S T A T E O F N E W Y O R K
________________________________________________________________________
7230--A
2021-2022 Regular Sessions
I N A S S E M B L Y
April 29, 2021
___________
Introduced by M. of A. GOTTFRIED, HEVESI, DINOWITZ, BRAUNSTEIN, McDONALD
-- read once and referred to the Committee on Health -- recommitted to
the Committee on Ways and Means in accordance with Assembly Rule 3,
sec. 2 -- committee discharged, bill amended, ordered reprinted as
amended and recommitted to said committee
AN ACT to amend the public health law, in relation to establishing the
primary care reform commission
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. The article heading of article 29-AA of the public health
law, as added by section 35 of part H of chapter 59 of the laws of 2011,
is amended to read as follows:
PATIENT CENTERED MEDICAL HOMES AND PRIMARY CARE
§ 2. The public health law is amended by adding a new section 2959-b
to read as follows:
§ 2959-B. PRIMARY CARE REFORM COMMISSION. 1. (A) COMMISSION ESTAB-
LISHED. THE PRIMARY CARE REFORM COMMISSION, REFERRED TO IN THIS SECTION
AS THE "COMMISSION", IS HEREBY ESTABLISHED IN THE DEPARTMENT. THE
COMMISSION SHALL REVIEW, EXAMINE, AND MAKE FINDINGS ON THE LEVEL OF
PRIMARY CARE SPENDING BY ALL PAYERS IN THE CONTEXT OF ALL HEALTH CARE
SPENDING IN THE STATE, AND SHALL PUBLISH AN ANNUAL REPORT ON THE FIND-
INGS. THE COMMISSION SHALL ALSO MAKE RECOMMENDATIONS TO INCREASE SPEND-
ING ON PRIMARY CARE AND STRENGTHEN PRIMARY CARE INFRASTRUCTURE IN THE
STATE, TAKING CARE TO AVOID INCREASING COSTS TO PATIENTS OR THE TOTAL
COST OF HEALTH CARE.
(B) COMPOSITION AND POWERS. (I) THE COMMISSION SHALL CONSIST OF:
(1) THE COMMISSIONER AND THE SUPERINTENDENT OF THE DEPARTMENT OF
FINANCIAL SERVICES, WHO MAY BE REPRESENTED BY THEIR RESPECTIVE DESIG-
NEES;
(2) SEVEN MEMBERS APPOINTED BY THE GOVERNOR; AND
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD10879-04-1
A. 7230--A 2
(3) EIGHT MEMBERS APPOINTED BY THE GOVERNOR AS FOLLOWS: THREE ON THE
RECOMMENDATION OF THE SPEAKER OF THE ASSEMBLY, THREE ON THE RECOMMENDA-
TION OF THE TEMPORARY PRESIDENT OF THE SENATE, ONE ON THE RECOMMENDATION
OF THE MINORITY LEADER OF THE ASSEMBLY, AND ONE ON THE RECOMMENDATION OF
THE MINORITY LEADER OF THE SENATE.
(II) ANY VACANCY IN THE MEMBERSHIP OF THE COMMISSION SHALL BE FILLED
IN THE SAME MANNER AS THE MEMBER BEING SUCCEEDED WAS APPOINTED.
(III) THE COMMISSION SHALL SELECT A CHAIRPERSON FROM AMONG THE MEMBERS
OF THE COMMISSION.
(IV) THE COMPOSITION OF THE COMMISSION SHALL INCLUDE AT LEAST ONE
MEMBER WITH EXPERTISE IN HEALTH CARE FINANCING, REIMBURSEMENT, AND REGU-
LATION, REPRESENTING EACH OF THE FOLLOWING CATEGORIES: PRACTICING PRIMA-
RY CARE PROVIDERS, FEDERALLY QUALIFIED HEALTH CENTERS, PROFESSIONAL
PRACTICE GROUPS, PRIMARY CARE ADVOCATES, PRIMARY CARE CONSUMER ADVO-
CATES, BUSINESSES, HEALTH PLANS, AND HOSPITALS OR HEALTH SYSTEMS.
