S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   5400
 
                        2021-2022 Regular Sessions
 
                             I N  S E N A T E
 
                               March 3, 2021
                                ___________
 
 Introduced  by  Sen. HINCHEY -- read twice and ordered printed, and when
   printed to be committed to the Committee on Health
 
 AN ACT to amend the public health law and the insurance law, in relation
   to providing information to patients and the  public  on  policy-based
   exclusions

   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Legislative findings. The legislature finds that since 2003
 more than 40 community hospitals in New York state have closed.
   The legislature additionally  finds  that  as  a  result  of  hospital
 consolidation,  large  health  care  systems  now  control  more than 70
 percent of acute hospital beds in the state and that these systems some-
 times remove categories of care from local hospitals,  leaving  patients
 in  regions  of  the  state  without access to particular types of care,
 including some types of emergency care.
   The legislature further finds that patients do not have the ability to
 determine whether the hospital, or hospitals, in their area provides the
 care they seek, because information about  how  hospitals'  restrictions
 impact options for care is too difficult to obtain.
   The  legislature  also  finds that denials of care can lead to serious
 adverse health impacts that jeopardize individuals' lives and  wellbeing
 and  that New York needs to understand health care gaps and their impact
 statewide.
   Finally, the legislature finds that some denials of care violate state
 and federal law.
   § 2. Section 2803 of the public health law is amended by adding a  new
 subdivision 13 to read as follows:
   13.  (A)  THE  COMMISSIONER  OR HIS OR HER DESIGNEE SHALL COLLECT FROM
 EACH GENERAL HOSPITAL A LIST OF ITS POLICY-BASED EXCLUSIONS ON AN ANNUAL
 BASIS.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD09581-01-1
              

