-  This bill is not active in this session.
 

A00264 Summary:

BILL NOA00264B
 
SAME ASSAME AS S03171-A
 
SPONSORCahill (MS)
 
COSPNSRColton, Arroyo, Jean-Pierre, Taylor, McDonough, Jacobson, Steck, Barron, Reyes, Ortiz, Blake
 
MLTSPNSREpstein, Richardson
 
Amd §§605, 608 & 604, Fin Serv L
 
Establishes patient protections from excessive hospital emergency charges; includes hospital charges, including hospital charges for inpatient services which follow an emergency room visit.
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A00264 Actions:

BILL NOA00264B
 
01/09/2019referred to insurance
05/02/2019amend (t) and recommit to insurance
05/02/2019print number 264a
05/17/2019amend (t) and recommit to insurance
05/17/2019print number 264b
05/21/2019reported referred to codes
06/05/2019reported referred to rules
06/05/2019reported
06/05/2019rules report cal.65
06/05/2019ordered to third reading rules cal.65
06/05/2019ruling of chair on point of order
06/05/2019passed assembly
06/05/2019delivered to senate
06/05/2019REFERRED TO RULES
06/18/2019SUBSTITUTED FOR S3171A
06/18/20193RD READING CAL.1598
06/18/2019PASSED SENATE
06/18/2019RETURNED TO ASSEMBLY
10/11/2019delivered to governor
10/17/2019signed chap.375
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A00264 Committee Votes:

INSURANCE Chair:Cahill DATE:05/21/2019AYE/NAY:22/1 Action: Favorable refer to committee Codes
CahillAyeGarbarinoAye
CookAyeHawleyAye
PretlowNayBlankenbushAye
RiveraExcusedFinchAye
CymbrowitzAyeRaiaAye
LavineAyePalmesanoAye
SteckAyeByrneAye
DilanAye
HunterAye
SimotasAye
WalkerAye
NiouAye
RosenthalAye
SternAye
McDonaldAye
RomeoAye
JacobsonAye

CODES Chair:Lentol DATE:06/05/2019AYE/NAY:19/3 Action: Favorable refer to committee Rules
LentolAyeRaNay
SchimmingerAyeGiglioAye
PretlowNayMontesanoAye
CookAyeMorinelloAye
CymbrowitzAyePalumboAye
O'DonnellAyeGarbarinoAye
LavineAye
PerryAye
ZebrowskiAye
AbinantiNay
WeprinAye
MosleyAye
HevesiAye
FahyAye
SeawrightAye
RosenthalAye

RULES Chair:Gottfried DATE:06/05/2019AYE/NAY:23/4 Action: Favorable
HeastieExcusedKolbNay
GottfriedAyeCrouchAye
LentolAyeFinchNay
GanttExcusedBarclayAye
NolanExcusedRaiaNay
WeinsteinAyeHawleyNay
OrtizAyeGiglioAye
PretlowAyeMalliotakisAye
CookAye
GlickAye
AubryAye
EnglebrightAye
DinowitzAye
ColtonAye
MagnarelliAye
PerryAye
PaulinExcused
TitusAye
Peoples-StokesAye
BenedettoAye
LavineAye
LupardoAye
ZebrowskiAye

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A00264 Floor Votes:

