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S06534 Summary:

BILL NOS06534B
 
SAME ASSAME AS A07230-A
 
SPONSORRIVERA
 
COSPNSRBROUK, MAY
 
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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S06534 Actions:

BILL NOS06534B
 
05/05/2021REFERRED TO HEALTH
05/12/2021AMEND AND RECOMMIT TO HEALTH
05/12/2021PRINT NUMBER 6534A
05/19/2021REPORTED AND COMMITTED TO FINANCE
01/05/2022REFERRED TO HEALTH
01/06/2022AMEND AND RECOMMIT TO HEALTH
01/06/2022PRINT NUMBER 6534B
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S06534 Memo:

Memo not available
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S06534 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                         6534--B
 
                               2021-2022 Regular Sessions
 
                    IN SENATE
 
                                       May 5, 2021
                                       ___________
 
        Introduced  by Sens. RIVERA, BROUK, MAY -- read twice and ordered print-
          ed, and when printed to be committed to the  Committee  on  Health  --
          committee  discharged,  bill amended, ordered reprinted as amended and
          recommitted to said committee  --  recommitted  to  the  Committee  on
          Health  in  accordance  with  Senate  Rule  6,  sec.  8  --  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;
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD10879-05-1

        S. 6534--B                          2
 
     1    (2) seven members appointed by the governor; and
     2    (3)  eight  members appointed by the governor as follows: three on the
     3  recommendation of the speaker of the assembly, three on the  recommenda-
     4  tion of the temporary president of the senate, one on the recommendation
     5  of the minority leader of the assembly, and one on the recommendation of
     6  the minority leader of the senate.
     7    (ii)  Any  vacancy in the membership of the commission shall be filled
     8  in the same manner as the member being succeeded was appointed.
     9    (iii) The commission shall select a chairperson from among the members
    10  of the commission.
    11    (iv) The composition of the commission  shall  include  at  least  one
    12  member with expertise in health care financing, reimbursement, and regu-
    13  lation, representing each of the following categories: practicing prima-
    14  ry  care  providers,  federally  qualified  health centers, professional
    15  practice groups, primary care advocates,  primary  care  consumer  advo-
    16  cates,  businesses,  health  plans,  and  hospitals  or  health systems.
    17  Commission members shall be appointed so as to represent a  geographical
    18  distribution across the state.
    19    (v)  Members of the commission, except for those representing New York
    20  state departments, agencies, authorities or councils, shall serve for  a
    21  term of four years and may be reappointed in the same manner as provided
    22  for their initial appointment.
    23    (vi)  A  majority  of  the current filled membership of the commission
    24  shall constitute a quorum for the transaction of  any  business  or  the
    25  exercise of any power or function of the commission, and any decision or
    26  action  by  the  commission shall be by a majority vote of those present
    27  and voting.
    28    (vii) The commission shall meet at least quarterly at the call of  the
    29  chairperson.  Additional  meetings  may  be  called  by  the chairperson
    30  subject to the giving of one week's notice, and shall be called  by  the
    31  chairperson  at  the request of a majority of the members of the commis-
    32  sion.
    33    (viii) The members of the commission shall receive no compensation for
    34  their services, but shall be allowed their actual and necessary expenses
    35  incurred in the performance of their duties.
    36    2. (a) Each Medicaid managed care provider under section three hundred
    37  sixty-four-j of the social  services  law  shall  provide  primary  care
    38  spending  data  for  the  five years prior to the effective date of this
    39  section and for each year thereafter  as  requested  by  the  commission
    40  under  this  section.  The information shall include, but not be limited
    41  to, primary care spending, total health care spending, and  all  further
    42  information the commission requests relating to its work.  Each medicaid
    43  managed care provider shall also provide the total cost of care provided
    44  by the provider annually for each of the years.
    45    (b)  Each insurance entity providing managed care products, individual
    46  comprehensive accident and health insurance or group or blanket  compre-
    47  hensive  accident and health insurance, as defined in the insurance law,
    48  corporation organized under article forty-three  of  the  insurance  law
    49  providing  comprehensive health insurance, entity licensed under article
    50  forty-four of this chapter  providing  comprehensive  health  insurance,
    51  every  other  plan  over  which the department of financial services has
    52  jurisdiction, and every  third-party  payor  providing  health  coverage
    53  shall provide primary care spending data for the five years prior to the
    54  effective date of this section and for each year thereafter as requested
    55  by the commission under this section. The information shall include, but
    56  not  be  limited  to, primary care spending, total health care spending,

