BILL NUMBER: S8758

SPONSOR: COMRIE
 
TITLE OF BILL:

An act to amend the social services law, in relation to prohibiting
medical assistance providers from refusing to furnish care, services or
supplies to any person who is entitled to receive such care, services or
supplies under Medicaid because benefits payable under Medicaid are
payable as secondary insurance

 
PURPOSE OR GENERAL IDEA OF BILL:

This bill will allow for people who have specific insurance coverages
such as Medicare HMO and Medicare Advantage PPO plans, to be given the
same services as someone who has Medicaid alone, without being denied
care due to what their primary insurance plan is.

 
SUMMARY OF SPECIFIC PROVISIONS:

Section 1. Subdivisions 1 and 2 of section 366-d of the social services
              

law, subdivision 1 as added by chapter 41 of the laws of 1992 and subdi-
vision 2 as amended by chapter 2 of the laws of 1998, are amended to
read as follows:

1. Definitions. As used in this section, "medical assistance provider"
means any person, firm, partnership, group, association, fiduciary,
hospital, employer or representative thereof or other entity who is
furnishing care, services or supplies under this title (eleven of arti-
cle five of this chapter).

2. No medical assistance provider shall:

(a) solicit, receive, accept or agree to receive or accept any payment
or other consideration in any form from another person to the extent
such payment or other consideration is given: (i) for the referral of
services for which payment is made under this title (eleven of article
five of this chapter); or (ii) to purchase, lease or order any good,
facility, service or item for which payment is made under this title
(eleven of article five of this chapter); or

(b) offer, agree to give or give any payment or other consideration in
any form to another person to the extent such payment or other consider-
ation is given: (i) for the referral of services for which payment is
made under this title (eleven of article five of this chapter); or (ii)
to purchase, lease or order any good, facility, service or item for
which payment is made under this title (eleven of article five of this
chapter); or

(c) refuse to furnish care, services or supplies to any person who is
entitled to receive such care, services or supplies under this title if
such medical assistance provider furnishes the same care, services or
supplies under the Medicare program pursuant to title XVIII of the
federal social security act and the person is dually eligible under that
program.

((c) as) (d) As used in this section "person" shall have the meaning set
forth in subdivision seven of section 10.00 of the penal law.((d) this)

(e) This subdivision shall not apply to any activity specifically exempt
by federal statute or federal regulations promulgated thereunder.

§ 2. The commissioner of health shall make any amendments to the state
plan for medical assistance, or apply for any waiver or approval under
the federal social security act that are necessary to carry out the
provisions of this act.

§ 3. This act shall take effect on the one hundred ninetieth day after
it shall have become a law. Effective immediately the addition, amend-
ment and/or repeal of any rule or regulation necessary for the implemen-
tation of this act on its effective date are authorized to be made and
completed on or before such date.

 
JUSTIFICATION:

Medicare HMO plans covers regular doctor visits but does not cover
urgent or emergency visits, which leaves patients who have Medicare HMO
to be forced to go seek outside help and pay out of pocket costs.  Same
goes for Medicare Advantage PPO when it comes to having to pay addi-
tional costs out of pocket. Thus, for patients who have insurance plans
other than Medicaid as their primary plan, their doctor can turn them
away due to them only accepting Medicaid as a primary form of insurance.
For this reason, patients should be covered no matter what insurance
their doctor accepts as their primary or secondary insurance coverage
because secondary insurance coverages should also be payable.

 
PRIOR LEGISLATIVE HISTORY:

New.

 
FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS:

None.

 
EFFECTIVE DATE:
This act shall take effect on the one hundred ninetieth day after it
shall have become a law.