Bill Text: NY A08507 | 2023-2024 | General Assembly | Introduced
Bill Title: Directs the department of civil service to collect and analyze health care claims data from the Empire Plan or its successor to develop a New York state health benefit plan pricing report; provides that such report shall include a comparative analysis of actual hospital in-network allowed amounts and out-of-network allowed amounts for each hospital facility located in the state of New York; specifies service categories.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Passed) 2024-01-26 - signed chap.4 [A08507 Detail]
Download: New_York-2023-A08507-Introduced.html
STATE OF NEW YORK ________________________________________________________________________ 8507 IN ASSEMBLY January 4, 2024 ___________ Introduced by M. of A. SOLAGES -- read once and referred to the Commit- tee on Governmental Employees AN ACT to amend the civil service law, in relation to health care claims data from the Empire Plan; and to amend a chapter of the laws of 2023, amending the civil service law relating to certain reports relating to health benefits for state and retired state employees, as proposed in legislative bills numbers S. 4097-B and A. 5817-A, in relation to the effectiveness thereof The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Paragraph (b) of subdivision 9 of section 162 of the civil 2 service law, as added by a chapter of the laws of 2023, amending the 3 civil service law relating to certain reports relating to health bene- 4 fits for state and retired state employees, as proposed in legislative 5 bills numbers S. 4097-B and A. 5817-A, is amended to read as follows: 6 (b) (i) As soon as practicable, but not later than December first of 7 each year, the department shall collect and analyze health care claims 8 data from the Empire Plan, or its successor, to develop, and make 9 publicly available, a New York state health benefit plan hospital pric- 10 ing report. [The president must collect health care claims data from11both health insurers and health maintenance organizations relating to12the "in-network negotiated rate" as such term is defined in, and limited13by, the transparency in coverage final rule or successor federal law, as14prepared for machine-readable files, as likewise defined by the trans-15parency in coverage final rule or successor federal law, and utilization16of hospital services by active employees, retired employees, and their17dependents receiving benefits from the prior state fiscal year, in18accordance with provisions under this article] Such report shall exclude 19 optional benefit plan health care claims data and claims for Medicare 20 primary individuals. The report[, which shall not identify the plan by21name,] shall include, but not be limited to, a comparative analysis of 22 actual hospital in-network [negotiated rates] allowed amounts and out- 23 of-network allowed amounts[, as such terms are defined in this para-24graph, by the plan,] for each hospital facility located in the state of EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD08351-07-4A. 8507 2 1 New York identified by name and CMS certification number (CCN) or 2 successor identifier, based on the following service categories: [(i)] 3 (A) inpatient hospital, [(ii)] (B) outpatient hospital, [(iii)] (C) 4 emergency room services, and [(iv)] (D) physician services provided [at5the hospital] (1) during an inpatient hospital admission and (2) as part 6 of an outpatient visit or in connection with the provision of emergency 7 room services, except to the extent that the department determines that 8 the analysis of physician services is not technically feasible and 9 explains the basis for such determination. 10 (ii) The report shall also include the in-network [negotiated rate] 11 allowed amount and out-of-network allowed amount per service [as such12terms are defined in this paragraph] per hospital facility on the top 13 twenty services by volume within each of the following service catego- 14 ries: (A) inpatient, (B) outpatient, (C) emergency room services, and 15 (D) physician services provided (1) during an inpatient hospital admis- 16 sion and (2) as part of an outpatient visit or in connection with the 17 provision of emergency room services, except to the extent that the 18 department determines that the analysis of physician services is not 19 technically feasible and explains the basis for such determination at 20 [the] each hospital located in the state of New York. The report shall 21 compare, to the best of the department's ability, the in-network [nego-22tiated rates] allowed amounts and out-of-network allowed amounts [to the23process] for similar services reimbursed under title eighteen of the 24 social security act. Such report shall also include a comprehensive 25 analysis of the prior [five] two years of hospital in-network [negoti-26ated rates] allowed amounts and out-of-network allowed amounts for such 27 services to [establish] illustrate trends in hospital prices. The report 28 shall also include an all-plan aggregated total yearly spend by hospital 29 facility identified by name and CMS certification number (CCN) or 30 successor identifier. In preparing the report, the president shall take 31 appropriate steps to ensure that individual insurer's or health plan's 32 confidential proprietary pricing information is maintained as confiden- 33 tial to the extent permissible by law. Such report shall be delivered to 34 the legislative fiscal committees, the chairs of the legislative health 35 care committees, the chair of the senate civil service and pensions 36 committee, and the chair of the assembly committee on governmental 37 employees, on or before December thirty-first of each year, and such 38 report shall be posted on the department's website no later than January 39 first of the following calendar year. For purposes of this subdivision, 40 "health care claims data" means any hospital claims [for inpatient,41outpatient, or ambulatory surgical services or other services normally] 42 paid by the [third-party payer] health benefit plan, or its designee, 43 for the service categories listed in this subdivision on form UB-04 or 44 successor forms, with UB-04 being the billing form identified by the 45 Centers for Medicare and Medicaid Services. 46 § 2. Section 2 of a chapter of the laws of 2023, amending the civil 47 service law relating to certain reports relating to health benefits for 48 state and retired state employees, as proposed in legislative bills 49 numbers S. 4097-B and A. 5817-A, is amended to read as follows: 50 § 2. This act shall take effect [immediately] January 1, 2024. 51 § 3. This act shall take effect immediately; provided, however, that 52 section one of this act shall take effect on the same date and in the 53 same manner as a chapter of the laws of 2023, amending the civil service 54 law relating to certain reports relating to health benefits for state 55 and retired state employees, as proposed in legislative bills numbers S. 56 4097-B and A. 5817-A, takes effect.