COMMISSION MEMBERS SHALL BE APPOINTED SO AS TO REPRESENT A GEOGRAPHICAL
DISTRIBUTION ACROSS THE STATE.
(V) MEMBERS OF THE COMMISSION, EXCEPT FOR THOSE REPRESENTING NEW YORK
STATE DEPARTMENTS, AGENCIES, AUTHORITIES OR COUNCILS, SHALL SERVE FOR A
TERM OF FOUR YEARS AND MAY BE REAPPOINTED IN THE SAME MANNER AS PROVIDED
FOR THEIR INITIAL APPOINTMENT.
(VI) A MAJORITY OF THE CURRENT FILLED MEMBERSHIP OF THE COMMISSION
SHALL CONSTITUTE A QUORUM FOR THE TRANSACTION OF ANY BUSINESS OR THE
EXERCISE OF ANY POWER OR FUNCTION OF THE COMMISSION, AND ANY DECISION OR
ACTION BY THE COMMISSION SHALL BE BY A MAJORITY VOTE OF THOSE PRESENT
AND VOTING.
(VII) THE COMMISSION SHALL MEET AT LEAST QUARTERLY AT THE CALL OF THE
CHAIRPERSON. ADDITIONAL MEETINGS MAY BE CALLED BY THE CHAIRPERSON
SUBJECT TO THE GIVING OF ONE WEEK'S NOTICE, AND SHALL BE CALLED BY THE
CHAIRPERSON AT THE REQUEST OF A MAJORITY OF THE MEMBERS OF THE COMMIS-
SION.
(VIII) THE MEMBERS OF THE COMMISSION SHALL RECEIVE NO COMPENSATION FOR
THEIR SERVICES, BUT SHALL BE ALLOWED THEIR ACTUAL AND NECESSARY EXPENSES
INCURRED IN THE PERFORMANCE OF THEIR DUTIES.
2. (A) EACH MEDICAID MANAGED CARE PROVIDER UNDER SECTION THREE HUNDRED
SIXTY-FOUR-J OF THE SOCIAL SERVICES LAW SHALL PROVIDE PRIMARY CARE
SPENDING DATA FOR THE FIVE YEARS PRIOR TO THE EFFECTIVE DATE OF THIS
SECTION AND FOR EACH YEAR THEREAFTER AS REQUESTED BY THE COMMISSION
UNDER THIS SECTION. THE INFORMATION SHALL INCLUDE, BUT NOT BE LIMITED
TO, PRIMARY CARE SPENDING, TOTAL HEALTH CARE SPENDING, AND ALL FURTHER
INFORMATION THE COMMISSION REQUESTS RELATING TO ITS WORK. EACH MEDICAID
MANAGED CARE PROVIDER SHALL ALSO PROVIDE THE TOTAL COST OF CARE PROVIDED
BY THE PROVIDER ANNUALLY FOR EACH OF THE YEARS.
(B) EACH INSURANCE ENTITY PROVIDING MANAGED CARE PRODUCTS, INDIVIDUAL
COMPREHENSIVE ACCIDENT AND HEALTH INSURANCE OR GROUP OR BLANKET COMPRE-
HENSIVE ACCIDENT AND HEALTH INSURANCE, AS DEFINED IN THE INSURANCE LAW,
CORPORATION ORGANIZED UNDER ARTICLE FORTY-THREE OF THE INSURANCE LAW
PROVIDING COMPREHENSIVE HEALTH INSURANCE, ENTITY LICENSED UNDER ARTICLE
FORTY-FOUR OF THIS CHAPTER PROVIDING COMPREHENSIVE HEALTH INSURANCE,
EVERY OTHER PLAN OVER WHICH THE DEPARTMENT OF FINANCIAL SERVICES HAS
JURISDICTION, AND EVERY THIRD-PARTY PAYOR PROVIDING HEALTH COVERAGE
SHALL PROVIDE PRIMARY CARE SPENDING DATA FOR THE FIVE YEARS PRIOR TO THE
EFFECTIVE DATE OF THIS SECTION AND FOR EACH YEAR THEREAFTER AS REQUESTED
BY THE COMMISSION UNDER THIS SECTION. THE INFORMATION SHALL INCLUDE, BUT
NOT BE LIMITED TO, PRIMARY CARE SPENDING, TOTAL HEALTH CARE SPENDING,
AND ALL FURTHER INFORMATION THE COMMISSION REQUESTS. EACH ENTITY SHALL
A. 7230--A 3
ALSO PROVIDE THE TOTAL COST OF CARE PROVIDED BY THE ENTITY ANNUALLY FOR
EACH OF THE YEARS. AN ENTITY THAT PROVIDES INFORMATION UNDER PARAGRAPH
(A) OF THIS SUBDIVISION SHALL NOT BE REQUIRED TO PROVIDE DUPLICATE
INFORMATION UNDER THIS PARAGRAPH.