DATE:06/05/2019MOTION:PRETLOW; To appeal decision of the chair YEA/NAY: 90/49
Yes
Abbate
Yes
Crespo
ER
Gantt
No
LiPetri
Yes
Perry
Yes
Simon
No
Abinanti
No
Crouch
Yes
Garbarino
Yes
Lupardo
Yes
Pheffer Amato
Yes
Simotas
No
Arroyo
Yes
Cruz
No
Giglio
Yes
Magnarelli
Yes
Pichardo
No
Smith
Yes
Ashby
Yes
Cusick
Yes
Glick
No
Malliotakis
No
Pretlow
No
Smullen
Yes
Aubry
Yes
Cymbrowitz
No
Goodell
No
Manktelow
Yes
Quart
Yes
Solages
Yes
Barclay
Yes
Davila
Yes
Gottfried
Yes
McDonald
No
Ra
No
Stec
Yes
Barnwell
Yes
De La Rosa
Yes
Griffin
ER
McDonough
No
Raia
Yes
Steck
Yes
Barrett
Yes
DenDekker
No
Gunther
Yes
McMahon
Yes
Ramos
Yes
Stern
Yes
Barron
No
DeStefano
No
Hawley
No
Mikulin
Yes
Raynor
Yes
Stirpe
Yes
Benedetto
Yes
Dickens
Yes
Hevesi
No
Miller B
No
Reilly
No
Tague
Yes
Bichotte
Yes
Dilan
Yes
Hunter
ER
Miller MG
Yes
Reyes
Yes
Taylor
ER
Blake
Yes
Dinowitz
Yes
Hyndman
No
Miller ML
Yes
Richardson
Yes
Thiele
No
Blankenbush
ER
DiPietro
Yes
Jacobson
No
Montesano
Yes
Rivera
Yes
Titus
No
Brabenec
Yes
D'Urso
Yes
Jaffee
No
Morinello
ER
Rodriguez
Yes
Vanel
Yes
Braunstein
Yes
Eichenstein
Yes
Jean-Pierre
Yes
Mosley
Yes
Romeo
No
Walczyk
Yes
Bronson
Yes
Englebright
No
Johns
Yes
Niou
Yes
Rosenthal D
ER
Walker
No
Buchwald
Yes
Epstein
Yes
Jones
Yes
Nolan
Yes
Rosenthal L
Yes
Wallace
Yes
Burke
No
Fahy
Yes
Joyner
No
Norris
Yes
Rozic
No
Walsh
Yes
Buttenschon
Yes
Fall
ER
Kim
Yes
O'Donnell
Yes
Ryan
Yes
Weinstein
No
Byrne
Yes
Fernandez
No
Kolb
Yes
Ortiz
No
Salka
Yes
Weprin
No
Byrnes
No
Finch
No
Lalor
No
Otis
Yes
Santabarbara
ER
Williams
Yes
Cahill
No
Fitzpatrick
Yes
Lavine
No
Palmesano
No
Sayegh
No
Woerner
Yes
Carroll
No
Friend
No
Lawrence
No
Palumbo
ER
Schimminger
Yes
Wright
Yes
Colton
Yes
Frontus
Yes
Lentol
No
Paulin
No
Schmitt
ER
Zebrowski
Yes
Cook
No
Galef
Yes
Lifton
Yes
Peoples-Stokes
Yes
Seawright
Yes
Mr. Speaker

‡ Indicates voting via videoconference
DATE:06/05/2019Assembly Vote  YEA/NAY: 91/47
Yes
Abbate
Yes
Crespo
ER
Gantt
No
LiPetri
Yes
Perry
Yes
Simon
No
Abinanti
No
Crouch
Yes
Garbarino
Yes
Lupardo
Yes
Pheffer Amato
Yes
Simotas
ER
Arroyo
Yes
Cruz
No
Giglio
Yes
Magnarelli
Yes
Pichardo
Yes
Smith
Yes
Ashby
Yes
Cusick
Yes
Glick
No
Malliotakis
No
Pretlow
No
Smullen
Yes
Aubry
Yes
Cymbrowitz
No
Goodell
No
Manktelow
Yes
Quart
Yes
Solages
Yes
Barclay
Yes
Davila
Yes
Gottfried
Yes
McDonald
No
Ra
No
Stec
Yes
Barnwell
Yes
De La Rosa
No
Griffin
ER
McDonough
No
Raia
Yes
Steck
Yes
Barrett
Yes
DenDekker
No
Gunther
Yes
McMahon
Yes
Ramos
Yes
Stern
Yes
Barron
Yes
DeStefano
No
Hawley
No
Mikulin
Yes
Raynor
Yes
Stirpe
Yes
Benedetto
Yes
Dickens
Yes
Hevesi
No
Miller B
No
Reilly
No
Tague
Yes
Bichotte
Yes
Dilan
Yes
Hunter
ER
Miller MG
Yes
Reyes
Yes
Taylor
ER
Blake
Yes
Dinowitz
Yes
Hyndman
No
Miller ML
Yes
Richardson
No
Thiele
No
Blankenbush
ER
DiPietro
Yes
Jacobson
No
Montesano
Yes
Rivera
Yes
Titus
No
Brabenec
Yes
D'Urso
Yes
Jaffee
No
Morinello
ER
Rodriguez
Yes
Vanel
Yes
Braunstein
Yes
Eichenstein
Yes
Jean-Pierre
Yes
Mosley
Yes
Romeo
No
Walczyk
Yes
Bronson
Yes
Englebright
No
Johns
Yes
Niou
Yes
Rosenthal D
ER
Walker
No
Buchwald
Yes
Epstein
Yes
Jones
Yes
Nolan
Yes
Rosenthal L
Yes
Wallace
Yes
Burke
Yes
Fahy
Yes
Joyner
No
Norris
Yes
Rozic
No
Walsh
Yes
Buttenschon
Yes
Fall
ER
Kim
Yes
O'Donnell
Yes
Ryan
Yes
Weinstein
No
Byrne
Yes
Fernandez
No
Kolb
Yes
Ortiz
No
Salka
Yes
Weprin
No
Byrnes
No
Finch
No
Lalor
No
Otis
Yes
Santabarbara
ER
Williams
Yes
Cahill
No
Fitzpatrick
Yes
Lavine
No
Palmesano
No
Sayegh
No
Woerner
Yes
Carroll
No
Friend
No
Lawrence
No
Palumbo
ER
Schimminger
Yes
Wright
Yes
Colton
Yes
Frontus
Yes
Lentol
No
Paulin
No
Schmitt
ER
Zebrowski
Yes
Cook
No
Galef
Yes
Lifton
Yes
Peoples-Stokes
Yes
Seawright
Yes
Mr. Speaker

