A07846 Summary:

BILL NOA07846A
 
SAME ASSAME AS S05486-A
 
SPONSORCahill
 
COSPNSRGunther
 
MLTSPNSRLifton
 
Amd S365-m, Soc Serv L; amd SS2511 & 4406-c, Pub Health L; amd SS3217-b & 4325, Ins L
 
Prohibits providers of health care coverage from requiring behavioral health providers to provide all products offered by the health care plan.
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A07846 Actions:

BILL NOA07846A
 
05/28/2015referred to health
06/05/2015amend and recommit to health
06/05/2015print number 7846a
06/09/2015reported referred to ways and means
06/18/2015reported referred to rules
06/19/2015reported
06/19/2015rules report cal.720
06/19/2015ordered to third reading rules cal.720
06/19/2015passed assembly
06/19/2015delivered to senate
06/19/2015REFERRED TO RULES
01/06/2016DIED IN SENATE
01/06/2016RETURNED TO ASSEMBLY
01/06/2016ordered to third reading cal.320
03/29/2016passed assembly
03/29/2016delivered to senate
03/29/2016REFERRED TO HEALTH
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A07846 Memo:

NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
submitted in accordance with Assembly Rule III, Sec 1(f)
 
BILL NUMBER: A7846A
 
SPONSOR: Cahill
  TITLE OF BILL: An act to amend the social services law, the public health law and the insurance law, in relation to prohibiting a provider of health care coverage from requiring providers of behavioral health services to offer all products offered by the provider of health care coverage   PURPOSE: To assure that behavioral health providers are permitted to select by execution of separate agreements the products that the provid- er will participate in with health care plans and health insurers.   SUMMARY OF PROVISIONS: Section one of the bill would amend Social Services law § 365-m to require Medicaid managed care plans to execute separate contracts with behavioral healthcare providers to provide coverage to Medicaid enrol- lees rather than rely upon previously-executed contracts. Sections two through five make corresponding changes to Public Health Law § 2511 for child health plus plans and Public Health Law § 4406-c and Insurance Law § S 3217-b and 4325, respectively for other health care plans and health insurers. Section six provides that this act shall take effect immediately.   JUSTIFICATION: Beginning in the summer of 2015, mental health and substance abuse clients and the providers who serve them will be moving out of Medicaid fee-for-service and into a managed care environment. Providers will be paid by managed care organizations (MCOs) for Medicaid clients pursuant to rates and terms defined in contracts with MCOs. Health insurance plans often include an All Products clause (APC) in their contracts with providers. The APC requires the provider to take all current and future product lines brought to them by the plans. If the provider does not agree to take all products - including those that do not include fair terms or adequately reimburse for their cost of services, then the provider cannot participate in the network for any of the insurance product lines. This would apply to products that serve Medicaid beneficiaries as well as patients enrolled in commercial, the Health Insurance Exchange and employer plans. The result could be a very serious access to care crisis in the public mental health and substance abuse services system - the front line providers for people with serious mental illness and those struggling with very serious substance abuse, opioid, heroin and other addictions. A State Office of Mental Health study conducted in 2012 revealed that approximately 40% of these providers are in significant financial distress. This is due in part to the fact that in the behavioral health system, commercial rates are paid at between 1/4 and 1/3 the rate currently paid for Medicaid fee for service. When this population is moved in managed care and all rates are able to be set by the plans at these disparately low levels through the use of APCs, providers would be in the untenable position of either discontinuing existing relationships with clients or accepting rates that are well below their costs for providing services. The All Products clause disrupts existing relationships between clini- cians and clients, and threatens continued access to care in a service system already overloaded with long waiting lists, workforce shortages and abysmal commercial rates. Seven states across the country have already banned the use of the APC in contracts between MCOs and certain providers. Attorneys General across the country as well as court deci- sions have prohibited plans from using the APC in contracts in instances where doing so has been deemed an unfair business practice to gain market share and deny competition that would otherwise occur. This legislation would take a similar action by prohibiting the use of the All Products clause in contracts between behavioral health providers and MCOs and other health insurance plans This is essential to assure continued access to care and continuity of care for our most vulnerable citizens who utilize the public mental health and substance abuse system. Doing so is also critical to ensuring a smooth transition of behavioral health clients into Medicaid managed care by giving the providers an opportunity to negotiate reasonable contracts with the plans for the clients they serve.   LEGISLATIVE HISTORY: None.   FISCAL IMPLICATIONS: None.   EFFECTIVE DATE: Immediately
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A07846 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                         7846--A
 
                               2015-2016 Regular Sessions
 
                   IN ASSEMBLY
 
                                      May 28, 2015
                                       ___________
 
        Introduced by M. of A. CAHILL -- read once and referred to the Committee
          on  Health -- committee discharged, bill amended, ordered reprinted as
          amended and recommitted to said committee
 
        AN ACT to amend the social services law, the public health law  and  the
          insurance  law,  in  relation to prohibiting a provider of health care
          coverage from requiring providers of  behavioral  health  services  to
          offer all products offered by the provider of health care coverage
 
