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A07230 Summary:

BILL NOA07230A
 
SAME ASSAME AS S06534-B
 
SPONSORGottfried
 
COSPNSRHevesi, Dinowitz, Braunstein, Barron, McDonald
 
MLTSPNSR
 
Amd Art 29-AA Art Head, add 2959-b, Pub Health L
 
Establishes the primary care reform commission to 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 publish an annual report on the findings, and also make recommendations to increase and strengthen spending on primary care in the state and improve primary care infrastructure, taking care to avoid increasing costs to patients or the total cost of health care.
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A07230 Actions:

BILL NOA07230A
 
04/29/2021referred to health
05/20/2021reported referred to codes
05/25/2021reported referred to ways and means
01/05/2022referred to ways and means
01/07/2022amend and recommit to ways and means
01/07/2022print number 7230a
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A07230 Memo:

NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
submitted in accordance with Assembly Rule III, Sec 1(f)
 
BILL NUMBER: A7230A
 
SPONSOR: Gottfried
  TITLE OF BILL: An act to amend the public health law, in relation to establishing the primary care reform commission   PURPOSE OR GENERAL IDEA OF BILL: Stakeholders would develop recommendations as to how much and by what means the proportion of health care spending that goes to primary care services should increase.   SUMMARY OF SPECIFIC PROVISIONS: A new section 2959-b is added to the Public Health law. The Primary care reform commission is constituted and charged. Participants would include experts on health care financing, reimbursement, and regulation from primary care providers, federally qualified health centers and profes- sional practice groups, as well as representatives with relevant exper- tise from businesses operating within New York, public and commercial health plans including managed care plans, and primary care professional and advocacy organizations. Third party payors would be compelled to provide data requested by the commission, with protections for proprie- tary property. The first report of recommendations would be published by March 31 following the year of enactment and include a comparative anal- ysis of current primary care spending, and recommendations to the Gover- nor and the legislature regarding the barriers to primary care and how to overcome them.   JUSTIFICATION: Primary care should be person's first contact with the health care system. Primary care is understanding and maintaining wellness, and identifying and treating illness before it becomes a chronic condition. Research shows that an increase of just one primary care provider per 10,000 people can generate 5.5% fewer hospital visits, 11% fewer emer- gency department visits, and 7% fewer surgeries. We know that health systems oriented towards primary care simply function better. Yet, it is estimated that as little as 5% of U.S. health care spending goes toward primary care. New York currently spends more per capita on health care than the national average, but consistently ranks below many other states in key health indicators. This is indicative of a lack of access to and an underinvestment in primary care. Currently, at least ten states have acted to rebalance their health care spending through legislative, regulatory, or executive means. This commission will define, measure, and report on current primary care spending in New York. Further, the commission will identify the means to increase the proportion of the health care dollar that goes to primary care services across all payers, for the benefit of all patients. An ounce of prevention is worth a pound of cure.   PRIOR LEGISLATIVE HISTORY: New bill   FISCAL IMPLICATIONS: None   EFFECTIVE DATE: Immediately
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A07230 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                         7230--A
 
                               2021-2022 Regular Sessions
 
                   IN ASSEMBLY
 
                                     April 29, 2021
                                       ___________
 
        Introduced by M. of A. GOTTFRIED, HEVESI, DINOWITZ, BRAUNSTEIN, McDONALD
          -- read once and referred to the Committee on Health -- recommitted to
          the  Committee  on  Ways and Means in accordance with Assembly Rule 3,
          sec. 2 -- committee discharged, bill  amended,  ordered  reprinted  as
          amended and recommitted to said committee

        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:
 
