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A05817 Summary:

BILL NOA05817A
 
SAME ASSAME AS S04097-B
 
SPONSORSolages
 
COSPNSRRivera, Hevesi, Santabarbara, Jackson, Otis, Taylor, Kim
 
MLTSPNSR
 
Amd 162, Civ Serv L
 
Directs the president of the civil service commission to collect health care claims data relating to the price and utilization of hospital benefits by active employees, retired employees and their dependents and to publish a New York State health benefit plan hospital pricing report.
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A05817 Actions:

BILL NOA05817A
 
03/23/2023referred to governmental employees
05/23/2023reported referred to ways and means
05/25/2023amend and recommit to ways and means
05/25/2023print number 5817a
06/01/2023reported referred to rules
06/05/2023reported
06/05/2023rules report cal.516
06/05/2023substituted by s4097b
 S04097 AMEND=B GOUNARDES
 02/03/2023REFERRED TO CIVIL SERVICE AND PENSIONS
 03/13/2023AMEND AND RECOMMIT TO CIVIL SERVICE AND PENSIONS
 03/13/2023PRINT NUMBER 4097A
 04/17/20231ST REPORT CAL.606
 04/18/20232ND REPORT CAL.
 04/19/2023ADVANCED TO THIRD READING
 05/22/2023PASSED SENATE
 05/22/2023DELIVERED TO ASSEMBLY
 05/22/2023referred to governmental employees
 05/23/2023RECALLED FROM ASSEMBLY
 05/23/2023returned to senate
 05/23/2023VOTE RECONSIDERED - RESTORED TO THIRD READING
 05/23/2023AMENDED ON THIRD READING 4097B
 05/30/2023REPASSED SENATE
 05/30/2023RETURNED TO ASSEMBLY
 05/30/2023referred to ways and means
 06/05/2023substituted for a5817a
 06/05/2023ordered to third reading rules cal.516
 06/05/2023passed assembly
 06/05/2023returned to senate
 11/29/2023DELIVERED TO GOVERNOR
 12/08/2023SIGNED CHAP.703
 12/08/2023APPROVAL MEMO.48
 02/03/2023REFERRED TO CIVIL SERVICE AND PENSIONS
 03/13/2023AMEND AND RECOMMIT TO CIVIL SERVICE AND PENSIONS
 03/13/2023PRINT NUMBER 4097A
 04/17/20231ST REPORT CAL.606
 04/18/20232ND REPORT CAL.
 04/19/2023ADVANCED TO THIRD READING
 05/22/2023PASSED SENATE
 05/22/2023DELIVERED TO ASSEMBLY
 05/22/2023referred to governmental employees
 05/23/2023RECALLED FROM ASSEMBLY
 05/23/2023returned to senate
 05/23/2023VOTE RECONSIDERED - RESTORED TO THIRD READING
 05/23/2023AMENDED ON THIRD READING 4097B
 05/30/2023REPASSED SENATE
 05/30/2023RETURNED TO ASSEMBLY
 05/30/2023referred to ways and means
 06/05/2023substituted for a5817a
 06/05/2023ordered to third reading rules cal.516
 06/05/2023passed assembly
 06/05/2023returned to senate
 11/29/2023DELIVERED TO GOVERNOR
 12/08/2023SIGNED CHAP.703
 12/08/2023APPROVAL MEMO.48
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A05817 Memo:

NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
submitted in accordance with Assembly Rule III, Sec 1(f)
 
