NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A378
SPONSOR: Abinanti TITLE OF BILL: An act to amend the public health law, in relation to
the state medical indemnity fund; to amend a chapter of the laws of
2016, amending the public health law relating to payments from the New
York state medical indemnity fund, in relation to the effectiveness
thereof; and to repeal subdivisions 2-a and 7-a of section 2999-j and
section 2999-k of the public health law, relating to requests for
denials of claims and denials of requests for prior authorizations and
consumer and stakeholder workgroups
PURPOSE OR GENERAL IDEA OF BILL:
The purpose of this bill to make modifications to the Medical Indemnity
Fund (MIF).
SUMMARY OF SPECIFIC PROVISIONS:
Section 1 repeals subdivisions 2-a and 7-a of section 2999-j of the
public health law.
Section 2 amends paragraph (c) of subdivision 2 of section 2999-j of the
public health law to clarify that the Department of Health is prohibited
from promulgating regulations disqualifying certain health care costs.
Section 3 amends subdivision 3 of section 2999-h of the public health
law to delete from the definition of "qualifying health care costs" the
phrase "including other therapeutic benefit."
Section 4 repeals section 2999-k of the public health law.
Section 5 directs the Superintendent of Financial Services to issue a
report to the Governor and the Legislature on the financial state of the
Medical Indemnity Fund by April 1, 2017.
Section 6 modifies the effective date of chapter 517 of the laws of 2016
as it pertains to increased reimbursement rates. The rates will take
effect on June 30, 2017, and shall expire and be deemed repealed on
December 31, 2019.
Section 7 is the effective date.
JUSTIFICATION:
The Medical Indemnity Fund (MIF) was designed to ensure that children
with birth-related neurological injuries are able to have their medical
needs met, and access services that they need to improve their quality
of life. In furtherance of that goal, the bill that created chapter 517
of the laws of 2016 as well this bill make changes to the MIF to allow
children to better access such services.
This bill clarifies that where a benefit has been determined to be
medically necessary for the injured individual, no regulation may permit
the denial of payment because someone else in the household may also
benefit. The new language makes it clear that the determining factor is
whether the individual benefits, and if so, it may not be prohibited
where, incidentally, someone else benefits.
Additionally, the phrase "including other therapeutic benefits" was
deleted from the definition of "qualifying health care cost," as that is
duplicative of other services delineated in such definition, such as
rehabilitation and habilitation. Rehabilitation traditionally provides
for various types of therapies to facilitate the recovery process, while
habilitation provides for a broad range of therapies to build on such
recovery and further improve activities of daily life. These therapies
help individuals recover and improve physically, socially, cognitively,
communicatively, and intellectually in order to maximize independence
and enhance the overall quality of life.
PRIOR LEGISLATIVE HISTORY:
This is a new bill.
FISCAL IMPLICATIONS:
Undetermined.
EFFECTIVE DATE:
This act shall take effect immediately; provided, however, that sections
one, two, three and four of this act shall take effect on the same date
and in the same manner as a chapter of the laws of 2016, amending the
public health law relating to payments from the New York state medical
indemnity fund, as proposed in legislative bills numbers S.7873-B and
A.9835-B, takes effect.
