article forty-
17 four of the public health law shall provide annually to the superinten-
18 dent and the commissioner of health, and the commissioner of health
19 shall provide to the superintendent, all of the information necessary
20 for the superintendent to produce the annual consumer guide, provided
21 that this requirement shall not apply to information provided for in
22 subsection (d) of this section if the superintendent already possesses
23 such information as part of the data collection system provided for in
24 title three-A of article two of the public health law. In compiling the
25 guide, the superintendent shall make every effort to ensure that the
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD01341-01-5
A. 2922 2
1 information is presented in a clear, understandable fashion which facil-
2 itates comparisons among individual insurers and entities, and in a
3 format which lends itself to the widest possible distribution to consum-
4 ers. The superintendent shall either include the information from the
5 annual consumer guide in the consumer shopping guide required by
6 subsection (a) of section four thousand three hundred twenty-three of
7 this chapter or combine the two guides as long as consumers in the indi-
8 vidual market are provided with the information required by subsection
9 (a) of section four thousand three hundred twenty-three of this chapter.
10 [(e)] (f) The superintendent shall contract with a national organiza-
11 tion for the purposes of drafting and designing the guide, including the
12 preparation of relevant explanatory material. Such organization shall
13 have actual experience in preparing a similar guide for at least one
14 other state. The superintendent, in consultation with the commissioner
15 of health, may also contract with one or more national organizations to
16 assist such commissioner in the collection of data and the analysis and
17 auditing of the clinical measurers. Such organizations shall consult
18 periodically with associations representing health insurers and health
19 maintenance organizations as well as with consumer representatives in
20 New York in preparing the consumer guide. In regard to information added
21 to the consumer guide or guides pursuant to subsection (d) of this
22 section, the data selected as well as the format shall be determined by
23 the superintendent in consultation with the commissioner of health, with
24 consideration given to the views expressed by stakeholders in the review
25 and comment process held pursuant to subdivision eleven of section two
26 hundred forty-seven of the public health law.
27 § 2. Subsection (a) of section 4323 of the insurance law, as amended
28 by chapter 1 of the laws of 1999, is amended to read as follows:
29 (a) All health maintenance organizations issued a certificate of
30 authority under article forty-four of the public health law or licensed
31 under this article shall prepare, in conjunction with the superinten-
32 dent, and shall participate in and share the cost of the publication and
33 dissemination of a consumer's shopping guide for standardized individual
34 health plans issued pursuant to sections four thousand three hundred
35 twenty-one and four thousand three hundred twenty-two of this article
36 and a separate consumer shopping guide for standardized qualifying indi-
37 vidual health insurance contracts and standardized qualifying group
38 health insurance contracts issued pursuant to section four thousand
39 three hundred twenty-six of this article. The consumer's shopping guides
40 shall be published annually and shall include the names, addresses and
41 telephone numbers of all health maintenance organizations offering such
42 coverage as well as a description of the plan design and premiums in
43 such a manner that facilitates consumer comparison. Such consumer guides
44 shall also contain, in a manner that facilitates consumer comparison, a
45 selection of the data applicable to each such health maintenance organ-
46 ization from the health care disparities data collection system estab-
47 lished under title three-A of article two of the public health law. The
48 data selected as well as the format shall be determined by the super-
49 intendent in consultation with the commissioner of health, with consid-
50 eration given to the views expressed by stakeholders in the review and
51 comment process held pursuant to subdivision eleven of section two
52 hundred forty-seven of the public health law.
53 § 3. Subdivision 1 of section 206 of the public health law is amended
54 by adding a new subdivision (v) to read as follows:
55 (v) establish, administer and enforce the health care disparities data
56 collection system established under title three-A of this article.
A. 2922 3
1 § 4. Article 2 of the public health law is amended by adding a new
2 title 3-A to read as follows:
3 TITLE III-A
4 HEALTH CARE DISPARITIES DATA COLLECTION SYSTEM
5 Section 245. Legislative intent.
6 246. Definitions.
7 247. Establishment of health care disparities data collection
8 system.
9 248. Dissemination of health care disparities data to the
10 public.
11 249. Enforcement.