BILL NUMBER: A5817A
 
SPONSOR: Solages
  TITLE OF BILL: An act to amend the civil service law, in relation to certain reports relating to health benefits for state and retired state employees   PURPOSE: Requires New York State health benefit plan hospital pricing report to increase transparency and evidence-based decisions concerning the New York State Health Insurance Program (NYSHIP) benefit through an analysis of the healthcare expenses, trends and the range of variables that influence health care spending, in particular, hospital costs.   SUMMARY: Section 1. Amends subdivision 9 of section 162 of the civil service law, as added by chapter 147 o f the laws of 2014. Section 2. Sets the effective date.   JUSTIFICATION: The New York State Health. Insurance Programs (NYSHIP) was established in 1957 for state employees, and a year later, included local govern- ments and school districts. Today, NYSHIP is one of the largest public employer health insurance programs in the country, insuring over 1.2 million active government employees, retirees, and their families. This NYSHIP benefit is a key component of state employment benefits and in the aggregate, has the ability to affect the state's fiscal health. It is critical that we make evidence-based decisions regarding the adminis- tration of this benefit through an analysis of the healthcare expenses, trends, and the range of variables that influence healthcare spending. Variation in hospital pricing has an impact on premiums; and ultimately, an impact on both the public employees and the state's fiscal plan. The state has little control over price differences in hospitals. How taxpayer dollars are being spent on these services is also opaque. Media reports have highlighted wild fluctuations in hospital prices for many routine procedures among large hospital systems. These fluctuations are not rooted in any apparent justification based on quality or outcomes. A recent 32BJ Health Fund report revealed that it paid private hospital systems more than 300% of Medicare rates. Understanding the underlying drivers of outrageous costs is an important aspect of provid- ing NYSHIP benefits for valued NYS public employees. We must take advan- tage of our access to data on expenditures made for hospital services for NYSHIP beneficiaries. This data should be routinely analyzed to determine what factors influence state spending for its covered employ- ees. This analysis can then be used to provide the solid base for any future decision-making. An updated annual analysis can provide needed transparency in this system to ensure that NYSHIP continues to be fiscally strong and taxpayer dollars are spent prudently. This bill will amend the civil service law to require the Department of Civil Service to conduct a hospital pricing report and make such report publicly available. The report shall include a comparative analysis of hospital prices based on the following service categories: (i) inpatient hospital, (ii) outpatient hospital, and (iii) emergency room services. The report shall compare these prices to the process for similar services reimbursed under title eighteen of the Social Security Act. Such report shall also include a comprehensive analysis of the prior five years of hospital prices and expenditures to establish trends in hospital prices and total expenditures.   RACIAL JUSTICE IMPACT: TBD.   GENDER JUSTICE IMPACT: TBD.   LEGISLATIVE HISTORY: New bill.   FISCAL IMPLICATIONS: None.   EFFECTIVE DATE: This act shall take effect immediately.
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A05817 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                         5817--A
 
                               2023-2024 Regular Sessions
 
                   IN ASSEMBLY
 
                                     March 23, 2023
                                       ___________
 
        Introduced  by  M.  of  A. SOLAGES, RIVERA, HEVESI, SANTABARBARA -- read
          once and referred  to  the  Committee  on  Governmental  Employees  --
          reported  and referred to the Committee on Ways and Means -- committee
          discharged, bill amended, ordered reprinted as amended and recommitted
          to said committee

        AN ACT to amend the civil service law, in relation  to  certain  reports
          relating to health benefits for state and retired state employees
 
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
 
     1    Section 1. Subdivision 9 of section 162 of the civil service  law,  as
     2  added by chapter 147 of the laws of 2014, is amended to read as follows:
     3    9.  (a)  (i) As soon as is practicable, but no later than the first of
     4  September, two thousand fourteen, the department  shall,  upon  request,
     5  but  no more frequently than semi-annually, provide to any participating
     6  employer a standard report which contains data relating to  the  use  of
     7  benefits by persons covered under the plan by such employer. Such report
     8  shall  include:  premiums  paid  by  month for each month covered in the
     9  report and  paid  claims  by  month  for  the  following  categories  of
    10  services:  inpatient  hospital, outpatient hospital, in network medical,
    11  out of network medical, prescription drugs, and treatment of  behavioral
    12  conditions, each reported separately. To the extent allowed by state and
    13  federal  privacy laws, such report shall also contain claims information
    14  for individual claimants for claims in excess of fifty thousand  dollars
    15  that were paid in any of the months covered by the report.
    16    (ii)  The  department  shall provide such reports to any participating
    17  employer, upon request submitted on or after the first of April for data
    18  from the first of January through the thirty-first of  December  of  the
    19  prior  year,  and  on  or after the first of September for data from the
    20  first of June of the prior year through the thirty-first of May  of  the
    21  current  year,  within  thirty days of receipt of said request. However,
    22  requests submitted in the two thousand fourteen calendar year  shall  be
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD08351-06-3