 S. 5400                             2
 
   (B) THE COMMISSIONER OR HIS OR  HER  DESIGNEE  SHALL  PUBLISH  ON  THE
 DEPARTMENT'S WEBSITE A CURRENT LIST OF ALL OF THE GENERAL HOSPITALS WITH
 POLICY-BASED EXCLUSIONS AND THE POLICY-BASED EXCLUSIONS FOR EACH GENERAL
 HOSPITAL  NOT  LATER  THAN  SIX  MONTHS AFTER THE EFFECTIVE DATE OF THIS
 SUBDIVISION.  THE  COMMISSIONER OR HIS OR HER DESIGNEE SHALL UPDATE THIS
 LIST ON AN ANNUAL BASIS. THE COMMISSIONER, IN CONSULTATION WITH  EXPERTS
 IN  HEALTH  CARE ACCESS, PATIENT ADVOCACY, TYPES OF HEALTH CARE THAT ARE
 FREQUENTLY INACCESSIBLE, AND HOSPITAL  ADMINISTRATION  SHALL  PROMULGATE
 RULES  AND  REGULATIONS  CREATING STANDARDIZED LANGUAGE FOR THIS LIST TO
 ENSURE THAT  IT  IS  READILY  UNDERSTANDABLE  TO  PATIENTS,  PROSPECTIVE
 PATIENTS, AND MEMBERS OF THE PUBLIC.
   (C)  WITHIN  ONE  YEAR  OF  THE EFFECTIVE DATE OF THIS SUBDIVISION AND
 EVERY FOUR YEARS THEREAFTER, THE COMMISSIONER SHALL SUBMIT A  REPORT  TO
 THE  TEMPORARY  PRESIDENT  OF THE SENATE AND THE SPEAKER OF THE ASSEMBLY
 REGARDING POLICY-BASED EXCLUSIONS IN THE STATE AND THE  IMPACT  OF  SUCH
 POLICY-BASED  EXCLUSIONS ON PATIENTS' ABILITY TO ACCESS QUALITY, COMPRE-
 HENSIVE, AFFORDABLE CARE NEAR  THEIR  RESIDENCES  AND  WHETHER  AND  HOW
 ACCESS  TO  CARE VARIES BY COMMUNITY, AS WELL AS BY RACE, ETHNICITY, AND
 SOCIOECONOMIC STATUS, ACROSS THE STATE. THE REPORT SHALL BE MADE PUBLIC-
 LY AVAILABLE ON THE DEPARTMENT'S WEBSITE.
   (D) THE COMMISSIONER OR HIS OR HER DESIGNEE SHALL EVALUATE AND  ENSURE
 COMMUNITY  AWARENESS OF POLICY-BASED EXCLUSIONS AND THE WEBSITE REQUIRED
 PURSUANT TO PARAGRAPH (B) OF THIS SUBDIVISION.
   (E) FOR THE PURPOSES OF THIS  SUBDIVISION,  "POLICY-BASED  EXCLUSIONS"
 SHALL MEAN NON-CLINICAL CRITERIA, RULES, OR POLICIES, WHETHER WRITTEN OR
 UNWRITTEN, THAT RESTRICT MEDICAL PERSONNEL AT THAT GENERAL HOSPITAL FROM
 PROVIDING  TYPES  OF  CARE  THAT  THE  MEDICAL PERSONNEL ARE LICENSED TO
 PROVIDE AND THAT THE GENERAL HOSPITAL IS LICENSED  TO  PROVIDE  OR  THAT
 RESTRICT THE PROVISION OF CARE TO CATEGORIES OF PATIENTS ON THE BASIS OF
 ANY CHARACTERISTIC PROTECTED UNDER SECTION TWO HUNDRED NINETY-SIX OF THE
 EXECUTIVE  LAW THAT THE GENERAL HOSPITAL IS LICENSED TO PROVIDE.  "POLI-
 CY-BASED EXCLUSIONS" SHALL INCLUDE, BUT NOT BE  LIMITED  TO,  OBJECTIONS
 UNDER  SECTION  TWENTY-NINE HUNDRED NINETY-FOUR-N OR TWENTY-NINE HUNDRED
 EIGHTY-FOUR OF THIS CHAPTER AND 10 NYCCRR § 405.9(B)(10).  "POLICY-BASED
 EXCLUSIONS" SHALL NOT INCLUDE RESTRICTIONS BASED ON LACK  OF  EQUIPMENT,
 AVAILABLE BED SPACE IN THE FACILITY, OR INSURANCE DENIAL.
   (F)  THE  COMMISSIONER MAY PROMULGATE ADDITIONAL RULES AND REGULATIONS
 AS MAY BE NECESSARY AND PROPER TO CARRY OUT EFFECTIVELY  THE  PROVISIONS
 OF THIS SUBDIVISION.
   § 3. Subdivision 1 of section 2803 of the public health law is amended
 by adding a new paragraph (m) to read as follows:
   (M)  THE  STATEMENT  REGARDING  PATIENT  RIGHTS  AND RESPONSIBILITIES,
 REQUIRED PURSUANT TO PARAGRAPH (G) OF THIS SUBDIVISION, SHALL INCLUDE  A
 LINK  TO  THE  SECTION OF THE DEPARTMENT'S WEBSITE REQUIRED IN PARAGRAPH
 (B) OF SUBDIVISION TWELVE  OF  THIS  SECTION.  EACH  GENERAL  HOSPITAL'S
 WEBSITE  SHALL  PROMINENTLY LINK TO THE DEPARTMENT'S WEBSITE REQUIRED IN
 PARAGRAPH (B) OF SUBDIVISION TWELVE OF THIS  SECTION.  THE  COMMISSIONER
 MAY  PROMULGATE  RULES AND REGULATIONS AS MAY BE NECESSARY AND PROPER TO
 CARRY OUT EFFECTIVELY THE PROVISIONS OF THIS PARAGRAPH.
   § 4. Subsection (a) of section 3217-a of the insurance law is  amended
 by adding a new paragraph 22 to read as follows:
   (22)(A)  AN  EXPLANATION  OF POLICY-BASED EXCLUSIONS AND THE FACT THAT
 SOME GENERAL HOSPITALS MAY HAVE POLICY-BASED EXCLUSIONS,  ALONG  WITH  A
 LINK  TO  THE WEBSITE REQUIRED PURSUANT TO SUBDIVISION TWELVE OF SECTION
 TWENTY-EIGHT HUNDRED THREE OF THE PUBLIC HEALTH LAW.

