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A00191 Summary:

BILL NOA00191A
 
SAME ASSAME AS S01451-A
 
SPONSORGottfried
 
COSPNSRReyes, Paulin, Simon, Barron, Steck, Epstein, Englebright, Bichotte Hermelyn, Galef, Abinanti, Nolan, Jackson, Mitaynes, Hevesi, Solages, Rosenthal L, Sayegh, Gonzalez-Rojas, Forrest
 
MLTSPNSR
 
Add §2802-b, Pub Health L
 
Requires a health equity assessment to be filed with an application for construction, or substantial reduction of, a hospital or health related service; includes a demonstration of whether and how a project will improve or affect access to hospital services and health care with particular reference to members of medically underserved groups in the applicant's service area.
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A00191 Actions:

BILL NOA00191A
 
01/06/2021referred to health
02/09/2021reported
02/11/2021advanced to third reading cal.88
02/22/2021substituted by s1451
 S01451 AMEND=A RIVERA
 03/25/2021substitution reconsidered
 03/25/2021restored to third reading
 03/25/2021amended on third reading 191a
 01/12/2021REFERRED TO HEALTH
 01/19/20211ST REPORT CAL.110
 01/20/20212ND REPORT CAL.
 01/25/2021ADVANCED TO THIRD READING
 02/01/2021PASSED SENATE
 02/01/2021DELIVERED TO ASSEMBLY
 02/01/2021referred to health
 02/22/2021substituted for a191
 02/22/2021ordered to third reading cal.88
 03/25/2021substitution reconsidered
 03/25/2021recommitted to health
 04/26/2021RECALLED FROM ASSEMBLY
 04/26/2021returned to senate
 04/26/2021VOTE RECONSIDERED - RESTORED TO THIRD READING
 04/26/2021AMENDED ON THIRD READING 1451A
 05/10/2021REPASSED SENATE
 05/10/2021RETURNED TO ASSEMBLY
 05/10/2021referred to health
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A00191 Memo:

NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
submitted in accordance with Assembly Rule III, Sec 1(f)
 
BILL NUMBER: A191A
 
SPONSOR: Gottfried
  TITLE OF BILL: An act to amend the public health law, in relation to health equity assessments in the establishment or construction of a hospital   PURPOSE OR GENERAL IDEA OF BILL: The Certificate of Need (CoN) process requires providers apply to the department of health, the commissioner, or the public health and health planning council for project approval: There is very little statutory criteria for these entities to consider when reviewing applications. This bill adds consideration of a project's impact on medically under- served groups to the documentation required for the applicant to submit and the reviewer to consider when reviewing the application.   SUMMARY OF SPECIFIC PROVISIONS: Section 1 - Adds a new Public Health Law section 2802-b including: (Subdivision 1) - Definitions, including "medically underserved group," "health equity impact assessment" (HEIA), and "project" (construction, establishment, change in the establishment, merger, acquisition, closure, or substantial reduction of a hospital service or health-related service of a hospital). (Subdivision 2) - Requirement that any project application include an HEIA with certain exemptions; requirement that the reviewer consider the HEIA when considering whether and on what terms to approve the applica- tion. This applies to full CoN review as well as other project approval processes short of full CoN review. (Subdivision 3) - Scope and contents to be included in an HEIA. (Subdivision 4) - Requirement that the HEIA be prepared by an independ- ent entity, including meaningful engagement of stakeholders•. (Subdivision 5) - Requirement that the department publicly post the application and the HEIA on the department's website within one week of filing. Section 2 - Effective date.   JUSTIFICATION: The certificate of need (CoN) process requires hospitals get State approval for the construction, establishment, change in the establish- ment, merger, acquisition, closure, or substantial reduction; expansion, or addition of a hospital service or includes nursing homes and other providers spelled out in PHL 2801.) However, there is very little statu- tory criteria for reviewers to consider. Statutory criteria in PHL 2802 includes availability of alternatives; economic considerations such as the applicant's financial resources; and compliance with applicable rules and regulations. Advocates have long raised concerns that nothing in the law specifically addresses the impact of projects on medically underserved communities. Disparities in access to care result in unequal health outcomes. The distribution of health care providers and to whom they provide what services contributes to these inequalities. While closure or reductions of facilities or services obviously impact access to care, new construction or modification and changes in ownership or control may also do so by drawing revenue to or away from certain providers, or further concentrating services in already well-served communities. The CoN process reviews material changes to our health care system involving general hospitals, community health centers, nursing homes, and other entities. In order to address health inequalities in a mean- ingful way, the CoN process must account for the needs of underserved communities such as people with disabilities, communities of color, LGBT and other noncisgender people, and low-income people. This bill does so by requiring that CoN applicants document how their projects will affect these communities and that reviewers consider these impacts in approval, rejection, or modification of CoN applications.   PRIOR LEGISLATIVE HISTORY: 2020: A11072 - Referred to Health / Referred to Rules   FISCAL IMPLICATIONS: N one   EFFECTIVE DATE: Immediately.
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A00191 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                         191--A
                                                                 Cal. No. 88
 
