Bill Text: NY A07296 | 2021-2022 | General Assembly | Introduced
Bill Title: Requires hospitals to inform emergency care patients whether the attending physician participates in the insured's insurance policy; requires insurance companies to cover the cost of out-of-network care for patients who are unconscious or otherwise unable to provide informed consent.
Spectrum: Moderate Partisan Bill (Democrat 6-1)
Status: (Introduced - Dead) 2022-01-05 - referred to health [A07296 Detail]
Download: New_York-2021-A07296-Introduced.html
STATE OF NEW YORK ________________________________________________________________________ 7296 2021-2022 Regular Sessions IN ASSEMBLY May 4, 2021 ___________ Introduced by M. of A. ENGLEBRIGHT, COLTON, COOK, McDONOUGH, CAHILL -- Multi-Sponsored by -- M. of A. GLICK, THIELE -- read once and referred to the Committee on Health AN ACT to amend the public health law and the insurance law, in relation to requiring hospitals to inform emergency care patients whether the attending physician participates with the patient's insurance policy and requiring insurance companies to cover the cost of out-of-network care for patients who are unconscious or otherwise unable to provide informed consent The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Section 2805-b of the public health law is amended by 2 adding a new subdivision 1-a to read as follows: 3 1-a. Every general hospital in which insured patients are admitted for 4 emergency care shall adopt regulations requiring its staff to inform 5 such patients whether the attending physician participates with the 6 patient's insurance policy. In the event such attending physician does 7 not participate with the patient's insurance policy, the patient shall 8 be permitted to decide whether to be treated by the out-of-network 9 attending physician or to request treatment by an in-network physician, 10 who must treat such patient with all convenient speed. 11 § 2. Subsection (i) of section 3216 of the insurance law is amended by 12 adding a new paragraph 9-a to read as follows: 13 (9-a)(A) Every policy that provides coverage for services to treat an 14 emergency condition in hospital facilities: 15 (i) without the need for any prior authorization determination; 16 (ii) in the case of patients who are unconscious or otherwise unable 17 to provide informed consent, regardless of whether the health care 18 provider furnishing such services is a participating provider with 19 respect to such services; EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD11148-01-1A. 7296 2 1 (iii) if the emergency services are provided by a non-participating 2 provider, without imposing any administrative requirement or limitation 3 on coverage that is more restrictive than the requirements or limita- 4 tions that apply to emergency services received from participating 5 providers; and 6 (iv) if the emergency services are provided by a non-participating 7 provider, the cost-sharing requirement (expressed as a copayment or 8 coinsurance) shall be the same requirement that would apply if such 9 services were provided by a participating provider. 10 (B) Any requirements of section 2719A(b) of the Public Health Service 11 Act, 42 U.S.C. § 300gg19a(b) and regulations thereunder that exceed the 12 requirements of this paragraph with respect to coverage of emergency 13 services shall be applicable to every policy subject to this paragraph. 14 (C) For purposes of this paragraph, an "emergency condition" means a 15 medical or behavioral condition that manifests itself by acute symptoms 16 of sufficient severity, including severe pain, such that a prudent 17 layperson, possessing an average knowledge of medicine and health, could 18 reasonably expect the absence of immediate medical attention to result 19 in (i) placing the health of the person afflicted with such condition in 20 serious jeopardy, or in the case of a behavioral condition placing the 21 health of such person or others in serious jeopardy; (ii) serious 22 impairment to such person's bodily functions; (iii) serious dysfunction 23 of any bodily organ or part of such person; (iv) serious disfigurement 24 of such person; or (v) a condition described in clause (i), (ii) or 25 (iii) of section 1867(e)(1)(A) of the Social Security Act. 26 (D) For purposes of this paragraph, "emergency services" means, with 27 respect to an emergency condition: (i) a medical screening examination 28 as required under section 1867 of the Social Security Act, 42 U.S.C. § 29 1395dd, which is within the capability of the emergency department of a 30 hospital, including ancillary services routinely available to the emer- 31 gency department to evaluate such emergency medical condition; and (ii) 32 within the capabilities of the staff and facilities available at the 33 hospital, such further medical examination and treatment as are required 34 under section 1867 of the Social Security Act, 42 U.S.C. § 1395dd, to 35 stabilize the patient. 36 (E) For purposes of this paragraph, "to stabilize" means, with respect 37 to an emergency condition, to provide such medical treatment of the 38 condition as may be necessary to assure, within reasonable medical prob- 39 ability, that no material deterioration of the condition is likely to 40 result from or occur during the transfer of the insured from a facility 41 or to deliver a newborn child (including the placenta). 42 § 3. This act shall take effect on the one hundred twentieth day after 43 it shall have become a law.