        S. 6534--B                          3
 
     1  and all further information the commission requests.  Each entity  shall
     2  also  provide the total cost of care provided by the entity annually for
     3  each of the years.  An entity that provides information under  paragraph
     4  (a)  of  this  subdivision  shall  not  be required to provide duplicate
     5  information under this paragraph.
     6    (c) Failure of any entity to provide  information  to  the  commission
     7  requested  by  the  commission  under this section shall be considered a
     8  violation under section twelve of this chapter.
     9    (d) The commissioner, and the  superintendent  of  the  department  of
    10  financial services with respect to entities regulated by the superinten-
    11  dent,  shall establish requirements to ensure compliance with all appli-
    12  cable laws and to protect the confidentiality of any proprietary  infor-
    13  mation that is provided to the commission under this section.
    14    3.  The  department  and  the  department  of financial services shall
    15  provide assistance and staff to the  commission,  as  requested  by  the
    16  commission.    Assistance  shall also be made available, as requested by
    17  the commission, from other agencies, departments, and public authorities
    18  of the state.   The commission may accept funding  or  grants  from  the
    19  state  or  federal  government,  or any other government agency or other
    20  source determined by the commission, to aid in the commission's work.
    21    4. The following terms, when used in  this  section,  shall  have  the
    22  following meanings:
    23    (a)  "Primary  care"  means the health care fields of family practice,
    24  general pediatrics, primary care internal medicine, primary care obstet-
    25  rics, and primary care gynecology, provided in all  outpatient  settings
    26  including,  but  not  limited to, health care professional practices and
    27  hospitals as defined by article twenty-eight of this chapter.    Primary
    28  care shall not include inpatient services. Primary care includes, but is
    29  not  limited  to, primary care services for acute and chronic conditions
    30  and preventive care, services  provided  in  regular  check-ups,  office
    31  visits,  telemedicine,  and  other  services,  provided  by or under the
    32  direction of a physician, nurse practitioner,  physician  assistant,  or
    33  midwife.    The  commission  shall consider expanding this definition to
    34  include primary care services provided  by  other  health  care  profes-
    35  sionals.
    36    (b)  "Primary  care  spending"  means any expenditure of funds made by
    37  third party payors, public entities, or the state  for  the  purpose  of
    38  paying  for  primary  care or supporting primary care providers. Primary
    39  care spending is included regardless of  payment  methodology,  such  as
    40  fee-for-service,  capitation,  incentives, value-based payments or other
    41  methodologies, adjusted appropriately to  exclude  any  portion  of  the
    42  expenditure that is reasonably apportioned to exclude expenses for inpa-
    43  tient services or other non-primary care services.
    44    5. (a) The commission shall publish, post on the department's website,
    45  and deliver an annual report to the governor, the temporary president of
    46  the  senate,  the speaker of the assembly, the chairperson of the senate
    47  finance committee, the  chairperson  of  the  assembly  ways  and  means
    48  committee and the chairs of the senate and assembly health and insurance
    49  committees.  The  first report shall be published and delivered no later
    50  than March thirty-first of the year following the effective date of this
    51  section.
    52    (b) The content of the annual reports shall be at  the  discretion  of
    53  the commission but the first report shall include:
    54    (i)  An  analysis  of  current  primary  care  spending,  including by
    55  geographic region, in relation to all other health care spending in  the
    56  aggregate.

        S. 6534--B                          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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