Establishes patient protections from excessive hospital emergency charges; includes hospital charges, including hospital charges for inpatient services which follow an emergency room visit.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A264B
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.
