Bill Text: NY A07611 | 2017-2018 | General Assembly | Introduced

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Relates to establishing protections from excessive hospital emergency charges; includes hospital charges.

Spectrum: Moderate Partisan Bill (Democrat 7-1)

Status: (Engrossed - Dead) 2018-06-12 - COMMITTED TO RULES [A07611 Detail]

Download: New_York-2017-A07611-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________
                                          7611
                               2017-2018 Regular Sessions
                   IN ASSEMBLY
                                       May 3, 2017
                                       ___________
        Introduced by M. of A. CAHILL -- read once and referred to the Committee
          on Insurance
        AN  ACT to amend the financial services law, in relation to establishing
          protections from excessive hospital emergency 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,  the
     7  health  care  plan  shall pay an amount that it determines is reasonable
     8  for the emergency services rendered by the  non-participating  physician
     9  or hospital, in accordance with section three thousand two hundred twen-
    10  ty-four-a  of  the  insurance  law, except for the insured's co-payment,
    11  coinsurance or deductible, if any, and shall  ensure  that  the  insured
    12  shall  incur  no  greater out-of-pocket costs for the emergency services
    13  than the insured would have incurred with a participating  physician  or
    14  hospital  pursuant  to  subsection  (c)  of  section  three thousand two
    15  hundred forty-one of the insurance law.
    16    (2) A non-participating physician or hospital or a  health  care  plan
    17  may  submit  a dispute regarding a fee or payment for emergency services
    18  for review to an independent dispute resolution entity. In cases where a
    19  health care plan submits a dispute regarding a  fee  for  payment  of  a
    20  non-participating  hospital's  emergency  room services, the health care
    21  plan shall pay the amount it determines is reasonably  directly  to  the
    22  non-participating hospital.
    23    (3)  The  independent  dispute resolution entity shall make a determi-
    24  nation within thirty days of receipt of the dispute for review.
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD09770-01-7
        A. 7611                             2
     1    (4) In determining a reasonable fee  for  the  services  rendered,  an
     2  independent  dispute  resolution  entity  shall select either the health
     3  care plan's payment or the non-participating physician's  or  hospital's
     4  fee.  The  independent  dispute  resolution entity shall determine which
     5  amount  to  select  based  upon  the conditions and factors set forth in
     6  section six hundred four of this  article.  If  an  independent  dispute
     7  resolution  entity  determines,  based on the health care plan's payment
     8  and the non-participating physician's or hospital's fee, that a  settle-
     9  ment  between  the  health  care plan and non-participating physician or
    10  hospital is reasonably likely, or  that  both  the  health  care  plan's
    11  payment  and  the non-participating physician's or hospital's fee repre-
    12  sent unreasonable extremes,  then  the  independent  dispute  resolution
    13  entity  may  direct both parties to attempt a good faith negotiation for
    14  settlement. The health care  plan  and  non-participating  physician  or
    15  hospital  may  be  granted up to ten business days for this negotiation,
    16  which shall run concurrently with the  thirty  day  period  for  dispute
    17  resolution.
    18    (b)  Emergency  services  for  a patient that is not an insured. (1) A
    19  patient that is not an insured or the patient's physician may  submit  a
    20  dispute  regarding  a  fee for emergency services for review to an inde-
    21  pendent dispute resolution entity upon approval of the superintendent.
    22    (2) An independent dispute resolution entity shall determine a reason-
    23  able fee for the services based upon the same conditions and factors set
    24  forth in section six hundred four of this article.
    25    (3) A patient that is not an insured shall not be required to pay  the
    26  physician's  or  hospital's  fee  in  order to be eligible to submit the
    27  dispute for review to an independent dispute resolution entity.
    28    (c) The determination of  an  independent  dispute  resolution  entity
    29  shall  be  binding  on  the  health care plan, physician or hospital and
    30  patient, and shall be admissible in any  court  proceeding  between  the
    31  health  care  plan, physician or hospital or patient, or in any adminis-
    32  trative proceeding between this state and the physician or hospital.
    33    § 2. Paragraph (a) of section 608 of the financial  services  law,  as
    34  added  by  section  26  of  part H of chapter 60 of the laws of 2014, is
    35  amended to read as follows:
    36    (a) For disputes involving an insured, when  the  independent  dispute
    37  resolution  entity  determines the health care plan's payment is reason-
    38  able, payment for the dispute resolution process shall be the  responsi-
    39  bility  of  the non-participating physician or hospital.  When the inde-
    40  pendent  dispute  resolution  entity  determines  the  non-participating
    41  physician's  or  hospital's  fee  is reasonable, payment for the dispute
    42  resolution process shall be the responsibility of the health care  plan.
    43  When a good faith negotiation directed by the independent dispute resol-
    44  ution entity pursuant to paragraph four of subsection (a) of section six
    45  hundred  five  of  this  article,  or paragraph six of subsection (a) of
    46  section six hundred seven  of  this  article  results  in  a  settlement
    47  between the health care plan and non-participating physician, the health
    48  care  plan  and the non-participating physician or hospital shall evenly
    49  divide and share the prorated cost for dispute resolution.
    50    § 3. This act shall take effect immediately.