S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   4097
 
                        2023-2024 Regular Sessions
 
                             I N  S E N A T E
 
                             February 3, 2023
                                ___________
 
 Introduced by Sen. GOUNARDES -- read twice and ordered printed, and when
   printed to be committed to the Committee on Civil Service and Pensions
 
 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:
 
   Section  1.  Subdivision 9 of section 162 of the civil service law, as
 added by chapter 147 of the laws of 2014, is amended to read as follows:
   9. (A) (I) As soon as is practicable, but no later than the  first  of
 September,  two  thousand  fourteen, the department shall, upon request,
 but no more frequently than semi-annually, provide to any  participating
 employer  a  standard  report which contains data relating to the use of
 benefits by persons covered under the plan by such employer. Such report
 shall include: premiums paid by month for  each  month  covered  in  the
 report  and  paid  claims  by  month  for  the  following  categories of
 services: inpatient hospital, outpatient hospital, in  network  medical,
 out  of network medical, prescription drugs, and treatment of behavioral
 conditions, each reported separately. To the extent allowed by state and
 federal privacy laws, such report shall also contain claims  information
 for  individual claimants for claims in excess of fifty thousand dollars
 that were paid in any of the months covered by the report.
   (II) The department shall provide such reports  to  any  participating
 employer, upon request submitted on or after the first of April for data
 from  the  first  of January through the thirty-first of December of the
 prior year, and on or after the first of September  for  data  from  the
 first  of  June of the prior year through the thirty-first of May of the
 current year, within thirty days of receipt of  said  request.  However,
 requests  submitted  in the two thousand fourteen calendar year shall be
 provided as soon as practicable, but no later than the first of  Septem-
 ber,  two thousand fourteen, or within thirty days after said request if
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD08351-01-3
 S. 4097                             2
              

 
 request is submitted on or after the first of August, two thousand four-
 teen.
   (B)  AS SOON AS PRACTICABLE, BUT NOT LATER THAN DECEMBER FIRST OF EACH
 YEAR, THE DEPARTMENT SHALL COLLECT AND ANALYZE HEALTHCARE CLAIMS DATA TO
 DEVELOP, AND MAKE PUBLICLY AVAILABLE, A NEW YORK  STATE  HEALTH  BENEFIT
 PLAN  HOSPITAL  PRICING  REPORT.  THE  PRESIDENT MUST COLLECT HEALTHCARE
 CLAIMS DATA RELATING TO THE PRICE AND UTILIZATION OF  HOSPITAL  BENEFITS
 BY  ACTIVE  EMPLOYEES, RETIRED EMPLOYEES, AND THEIR DEPENDENTS RECEIVING
 BENEFITS FROM THE PRIOR STATE FISCAL YEAR, IN ACCORDANCE WITH PROVISIONS
 UNDER THIS ARTICLE.  THE REPORT SHALL INCLUDE, BUT NOT BE LIMITED TO,  A
 COMPARATIVE  ANALYSIS  OF  HOSPITAL PRICES PAID BY THE PLAN BASED ON THE
 FOLLOWING SERVICE CATEGORIES:  (I) INPATIENT HOSPITAL,  (II)  OUTPATIENT
 HOSPITAL,  AND  (III)  EMERGENCY  ROOM SERVICES; AND WITHIN EACH SERVICE
 CATEGORY THE REPORT SHALL INCLUDE THE PRICE PER SERVICE AND GROSS AMOUNT
 SPENT ON THE TOP INPATIENT, OUTPATIENT AND EMERGENCY ROOM SERVICES WITH-
 IN EACH SERVICE CATEGORY.  THE REPORT SHALL COMPARE THE  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 FOR THE PLAN.
 SUCH REPORT SHALL BE DELIVERED TO  THE  SENATE  FINANCE  COMMITTEE,  THE
 ASSEMBLY  WAYS  AND MEANS COMMITTEE, THE CHAIRS OF THE HEALTH COMMITTEES
 IN EACH HOUSE, THE CHAIR  OF  THE  SENATE  CIVIL  SERVICE  AND  PENSIONS
 COMMITTEE, AND THE CHAIR OF THE ASSEMBLY COMMITTEE ON GOVERNMENT EMPLOY-
 EES,  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 PARAGRAPH, "HEALTH-
 CARE CLAIMS DATA" MEANS ANY CLAIMS FOR INPATIENT, OUTPATIENT, OR AMBULA-
 TORY  SURGICAL  SERVICES  OR  OTHER  SERVICES  NORMALLY SUBMITTED TO THE
 THIRD-PARTY PAYER ON FORM UB-04 OR SUCCESSOR FORMS, WITH UB-04 BEING THE
 BILLING FORM IDENTIFIED BY THE FEDERAL CENTERS FOR MEDICARE AND MEDICAID
 SERVICES.
   § 2. This act shall take effect immediately.

