Relates to the designation of an independent consumer assistance program to assist consumers with the filing of complaints and appeals, track problems, educate consumers, assist uninsured, insured, or underinsured consumers in accessing appropriate health care services, assist with enrollment and provide other health insurance assistance.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A1733
SPONSOR: Gottfried TITLE OF BILL:
An act to amend the insurance law, in relation to the designation of an
independent consumer assistance program
PURPOSE OR GENERAL IDEA OF BILL:
To designate an independent consumer assistance program, define its
duties and require New York state regulated health plans to provide
contact information for the independent consumer assistance program to
consumers.
SUMMARY OF SPECIFIC PROVISIONS:
Section one amends the insurance law by adding a new section 211 requir-
ing the superintendent of financial services, in consultation with the
commissioner of health, to designate an independent consumer assistance
program and sets out the duties of the program. Section one also
requires New York State regulated health plans to provide the contact
information of the independent consumer assistance program on documents
the plans send to consumers.
Section two of the bill establishes the effective date.
JUSTIFICATION:
Navigating the health care system is difficult. This is especially true
for people who are uninsured, underinsured, denied coverage for services
they thought their health plan covers, forced to obtain prior authori-
zations for the tests ordered by their health care providers, receiving
"surprise" bills from "out-of-network" providers thought to be "in
network" or even being unfairly dropped from their health insurance plan
altogether.
Recognizing these challenges, independent consumer assistance programs
were established and initially funded as part of the Affordable Care
Act. New York has continued the program with funding supported by the
Legislature and the Governor.
New York contracts with Community Health Advocates, CHA, to operate the
program. CHA has handled over 337,000 cases since 2010, including over
28,000 in 2018. CHA has saved New Yorkers approximately $35 million
since 2010, $5.9 million in 2018. CHA advocates also assist small busi-
ness owners to understand how they can offer health insurance to their
employees and receive health insurance tax credits. This bill seeks to
codify the independent consumer assistance program to ensure the valu-
able services it provides continue into the future.
PRIOR LEGISLATIVE HISTORY:
2019-2020: A.7754 - referred to Insurance Committee
FISCAL IMPLICATIONS:
Funding for the program is included in the budget annually.
EFFECTIVE DATE:
This act shall take effect immediately.
STATE OF NEW YORK
________________________________________________________________________
1733
2021-2022 Regular Sessions
IN ASSEMBLY
January 11, 2021
___________
Introduced by M. of A. GOTTFRIED -- read once and referred to the
Committee on Insurance
AN ACT to amend the insurance law, in relation to the designation of an
independent consumer assistance program
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. The insurance law is amended by adding a new section 211 to
2 read as follows:
3 § 211. Independent consumer assistance program. The superintendent, in
4 consultation with the commissioner of health, shall designate an inde-
5 pendent consumer assistance program that will have the following duties:
6 (a) The independent consumer assistance program shall:
7 (1) assist consumers with the filing of complaints and appeals,
8 including filing appeals with the internal appeal or grievance process
9 of the group health plans or health insurance issuers involved and
10 providing information about and assisting consumers with the external
11 appeals and administrative hearing process;
12 (2) collect, track, and quantify problems and inquiries encountered by
13 consumers;
14 (3) educate consumers on their rights and responsibilities with
15 respect to group health plans and health insurance coverage;
16 (4) assist consumers with enrollment in a group health plan or health
17 insurance coverage by providing information, referral, and assistance;
18 (5) resolve problems with obtaining premium tax credits under section
19 36B of the Internal Revenue Code of 1986;
20 (6) assist consumers with disputes eligible for resolution under arti-
21 cle six of the financial services law;
22 (7) assist uninsured, insured, or underinsured consumers in accessing
23 appropriate health care services, hospital financial assistance or the
24 resolution of their health care bills; and
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD00383-01-1
A. 1733 2
1 (8) provide assistance to health consumers on any additional matters
2 related to accessing health insurance coverage and health care services.
3 (b) All New York state regulated health plans shall be required to
4 list the name, phone number, address and email of the state independent
5 consumer assistance programs on notices to consumers of adverse determi-
6 nations and explanation of benefits and in the subscriber agreement,
7 member handbook and any additional consumer facing materials as deter-
8 mined by the superintendent and the commissioner of health.
9 § 2. This act shall take effect immediately.