                               2021-2022 Regular Sessions
 
                   IN ASSEMBLY
 
                                       (Prefiled)
 
                                     January 6, 2021
                                       ___________
 
        Introduced  by  M. of A. GOTTFRIED, REYES, PAULIN, SIMON, BARRON, STECK,
          EPSTEIN, ENGLEBRIGHT, BICHOTTE HERMELYN, GALEF, ABINANTI, NOLAN, JACK-
          SON, MITAYNES, HEVESI, SOLAGES, L. ROSENTHAL, SAYEGH,  GONZALEZ-ROJAS,
          FORREST  --  read  once  and  referred  to  the Committee on Health --
          reported from committee, advanced to  a  third  reading,  amended  and
          ordered reprinted, retaining its place on the order of third reading
 
        AN  ACT  to  amend  the  public health law, in relation to health equity
          assessments in the establishment or construction of a hospital
 
          The People of the State of New York, represented in Senate and  Assem-
        bly, do enact as follows:
 
     1    Section  1.  The  public health law is amended by adding a new section
     2  2802-b to read as follows:
     3    § 2802-b. Health equity impact assessments. 1. Definitions. As used in
     4  this section:
     5    (a) "Application" means an application  under  this  article  for  the
     6  construction, establishment, change in the establishment, merger, acqui-
     7  sition,  closure,  or substantial reduction, expansion, or addition of a
     8  hospital service or health-related service of a hospital  that  requires
     9  review  or approval by the council or the commissioner, where the appli-
    10  cation is filed or submitted to the council,  the  commissioner  or  the
    11  department after this section takes effect.
    12    (b)  "Project"  means  the  construction, establishment, change in the
    13  establishment, merger, acquisition, closure, or substantial reduction of
    14  a hospital service or health-related service of a hospital that  is  the
    15  subject of an application.
    16    (c)  "Health equity impact assessment" or "impact assessment" means an
    17  assessment of whether, and if so how, a project will improve  access  to
    18  hospital services and health care, health equity and reduction of health
    19  disparities,  with  particular  reference to members of medically under-
    20  served groups, in the applicant's service area.
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD00607-04-1

