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A07976 Summary:

BILL NOA07976A
 
SAME ASSAME AS S07614
 
SPONSORSeawright
 
COSPNSRMcDonald, Griffin, Jacobson, Sayegh, Davila, Gottfried, Gunther, O'Donnell, Simon, Giglio JM, Montesano, Stirpe, Glick, Rosenthal L
 
MLTSPNSR
 
Amd §268-d, Pub Health L; amd §§364-j & 369-gg, Soc Serv L
 
Enacts the "access to comprehensive cancer enhanced services strategy (ACCESS) demonstration project" to assure more equitable access to specialized cancer care; makes related provisions.
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A07976 Actions:

BILL NOA07976A
 
06/04/2021referred to health
12/15/2021amend and recommit to health
12/15/2021print number 7976a
01/05/2022referred to health
01/25/2022reported referred to ways and means
03/28/2022reported referred to rules
03/28/2022reported
03/28/2022rules report cal.64
03/28/2022ordered to third reading rules cal.64
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A07976 Memo:

NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
submitted in accordance with Assembly Rule III, Sec 1(f)
 
BILL NUMBER: A7976A
 
SPONSOR: Seawright
  TITLE OF BILL: An act to amend the public health law and the social services law, in relation to assuring more equitable access to specialized cancer care; and providing for the repeal of such provisions upon expiration thereof   TITLE OF BILL: AN ACT to amend the public health law and the social services law to assure more equitable access to specialized cancer care.   PURPOSE OR GENERAL IDEA OF BILL: To ensure that individuals who are enrolled in Medicaid managed care, the Essential Plan and individual and small group qualified health plans offered on the New York State of Health Exchange have greater access to National Cancer Institute (NCI)-designated cancer centers   SUMMARY OF PROVISIONS: Section 1: Provides that the legislation may be cited as the "access to comprehensive cancer enhanced services strategy (ACCESS) demonstration project". Section 2: Requires qualified health plans offering coverage through the New York State of Health ACA Exchange to include in their provider network any NCI-designated cancer center operating in the plan's service area that is willing to contract for hospital services at prevailing rates, which shall be no less than the Medicaid fee-for-service rate. Section 3: Requires Medicaid managed care plans to include in their provider network any NCI-designated cancer center operating in the plan's service area that is willing to contract for hospital services at prevailing rates, which shall be no less than the Medicaid fee-for-ser- vice rate. Section 4: Requires health plans offering coverage through the Basic Health Program, known as the Essential Plan, to include in their provid- er network any NCI-designated cancer center operating in the plan's service area that is willing to contract for hospital services at prevailing rates, which shall be no less than the FFS payment rate and methodology applicable to Essential Plan (known in statute as Basic Health Plan) payments for hospital inpatient and outpatient services. Section 5: Sets forth the effective date for the legislation as the first of January next succeeding the date of enactment and shall apply to all coverage or policies issued or renewed on or after such effective date, and it provides that the demonstration shall expire and be deemed repealed five years after such date.   JUSTIFICATION: Housed within the National Institutes of Health, the NCI administers the NCI cancer centers designation program. This program recognizes cancer centers that meet rigorous standards for transdisciplinary, state-of- the-art research focused on developing new and better approaches to preventing, diagnosing, and treating cancer. NCI-designated cancer centers enroll thousands of patients in clinical trials each year, and they pioneer the discovery and dissemination of new cancer treatments. The extraordinary resources that NCI-designated cancer centers bring to bear on clinical care have been demonstrated to result in superior outcomes for patients. For example, a 2015 analysis of outcomes for cancer patients in JAMA Oncology demonstrated that risk-adjusted five- year survival was higher for patients treated at NCI-designated cancer centers compared to patients treated at other academic medical centers or at community hospitals (see Pfister et al., 2015, JAMA Oncology). Similarly, a 2015 study in Cancer concluded that patients first treated at NCI-designated comprehensive cancer centers had better survival and outcomes across multiple diagnoses than patients treated at other hospi- tals (see Wolfson et al., 2015, Cancer). Unfortunately, NCI-designated cancer centers are often excluded from health plan networks for those plans offered to individuals and small groups, including Medicaid managed care plans, qualified health plans, and Essential plans. Health plans often cite the fear of "adverse selection," In other words, health plans do not want to attract a disproportionately high number of high-cost patients with a cancer diag- nosis by including an NCI-designated cancer center in their plan network. By requiring all plans to include any such hospitals operating in their service area and willing to contract at prevailing rates with all such plans in their networks, the risk of adverse selection is elim- inated. Public education and outreach programs on cancer prevention and screen- ing are an important aspect of the mission of NCI-designated cancer centers, and NCI-designated cancer centers are committed to ensuring equitable access to their services, including for historically under- served communities. At present, the exclusion of these centers from many health plan networks makes their outreach, screening, and education programming more difficult, because patients' health plans may not permit them to receive treatment services from these institutions. To avoid a fiscal impact to the state, in the absence of any other nego- tiated agreement, the bill would require NCI-designated cancer centers to accept the prevailing rate for hospital services, i.e., not lower than the Medicaid 1-TS rate for Medicaid managed care and qualified health plans and not less than the FFS rate applicable to the Essential plan. The bill does not require that any patient would have to be referred to an NCI-designated cancer center for treatment. The bill would remove an impediment to access to these centers of excellence in cancer care, giving populations enrolled in Medicaid managed care, the Essential Plan, and other qualified health plans in the individual and small group market more equitable access to specialty cancer care.   PRIOR LEGISLATIVE HISTORY: None.   FISCAL IMPLICATIONS: Minimal, if any. The bill does not mandate that patients with cancer would automatically be referred to an NCI-designated cancer center for care, a determination that would still have to be made by the patient, his or her treating physician and the health plan. Even if, as antic- ipated and intended, more patients access services at NCI-designated cancer centers, the bill requires, in the absence of an otherwise nego- tiated rate, such hospitals to accept the fee-for-service Medicaid rate for hospital services provided to those patients enrolled in Medicaid managed care and qualified health plans and the FFS rate applicable to the Essential plan for those patients enrolled in the Essential Plan.   EFFECTIVE DATE: The bill would take effect on January 1 following its enactment and shall expire and be deemed repealed five years after it has taken effect.
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A07976 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                         7976--A
 