        A. 5817--A                          2
 
     1  provided  as soon as practicable, but no later than the first of Septem-
     2  ber, two thousand fourteen, or within thirty days after said request  if
     3  request is submitted on or after the first of August, two thousand four-
     4  teen.
     5    (b)  As soon as practicable, but not later than December first of each
     6  year, the department shall collect and analyze health care  claims  data
     7  to develop, and make publicly available, a New York state health benefit
     8  plan  hospital  pricing  report.  The president must collect health care
     9  claims data from both health insurers and health  maintenance  organiza-
    10  tions  relating  to  the  "in-network  negotiated  rate" as such term is
    11  defined in, and limited by, the transparency in coverage final  rule  or
    12  successor  federal law, as prepared for machine-readable files, as like-
    13  wise defined by the transparency in coverage  final  rule  or  successor
    14  federal  law,  and utilization of hospital services by active employees,
    15  retired employees, and their  dependents  receiving  benefits  from  the
    16  prior  state fiscal year, in accordance with provisions under this arti-
    17  cle.   The report, which shall not identify  the  plan  by  name,  shall
    18  include,  but not be limited to, a comparative analysis of actual hospi-
    19  tal in-network negotiated rates and out-of-network allowed  amounts,  as
    20  such terms are defined in this paragraph, by the plan, for each hospital
    21  facility  identified  by  name  and  CMS  certification  number (CCN) or
    22  successor identifier, based on the  following  service  categories:  (i)
    23  inpatient  hospital,  (ii)  outpatient  hospital,  (iii)  emergency room
    24  services, and (iv) physician services  provided  at  the  hospital.  The
    25  report shall also include the in-network negotiated rate and out-of-net-
    26  work  allowed amount per service as such terms are defined in this para-
    27  graph per hospital facility on the top twenty services by volume  within
    28  each of the following service categories: (A) inpatient, (B) outpatient,
    29  (C)  emergency room services, and (D) physician services provided at the
    30  hospital. The report shall compare the in-network negotiated  rates  and
    31  out-of-network allowed amounts to the process for similar services reim-
    32  bursed  under  title  eighteen  of  the social security act. Such report
    33  shall also include a comprehensive analysis of the prior five  years  of
    34  hospital  in-network negotiated rates and out-of-network allowed amounts
    35  for such services to establish trends in  hospital  prices.  The  report
    36  shall also include an all-plan aggregated total yearly spend by hospital
    37  facility  identified  by  name  and  CMS  certification  number (CCN) or
    38  successor identifier. In preparing the report, the president shall  take
    39  appropriate  steps  to ensure that individual insurer's or health plan's
    40  confidential proprietary pricing information is maintained as  confiden-
    41  tial to the extent permissible by law. Such report shall be delivered to
    42  the  legislative fiscal committees, the chairs of the legislative health
    43  care committees, the chair of the  senate  civil  service  and  pensions
    44  committee,  and  the  chair  of  the  assembly committee on governmental
    45  employees, on or before December thirty-first of  each  year,  and  such
    46  report shall be posted on the department's website no later than January
    47  first  of the following calendar year. For purposes of this subdivision,
    48  "health care claims data" means any claims for inpatient, outpatient, or
    49  ambulatory surgical services or other  services  normally  paid  by  the
    50  third-party payer on form UB-04 or successor forms, with UB-04 being the
    51  billing  form  identified  by  the  Centers  for  Medicare  and Medicaid
    52  Services.
    53    § 2. This act shall take effect immediately.
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