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A06119 Text:

                STATE OF NEW YORK
                               2017-2018 Regular Sessions
                   IN ASSEMBLY
                                    February 23, 2017
        Introduced  by  M.  of A. ENGLEBRIGHT, COLTON, SIMANOWITZ, TITONE, COOK,
          SKOUFIS, McDONOUGH, JAFFEE, DenDEKKER, CAHILL, MOYA -- Multi-Sponsored
          by -- M.  of A. ARROYO, GLICK, MOSLEY, SKARTADOS, THIELE -- read  once
          and referred to the Committee on Health
        AN ACT to amend the public health law and the insurance law, in relation
          to  requiring  hospitals to inform emergency care patients whether the
          attending physician participates with the patient's  insurance  policy
          and  requiring insurance companies to cover the cost of out-of-network
          care for patients who are unconscious or otherwise unable  to  provide
          informed consent
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
     1    Section 1. Section 2805-b of the  public  health  law  is  amended  by
     2  adding a new subdivision 1-a to read as follows:
     3    1-a. Every general hospital in which insured patients are admitted for
     4  emergency  care  shall  adopt  regulations requiring its staff to inform
     5  such patients whether the  attending  physician  participates  with  the
     6  patient's  insurance  policy. In the event such attending physician does
     7  not participate with the patient's insurance policy, the  patient  shall
     8  be  permitted  to  decide  whether  to  be treated by the out-of-network
     9  attending physician or to request treatment by an in-network  physician,
    10  who must treat such patient with all convenient speed.
    11    § 2. Subsection (i) of section 3216 of the insurance law is amended by
    12  adding a new paragraph 9-a to read as follows:
    13    (9-a)(A)  Every policy that provides coverage for services to treat an
    14  emergency condition in hospital facilities:
    15    (i) without the need for any prior authorization determination;
    16    (ii) in the case of patients who are unconscious or  otherwise  unable
    17  to  provide  informed  consent,  regardless  of  whether the health care
    18  provider furnishing such  services  is  a  participating  provider  with
    19  respect to such services;
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.

        A. 6119                             2
     1    (iii)  if  the  emergency services are provided by a non-participating
     2  provider, without imposing any administrative requirement or  limitation
     3  on  coverage  that  is more restrictive than the requirements or limita-
     4  tions that apply  to  emergency  services  received  from  participating
     5  providers; and
     6    (iv)  if  the  emergency  services are provided by a non-participating
     7  provider, the cost-sharing requirement  (expressed  as  a  copayment  or
     8  coinsurance)  shall  be  the  same  requirement that would apply if such
     9  services were provided by a participating provider.
    10    (B) Any requirements of section 2719A(b) of the Public Health  Service
    11  Act,  42 U.S.C. § 300gg19a(b) and regulations thereunder that exceed the
    12  requirements of this paragraph with respect  to  coverage  of  emergency
    13  services shall be applicable to every policy subject to this paragraph.
    14    (C)  For  purposes of this paragraph, an "emergency condition" means a
    15  medical or behavioral condition that manifests itself by acute  symptoms
    16  of  sufficient  severity,  including  severe  pain,  such that a prudent
    17  layperson, possessing an average knowledge of medicine and health, could
    18  reasonably expect the absence of immediate medical attention  to  result
    19  in (i) placing the health of the person afflicted with such condition in
    20  serious  jeopardy,  or in the case of a behavioral condition placing the
    21  health of such person  or  others  in  serious  jeopardy;  (ii)  serious
    22  impairment  to such person's bodily functions; (iii) serious dysfunction
    23  of any bodily  organ or part of such person; (iv) serious  disfigurement
    24  of  such  person;  or  (v)  a condition described in clause (i), (ii) or
    25  (iii) of section 1867(e)(1)(A) of the Social Security Act.
    26    (D) For purposes of this paragraph, "emergency services"  means,  with
    27  respect  to  an emergency condition: (i) a medical screening examination
    28  as required under section 1867 of the Social Security Act, 42  U.S.C.  §
    29  1395dd,  which is within the capability of the emergency department of a
    30  hospital, including ancillary services routinely available to the  emer-
    31  gency  department to evaluate such emergency medical condition; and (ii)
    32  within the capabilities of the staff and  facilities  available  at  the
    33  hospital, such further medical examination and treatment as are required
    34  under  section  1867  of the Social Security Act, 42 U.S.C. § 1395dd, to
    35  stabilize the patient.
    36    (E) For purposes of this paragraph, "to stabilize" means, with respect
    37  to an emergency condition, to provide  such  medical  treatment  of  the
    38  condition as may be necessary to assure, within reasonable medical prob-
    39  ability,  that  no  material deterioration of the condition is likely to
    40  result from or occur during the transfer of the insured from a  facility
    41  or to deliver a newborn child (including the placenta).
    42    § 3. This act shall take effect on the one hundred twentieth day after
    43  it shall have become a law.
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