‡ Indicates voting via videoconference
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A00264 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                         264--B
 
                               2019-2020 Regular Sessions
 
                   IN ASSEMBLY
 
                                       (Prefiled)
 
                                     January 9, 2019
                                       ___________
 
        Introduced  by  M.  of  A.  CAHILL, COLTON, ARROYO, JEAN-PIERRE, TAYLOR,
          McDONOUGH, JACOBSON -- Multi-Sponsored by -- M. of A. EPSTEIN --  read
          once   and  referred  to  the  Committee  on  Insurance  --  committee
          discharged, bill amended, ordered reprinted as amended and recommitted
          to said committee -- again reported from said  committee  with  amend-
          ments, ordered reprinted as amended and recommitted to said committee
 
        AN  ACT to amend the financial services law, in relation to establishing
          protections from excess hospital charges
 
          The People of the State of New York, represented in Senate and  Assem-
        bly, do enact as follows:
 
     1    Section  1.  Section  605  of  the financial services law, as added by
     2  section 26 of part H of chapter 60 of the laws of 2014,  is  amended  to
     3  read as follows:
     4    §  605.  Dispute  resolution  for  emergency  services.  (a) Emergency
     5  services for an insured. (1) When a health care plan receives a bill for
     6  emergency services  from  a  non-participating  physician  or  hospital,
     7  including  a  bill for inpatient services which follow an emergency room
     8  visit, the health care plan shall pay an amount that  it  determines  is
     9  reasonable  for the emergency services rendered by the non-participating
    10  physician or hospital, in accordance with  section  three  thousand  two
    11  hundred  twenty-four-a  of  the  insurance law, except for the insured's
    12  co-payment, coinsurance or deductible, if any, and shall ensure that the
    13  insured shall incur no greater out-of-pocket  costs  for  the  emergency
    14  services  than  the  insured  would  have  incurred with a participating
    15  physician or hospital pursuant to subsection (c) of section three  thou-
    16  sand two hundred forty-one of the insurance law.
    17    (2)  A  non-participating  physician or hospital or a health care plan
    18  may submit a dispute regarding a fee or payment for  emergency  services
    19  for  review to an independent dispute resolution entity.  In cases where
    20  a health care plan submits a dispute regarding a fee for  payment  of  a
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD03101-05-9