12 § 245. Legislative intent. The legislature finds and declares that
13 substantial disparities exist as to health care outcomes based on race,
14 ethnicity, sex, primary language, disability status, and sexual orien-
15 tation in this state and in the nation. The intent of this title is to
16 establish a uniform data health care disparities data collection system
17 in this state which will enable health care consumers to be fully
18 informed as to the record of health plans and health care institutions
19 in addressing disparities based on these factors in order to make
20 informed health care choices and for state policymakers to address
21 disparities. The data collection system established under this title
22 shall incorporate the disparities data collected under the patient
23 protection and affordable care act, existing state and federal laws and
24 regulations, and the additional requirements established under this
25 title. It is further the intent of this title that the department assem-
26 ble health disparities data from all state and federal agencies that
27 presently collect such data or that will be required to collect it in
28 the future and compile this data in a format that is easily accessible
29 and available to the public at no charge.
30 § 246. Definitions. The following words and phrases, as used in this
31 title, shall have the following meanings: 1. "Article twenty-eight
32 facility" means any entity regulated under article twenty-eight of this
33 chapter, including a hospital, nursing home, or residential health care
34 facility.
35 2. "Data provider" means an article twenty-eight facility defined
36 pursuant to subdivision one of this section or a health insurer defined
37 pursuant to subdivision four of this section.
38 3. "Health care disparities data collection system" or "data
39 collection system" means the collection of information in the form
40 established in this title.
41 4. "Health insurer" means a health maintenance organization issued a
42 certificate of authority under article forty-four of this chapter, an
43 entity licensed under article forty-three or forty-four of the insurance
44 law, or a person, firm or corporation providing health insurance poli-
45 cies under article thirty-two of the insurance law. Such term shall
46 include a public insurance program.
47 5. "Patient protection and affordable care act" or "affordable care
48 act" means public law 111-148 and public law 111-152, as such laws may
49 from time to time be amended.
50 6. "Public insurance program" includes an approved organization pursu-
51 ant to title one-A of article twenty-five of this chapter, an approved
52 organization pursuant to section three hundred sixty-nine-ee of the
53 social services law, and a participant in the program created by section
54 four thousand three hundred twenty-six of the insurance law. Such term
55 shall also include medical assistance for needy persons pursuant to
56 title eleven of article five of the social services law.
A. 2922 4
1 7. "Race and ethnicity" means all racial categories compiled by the
2 United States census, provided that the "Asian" racial category shall be
3 broken down further into the subcategories designated by the census,
4 including "Asian Indian," "Chinese," "Filipino," "Japanese," "Korean,"
5 "Vietnamese," and "other Asian."
6 8. "Retention rate" means the percentage of those enrolled in a public
7 insurance program that are asked to renew or recertify and do renew or
8 recertify as of two months after the expiration of their previous health
9 insurance coverage.
10 9. "Take up rate" means the percentage of those eligible for a public
11 insurance program that enroll in the program.
12 § 247. Establishment of health care disparities data collection
13 system. 1. The department shall establish by rulemaking a health care
14 disparities data collection system. Once established, the data included
15 in such system shall be made available to the public under the terms
16 established in this title.
17 2. All data providers shall be required to furnish the data mandated
18 to be submitted under subdivision three of this section and any other
19 data which the department shall prescribe, and otherwise participate in
20 the health care disparities collection system established under this
21 title.
22 3. The data collection system shall include at least the following
23 data sets disaggregated by race and ethnicity, sex, primary language,
24 disability status, and sexual orientation:
25 a. in the case of health insurers, the number of subscribers, covered
26 persons (including spouses and children in the case of family coverage),
27 and applicants;
28 b. in the case of article twenty-eight facilities, the number of
29 patients and data concerning health care quality and health outcomes
30 collected and/or disseminated pursuant to section two thousand nine
31 hundred ninety-five-b of this chapter, and/or any other data in regard
32 to health care quality and health outcomes selected by the department
33 that is generally recognized as authoritative and reliable;
34 c. in the case of public insurance programs, take up rates and
35 retention rates;
36 d. data collected or compiled pursuant to section two thousand nine
37 hundred ninety-five-c of this chapter;
38 e. any data in addition to the data referred to in paragraphs b, c and
39 d of this subdivision in regard to health care quality and outcomes
40 which is required to be disclosed or furnished to any state agency by
41 any provision of law, that is already disaggregated by race and/or
42 ethnicity, sex, primary language, disability status, and/or sexual
43 orientation, or for which it is practicable to disaggregate such data by
44 such factors;
45 f. any data that is required to be reported in regard to applicants,
46 recipients or participants under title one of the patient protection and
47 affordable care act (42 U.S.C. 300k) and its implementing regulations,
48 as such regulations may from time to time be amended; and
49 g. any other data or data methodology that the department determines
50 would meet the goals of this title, including data produced or collected
51 by the federal government.