     1    Section  1.  The article heading of article 29-AA of the public health
     2  law, as added by section 35 of part H of chapter 59 of the laws of 2011,
     3  is amended to read as follows:
     4               PATIENT CENTERED MEDICAL HOMES AND PRIMARY CARE
     5    § 2. The public health law is amended by adding a new  section  2959-b
     6  to read as follows:
     7    §  2959-b.  Primary  care  reform commission. 1. (a) Commission estab-
     8  lished. The primary care reform commission, referred to in this  section
     9  as  the  "commission",  is  hereby  established  in  the department. The
    10  commission shall review, examine, and make  findings  on  the  level  of
    11  primary  care  spending  by all payers in the context of all health care
    12  spending in the state, and shall publish an annual report on  the  find-
    13  ings.  The commission shall also make recommendations to increase spend-
    14  ing on primary care and strengthen primary care  infrastructure  in  the
    15  state,  taking  care  to avoid increasing costs to patients or the total
    16  cost of health care.
    17    (b) Composition and powers. (i) The commission shall consist of:
    18    (1) the commissioner and  the  superintendent  of  the  department  of
    19  financial  services,  who  may be represented by their respective desig-
    20  nees;
    21    (2) seven members appointed by the governor; and

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD10879-04-1

        A. 7230--A                          2
 
     1    (3) eight members appointed by the governor as follows: three  on  the
     2  recommendation  of the speaker of the assembly, three on the recommenda-
     3  tion of the temporary president of the senate, one on the recommendation
     4  of the minority leader of the assembly, and one on the recommendation of
     5  the minority leader of the senate.
     6    (ii)  Any  vacancy in the membership of the commission shall be filled
     7  in the same manner as the member being succeeded was appointed.
     8    (iii) The commission shall select a chairperson from among the members
     9  of the commission.
    10    (iv) The composition of the commission  shall  include  at  least  one
    11  member with expertise in health care financing, reimbursement, and regu-
    12  lation, representing each of the following categories: practicing prima-
    13  ry  care  providers,  federally  qualified  health centers, professional
    14  practice groups, primary care advocates,  primary  care  consumer  advo-
    15  cates,  businesses,  health  plans,  and  hospitals  or  health systems.
    16  Commission members shall be appointed so as to represent a  geographical
    17  distribution across the state.
    18    (v)  Members of the commission, except for those representing New York
    19  state departments, agencies, authorities or councils, shall serve for  a
    20  term of four years and may be reappointed in the same manner as provided
    21  for their initial appointment.
    22    (vi)  A  majority  of  the current filled membership of the commission
    23  shall constitute a quorum for the transaction of  any  business  or  the
    24  exercise of any power or function of the commission, and any decision or
    25  action  by  the  commission shall be by a majority vote of those present
    26  and voting.
    27    (vii) The commission shall meet at least quarterly at the call of  the
    28  chairperson.  Additional  meetings  may  be  called  by  the chairperson
    29  subject to the giving of one week's notice, and shall be called  by  the
    30  chairperson  at  the request of a majority of the members of the commis-
    31  sion.
    32    (viii) The members of the commission shall receive no compensation for
    33  their services, but shall be allowed their actual and necessary expenses
    34  incurred in the performance of their duties.
    35    2. (a) Each Medicaid managed care provider under section three hundred
    36  sixty-four-j of the social  services  law  shall  provide  primary  care
    37  spending  data  for  the  five years prior to the effective date of this
    38  section and for each year thereafter  as  requested  by  the  commission
    39  under  this  section.  The information shall include, but not be limited
    40  to, primary care spending, total health care spending, and  all  further
    41  information the commission requests relating to its work.  Each medicaid
    42  managed care provider shall also provide the total cost of care provided
    43  by the provider annually for each of the years.
    44    (b)  Each insurance entity providing managed care products, individual
    45  comprehensive accident and health insurance or group or blanket  compre-
    46  hensive  accident and health insurance, as defined in the insurance law,
    47  corporation organized under article forty-three  of  the  insurance  law
    48  providing  comprehensive health insurance, entity licensed under article
    49  forty-four of this chapter  providing  comprehensive  health  insurance,
    50  every  other  plan  over  which the department of financial services has
    51  jurisdiction, and every  third-party  payor  providing  health  coverage
    52  shall provide primary care spending data for the five years prior to the
    53  effective date of this section and for each year thereafter as requested
    54  by the commission under this section. The information shall include, but
    55  not  be  limited  to, primary care spending, total health care spending,
    56  and all further information the commission requests.  Each entity  shall