(C) FAILURE OF ANY ENTITY TO PROVIDE INFORMATION TO THE COMMISSION
REQUESTED BY THE COMMISSION UNDER THIS SECTION SHALL BE CONSIDERED A
VIOLATION UNDER SECTION TWELVE OF THIS CHAPTER.
(D) THE COMMISSIONER, AND THE SUPERINTENDENT OF THE DEPARTMENT OF
FINANCIAL SERVICES WITH RESPECT TO ENTITIES REGULATED BY THE SUPERINTEN-
DENT, SHALL ESTABLISH REQUIREMENTS TO ENSURE COMPLIANCE WITH ALL APPLI-
CABLE LAWS AND TO PROTECT THE CONFIDENTIALITY OF ANY PROPRIETARY INFOR-
MATION THAT IS PROVIDED TO THE COMMISSION UNDER THIS SECTION.
3. THE DEPARTMENT AND THE DEPARTMENT OF FINANCIAL SERVICES SHALL
PROVIDE ASSISTANCE AND STAFF TO THE COMMISSION, AS REQUESTED BY THE
COMMISSION. ASSISTANCE SHALL ALSO BE MADE AVAILABLE, AS REQUESTED BY
THE COMMISSION, FROM OTHER AGENCIES, DEPARTMENTS, AND PUBLIC AUTHORITIES
OF THE STATE. THE COMMISSION MAY ACCEPT FUNDING OR GRANTS FROM THE
STATE OR FEDERAL GOVERNMENT, OR ANY OTHER GOVERNMENT AGENCY OR OTHER
SOURCE DETERMINED BY THE COMMISSION, TO AID IN THE COMMISSION'S WORK.
4. THE FOLLOWING TERMS, WHEN USED IN THIS SECTION, SHALL HAVE THE
FOLLOWING MEANINGS:
(A) "PRIMARY CARE" MEANS THE HEALTH CARE FIELDS OF FAMILY PRACTICE,
GENERAL PEDIATRICS, PRIMARY CARE INTERNAL MEDICINE, PRIMARY CARE OBSTET-
RICS, AND PRIMARY CARE GYNECOLOGY, PROVIDED IN ALL OUTPATIENT SETTINGS
INCLUDING, BUT NOT LIMITED TO, HEALTH CARE PROFESSIONAL PRACTICES AND
HOSPITALS AS DEFINED BY ARTICLE TWENTY-EIGHT OF THIS CHAPTER. PRIMARY
CARE SHALL NOT INCLUDE INPATIENT SERVICES. PRIMARY CARE INCLUDES, BUT IS
NOT LIMITED TO, PRIMARY CARE SERVICES FOR ACUTE AND CHRONIC CONDITIONS
AND PREVENTIVE CARE, SERVICES PROVIDED IN REGULAR CHECK-UPS, OFFICE
VISITS, TELEMEDICINE, AND OTHER SERVICES, PROVIDED BY OR UNDER THE
DIRECTION OF A PHYSICIAN, NURSE PRACTITIONER, PHYSICIAN ASSISTANT, OR
MIDWIFE. THE COMMISSION SHALL CONSIDER EXPANDING THIS DEFINITION TO
INCLUDE PRIMARY CARE SERVICES PROVIDED BY OTHER HEALTH CARE PROFES-
SIONALS.