52 4. Unless the context clearly indicates otherwise, for the purposes of
53 paragraph f of subdivision three of this section, the terms "applicant,"
54 "recipient" or "participant" shall have the same meaning as such terms
55 are given in the affordable care act and its implementing regulations,
56 as such act and regulations shall from time to time be amended.
A. 2922 5
1 5. The department shall require data providers to update at least
2 annually any data that is furnished under subdivision three of this
3 section. Notwithstanding the preceding sentence, for any data collected
4 pursuant to any other provision of law which requires updating more
5 frequently than annually, the frequency provided for in such provision
6 shall apply.
7 6. Any state agency, including any health benefit exchange or
8 exchanges created in the state under the affordable care act which
9 obtains or possesses data which is subject to this title shall be
10 required to furnish such data to the department upon request, in the
11 format and manner requested by the department. Such agency or entity
12 shall also be required to cooperate with the department in the estab-
13 lishment and maintenance of the data collection system.
14 7. a. The department is authorized to enter into any agreement with
15 the federal department of health and human services or any other entity
16 that is necessary to obtain the data obtained by the federal department
17 of health and human services from any federally conducted or supported
18 health care or public health program, activity or survey pursuant to
19 title XXXI of the affordable care act (42 U.S.C. 300k) and its imple-
20 menting regulations for inclusion in the data collection system.
21 b. The commissioner is authorized to contract with one or more enti-
22 ties to operate any part of the health care disparities data collection
23 system, and to accept grants and enter into contracts as may be neces-
24 sary to provide funding for such data collection system.
25 8. The department shall prescribe forms or questionnaires for the
26 collection of data from data providers that are necessary for the data
27 collection system, along with appropriate instructions for persons
28 completing the form or questionnaire. Notwithstanding the preceding
29 sentence, the department shall be authorized to use means other than
30 such form or questionnaire if data needed for the data collection system
31 is otherwise reasonably obtainable by other means, including from the
32 department of health and human services pursuant to the affordable care
33 act. In order to reduce the costs or administrative burdens on data
34 providers, patients, applicants, or other persons, the department may
35 alternatively include questions eliciting the data mandated by this
36 title on a questionnaire or form developed for purposes other than spec-
37 ified in this title.
38 9. Unless required by any other provision of law, it shall be volun-
39 tary for any patient, applicant or any other person receiving or seeking
40 services from a data provider to provide information in regard to their
41 race, ethnicity, sex, primary language, disability status, or sexual
42 orientation, and no patient, applicant or any other such person shall be
43 denied services or in any way discriminated against in the receipt of
44 services for failure to answer any such question. The department shall
45 include a statement explaining that the information requested is volun-
46 tary in all questionnaires or forms provided for in subdivision eight of
47 this section.
48 10. In administering this title, the department shall seek to avoid
49 duplicative requirements on data providers, state agencies, and state
50 entities, so long as the methodology selected meets the goals of this
51 title.
52 11. Stakeholders selected by the commissioner, including health care
53 consumer organizations, organizations that represent racial and ethnic
54 minorities, women, those whose first language is not English, people
55 with disabilities, and gay and lesbian data providers, as well as the
56 superintendent of financial services, shall be provided with the oppor-
A. 2922 6
1 tunity to review and comment on the methodology used to comply with this
2 title, including collection methods, analysis, formatting, and methods
3 and means for release and dissemination. Such opportunity to review and
4 comment shall include, but not be limited to, whether the data is
5 formatted in a manner so as to enable consumers to make informed choices
6 of health insurers and article twenty-eight facilities and the usability
7 of the website under section two hundred forty-eight of this title. The
8 opportunity for review and comment shall include at least one meeting of
9 such stakeholders prior to the development of the regulations promulgat-
10 ed pursuant to this title, and at least one meeting annually thereafter
11 so that modifications to the data collection system may be considered by
12 the department. The department shall report the results of such review
13 and comment process to the superintendent of financial services.
14 § 248. Dissemination of health care disparities data to the public. 1.