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  4097--B
     Cal. No. 606
 
                        2023-2024 Regular Sessions
 
                             I N  S E N A T E
 
                             February 3, 2023
                                ___________
 
 Introduced by Sen. GOUNARDES -- read twice and ordered printed, and when
   printed to be committed to the Committee on Civil Service and Pensions
   --  committee  discharged,  bill amended, ordered reprinted as amended
   and recommitted to said committee  --  reported  favorably  from  said
   committee,  ordered  to  first  and  second report, ordered to a third
   reading, passed by Senate and delivered  to  the  Assembly,  recalled,
   vote  reconsidered,  restored  to  third  reading, amended and ordered
   reprinted, retaining its place in the order of third reading
 
 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:
 
   Section 1. Subdivision 9 of section 162 of the civil service  law,  as
 added by chapter 147 of the laws of 2014, is amended to read as follows:
   9.  (A)  (I) As soon as is practicable, but no later than the first of
 September, two thousand fourteen, the department  shall,  upon  request,
 but  no more frequently than semi-annually, provide to any participating
 employer a standard report which contains data relating to  the  use  of
 benefits by persons covered under the plan by such employer. Such report
 shall  include:  premiums  paid  by  month for each month covered in the
 report and  paid  claims  by  month  for  the  following  categories  of
 services:  inpatient  hospital, outpatient hospital, in network medical,
 out of network medical, prescription drugs, and treatment of  behavioral
 conditions, each reported separately. To the extent allowed by state and
 federal  privacy laws, such report shall also contain claims information
 for individual claimants for claims in excess of fifty thousand  dollars
 that were paid in any of the months covered by the report.
   (II)  The  department  shall provide such reports to any participating
 employer, upon request submitted on or after the first of April for data
 from the first of January through the thirty-first of  December  of  the
 prior  year,  and  on  or after the first of September for data from the
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD08351-05-3
 S. 4097--B                          2
 
 first of June of the prior year through the thirty-first of May  of  the
 current  year,  within  thirty days of receipt of said request. However,
 requests submitted in the two thousand fourteen calendar year  shall  be
 provided  as soon as practicable, but no later than the first of Septem-
 ber, two thousand fourteen, or within thirty days after said request  if
 request is submitted on or after the first of August, two thousand four-
 teen.
   (B)  AS SOON AS PRACTICABLE, BUT NOT LATER THAN DECEMBER FIRST OF EACH
 YEAR, THE DEPARTMENT SHALL COLLECT AND ANALYZE HEALTH CARE  CLAIMS  DATA
 TO DEVELOP, AND MAKE PUBLICLY AVAILABLE, A NEW YORK STATE HEALTH BENEFIT
 PLAN  HOSPITAL  PRICING  REPORT.  THE PRESIDENT MUST COLLECT HEALTH CARE
 CLAIMS DATA FROM BOTH HEALTH INSURERS AND HEALTH  MAINTENANCE  ORGANIZA-
 TIONS  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 LIKE-
 WISE DEFINED BY THE TRANSPARENCY 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 ARTI-
 CLE.   THE REPORT, WHICH SHALL NOT IDENTIFY  THE  PLAN  BY  NAME,  SHALL
 INCLUDE,  BUT NOT BE LIMITED TO, A COMPARATIVE ANALYSIS OF ACTUAL HOSPI-
 TAL IN-NETWORK NEGOTIATED RATES AND OUT-OF-NETWORK ALLOWED  AMOUNTS,  AS
 SUCH TERMS ARE DEFINED IN THIS PARAGRAPH, BY THE PLAN, FOR EACH HOSPITAL
 FACILITY  IDENTIFIED  BY  NAME  AND  CMS  CERTIFICATION  NUMBER (CCN) OR
 SUCCESSOR IDENTIFIER, BASED ON THE  FOLLOWING  SERVICE  CATEGORIES:  (I)
 INPATIENT  HOSPITAL,  (II)  OUTPATIENT  HOSPITAL,  (III)  EMERGENCY ROOM
 SERVICES, AND (IV) PHYSICIAN SERVICES  PROVIDED  AT  THE  HOSPITAL.  THE
 REPORT SHALL ALSO INCLUDE THE IN-NETWORK NEGOTIATED RATE AND OUT-OF-NET-
 WORK  ALLOWED AMOUNT PER SERVICE AS SUCH TERMS ARE DEFINED IN THIS PARA-
 GRAPH PER HOSPITAL FACILITY ON THE TOP TWENTY SERVICES BY VOLUME  WITHIN
 EACH OF THE FOLLOWING SERVICE CATEGORIES: (A) INPATIENT, (B) OUTPATIENT,
 (C)  EMERGENCY ROOM SERVICES, AND (D) PHYSICIAN SERVICES PROVIDED AT THE
 HOSPITAL. THE REPORT SHALL COMPARE THE IN-NETWORK NEGOTIATED  RATES  AND
 OUT-OF-NETWORK ALLOWED AMOUNTS TO THE PROCESS FOR SIMILAR SERVICES REIM-
 BURSED  UNDER  TITLE  EIGHTEEN  OF  THE SOCIAL SECURITY ACT. SUCH REPORT
 SHALL ALSO INCLUDE A COMPREHENSIVE ANALYSIS OF THE PRIOR FIVE  YEARS  OF
 HOSPITAL  IN-NETWORK NEGOTIATED RATES AND OUT-OF-NETWORK ALLOWED AMOUNTS
 FOR SUCH SERVICES TO ESTABLISH 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 CLAIMS FOR INPATIENT, OUTPATIENT, OR
 AMBULATORY SURGICAL SERVICES OR OTHER  SERVICES  NORMALLY  PAID  BY  THE
 THIRD-PARTY PAYER ON FORM UB-04 OR SUCCESSOR FORMS, WITH UB-04 BEING THE
 BILLING  FORM  IDENTIFIED  BY  THE  CENTERS  FOR  MEDICARE  AND MEDICAID
 SERVICES.
   § 2. This act shall take effect immediately.