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Who cares
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Sponsors
No co-sponsors yet.
History
- Referred to health
- Delivered to assembly
- Passed senateVote 61–0
- Advanced to third reading
- 2nd report cal.
- 1st report cal.785
- Referred to health
Full text
The text isn't available here yet. Check nysenate.gov.
Sponsor's memo
Title of bill
An act to amend the public health law, in relation to patient notice of care under an alternate payment system
Purpose
To ensure patients who receive treatment in a hospital participating in a bundled payment arrangement, system or model are provided with notice of such arrangements, treatment options and other relevant information upon admission or immediately following the decision to schedule surgery whichever occurs later.
Summary of provisions
Section 1 of this bill amends the public health law by adding a new section 2805-w-1 entitled Patient notice of care under an alternate payment. This section requires all general hospitals which participate in bundled payment arrangements, systems or models which include coverage of post acute care, to provide patients covered under such payment arrangements, with an oral and written notice of his or her inclusion in such an arrangement. The notice shall be provided upon admission to the participant hospital or immediately following the decision to schedule surgery whichever occurs later. The written notice shall include, but not be limited to, a detailed explanation of the payment model and how it might be expected to affect the patient's care including post acute care services; notification that the patient retains freedom of choice to chose providers and services including impatient and outpatient rehabilitative therapy and services, and that he or she should contact their insurance plan to better understand the implications of the payment model; a list of providers and suppliers with whom the participant hospital has a collaborator agreement; and an explanation of how patients can access care records and claims data and share such information with caregivers. The commissioner shall develop and make available guidance on the notice.
Read the full memo (699 words)
Section 2 provides an effective date of within 90 days of becoming law.
Justification
New federal Medicare rules effective April 1, 2016 require certain hospitals across the nation to be accountable for all costs related to hip and knee replacements for 90 days by establishing bundled payment rates. Patients who go home and recover quickly could save hospitals money and increase their Medicare payment, while those who have complications or lengthy stays in rehabilitation facilities could result in hospitals owing Medicare. As part of the new Medicare rule hospitals are required to provide notices to Medicare beneficiaries whose care is being reimbursed under such a payment arrangement.
Several NYC hospitals participated voluntarily in Medicare's bundled payment program for knee and hip replacements prior to the mandatory program going into effect April 2016. Bundled payment arrangements are not unique to this new Medicare model, as any hospital can negotiate with a payer to provide care in this manner. For example, in April 2016 Mount Sinai announced that it was launching a value-based joint replacement initiative covering 70,000 New York members of the services union 32BJ SEIU who are insured by Empire BCBS. Through the arrangement the hospital expects to reduce unnecessary consultations, post acute care and readmissions while providing the union member patients who choose Mount Sinai for their knee or hip replacements access without any co-payments.
While these arrangements may help in achieve the triple aim of health care: better care, better health, at lower cost, they can also incentivize less utilization of post acute care different or less intensive rehabilitation and care outside of the specified period of the bundled payment.
Making sure that patients are well aware of the arrangements and their options will protect against such abuses.
This legislation builds upon the existing notice hospitals must provide to patients under the Medicare bundled payment program, and expands such notice requirement to all cases in the state where a hospital is caring for a patient under similar payment arrangements. Patients must be informed that such payment arrangement exists, that the arrangements may affect the patient's care, and that patient's retain freedom of choice to choose providers and services.
Patient notices will help to maximize the benefit of the new payment model incentives by safeguarding against any unintended consequences and ensuring the welfare of patients in New York State.
Legislative history
New Bill
Fiscal implications
None to state.
Effective date
90th day after it shall be enacted.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.