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--A
 
                        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
 
 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-
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD08351-03-3
              

 S. 4097--A                          2
 
 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 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, 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, AND (III)  EMERGENCY  ROOM
 SERVICES;  AND  THE  REPORT SHALL ALSO INCLUDE THE PRICE PER SERVICE AND
 GROSS AMOUNT SPENT PER HOSPITAL FACILITY  ON  THE  TOP  TWENTY  SERVICES
 WITHIN  EACH  OF  THE  FOLLOWING  SERVICE CATEGORIES: (A) INPATIENT, (B)
 OUTPATIENT AND (C) EMERGENCY ROOM SERVICES.   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  EXPENDI-
 TURES  FOR  THE PLAN.  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 SUBMITTED TO 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.