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GOVERNOR SIGNS BILL THAT PROVIDES NEW RIGHTS TO CONSUMERS AND PHYSICIANS IN MANAGED CARE PLANS

Governor Eliot Spitzer today signed far-reaching legislation to broaden the rights of health care consumers, physicians and hospitals associated with managed care health plans. The new legislation provides key legal protections to address long-standing problems of patients who feel caught in the middle between hospital and insurer disputes. The legislation also helps untangle the complicated maze of rules that have been developed by hospitals and insurers so that clear and timely health care decisions can be made.

“This legislation secures important new rights for health care consumers, doctors and hospitals and represents the type of coordination among all stakeholders in the health care system that will be necessary in our march toward universal health coverage for all New Yorkers,” said Governor Spitzer. “I thank Commissioner Daines and Superintendent Dinallo for bringing together representatives from across the healthcare sector to correct the long-standing flaws in the current system so that we can better provide consumers with the level of care they deserve.”

The new health protections were the result of a cooperative effort among government, consumers, doctors, hospitals and health plans - stakeholders that have long been unable to come together to address a system that does not work for anyone in the system. Health Commissioner Richard F. Daines, M.D., and Insurance Superintendent Eric Dinallo gathered stakeholders from key organizations across the health care system to diagnose the problems with the existing system and develop the innovative solutions that ultimately translated into this enacted legislation.

Organizations that participated in this process include the Medical Society of the State of New York, the Healthcare Association of New York State, New York Health Plan Association, Empire Blue Cross Blue Shield, Excellus Blue Cross Blue Shield, the Suburban Health Care Alliance and the Greater New York Hospital Association.

The result is a package of legal protections that advances consumer and provider rights in several crucial areas:

• Limits a health plan’s ability to deny care that it had already preauthorized;
• Gives consumers the ability to appeal to an independent reviewer when a health plan denies a request to see an out-of-network specialist for a service not available in their plan network;
• Provides for a cooling-off period so that consumers aren’t needlessly alarmed by notices that a hospital may no longer be in a health plan’s network when a contract negotiation between the health plan and a hospital goes down to the wire;
• Requires managed care plans to report key data on health care quality that the Department of Health can then publish for consumers;
• Sets a time limit of 15 months for hospitals to submit claims to health plans when they have provided out-of-network services to patients.

Senator Kemp Hannon, who sponsored the bill in the Senate, said: “Improving the processes for payment and access are essential steps to improving delivery of quality healthcare services for all New Yorkers. This measure is an important step in that reform.”

Assembly Health Committee Chair Richard N. Gottfried, who sponsored the bill in the Assembly, said: “This is an important step ahead for making sure health care decisions are based on what is right for the patient, and for protecting patients and health care providers in dealing with health plans. Governor Spitzer is helping get New York back on track in health care.”

Legislative Counsel of New Yorkers for Accessible Health Coverage, Mark Scherzer, said: “Despite the strong protections of New York's Managed Care Consumer Bill of Rights, in the years since its enactment many consumers have confronted frustration and considerable financial harm when their health plans refuse to pay for services they have already authorized and when they deny access to out of network specialists offering services unavailable in the health plan's network. This law will take important steps toward protecting consumers from those harms.”

President of the Medical Society of the State of New York, Robert Goldberg, DO, said: “This legislation builds upon the managed care reforms enacted last year and takes further steps to address the difficulties encountered by patients seeking to obtain the care they need as well the physicians and hospitals that provide this care. We want particularly to thank both the Department of Insurance and the Department of Health for their leadership on this issue. We look forward to working with Governor Spitzer and the Legislature to achieve further needed reforms. By doing so, we better assure our ultimate attainment of Governor Spitzer’s goal, as stated in his Health Message earlier this year that patients can access needed care in a timely manner and that reimbursement for such care is not inappropriately denied or delayed.”

President of the Healthcare Association of New York State, Daniel Sisto, said: “This legislation will result in significant improvements to the health care system by better balancing consumer protection, provider rights and payer concerns. HANYS recognizes the critical role that the State Departments of Insurance and Health provided in leading these discussions and forging a consensus among key stakeholders in health care. We look forward to an era of progressive engagement and future collaboration with the Governor, the agencies, and the Legislature as we continue to work toward managed care reform.”

President of the Health Plan Association, Paul Macielak, said: “This legislation is the result of all parties working together in the spirit of ‘putting patients first’. It was important to have both payers and providers at the table, and for all parties willing to give and take, to reach this final bill that carefully balances consumer protections, provider rights and plan operations. Everyone had equal input into the negotiations and in the end, the ‘winners,’ really, are New York’s health care consumers. The Superintendent of Insurance and Commissioner of Health and their key staff were instrumental in bringing the parties together and providing valuable guidance throughout the discussions to ensure any final compromise would be balanced for all.”

President of Empire Blue Cross Blue Shield, Mark Wagar, said: “This bill is a reflection of the collaboration that can exist between payers, providers and state government when we come together to find ways to improve the health care delivery system and enhance the quality and affordability of care for all New Yorkers.”

CEO of Excellus Blue Cross Blue Shield, David Klein, said: “This bill is yet another example of the Governor facilitating a consensus among stakeholders to enhance consumer protections and create some uniformity in the marketplace.”

The Suburban Health Care Alliance, which includes the Westchester County Association, the Northern Metropolitan Hospital Association, the Nassau-Suffolk Hospital Council, and business leaders from across New York State, issued the following statement: “This legislation is a major step forward for health care consumers and providers. It will ensure that if a health insurer authorizes a medical procedure to move forward, the provider will be guaranteed payment for providing that service. While this is common business practice, it has not always been the rule. Now it will be. This new law will enable health care providers to spend more time delivering the best possible services to their patients, rather than wasting time fighting insurance companies to get paid for services that had previously been authorized. Insurance Superintendent Dinallo and Health Commissioner Daines, along with legislators from both houses and both parties, deserve the gratitude of all New Yorkers for helping to make this new legislation a reality.”