15 As early as practicable after the receipt by the department of any data
16 which is a component of the data collection system and in no case longer
17 than ninety days after receipt, the department shall post such data on a
18 website maintained by the department which is easily accessible to the
19 public and downloadable using a spreadsheet program used by substantial
20 numbers of the general public that permits manipulation of the data
21 after downloading. The department shall ensure that the data is
22 displayed in a clear format which is easily understandable, and which
23 facilitates consumer comparison in such a manner so as to enable consum-
24 ers to make informed choices of health insurers or article twenty-eight
25 facilities. The website shall also include easily understandable
26 instructions on how to access the data, and a glossary of the terms
27 used. The data shall be made available to the public on the website at
28 no charge.
29 2. a. The department shall compile the data collected under this title
30 and post it on the website on a statewide basis and also in a form that
31 is disaggregated by group factors. In addition, such data collected
32 shall be further disaggregated on a county and an industry basis,
33 provided that for any city with a population of one million residents or
34 more, such data shall also be further disaggregated on a citywide basis.
35 The department shall consider the feasibility of including other methods
36 of presenting the data other than that as mandated in this title that
37 might promote the goals of this title of helping consumers make informed
38 health care choices and state policymakers in addressing disparities.
39 b. For the purposes of paragraph a of this subdivision:
40 i. to "compile the data collected" means to calculate the total number
41 of patients, subscribers, applicants or other persons receiving or
42 applying for services, as applicable, and the percentage of the total
43 for each data element;
44 ii. to disaggregate by "group factors" means by race and ethnicity,
45 sex, primary language, disability status, and sexual orientation; and
46 iii. to disaggregate by "industry" means to disaggregate the data into
47 at least the following categories: general hospitals, nursing homes and
48 residential care facilities in the case of article twenty-eight facili-
49 ties, and commercial insurers, health maintenance organizations, and
50 public insurance programs in the case of health insurers. In the case of
51 public insurance programs, the data shall also be broken down further,
52 into the following categories: all approved organizations pursuant to
53 title one-A of article twenty-five of this chapter, all approved organ-
54 izations pursuant to section three hundred sixty-nine-ee of the social
55 services law, all participants in the program created by section four
56 thousand three hundred twenty-six of the insurance law, and all data in
A. 2922 7
1 regard to providing medical assistance for needy persons pursuant to
2 title eleven of article five of the social services law.
3 3. Notwithstanding any other provision of state or federal law, the
4 department shall restrict dissemination of any data subject to this
5 title if such dissemination would reveal any data as to any individual
6 consumer, including but not limited to his or her race and/or ethnicity,
7 primary language, disability status, or sexual orientation.
8 4. For all data compiled by the department pursuant to section two
9 hundred forty-seven of this title or disseminated pursuant to this
10 section, data in regard to the Asian racial category shall be compiled
11 and disseminated as to all Asians, and also for the subcategories of
12 Asians provided for in subdivision seven of section two hundred forty-
13 six of this title. Hispanics shall be listed both under their race, and
14 separate data shall be compiled and disseminated for Hispanics of all
15 races.
16 § 249. Enforcement. In addition to the penalties otherwise provided
17 under this chapter, any violation of this title by an authorized insur-
18 er, representative of the insurer, or any other person or entity
19 licensed, certified, registered, or authorized pursuant to the insurance
20 law, the superintendent of financial services shall be authorized to
21 seek the remedies provided in section one hundred nine of the insurance
22 law. Nothing in this title shall in any way contravene or limit the
23 rights or remedies that are otherwise available to a state agency or a
24 consumer under any other provision of law.
25 § 5. This act shall take effect three months after the effective date
26 of regulations implementing Title XXXI of the patient protection and
27 affordable care act (42 U.S.C. 300k) or July 1, 2015, whichever is
28 later; provided, however that effective immediately, the addition,
29 amendment and/or repeal of any rule or regulation necessary for the
30 implementation of this act on its effective date are authorized and
31 directed to be made and completed on or before such effective date, and
32 provided further, that any state agency may gather information or take
33 any other action necessary for the implementation of this act on its
34 effective date; provided, further, however, that the commissioner of
35 health shall notify the legislative bill drafting commission upon the
36 occurrence of the issuance of the regulations implementing Title XXXI of
37 the patient protection and affordable care act in order that the commis-
38 sion may maintain an accurate and timely effective data base of the
39 official text of the laws of the state of New York in furtherance of
40 effectuating the provisions of section 44 of the legislative law and
41 section 70-b of the public officers law.
