Bill Text: NY A04730 | 2013-2014 | General Assembly | Introduced
Bill Title: Relates to substantial reductions by health maintenance organizations of inpatient referrals to a hospital.
Spectrum: Partisan Bill (Democrat 2-0)
Status: (Introduced - Dead) 2014-01-08 - referred to health [A04730 Detail]
Download: New_York-2013-A04730-Introduced.html
S T A T E O F N E W Y O R K ________________________________________________________________________ 4730 2013-2014 Regular Sessions I N A S S E M B L Y February 8, 2013 ___________ Introduced by M. of A. PERRY, CASTRO -- read once and referred to the Committee on Health AN ACT to amend the public health law, in relation to substantial reductions by health maintenance organizations of inpatient referrals to a hospital THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: 1 Section 1. The public health law is amended by adding a new section 2 4405-c to read as follows: 3 S 4405-C. SUBSTANTIAL REDUCTIONS OF REFERRALS TO A HOSPITAL. 1. NO 4 HEALTH MAINTENANCE ORGANIZATION SHALL MAKE A SUBSTANTIAL REDUCTION IN 5 INPATIENT REFERRALS TO ANY HOSPITAL, TO WHICH THE HEALTH MAINTENANCE 6 ORGANIZATION HAS REFERRED NON-EMERGENCY INPATIENTS FOR AT LEAST THREE 7 YEARS, OR ISSUE ORDERS, DIRECTIVES, INSTRUCTIONS OR SUGGEST IN ANY 8 MANNER TO ANY PARTICIPANT MEDICAL PRACTITIONER REGISTERED IN THE HEALTH 9 MAINTENANCE ORGANIZATION PLAN THAT SUCH PRACTITIONER SHOULD REDUCE OR 10 DISCONTINUE REFERRING PATIENTS TO ANY HOSPITAL, WITHOUT APPROVAL OF THE 11 COMMISSIONER. 12 2. FOR THE PURPOSES OF THIS SECTION, ANY REDUCTION IN A HEALTH MAINTE- 13 NANCE ORGANIZATION'S INPATIENT REFERRALS TO A HOSPITAL SHALL BE CONSID- 14 ERED SUBSTANTIAL IF SUCH REDUCTION WOULD RESULT IN A DECREASE IN THE 15 PROJECTED ANNUALIZED DISCHARGES OF THE HOSPITAL THAT EXCEEDS FIVE 16 PERCENT OF ITS TOTAL DISCHARGES IN THE PRIOR CALENDAR YEAR. 17 3. A HEALTH MAINTENANCE ORGANIZATION THAT PLANS TO MAKE A SUBSTANTIAL 18 REDUCTION IN INPATIENT REFERRALS TO A PARTICULAR HOSPITAL SHALL FILE 19 WITH THE DEPARTMENT AND WITH THE APPROPRIATE HEALTH SYSTEMS AGENCY A 20 WRITTEN PLAN THAT SHALL INCLUDE: (A) THE PROJECTED NUMBER OF REDUCED 21 REFERRALS BY SERVICE; (B) THE PLANS TO ASSURE QUALITY AND CONTINUITY OF 22 SERVICE TO THE HEALTH MAINTENANCE ORGANIZATION ENROLLEES; AND (C) THE 23 STEPS THAT CAN BE TAKEN TO MINIMIZE THE ADVERSE IMPACT OF THE REDUCED 24 ADMISSIONS ON THE HOSPITAL. EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD00093-01-3 A. 4730 2 1 4. THE HEALTH SYSTEMS AGENCY SHALL HAVE AN OPPORTUNITY TO GIVE ITS 2 VIEWS TO THE COMMISSIONER. THE COMMISSIONER SHALL NOT GRANT APPROVAL FOR 3 THE SUBSTANTIAL REDUCTION IN INPATIENT REFERRALS UNLESS HE OR SHE IS 4 SATISFIED THAT THE WRITTEN PLAN SUBMITTED BY THE HEALTH MAINTENANCE 5 ORGANIZATION: (A) ADEQUATELY PROTECTS QUALITY AND ACCESSIBILITY OF 6 SERVICES TO HEALTH MAINTENANCE ORGANIZATION MEMBERS; (B) REFLECTS ALL 7 REASONABLE EFFORTS BY THE HEALTH MAINTENANCE ORGANIZATION TO MINIMIZE 8 THE ADVERSE IMPACT OF THE REDUCTION UPON THE HOSPITAL; AND (C) DOES NOT 9 UNDULY RISK THE QUALITY OR ACCESSIBILITY OF HOSPITAL SERVICES IN THE 10 COMMUNITY SERVED BY THE HOSPITAL. TO PROTECT THE PUBLIC INTEREST, THE 11 COMMISSIONER MAY ESTABLISH A REASONABLE WITHDRAWAL SCHEDULE. 12 S 2. This act shall take effect immediately.