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A04472 Summary:

BILL NOA04472
 
SAME ASNo Same As
 
SPONSORGottfried
 
COSPNSRCahill, Colton, Magnarelli, Galef, Paulin, Lifton, Cusick, O'Donnell, Jaffee, Perry, Jenne, Bronson, Rosenthal, Thiele, Benedetto, Titone, Peoples-Stokes, Gunther, Weprin, Abinanti, Englebright, Skoufis, Otis, Aubry, Stirpe, Crespo, Steck, Hunter, Zebrowski
 
MLTSPNSRAbbate, Arroyo, Braunstein, Buchwald, Carroll, Cook, Cymbrowitz, Dinowitz, Fahy, Glick, Hikind, Hooper, Lentol, Lopez, Lupardo, Lupinacci, Magee, Malliotakis, McDonald, McDonough, Montesano, Moya, Ortiz, Pretlow, Ra, Raia, Richardson, Sepulveda
 
Add Art 49 Title III 4920 - 4929, Pub Health L
 
Enacts provisions relating to collective negotiations by health care providers with certain health care plans in certain counties; applies to health benefit plans that provide benefits for medical or surgical expenses incurred as a result of a health condition, accident or sickness, including an individual, group, blanket or franchise insurance policy or insurance agreement offered by certain enumerated entities.
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A04472 Memo:

NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
submitted in accordance with Assembly Rule III, Sec 1(f)
 
BILL NUMBER: A4472
 
SPONSOR: Gottfried (MS)
  TITLE OF BILL: An act to amend the public health law, in relation to requirements for collective negotiations by health care providers with certain health benefit plans   PURPOSE OR GENERAL IDEA OF BILL: This bill is designed to restore fairness in the contracting process between physicians and large managed care plans by allowing doctors to join together to negotiate contract provisions. This legislation would not authorize strikes of health benefit plans by physicians.   SUMMARY OF SPECIFIC PROVISIONS: Section 1 is a statement of legislative intent that states that the legislature finds it appropriate and necessary to authorize collective negotiations on patient care issues and on fee-related and other issues where it determines that health plans have an undue advantage negotiat- ing the terms of contracts with health care providers. The legislative intent clarifies that the act is not intended to apply or affect collec- tive bargaining relationships involving health care providers who are employees of health care providers or rights relating to collective bargaining arising under applicable federal/state collective bargaining statutes. Section 2 cites the bill as the Health Care Consumer and Provider Protection Act Section 3 amends article 49 to the public health law by adding a new title III titled Collective Negotiations by Health Care Providers with Health Care Plans This legislation adds a new Article 49-A to the public health law to authorize collective bargaining for independent contractor health care providers including physicians or an entity that employs or utilizes health care providers to provide health care services. This bill would create a system under which the state would closely monitor those nego- tiations, and any negotiations involving fee-related matters would only be permitted when an individual managed care plan controls a substantial share of the managed care market. The Commissioner of Health would be authorized to approve the health care providers' representative request to negotiate based upon the benefits to be achieved for providers and consumers of health services, and is required to review any offer submitted to the health care providers' representative prior to sharing with affected health care providers. The legislation would also create a mechanism for resolving disputes when there is an impasse or when the health plan refuses to negotiate. The bill would also direct the Commis- sioner of Health to approve any final agreement as well as monitor the implemented agreements to ensure continued compliance with the law. Importantly, this legislation would not authorize strikes or concerted action by physicians in response to negotiations with health care plans.   JUSTIFICATION: Currently, federal antitrust laws prohibit individual physicians from collectively negotiating any provisions of contracts they sign with managed care entities. This bill would allow physicians in New York State to conduct some collective negotiations by creating a system under which the state would closely monitor those negotiations, facilitate resolution of negotiation impasses, and actively monitor implementation of agreements. Negotiations involving fee-related matters would be prohibited unless an individual managed care plan controls a substantial share of the managed care market. Giving physicians greater ability to advocate for patients in contract negotiations is critical since large health maintenance organizations control huge shares of the health insurance market, both in New York and across the country. In the last few years we have seen the mergers of United Healthcare and Oxford, MVP and Preferred Care, and Wellpoint with Wellchoice (Empire). As of March 2008, almost 75% of the enrollees in managed care plans in New York State were enrolled in just five health plans (GHWHIP, United/Oxford/Amerchoice, Excellus, Empire and MVP/Preferred Care). We have also seen an emerging trend of long-time not-for-profit health insurance companies such as Empire and HIP seeking to convert to for-profit status. Due to the current imbalance of negotiating power in favor of the managed care plans, physicians and other health care providers are offered take-it-or-leave-it contracts by health plans that significantly hamper their ability to provide quality patient care. These contracts permit burdensome processes and unjustifiably long wait times for obtaining pre-authorization to provide needed patient care; impose limi- tations on whom a physician may refer a patient for necessary care; permit demands for refunds of payments long after the time that such payments were originally made; permit health plans to make major changes to key elements of a contract without physician consent; and cede to physicians the legal consequences for patients harmed by health plan utilization review decisions. This bill, by allowing independent contractor physicians to conduct some collective negotiations while being closely monitored by the state, would give physicians greater ability to advocate for patients in contract negotiations. This bill would create a system under which the state would closely monitor those negotiations, and any negotiations involving fee-related matters would only be permitted when an individual managed care plan controls a substantial share of the managed care market. This legislation would not authorize strikes or boycotts of health benefit plans by physicians   PRIOR LEGISLATIVE HISTORY: 2000: A.9484-A (Canastrari) - A Referred to Health/Senate Finance 2001-2002: A.5466 (Canastrari) - Reported to Third Reading Calendar 2003-2004: A.1317-A (Canastrari) - Reported to Ways & Means 2005-2006: A.6458 (Canastrari) - Reported to Ways & Means 2007-2008: A.2177 (Canastrari) - Reported to Ways & Means 2009-2010: A.430143 (Canastrari) - Reported to Ways and Means 2011-2012: A.2474-8 (Canastrari) - Reported to Ways and Means 2013-2014: A.5692 - Reported to Ways and Means 2015-2016: A.336-A- Reported to Ways and Means   FISCAL IMPLICATIONS: None to the State. The bill would provide the legal basis for an appro- priation of funds to implement the provisions of the bill.   EFFECTIVE DATE: 120 days after it shall have become a law, provided that the department of health may promulgate and establish any regulations pursuant hereto prior to the effective date.
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