What's happening
This bill requires health maintenance organizations to get state approval before making substantial reductions in inpatient hospital referrals.
Why it matters
Adds oversight to major referral reductions. By requiring state approval for any substantial drop in inpatient hospital referrals (over 5% of a hospital’s annual discharges), the bill prevents sudden, disruptive changes that could threaten hospital stability or community health access.
Protects hospital financial viability. Hospitals often rely on consistent patient referrals to maintain operations. This legislation aims to minimize abrupt losses in patient volume that could lead to financial crises or even hospital closures, especially in vulnerable or underserved areas.
Ensures continuity and quality of patient care. The bill mandates that health maintenance organizations submit a detailed plan showing how they will maintain quality and continuity of care for their enrollees if referrals are reduced, helping prevent negative impacts on patients.
Gives local health systems a voice. By involving the local health systems agency in the review process, the bill ensures that community needs and potential impacts are considered before approval is granted, adding an extra layer of public interest protection.
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Who cares
Headline styles
Limit HMO Hospital Referral Cuts
Plain English, a few words. Used as the page title.
Sponsors
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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
517
2019-2020 Regular Sessions
IN ASSEMBLY (Prefiled)
January 9, 2019
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
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD05296-01-9
A. 517 2
steps that can be taken to minimize the adverse impact of the reduced admissions on the hospital.
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.