        A. 7230--A                          3
 
     1  also  provide the total cost of care provided by the entity annually for
     2  each of the years.  An entity that provides information under  paragraph
     3  (a)  of  this  subdivision  shall  not  be required to provide duplicate
     4  information under this paragraph.
     5    (c)  Failure  of  any  entity to provide information to the commission
     6  requested by the commission under this section  shall  be  considered  a
     7  violation under section twelve of this chapter.
     8    (d)  The  commissioner,  and  the  superintendent of the department of
     9  financial services with respect to entities regulated by the superinten-
    10  dent, shall establish requirements to ensure compliance with all  appli-
    11  cable  laws and to protect the confidentiality of any proprietary infor-
    12  mation that is provided to the commission under this section.
    13    3. The department and  the  department  of  financial  services  shall
    14  provide  assistance  and  staff  to  the commission, as requested by the
    15  commission.  Assistance shall also be made available,  as  requested  by
    16  the commission, from other agencies, departments, and public authorities
    17  of  the  state.    The  commission may accept funding or grants from the
    18  state or federal government, or any other  government  agency  or  other
    19  source determined by the commission, to aid in the commission's work.
    20    4.  The  following  terms,  when  used in this section, shall have the
    21  following meanings:
    22    (a) "Primary care" means the health care fields  of  family  practice,
    23  general pediatrics, primary care internal medicine, primary care obstet-
    24  rics,  and  primary care gynecology, provided in all outpatient settings
    25  including, but not limited to, health care  professional  practices  and
    26  hospitals  as  defined by article twenty-eight of this chapter.  Primary
    27  care shall not include inpatient services. Primary care includes, but is
    28  not limited to, primary care services for acute and  chronic  conditions
    29  and  preventive  care,  services  provided  in regular check-ups, office
    30  visits, telemedicine, and other  services,  provided  by  or  under  the
    31  direction  of  a  physician, nurse practitioner, physician assistant, or
    32  midwife.  The commission shall consider  expanding  this  definition  to
    33  include  primary  care  services  provided  by other health care profes-
    34  sionals.
    35    (b) "Primary care spending" means any expenditure  of  funds  made  by
    36  third  party  payors,  public  entities, or the state for the purpose of
    37  paying for primary care or supporting primary  care  providers.  Primary
    38  care  spending  is  included  regardless of payment methodology, such as
    39  fee-for-service, capitation, incentives, value-based payments  or  other
    40  methodologies,  adjusted  appropriately  to  exclude  any portion of the
    41  expenditure that is reasonably apportioned to exclude expenses for inpa-
    42  tient services or other non-primary care services.
    43    5. (a) The commission shall publish, post on the department's website,
    44  and deliver an annual report to the governor, the temporary president of
    45  the senate, the speaker of the assembly, the chairperson of  the  senate
    46  finance  committee,  the  chairperson  of  the  assembly  ways and means
    47  committee and the chairs of the senate and assembly health and insurance
    48  committees. The first report shall be published and delivered  no  later
    49  than March thirty-first of the year following the effective date of this
    50  section.
    51    (b)  The  content  of the annual reports shall be at the discretion of
    52  the commission but the first report shall include:
    53    (i) An  analysis  of  current  primary  care  spending,  including  by
    54  geographic  region, in relation to all other health care spending in the
    55  aggregate.

        A. 7230--A                          4
 
     1    (ii) Recommendations to the governor and the legislature of any chang-
     2  es to the definition of "primary care" for the purposes of  the  commis-
     3  sion's  future  work. Such recommendations may be made prior to delivery
     4  of the commission's report.
     5    (iii) Recommendations for legislative and executive action.
     6    (iv)  Identification  of  barriers, including payment methodologies by
     7  health care payors and providers, to providing primary care and increas-
     8  ing primary care spending.
     9    (v) Recommendations to improve providing increased and  higher-quality
    10  primary  care  and  primary  care  spending,  with  special attention to
    11  increasing health care equity, reducing  health  care  disparities,  and
    12  avoiding increasing costs to patients or the total cost of health care.
    13    (vi)  Recommendations  to  increase  primary  care spending, to be the
    14  greater of twelve percent or a one percent increase year after  year  of
    15  overall  health care spending by five years following the effective date
    16  of this section.
    17    § 3. This act shall take effect immediately.
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