Bill Text: NY S04241 | 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: Bipartisan Bill

Status: (Introduced - Dead) 2018-06-20 - COMMITTED TO RULES [S04241 Detail]

Download: New_York-2017-S04241-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________
                                          4241
                               2017-2018 Regular Sessions
                    IN SENATE
                                    February 6, 2017
                                       ___________
        Introduced  by  Sen.  SEWARD -- read twice and ordered printed, and when
          printed to be committed 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
        S. 4241                             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.