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
 
     1    Section 1. Section 365-m of the social  services  law  is  amended  by
     2  adding a new subdivision 6 to read as follows:
     3    6.  (a)  No  managed  care provider under section three hundred sixty-
     4  four-j of this title shall by contract or written policy  or  procedure,
     5  require  a  behavioral  health  services  provider to participate in the
     6  in-network portion of any product offered by such managed care provider,
     7  other than products  under  such  section.  Behavioral  health  services
     8  providers  shall  have  the  right  to select by execution of a separate
     9  agreement the products of  such  managed  care  provider  in  which  the
    10  provider agrees to participate in the in-network portion.
    11    (b)  As  used  in this subdivision, "behavioral health services" means
    12  inpatient and outpatient behavioral health services  provided  by  those
    13  licensed  or  certified  pursuant to article thirty-one or thirty-two of
    14  the mental hygiene law, or programs that are licensed pursuant  to  both
    15  article thirty-one of the mental hygiene law and article twenty-eight of
    16  the public health law, or certified under both article thirty-two of the
    17  mental hygiene law and article twenty-eight of the public health law.
    18    §  2. Section 2511 of the public health law is amended by adding a new
    19  subdivision 22 to read as follows:
    20    22. (a) No approved organization shall by contract or  written  policy
    21  or  procedure,  require a behavioral health services provider to partic-
    22  ipate in the in-network portion of any product offered by such organiza-
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD10990-02-5

        A. 7846--A                          2
 
     1  tion, other than products under this title.  Behavioral health  services
     2  providers  shall  have  the  right  to select by execution of a separate
     3  agreement the products  of  such  approved  organization  in  which  the
     4  provider agrees to participate in the in-network portion.
     5    (b)  As  used  in this subdivision, "behavioral health services" means
     6  inpatient and outpatient behavioral health services  provided  by  those
     7  licensed  or  certified  pursuant to article thirty-one or thirty-two of
     8  the mental hygiene law, or programs that are licensed pursuant  to  both
     9  article thirty-one of the mental hygiene law and article twenty-eight of
    10  this  chapter,  or certified under both article thirty-two of the mental
    11  hygiene law and article twenty-eight of this chapter.
    12    § 3. Section 4406-c of the public health law is amended  by  adding  a
    13  new subdivision 9 to read as follows:
    14    9.  (a) No health care plan licensed pursuant to this article shall by
    15  contract or written policy or procedure,  require  a  behavioral  health
    16  services  provider to participate in the in-network portion of any prod-
    17  uct offered by such plan. Behavioral  health  services  providers  shall
    18  have  the  right  to  select  by  execution  of a separate agreement the
    19  products of such plan in which the provider agrees to participate in the
    20  in-network portion.
    21    (b) As used in this subdivision, "behavioral  health  services"  means
    22  inpatient  and  outpatient  behavioral health services provided by those
    23  licensed or certified pursuant to article thirty-one  or  thirty-two  of
    24  the  mental  hygiene law, or programs that are licensed pursuant to both
    25  article thirty-one of the mental hygiene law and article twenty-eight of
    26  this chapter, or certified under both article thirty-two of  the  mental
    27  hygiene law and article twenty-eight of this chapter.
    28    §  4.  Section  3217-b of the insurance law is amended by adding a new
    29  subsection (k) to read as follows:
    30    (k) (1) No insurer subject to the provisions of this article shall  by
    31  contract,  written  policy  or  procedure,  require  a behavioral health
    32  services provider to participate in the in-network portion of any  prod-
    33  uct  offered by such insurer. Behavioral health services providers shall
    34  have the right to select  by  execution  of  a  separate  agreement  the
    35  products of such insurers in which the provider agrees to participate in
    36  the in-network portion.
    37    (2)  As  used  in  this subsection, "behavioral health services" means
    38  inpatient and outpatient behavioral health services  provided  by  those
    39  licensed  or  certified  pursuant to article thirty-one or thirty-two of
    40  the mental hygiene law, or programs that are licensed pursuant  to  both
    41  article thirty-one of the mental hygiene law and article twenty-eight of
    42  the public health law, or certified under both article thirty-two of the
    43  mental hygiene law and article twenty-eight of the public health law.
    44    §  5.  Section  4325  of  the insurance law is amended by adding a new
    45  subsection (l) to read as follows:
    46    (l) (1) No corporation organized pursuant to  this  article  shall  by
    47  contract,  written  policy  or  procedure,  require  a behavioral health
    48  services provider to participate in the in-network portion of any  prod-
    49  uct  offered  by  such corporation. Behavioral health services providers
    50  shall have the right to select by execution of a separate agreement  the
    51  products of such corporation in which the provider agrees to participate
    52  in the in-network portion.
    53    (2)  As  used  in  this subsection, "behavioral health services" means
    54  inpatient and outpatient behavioral health services  provided  by  those
    55  licensed  or  certified  pursuant to article thirty-one or thirty-two of
    56  the mental hygiene law, or programs that are licensed pursuant  to  both

        A. 7846--A                          3
 
     1  article thirty-one of the mental hygiene law and article twenty-eight of
     2  the public health law, or certified under both article thirty-two of the
     3  mental hygiene law and article twenty-eight of the public health law.
     4    § 6. This act shall take effect immediately.
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