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.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A191A
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
Section 2 - Effective date.
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
STATE OF NEW YORK
Cal. No. 88
2021-2022 Regular Sessions
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.
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
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
6 (iii) physician and professional staffing issues related to the
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