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.
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.
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.
