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A07230 Summary:

BILL NOA07230B
 
SAME ASSAME AS S06534-C
 
SPONSORGottfried
 
COSPNSRHevesi, Dinowitz, Braunstein, Barron, McDonald, Thiele, Stirpe, Simon, Steck, Fernandez, Solages, Rosenthal L, Seawright, Glick, Bronson, Jean-Pierre, Colton, Walker, Pretlow, Woerner, Reyes, Burgos, Aubry, Galef, Zebrowski, Griffin
 
MLTSPNSRCook
 
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 NOA07230B
 
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
05/05/2022amend and recommit to ways and means
05/05/2022print number 7230b
05/23/2022reported referred to rules
05/24/2022reported
05/24/2022rules report cal.405
05/24/2022ordered to third reading rules cal.405
06/01/2022passed assembly
06/01/2022delivered to senate
06/01/2022REFERRED TO FINANCE
06/02/2022SUBSTITUTED FOR S6534C
06/02/20223RD READING CAL.596
06/02/2022PASSED SENATE
06/02/2022RETURNED TO ASSEMBLY
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A07230 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                         7230--B
 
                               2021-2022 Regular Sessions
 
                   IN ASSEMBLY
 
                                     April 29, 2021
                                       ___________
 
        Introduced  by  M.  of A. GOTTFRIED, HEVESI, DINOWITZ, BRAUNSTEIN, McDO-
          NALD, THIELE, STIRPE, SIMON, STECK, FERNANDEZ, SOLAGES,  L. ROSENTHAL,
          SEAWRIGHT,  GLICK,  BRONSON,  JEAN-PIERRE,  COLTON  --  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 -- again reported from said  committee  with  amend-
          ments, 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:

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD10879-06-2

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

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

        A. 7230--B                          4
 
     1    (i) An  analysis  of  current  primary  care  spending,  including  by
     2  geographic  region, in relation to all other health care spending in the
     3  aggregate.
     4    (ii) Recommendations to the governor and the legislature of any chang-
     5  es  to  the definition of "primary care" for the purposes of the commis-
     6  sion's future work. Such recommendations may be made prior  to  delivery
     7  of the commission's report.
     8    (iii) Recommendations for legislative and executive action.
     9    (iv)  Identification  of  barriers, including payment methodologies by
    10  health care payors and providers, to providing primary care and increas-
    11  ing primary care spending.
    12    (v) Recommendations to improve providing increased and  higher-quality
    13  primary  care  and  primary  care  spending,  with  special attention to
    14  increasing health care equity, reducing  health  care  disparities,  and
    15  avoiding increasing costs to patients or the total cost of health care.
    16    (vi) Recommendations to increase primary care spending.
    17    § 3. This act shall take effect immediately.
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