                               2021-2022 Regular Sessions
 
                   IN ASSEMBLY
 
                                      June 4, 2021
                                       ___________
 
        Introduced  by  M.  of  A.  SEAWRIGHT  --  read once and referred to the
          Committee on Health -- committee  discharged,  bill  amended,  ordered
          reprinted as amended and recommitted to said committee
 
        AN  ACT  to  amend the public health law and the social services law, in
          relation to assuring more equitable access to specialized cancer care;
          and providing for the repeal of such provisions upon expiration there-
          of
 
          The People of the State of New York, represented in Senate and  Assem-
        bly, do enact as follows:
 
     1    Section 1.  This act shall be known and may be cited as the "access to
     2  comprehensive  cancer  enhanced services strategy (ACCESS) demonstration
     3  project."
     4    § 2. Subparagraph (vi) of paragraph (b) of subdivision  1  of  section
     5  268-d of the public health law, as added by section 2 of part T of chap-
     6  ter 57 of the laws of 2019, is amended to read as follows:
     7    (vi)    contracts with any national cancer institute-designated cancer
     8  center licensed by the department  within the health plan's service area
     9  that is willing to  provide  cancer-related  inpatient,  outpatient  and
    10  medical  services  to enrollees in all health plans offering Marketplace
    11  coverage in such cancer center's service  area    under  the  prevailing
    12  terms  and  conditions that the plan requires of other similar providers
    13  to be included in the plan's provider network, provided that such  terms
    14  shall  include  reimbursement  of  such  center  at  no less than and in
    15  accordance with the fee-for-service Medicaid payment rate and  methodol-
    16  ogy applicable to the center's inpatient and outpatient services; and
    17    (vii)  complies  with  the insurance law and this chapter requirements
    18  applicable to health insurance issued in this state and any  regulations
    19  promulgated  pursuant  thereto  that do not conflict with or prevent the
    20  application of federal requirements; and
    21    § 3.  Subdivision 4 of section 364-j of the  social  services  law  is
    22  amended by adding a new paragraph (w) to read as follows:
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD11279-03-1

        A. 7976--A                          2
 
     1    (w)  A  managed  care  provider  shall provide or arrange, directly or
     2  indirectly (including   by   referral), for access to  and  coverage  of
     3  services  provided  by  any  national cancer institute-designated cancer
     4  center licensed by the department of  health  within  the  managed  care
     5  provider's  service  area that is willing to agree to provide cancer-re-
     6  lated inpatient, outpatient and medical services to participants in  all
     7  managed  care  providers offering coverage to medical assistance recipi-
     8  ents in such cancer center's service area under the prevailing terms and
     9  conditions that the managed care  provider  requires  of  other  similar
    10  providers  to  be  included  in  the  managed  care  provider's network,
    11  provided that such terms shall include reimbursement of such  center  at
    12  no less than and in accordance with the fee-for-service Medicaid payment
    13  rate and methodology applicable to the center's inpatient and outpatient
    14  services.
    15    §  4.  Paragraph  (c) of subdivision 1 of section 369-gg of the social
    16  services law, as amended by section 2 of part H of  chapter  57  of  the
    17  laws of 2021, is amended to read as follows:
    18    (c)  "Health  care  services"  means  (i) the services and supplies as
    19  defined by the commissioner in consultation with the  superintendent  of
    20  financial  services,  and  shall  be  consistent with and subject to the
    21  essential health benefits as defined by the commissioner  in  accordance
    22  with  the  provisions  of the patient protection and affordable care act
    23  (P.L. 111-148) and consistent with the benefits provided by  the  refer-
    24  ence plan selected by the commissioner for the purposes of defining such
    25  benefits,  and  shall  include coverage of and access to the services of
    26  any national cancer institute-designated cancer center licensed  by  the
    27  department  of  health within the service area of the approved organiza-
    28  tion that is willing  to  agree  to  provide  cancer-related  inpatient,
    29  outpatient  and  medical services to all enrollees in approved organiza-
    30  tions' plans in such cancer center's service area under  the  prevailing
    31  terms  and  conditions  that the approved organization requires of other
    32  similar providers to be included in the approved organization's network,
    33  provided that such terms shall include reimbursement of such  center  at
    34  no less than and in accordance with the fee-for-service payment rate and
    35  methodology applicable to basic health insurance plan payments for inpa-
    36  tient  and  outpatient  services; and (ii) dental and vision services as
    37  defined by the commissioner.
    38    § 5. This act shall take effect on the first of January next  succeed-
    39  ing  the date on which it shall have become a law and shall apply to all
    40  coverage or policies issued or renewed on or after such  effective  date
    41  and  shall  expire  and  be  deemed repealed five years after such date;
    42  provided, however, that the amendments to subdivision 4 of section 364-j
    43  of the social services law made by section three of this act  shall  not
    44  affect  the  repeal  of such section and shall be deemed repealed there-
    45  with; provided, further, that the amendments to paragraph (c) of  subdi-
    46  vision  1  of  section 369-gg of the social services law made by section
    47  four of this act shall not affect the expiration of such  paragraph  and
    48  shall be deemed to expire therewith.
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