NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A8392A
SPONSOR: Paulin TITLE OF BILL:
An act to amend the public health law and the insurance law, in relation
to premium reduction for obstetric practitioners who complete a risk
management strategies course
PURPOSE OR GENERAL IDEA OF BILL:
To improve birth outcomes and to promote informed consultation by
patients with their physicians and licensed midwives.
SUMMARY OF SPECIFIC PROVISIONS:
Section one amends the public health law by adding a new section 2506-a
that provides that the commissioner of health shall approve professional
education courses for eligible physicians and licensed midwives that
cover risk management strategies in obstetrics, including information on
potential risks and strategies to fully inform patients of risks associ-
ated with their decisions. Such courses shall be subject to standards as
the commissioner shall prescribe by regulation. Physicians and licensed
midwives who successfully complete a risk reduction course may receive
continuing medical education credit and a certificate of completion.
Topics to be included in such course are provided. Attendance at any
course approved by the commissioner may be in person or through distance
learning methods. The commissioner is authorized to prescribe any rules
and regulations necessary and shall consult with the Superintendent of
Financial Services.
Section two amends section 2343 of the insurance law by amending
subsection (e) and adding a new subsection (f). Subsection (e) provides
that the superintendent shall approve an actuarially appropriate premium
reduction for an insured physician or licensed midwife who successfully
completes a risk management course or a risk management course in
obstetrics and midwifery. Subsection (f) provides that an insured physi-
cian or licensed midwife who successfully completes a course authorized
by the commissioner of health shall not be eligible for additional
premium reductions during the period set forth in the superintendent's
regulations.
Section three provides the effective date.
JUSTIFICATION:
In order for a woman to determine the most appropriate mode of delivery
in light of her individual circumstances, it is critical that she be
fully informed about the risks of each birth option as well as consider-
ations regarding options for labor. For example, cesarean delivery has
been shown to imply a higher risk of maternal death, a longer recovery
time and operative complications as well as a higher risk of unexplained
stillbirths in subsequent pregnancies and respiratory problems of the
newborn. Elective cesarean deliveries (cesareans performed in the
absence of medical indication) are considered by many to account for the
significant rise in cesarean births.
To promote informed consultation with patients during pregnancy by their
physicians and licensed midwives, physicians and licensed midwives
should be knowledgeable of current, evidence-based information regarding
options for labor and delivery, including potential risks. This bill
will provide eligible physicians and licensed midwives with the opportu-
nity, through approved professional risk management strategies in
obstetrics and midwifery education courses, to stay well-versed in the
considerations and concerns that should be taken into account regarding
available options while providing a possible insurance premium
reduction.
Obstetrics and gynecology is considered among the specialties at highest
risk for malpractice claims and most severely affected by rising insur-
ance premiums. The increases in medical malpractice, premiums discourage
licensed midwives from practicing in New York State and have caused many
OBGYNs to retire early, drop high-risk obstetric patients, or to drop
obstetric services altogether.
Physicians and licensed midwives will thereby be better able to educate
their patients so that they can make informed decisions regarding their
labor and delivery. In facilitating greater education of physicians and
licensed midwives and their patients, resulting in more informed deci-
sion-making by patients, we will enhance our ability to improve birth as
well as maternal and neonatal outcomes.
PRIOR LEGISLATIVE HISTORY:
A.568 of 2019, vetoed. Same as S.3158 of 2019, vetoed.
A.275 of 2017 and 2018, ordered to third reading in 2018. Same as 5.3705
of 2017 and 2018, reported to insurance in both years.
A.115A of 2015 and 2016, passed Assembly in 2015 and was ordered to a
third reading in 2016.
A.414-A, 2013 and 2014 passed Assembly. Same as S.4488-A of 2015 and
2015, committed to insurance in both years.
S.1674-A, 2013 and 2014 committed to finance.
A.344-B, 2011 referred to ways and means, and 2012 passed Assembly. Same
as 5.5153-B, 2011 and 2012 reported to finance.
A.759, 2009 and 2010 referred to health.
A.8125-B, 2007 and 2008 advanced to third reading.
FISCAL IMPLICATION:
None to the state.
EFFECTIVE DATE:
This act shall take effect one year after it shall have become a law and
shall apply to all insurance policies and contracts issued, renewed,
modified or altered on and after such, effective date.