 S. 5400                             3
 
   (B) FOR THE PURPOSES  OF  THIS  PARAGRAPH,  "POLICY-BASED  EXCLUSIONS"
 SHALL MEAN NON-CLINICAL CRITERIA, RULES, OR POLICIES, WHETHER WRITTEN OR
 UNWRITTEN, THAT RESTRICT MEDICAL PERSONNEL AT THAT GENERAL HOSPITAL FROM
 PROVIDING  TYPES  OF  CARE  THAT  THE  MEDICAL PERSONNEL ARE LICENSED TO
 PROVIDE  AND  THAT  THE  GENERAL HOSPITAL IS LICENSED TO PROVIDE OR THAT
 RESTRICT THE PROVISION OF CARE TO CATEGORIES OF PATIENTS ON THE BASIS OF
 ANY CHARACTERISTIC PROTECTED UNDER SECTION TWO HUNDRED NINETY-SIX OF THE
 EXECUTIVE LAW THAT THE GENERAL HOSPITAL IS LICENSED TO PROVIDE.   "POLI-
 CY-BASED  EXCLUSIONS"  SHALL  INCLUDE, BUT NOT BE LIMITED TO, OBJECTIONS
 UNDER SECTION TWENTY-NINE HUNDRED NINETY-FOUR-N OR  TWENTY-NINE  HUNDRED
 EIGHTY-FOUR  OF  THE  PUBLIC  HEALTH  LAW  AND 10 NYCCRR § 405.9(B)(10).
 "POLICY-BASED EXCLUSIONS" SHALL NOT INCLUDE RESTRICTIONS BASED  ON  LACK
 OF EQUIPMENT, AVAILABLE BED SPACE IN THE FACILITY, OR INSURANCE DENIAL.
   § 5. Subsection (a) of section 4324 of the insurance law is amended by
 adding a new paragraph 23 to read as follows:
   (23)(A)  AN  EXPLANATION  OF POLICY-BASED EXCLUSIONS AND THE FACT THAT
 SOME GENERAL HOSPITALS MAY HAVE POLICY-BASED EXCLUSIONS,  ALONG  WITH  A
 LINK  TO  THE WEBSITE REQUIRED PURSUANT TO SUBDIVISION TWELVE OF SECTION
 TWENTY-EIGHT HUNDRED THREE OF THE PUBLIC HEALTH LAW.
   (B) FOR THE PURPOSES  OF  THIS  PARAGRAPH,  "POLICY-BASED  EXCLUSIONS"
 SHALL MEAN NON-CLINICAL CRITERIA, RULES, OR POLICIES, WHETHER WRITTEN OR
 UNWRITTEN, THAT RESTRICT MEDICAL PERSONNEL AT THAT GENERAL HOSPITAL FROM
 PROVIDING  TYPES  OF  CARE  THAT  THE  MEDICAL PERSONNEL ARE LICENSED TO
 PROVIDE AND THAT THE GENERAL HOSPITAL IS LICENSED  TO  PROVIDE  OR  THAT
 RESTRICT THE PROVISION OF CARE TO CATEGORIES OF PATIENTS ON THE BASIS OF
 ANY CHARACTERISTIC PROTECTED UNDER SECTION TWO HUNDRED NINETY-SIX OF THE
 EXECUTIVE  LAW THAT THE GENERAL HOSPITAL IS LICENSED TO PROVIDE.  "POLI-
 CY-BASED EXCLUSIONS" SHALL INCLUDE, BUT NOT BE  LIMITED  TO,  OBJECTIONS
 UNDER  SECTION  TWENTY-NINE HUNDRED NINETY-FOUR-N OR TWENTY-NINE HUNDRED
 EIGHTY-FOUR OF THE PUBLIC HEALTH  LAW  AND  10  NYCCRR  §  405.9(B)(10).
 "POLICY-BASED  EXCLUSIONS"  SHALL NOT INCLUDE RESTRICTIONS BASED ON LACK
 OF EQUIPMENT, AVAILABLE BED SPACE IN THE FACILITY, OR INSURANCE DENIAL.
   § 6. Nothing in this act shall be construed  to  permit  or  authorize
 denials  of  care  or  discrimination in the provision of health care or
 health insurance. Compliance with this act does not reduce or limit  any
 liability  for  general hospitals in connection with policy-based exclu-
 sions, including violations of state or federal law.
   § 7. Severability clause. If any clause, sentence, paragraph, subdivi-
 sion, section or part of this act shall be  adjudged  by  any  court  of
 competent  jurisdiction  to  be invalid, such judgment shall not affect,
 impair, or invalidate the remainder thereof, but shall  be  confined  in
 its  operation  to the clause, sentence, paragraph, subdivision, section
 or part thereof directly involved in the controversy in which such judg-
 ment shall have been rendered. It is hereby declared to be the intent of
 the legislature that this act would  have  been  enacted  even  if  such
 invalid provisions had not been included herein.
   §  8. This act shall take effect six months after it shall have become
 a law. Effective immediately, the addition, amendment and/or  repeal  of
 any  rule  or regulation necessary for the implementation of this act on
 its effective date are authorized to be made and completed on or  before
 such effective date.