S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   8507
 
                           I N  A S S E M B L Y
 
                              January 4, 2024
                                ___________
 
 Introduced  by M. of A. SOLAGES -- read once and referred to the Commit-
   tee on Governmental Employees
 
 AN ACT to amend the civil service law, in relation to health care claims
   data from the Empire Plan; and to amend a chapter of the laws of 2023,
   amending the civil service law relating to certain reports relating to
   health benefits for state and retired state employees, as proposed  in
   legislative bills numbers S.  4097-B and A. 5817-A, in relation to the
   effectiveness thereof
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Paragraph (b) of subdivision 9 of section 162 of the  civil
 service  law,  as  added  by a chapter of the laws of 2023, amending the
 civil service law relating to certain reports relating to  health  bene-
 fits  for  state and retired state employees, as proposed in legislative
 bills numbers S. 4097-B and A.  5817-A, is amended to read as follows:
   (b) (I) As soon as practicable, but not later than December  first  of
 each  year,  the department shall collect and analyze health care claims
 data FROM THE EMPIRE PLAN,  OR  ITS  SUCCESSOR,  to  develop,  and  make
 publicly  available, a New York state health benefit plan hospital pric-
 ing report. [The president must collect health  care  claims  data  from
 both  health  insurers  and health maintenance organizations relating to
 the "in-network negotiated rate" as such term is defined in, and limited
 by, the transparency in coverage final rule or successor federal law, as
 prepared for machine-readable files, as likewise defined by  the  trans-
 parency in coverage final rule or successor federal law, and utilization
 of  hospital  services by active employees, retired employees, and their
 dependents receiving benefits from  the  prior  state  fiscal  year,  in
 accordance with provisions under this article] SUCH REPORT SHALL EXCLUDE
 OPTIONAL  BENEFIT  PLAN  HEALTH CARE CLAIMS DATA AND CLAIMS FOR MEDICARE
 PRIMARY INDIVIDUALS. The report[, which shall not identify the  plan  by
 name,]  shall  include, but not be limited to, a comparative analysis of
 actual hospital in-network [negotiated rates] ALLOWED AMOUNTS  and  out-
 of-network  allowed  amounts[,  as  such terms are defined in this para-
 graph, by the plan,] for each hospital facility LOCATED IN THE STATE  OF
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD08351-07-4
 A. 8507                             2

 NEW  YORK  identified  by  name  and  CMS  certification number (CCN) or
 successor identifier, based on the following service  categories:  [(i)]
 (A)  inpatient  hospital,  [(ii)]  (B)  outpatient hospital, [(iii)] (C)
 emergency  room services, and [(iv)] (D) physician services provided [at
 the hospital] (1) DURING AN INPATIENT HOSPITAL ADMISSION AND (2) AS PART
 OF AN OUTPATIENT VISIT OR IN CONNECTION WITH THE PROVISION OF  EMERGENCY
 ROOM  SERVICES, EXCEPT TO THE EXTENT THAT THE DEPARTMENT DETERMINES THAT
 THE ANALYSIS OF PHYSICIAN  SERVICES  IS  NOT  TECHNICALLY  FEASIBLE  AND
 EXPLAINS THE BASIS FOR SUCH DETERMINATION.
   (II)  The  report  shall also include the in-network [negotiated rate]
 ALLOWED AMOUNT and out-of-network allowed amount per  service  [as  such
 terms  are  defined  in this paragraph] per hospital facility on the top
 twenty services by volume within each of the following  service  catego-
 ries:  (A)  inpatient,  (B) outpatient, (C) emergency room services, and
 (D) physician services provided (1) DURING AN INPATIENT HOSPITAL  ADMIS-
 SION  AND  (2)  AS PART OF AN OUTPATIENT VISIT OR IN CONNECTION WITH THE
 PROVISION OF EMERGENCY ROOM SERVICES, EXCEPT  TO  THE  EXTENT  THAT  THE
 DEPARTMENT  DETERMINES  THAT  THE  ANALYSIS OF PHYSICIAN SERVICES IS NOT
 TECHNICALLY FEASIBLE AND EXPLAINS THE BASIS FOR  SUCH  DETERMINATION  at
 [the]  EACH  hospital LOCATED IN THE STATE OF NEW YORK. The report shall
 compare, TO THE BEST OF THE DEPARTMENT'S ABILITY, the in-network  [nego-
 tiated rates] ALLOWED AMOUNTS and out-of-network allowed amounts [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] TWO years of hospital in-network [negoti-
 ated rates] ALLOWED AMOUNTS and out-of-network allowed amounts for  such
 services to [establish] ILLUSTRATE trends in hospital prices. The report
 shall also include an all-plan aggregated total yearly spend by hospital
 facility  identified  by  name  and  CMS  certification  number (CCN) or
 successor identifier. In preparing the report, the president shall  take
 appropriate  steps  to ensure that individual insurer's or health plan's
 confidential proprietary pricing information is maintained as  confiden-
 tial to the extent permissible by law. Such report shall be delivered to
 the  legislative fiscal committees, the chairs of the legislative health
 care committees, the chair of the  senate  civil  service  and  pensions
 committee,  and  the  chair  of  the  assembly committee on governmental
 employees, on or before December thirty-first of  each  year,  and  such
 report shall be posted on the department's website no later than January
 first  of the following calendar year. For purposes of this subdivision,
 "health care claims data" means  any  HOSPITAL  claims  [for  inpatient,
 outpatient,  or ambulatory surgical services or other services normally]
 paid by the [third-party payer] HEALTH BENEFIT PLAN,  OR  ITS  DESIGNEE,
 FOR  THE  SERVICE CATEGORIES LISTED IN THIS SUBDIVISION on form UB-04 or
 successor forms, with UB-04 being the billing  form  identified  by  the
 Centers for Medicare and Medicaid Services.
   §  2.  Section  2 of a chapter of the laws of 2023, amending the civil
 service law relating to certain reports relating to health benefits  for
 state  and  retired  state  employees,  as proposed in legislative bills
 numbers S. 4097-B and A.  5817-A, is amended to read as follows:
   § 2. This act shall take effect [immediately] JANUARY 1, 2024.
   § 3. This act shall take effect immediately; provided,  however,  that
 section  one  of  this act shall take effect on the same date and in the
 same manner as a chapter of the laws of 2023, amending the civil service
 law relating to certain reports relating to health  benefits  for  state
 and retired state employees, as proposed in legislative bills numbers S.
 4097-B and A. 5817-A, takes effect.