NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
 
BILL NUMBER: A378
SPONSOR: Abinanti
 
TITLE OF BILL: An act to amend the public health law, in relation to
the state medical indemnity fund; to amend a chapter of the laws of
2016, amending the public health law relating to payments from the New
York state medical indemnity fund, in relation to the effectiveness
thereof; and to repeal subdivisions 2-a and 7-a of section 2999-j and
section 2999-k of the public health law, relating to requests for
denials of claims and denials of requests for prior authorizations and
consumer and stakeholder workgroups
 
PURPOSE OR GENERAL IDEA OF BILL:
The purpose of this bill to make modifications to the Medical Indemnity
Fund (MIF).
 
SUMMARY OF SPECIFIC PROVISIONS:
Section 1 repeals subdivisions 2-a and 7-a of section 2999-j of the
public health law.
Section 2 amends paragraph (c) of subdivision 2 of section 2999-j of the
public health law to clarify that the Department of Health is prohibited
from promulgating regulations disqualifying certain health care costs.
Section 3 amends subdivision 3 of section 2999-h of the public health
law to delete from the definition of "qualifying health care costs" the
phrase "including other therapeutic benefit."
Section 4 repeals section 2999-k of the public health law.
Section 5 directs the Superintendent of Financial Services to issue a
report to the Governor and the Legislature on the financial state of the
Medical Indemnity Fund by April 1, 2017.
Section 6 modifies the effective date of chapter 517 of the laws of 2016
as it pertains to increased reimbursement rates. The rates will take
effect on June 30, 2017, and shall expire and be deemed repealed on
December 31, 2019.
Section 7 is the effective date.
 
JUSTIFICATION:
The Medical Indemnity Fund (MIF) was designed to ensure that children
with birth-related neurological injuries are able to have their medical
needs met, and access services that they need to improve their quality
of life. In furtherance of that goal, the bill that created chapter 517
of the laws of 2016 as well this bill make changes to the MIF to allow
children to better access such services.
This bill clarifies that where a benefit has been determined to be
medically necessary for the injured individual, no regulation may permit
the denial of payment because someone else in the household may also
benefit. The new language makes it clear that the determining factor is
whether the individual benefits, and if so, it may not be prohibited
where, incidentally, someone else benefits.
Additionally, the phrase "including other therapeutic benefits" was
deleted from the definition of "qualifying health care cost," as that is
duplicative of other services delineated in such definition, such as
rehabilitation and habilitation. Rehabilitation traditionally provides
for various types of therapies to facilitate the recovery process, while
habilitation provides for a broad range of therapies to build on such
recovery and further improve activities of daily life. These therapies
help individuals recover and improve physically, socially, cognitively,
communicatively, and intellectually in order to maximize independence
and enhance the overall quality of life.
 
PRIOR LEGISLATIVE HISTORY:
This is a new bill.
 
FISCAL IMPLICATIONS:
Undetermined.
 
EFFECTIVE DATE:
This act shall take effect immediately; provided, however, that sections
one, two, three and four of this act shall take effect on the same date
and in the same manner as a chapter of the laws of 2016, amending the
public health law relating to payments from the New York state medical
indemnity fund, as proposed in legislative bills numbers S.7873-B and
A.9835-B, takes effect.
STATE OF NEW YORK
________________________________________________________________________
378
2017-2018 Regular Sessions
IN ASSEMBLY
January 5, 2017
___________
Introduced by M. of A. ABINANTI -- read once and referred to the Commit-
tee on Health
AN ACT to amend the public health law, in relation to the state medical
indemnity fund; to amend a chapter of the laws of 2016, amending the
public health law relating to payments from the New York state medical
indemnity fund, in relation to the effectiveness thereof; and to
repeal subdivisions 2-a and 7-a of section 2999-j and section 2999-k
of the public health law, relating to requests for denials of claims
and denials of requests for prior authorizations and consumer and
stakeholder workgroups
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Subdivisions 2-a and 7-a of section 2999-j of the public
2 health law, as added by a chapter of the laws of 2016, amending the
3 public health law relating to payments from the New York state medical
4 indemnity fund, as proposed in legislative bills numbers S.7873-B and
5 A.9835-B, are REPEALED.
6 § 2. Paragraph (c) of subdivision 2 of section 2999-j of the public
7 health law, as added by a chapter of the laws of 2016, amending the
8 public health law relating to payments from the New York state medical
9 indemnity fund, as proposed in legislative bills numbers S.7873-B and
10 A.9835-B, is amended to read as follows:
11 (c) such regulations shall not prohibit qualifying health care costs
12 on the grounds that the qualifying health care cost [is not limited to
13 the direct need of the patient and] may incidentally benefit other
14 members of the household, provided that whether the qualifying health
15 care cost primarily benefits the patient may be considered.
16 § 3. Subdivision 3 of section 2999-h of the public health law, as
17 amended by a chapter of the laws of 2016, amending the public health law
18 relating to payments from the New York state medical indemnity fund, as
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD06718-04-7
A. 378 2
1 proposed in legislative bills numbers S.7873-B and A.9835-B, is amended
2 to read as follows:
3 3. "Qualifying health care costs" means the future medical, hospital,
4 surgical, nursing, dental, rehabilitation, habilitation, respite, custo-
5 dial, durable medical equipment, home modifications, assistive technolo-
6 gy, vehicle modifications, transportation for purposes of health care
7 related appointments, prescription and non-prescription medications, and
8 other health care costs actually incurred for services rendered to and
9 supplies utilized by qualified plaintiffs, which are necessary to meet
10 their health care needs, [including providing therapeutic benefit,] as
11 determined by their treating physicians, physician assistants, or nurse
12 practitioners and as otherwise defined by the commissioner in regu-
13 lation.
14 § 4. Section 2999-k of the public health law, as added by a chapter of
15 the laws of 2016, amending the public health law relating to payments
16 from the New York state medical indemnity fund, as proposed in legisla-
17 tive bills numbers S.7873-B and A.9835-B, is REPEALED.
18 § 5. On or before April 1, 2017, the superintendent of financial
19 services shall issue a report to the governor and the legislature
20 addressing the financial condition of the state medical indemnity fund,
21 the future solvency of such fund, and any issues relating to the opera-
22 tion of such fund that the superintendent, in his or her sole
23 discretion, elects to include in the report. In preparing the report,
24 the superintendent may consult with qualified plaintiffs, represen-
25 tatives of qualified plaintiffs, and physicians, advocates, and other
26 interested parties.
27 § 6. Section 5 of a chapter of the laws of 2016, amending the public
28 health law relating to payments from the New York state medical indem-
29 nity fund, as proposed in legislative bills numbers S.7873-B and
30 A.9835-B, is amended to read as follows:
31 § 5. This act shall take effect on the forty-fifth day after it shall
32 have become a law, provided that the amendments to subdivision 4 of
33 section 2999-j of the public health law made by section two of this act
34 shall take effect on June 30, 2017 and shall expire and be deemed
35 repealed December 31, 2019.
36 § 7. This act shall take effect immediately; provided, however, that
37 sections one, two, three and four of this act shall take effect on the
38 same date and in the same manner as a chapter of the laws of 2016,
39 amending the public health law relating to payments from the New York
40 state medical indemnity fund, as proposed in legislative bills numbers
41 S.7873-B and A.9835-B, takes effect.