(B) "PRIMARY CARE SPENDING" MEANS ANY EXPENDITURE OF FUNDS MADE BY
THIRD PARTY PAYORS, PUBLIC ENTITIES, OR THE STATE FOR THE PURPOSE OF
PAYING FOR PRIMARY CARE OR SUPPORTING PRIMARY CARE PROVIDERS. PRIMARY
CARE SPENDING IS INCLUDED REGARDLESS OF PAYMENT METHODOLOGY, SUCH AS
FEE-FOR-SERVICE, CAPITATION, INCENTIVES, VALUE-BASED PAYMENTS OR OTHER
METHODOLOGIES, ADJUSTED APPROPRIATELY TO EXCLUDE ANY PORTION OF THE
EXPENDITURE THAT IS REASONABLY APPORTIONED TO EXCLUDE EXPENSES FOR INPA-
TIENT SERVICES OR OTHER NON-PRIMARY CARE SERVICES.
5. (A) THE COMMISSION SHALL PUBLISH, POST ON THE DEPARTMENT'S WEBSITE,
AND DELIVER AN ANNUAL REPORT TO THE GOVERNOR, THE TEMPORARY PRESIDENT OF
THE SENATE, THE SPEAKER OF THE ASSEMBLY, THE CHAIRPERSON OF THE SENATE
FINANCE COMMITTEE, THE CHAIRPERSON OF THE ASSEMBLY WAYS AND MEANS
COMMITTEE AND THE CHAIRS OF THE SENATE AND ASSEMBLY HEALTH AND INSURANCE
COMMITTEES. THE FIRST REPORT SHALL BE PUBLISHED AND DELIVERED NO LATER
THAN MARCH THIRTY-FIRST OF THE YEAR FOLLOWING THE EFFECTIVE DATE OF THIS
SECTION.
(B) THE CONTENT OF THE ANNUAL REPORTS SHALL BE AT THE DISCRETION OF
THE COMMISSION BUT THE FIRST REPORT SHALL INCLUDE:
(I) AN ANALYSIS OF CURRENT PRIMARY CARE SPENDING, INCLUDING BY
GEOGRAPHIC REGION, IN RELATION TO ALL OTHER HEALTH CARE SPENDING IN THE
AGGREGATE.
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(II) RECOMMENDATIONS TO THE GOVERNOR AND THE LEGISLATURE OF ANY CHANG-
ES TO THE DEFINITION OF "PRIMARY CARE" FOR THE PURPOSES OF THE COMMIS-
SION'S FUTURE WORK. SUCH RECOMMENDATIONS MAY BE MADE PRIOR TO DELIVERY
OF THE COMMISSION'S REPORT.
(III) RECOMMENDATIONS FOR LEGISLATIVE AND EXECUTIVE ACTION.
(IV) IDENTIFICATION OF BARRIERS, INCLUDING PAYMENT METHODOLOGIES BY
HEALTH CARE PAYORS AND PROVIDERS, TO PROVIDING PRIMARY CARE AND INCREAS-
ING PRIMARY CARE SPENDING.
(V) RECOMMENDATIONS TO IMPROVE PROVIDING INCREASED AND HIGHER-QUALITY
PRIMARY CARE AND PRIMARY CARE SPENDING, WITH SPECIAL ATTENTION TO
INCREASING HEALTH CARE EQUITY, REDUCING HEALTH CARE DISPARITIES, AND
AVOIDING INCREASING COSTS TO PATIENTS OR THE TOTAL COST OF HEALTH CARE.
(VI) RECOMMENDATIONS TO INCREASE PRIMARY CARE SPENDING, TO BE THE
GREATER OF TWELVE PERCENT OR A ONE PERCENT INCREASE YEAR AFTER YEAR OF
OVERALL HEALTH CARE SPENDING BY FIVE YEARS FOLLOWING THE EFFECTIVE DATE
OF THIS SECTION.
§ 3. This act shall take effect immediately.