        A. 191--A                           2
 
     1    (d) "Medically underserved group" means: low-income people; racial and
     2  ethnic minorities; immigrants; women; lesbian, gay, bisexual,  transgen-
     3  der,  or  other-than-cisgender  people;  people with disabilities; older
     4  adults; persons living with a prevalent infectious disease or condition;
     5  persons  living  in  rural areas; people who are eligible for or receive
     6  public health benefits; people who do not have third-party health cover-
     7  age or have inadequate third-party health coverage; and other people who
     8  are unable to obtain health care.
     9    2. (a) (i) Every application shall  include  a  health  equity  impact
    10  assessment of the project. The impact assessment shall be filed together
    11  with  the application, and the application shall not be complete without
    12  the impact statement. The applicant shall promptly amend or  modify  the
    13  impact statement as necessary.
    14    (ii)  However,  in the case of a diagnostic and treatment center whose
    15  patient population is over fifty percent combined patients  enrolled  in
    16  Medicaid or uninsured, a health equity impact assessment is not required
    17  unless  the application includes a change in controlling person, princi-
    18  pal stockholder, or principal member (as defined in section twenty-eight
    19  hundred one-a of this article) of the applicant.
    20    (b) In considering whether and on what terms to  approve  an  applica-
    21  tion,  the  commissioner  and  the  council,  as  the case may be, shall
    22  consider the health equity impact statement.
    23    3. Scope and contents of a health equity impact assessment.  A  health
    24  equity impact assessment shall include:
    25    (a)  A  demonstration  of whether, and if so how, the proposed project
    26  will improve access to hospital services and health care, health  equity
    27  and  reduction  of  health  disparities,  with  particular  reference to
    28  members of medically underserved  groups,  in  the  applicant's  service
    29  area.
    30    (b)  The  extent  to  which medically underserved groups in the appli-
    31  cant's service area  use  the  applicant's  hospital  or  health-related
    32  services  or  similar  services  at  the time of the application and the
    33  extent to which they are expected to if the project is implemented.
    34    (c) The performance of the applicant in meeting  its  obligations,  if
    35  any,  under  section  twenty-eight  hundred  seven-k of this article and
    36  federal regulations requiring providing  uncompensated  care,  community
    37  services,  and  access  by  minorities  and  people with disabilities to
    38  programs receiving federal financial assistance, including the existence
    39  of any civil rights access complaints against the applicant, and how the
    40  applicant's meeting of these obligations will be affected by implementa-
    41  tion of the project.
    42    (d) How and to what extent the applicant  will  provide  hospital  and
    43  health-related  services to the medically indigent, Medicare recipients,
    44  Medicaid recipients and members of medically underserved groups  if  the
    45  project is implemented.
    46    (e)  The  amount of indigent care, both free and below cost, that will
    47  be provided by the applicant if the project is approved.
    48    (f) Access by public or private transportation,  including  applicant-
    49  sponsored  transportation  services,  to  the  applicant's  hospital  or
    50  health-related services if the project is implemented.
    51    (g) The means of assuring effective communication between  the  appli-
    52  cant's  hospital  and health-related service staff and people of limited
    53  English-speaking ability  and  those  with  speech,  hearing  or  visual
    54  impairments handicaps if the project is implemented.
    55    (h)  The  extent  to  which  implementation of the project will reduce
    56  architectural barriers for people with mobility impairments.

        A. 191--A                           3
 
     1    (i) A review of how the applicant will maintain or improve the quality
     2  of hospital and health-related services including a review of:
     3    (i) demographics of the applicant's service area;
     4    (ii)  economic  status  of  the  population of the applicant's service
     5  area;
     6    (iii) physician  and  professional  staffing  issues  related  to  the
     7  project;
     8    (iv) availability of similar services at other institutions in or near
     9  the applicant's service area; and
    10    (v) historical and projected market shares of hospital and health care
    11  service providers in the applicant's service area.
    12    4.  The  health  equity  impact  assessment  shall be prepared for the
    13  applicant by an independent entity and include the meaningful engagement
    14  of public health experts, organizations representing  employees  of  the
    15  applicant,  stakeholders,  and  community  leaders  and residents of the
    16  applicant's service area.
    17    5. The department shall publicly post the application and  the  health
    18  equity  impact assessment on the department's website within one week of
    19  the filing with the department, including any filing with the council.
    20    § 2. This act shall take effect on the one hundred eightieth day after
    21  it becomes a law.  Effective immediately, the commissioner of health and
    22  the public health and health planning council shall make regulations and
    23  take other actions reasonably necessary to implement this  act  on  that
    24  date.
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