What's happening
This bill requires health maintenance organizations to get state approval before making substantial reductions in inpatient hospital referrals.
Why it matters
Protects hospital financial stability and service capacity. By requiring state approval for substantial reductions in inpatient referrals, the bill aims to prevent sudden drops in patient volume that could threaten a hospital’s ability to operate, especially in communities reliant on a few providers.
Prioritizes patient care continuity and quality. Health maintenance organizations (HMOs) must detail how they will maintain quality and continuity of care for their enrollees if they reduce hospital referrals, ensuring patients are not left without adequate care options.
Increases transparency and oversight. The bill mandates written plans and allows local health systems agencies to provide input, giving the Department of Health and the public more visibility and control over major changes in healthcare delivery.
Mitigates negative community impacts. The requirement that HMOs minimize adverse effects on hospitals and that the commissioner can set a withdrawal schedule helps safeguard both hospital resources and public health in affected communities.
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Who cares
Headline styles
Limit Hospital Referral Cuts
Plain English, a few words. Used as the page title.
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History
- Referred to health
- Referred to health
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
904
2017-2018 Regular Sessions
IN ASSEMBLY
January 9, 2017
Introduced by M. of A. PERRY -- read once and referred to the Committee on Health
AN ACT to amend the public health law, in relation to substantial reductions by health maintenance organizations of inpatient referrals to a hospital
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. The public health law is amended by adding a new section 4405-c to read as follows:
§ 4405-c. Substantial reductions of referrals to a hospital. 1. No health maintenance organization shall make a substantial reduction in inpatient referrals to any hospital, to which the health maintenance organization has referred non-emergency inpatients for at least three years, or issue orders, directives, instructions or suggest in any manner to any participant medical practitioner registered in the health maintenance organization plan that such practitioner should reduce or discontinue referring patients to any hospital, without approval of the commissioner.
2. For the purposes of this section, any reduction in a health maintenance organization's inpatient referrals to a hospital shall be considered substantial if such reduction would result in a decrease in the projected annualized discharges of the hospital that exceeds five percent of its total discharges in the prior calendar year.
3. A health maintenance organization that plans to make a substantial reduction in inpatient referrals to a particular hospital shall file with the department and with the appropriate health systems agency a written plan that shall include: (a) the projected number of reduced referrals by service; (b) the plans to assure quality and continuity of service to the health maintenance organization enrollees; and (c) the steps that can be taken to minimize the adverse impact of the reduced admissions on the hospital.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD06402-01-7
A. 904 2
4. The health systems agency shall have an opportunity to give its views to the commissioner. The commissioner shall not grant approval for the substantial reduction in inpatient referrals unless he or she is satisfied that the written plan submitted by the health maintenance organization: (a) adequately protects quality and accessibility of services to health maintenance organization members; (b) reflects all reasonable efforts by the health maintenance organization to minimize the adverse impact of the reduction upon the hospital; and (c) does not unduly risk the quality or accessibility of hospital services in the community served by the hospital. To protect the public interest, the commissioner may establish a reasonable withdrawal schedule.
§ 2. This act shall take effect immediately.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.