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A00264 Summary:

COSPNSRColton, Arroyo, Jean-Pierre, Taylor, McDonough, Jacobson, Steck, Barron, Reyes, Ortiz, Blake
MLTSPNSREpstein, Richardson
Amd §§605, 608 & 604, Fin Serv L
Establishes patient protections from excessive hospital emergency charges; includes hospital charges, including hospital charges for inpatient services which follow an emergency room visit.
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A00264 Memo:

submitted in accordance with Assembly Rule III, Sec 1(f)
SPONSOR: Cahill (MS)
  TITLE OF BILL: An act to amend the financial services law, in relation to establishing protections from excess hospital charges   PURPOSE: This bill subjects hospital charges for emergency services to the inde- pendent dispute resolution process established to protect against exces- sive emergency charges.   SUMMARY OF PROVISIONS: Section 1 amends section 605 of the financial services law by including hospital charges, including bills for inpatient services which follow an emergency room visit, in the emergency charges that are subject to the independent dispute resolution process. It provides that if a health insurer submits a dispute regarding the hospital's charge to dispute resolution, the health insurer shall pay a reasonable amount for the services directly to the hospital. It also exempts hospitals that had at least sixty percent of inpatient discharges annually which consisted of medicaid, uninsured and dual eligible individuals as determined by the department of health in its determination of safety net hospitals. Section 2 amends section 608 of the financial services law by including hospitals in the payment and settlement provisions with respect to the cost of the independent dispute resolution process. Section 3 amends section 604 of the financial services law by including hospitals in the standard of review with respect to the criteria for determining a reasonable fee. Section 4 sets the effective date.   JUSTIFICATION: Section 3241 of the insurance law requires health insurers to ensure that enrollees incur no greater out-of-pocket costs than they would have incurred with a participating provider when emergency services are received from a non-participating provider. Currently, section 605 of the financial services law establishes an independent dispute resolution process for physician emergency charges. The charges billed by hospitals for emergency services when they are out-of-network are often excessive. This is particularly true given section 3241 of the insurance law cited above, which essentially requires health insurers to pay charges to non-participating hospitals for emergency services to ensure that members are not balance billed. Hospitals are assured of receiving their billed charges, notwithstanding how excessive the charges might be. Hospital charges for emergency services must be subject to dispute resolution to ensure that hospitals are not able to take advantage of section 3241 of the insurance law by charging exorbitant fees which ultimately drive up the cost of health insurance.   LEGISLATIVE HISTORY: 2017-2018: A7611C - Passed Assembly 06/04/18 amended on third reading 7611c 05/14/18 - Amended on third reading 7611b 06/12/17 - Amended on third reading 7611a 2015 -2016: A.10470 - Passed Assembly   FISCAL IMPLICATIONS: None.   EFFECTIVE DATE: This act shall take effect immediately.
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