STATE OF NEW YORK
________________________________________________________________________
8392--A
2021-2022 Regular Sessions
IN ASSEMBLY
October 20, 2021
___________
Introduced by M. of A. PAULIN, GUNTHER, L. ROSENTHAL, GOTTFRIED, ENGLE-
BRIGHT, WOERNER, FAHY, TAYLOR, CARROLL, JACOBSON, GRIFFIN, SIMON,
SEAWRIGHT, ASHBY, SAYEGH, BURDICK, JEAN-PIERRE -- Multi-Sponsored by
-- M. of A. GALEF, LUPARDO, McDONOUGH -- read once and referred to the
Committee on Health -- recommitted to the Committee on Health in
accordance with Assembly Rule 3, sec. 2 -- committee discharged, bill
amended, ordered reprinted as amended and recommitted to said commit-
tee
AN ACT to amend the public health law and the insurance law, in relation
to premium reduction for obstetric practitioners who complete a risk
management strategies course
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 2506-a to read as follows:
3 § 2506-a. Risk management strategies in obstetrics and midwifery
4 courses. 1. In order to improve patient safety, birth outcomes and to
5 promote informed consultation by patients with their physicians and
6 licensed midwives during the prenatal through intrapartum and postpartum
7 periods, the commissioner shall approve professional education courses
8 for eligible physicians and licensed midwives as provided in subdivision
9 four of this section that covers risk management strategies in obstet-
10 rics and midwifery as described in subdivision two of this section. Such
11 risk management strategies courses shall be subject to such standards as
12 the commissioner may prescribe by regulation. In prescribing such regu-
13 lations, the commissioner may consult with the American Congress of
14 Obstetricians and Gynecologists, New York State Association of Licensed
15 Midwives and other health care organizations. An eligible physician or
16 licensed midwife who successfully completes such risk management strate-
17 gies course pursuant to this section shall receive continuing medical
18 education credit and a certificate of completion.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD06666-02-2
A. 8392--A 2
1 2. Courses on risk management strategies during the prenatal through
2 intrapartum and postpartum periods shall promote evidence-based clinical
3 guidelines and patient safety protocols from both the midwifery and
4 obstetrical perspectives. Options for courses should be appropriate for
5 the respective profession and may include information and education
6 addressing risks associated with the practice of obstetrics and midwif-
7 ery. Course options may include issues such as: methods to eliminate
8 non-medically indicated (elective) deliveries prior to thirty-nine weeks
9 gestation including the neonatal impact of late preterm births; vaginal
10 births after cesarean births and the applicability to a trial of labor;
11 reductions in cesarean births; monitoring of fetal well-being; manage-
12 ment of pain in labor; management of maternal hemorrhage, including
13 placenta accreta, hypertension in pregnancy, including pre-eclampsia and
14 eclampsia, vaginal breech and prevention of shoulder dystocia; and other
15 evidence-based guideline determined issues that improve the care and
16 outcomes of women.
17 3. Attendance at any course approved by the commissioner pursuant to
18 this section may be in person or through distance learning methods which
19 evince that all participants are in attendance for the duration of the
20 course and able to ask questions of the instructor.
21 4. Physicians who are board certified or are active candidates for
22 board certification in obstetrics and physicians who are board certified
23 or are eligible for board certification in family practice and provide
24 obstetric services and midwives who are licensed in the state are eligi-
25 ble for a risk management strategies course.
26 5. The commissioner is authorized to prescribe any rules and regu-
27 lations necessary to implement this section. In prescribing such rules
28 and regulations, the commissioner shall consider the rules and regu-
29 lations promulgated by the superintendent of financial services pursuant
30 to subsection (e) of section two thousand three hundred forty-three of
31 the insurance law and may consult with the superintendent of financial
32 services.
33 § 2. Subsection (e) of section 2343 of the insurance law, as added by
34 chapter 642 of the laws of 1990, is amended and a new subsection (f) is
35 added to read as follows:
36 (e) The superintendent may approve an actuarially appropriate premium
37 reduction for an insured physician or licensed midwife who successfully
38 completes a risk management course or a course authorized by the commis-
39 sioner of health under section two thousand five hundred six-a of the
40 public health law, which must be approved by the superintendent subject
41 to such standards as the superintendent may prescribe by regulation. In
42 prescribing such regulation the superintendent may consult with the
43 commissioner of health.
44 (f) An insured physician or licensed midwife who successfully
45 completes a course authorized by the commissioner of health under
46 section two thousand five hundred six-a of the public health law shall
47 not, during the period set forth in the superintendent's regulations
48 prescribing standards for the premium reduction, also be eligible for
49 additional premium reduction for an insured physician or licensed
50 midwife's medical malpractice insurance policy for successful completion
51 of a risk management course approved by the superintendent under part
52 152 of title 11 of the New York code of rules and regulations.
53 § 3. This act shall take effect one year after it shall have become a
54 law and shall apply to all insurance policies and contracts issued,
55 renewed, modified or altered on and after such effective date. The
56 commissioner of health and the superintendent of financial services are
A. 8392--A 3
1 authorized and directed to adopt, amend, suspend or repeal regulations
2 and take other actions necessary for the implementation of this act
3 prior to such effective date; provided, however, that such adoption,
4 amendment, suspension or repeal of regulations shall not have legal
5 effect until this act takes effect.