        A. 264--B                           2
 
     1  non-participating  hospital's  emergency  services, the health care plan
     2  shall, after the initial payment, pay any additional amounts  it  deter-
     3  mines is reasonable directly to the non-participating hospital.
     4    (3)  The  independent  dispute resolution entity shall make a determi-
     5  nation within thirty days of receipt of the dispute for review.
     6    (4) In determining a reasonable fee  for  the  services  rendered,  an
     7  independent  dispute  resolution  entity  shall select either the health
     8  care plan's payment or the non-participating physician's  or  hospital's
     9  fee.  The  independent  dispute  resolution entity shall determine which
    10  amount to select based upon the conditions  and  factors  set  forth  in
    11  section  six  hundred  four  of  this article. If an independent dispute
    12  resolution entity determines, based on the health  care  plan's  payment
    13  and  the non-participating physician's or hospital's fee, that a settle-
    14  ment between the health care plan  and  non-participating  physician  or
    15  hospital  is  reasonably  likely,  or  that  both the health care plan's
    16  payment and the non-participating physician's or hospital's  fee  repre-
    17  sent  unreasonable  extremes,  then  the  independent dispute resolution
    18  entity may direct both parties to attempt a good faith  negotiation  for
    19  settlement.  The  health  care  plan  and non-participating physician or
    20  hospital may be granted up to ten business days  for  this  negotiation,
    21  which  shall  run  concurrently  with  the thirty day period for dispute
    22  resolution.
    23    (b) Emergency services for a patient that is not  an  insured.  (1)  A
    24  patient  that  is not an insured or the patient's physician may submit a
    25  dispute regarding a fee for emergency services for review  to  an  inde-
    26  pendent dispute resolution entity upon approval of the superintendent.
    27    (2) An independent dispute resolution entity shall determine a reason-
    28  able fee for the services based upon the same conditions and factors set
    29  forth in section six hundred four of this article.
    30    (3)  A patient that is not an insured shall not be required to pay the
    31  physician's or hospital's fee in order to  be  eligible  to  submit  the
    32  dispute for review to an independent dispute resolution entity.
    33    (c)  The  determination  of  an  independent dispute resolution entity
    34  shall be binding on the health care  plan,  physician  or  hospital  and
    35  patient,  and  shall  be  admissible in any court proceeding between the
    36  health care plan, physician or hospital or patient, or in  any  adminis-
    37  trative proceeding between this state and the physician or hospital.
    38    (d)  The  provisions of this section shall not apply to hospitals that
    39  had at least  sixty  percent  of  inpatient  discharges  annually  which
    40  consisted  of  medicaid,  uninsured,  and  dual  eligible individuals as
    41  determined by the department of health in its  determination  of  safety
    42  net hospitals.
    43    §  2.  Subsection (a) of section 608 of the financial services law, as
    44  added by section 26 of part H of chapter 60 of  the  laws  of  2014,  is
    45  amended to read as follows:
    46    (a)  For  disputes  involving an insured, when the independent dispute
    47  resolution entity determines the health care plan's payment  is  reason-
    48  able,  payment for the dispute resolution process shall be the responsi-
    49  bility of the non-participating physician or hospital.   When the  inde-
    50  pendent  dispute  resolution  entity  determines  the  non-participating
    51  physician's or hospital's fee is reasonable,  payment  for  the  dispute
    52  resolution  process shall be the responsibility of the health care plan.
    53  When a good faith negotiation directed by the independent dispute resol-
    54  ution entity pursuant to paragraph four of subsection (a) of section six
    55  hundred five of this article, or paragraph  six  of  subsection  (a)  of
    56  section  six  hundred  seven  of  this  article  results in a settlement

        A. 264--B                           3
 
     1  between  the  health  care  plan  and  non-participating  physician   or
     2  hospital,  the  health  care plan and the non-participating physician or
     3  hospital shall evenly divide and share the  prorated  cost  for  dispute
     4  resolution.
     5    § 3. Section 604 of the financial services law, as added by section 26
     6  of  part  H  of  chapter  60  of the laws of 2014, is amended to read as
     7  follows:
     8    § 604. Criteria for determining a reasonable fee. In  determining  the
     9  appropriate  amount  to  pay  for  a health care service, an independent
    10  dispute resolution entity shall consider all relevant  factors,  includ-
    11  ing:
    12    (a)  whether there is a gross disparity between the fee charged by the
    13  [physician] health care provider for services rendered as compared to:
    14    (1) fees paid to the involved [physician] health care provider for the
    15  same services rendered by the [physician] health care provider to  other
    16  patients  in  health  care  plans  in  which the [physician] health care
    17  provider is not participating, and
    18    (2) in the case of a dispute involving a health care plan,  fees  paid
    19  by  the  health  care plan to reimburse similarly qualified [physicians]
    20  health care providers for the same services in the same region  who  are
    21  not participating with the health care plan;
    22    (b) the level of training, education and experience of the [physician]
    23  health care provider;
    24    (c) the [physician's] health care provider's usual charge for compara-
    25  ble  services  with regard to patients in health care plans in which the
    26  [physician] health care provider is not participating;
    27    (d) the circumstances and complexity of the particular case, including
    28  time and place of the service;
    29    (e) individual patient characteristics; and, with regard to  physician
    30  services,
    31    (f) the usual and customary cost of the service.
    32    § 4. This act shall take effect immediately.
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