Requires Medicare and Medicaid managed care providers to provide coverage for certain out-of-network health care when the patient has a long term relationship with a medical professional who is not a recurring provider under the managed care provider's network.
Summary
Bill A07239, known as the 'Patient Choice of Health Care Provider Protection Act,' seeks to amend the social services law to require Medicare and Medicaid managed care providers to cover out-of-network health care services under specific circumstances. The bill stipulates that if a patient has established a long-term relationship with a healthcare professional—defined as a treatment relationship lasting at least 90 days with a minimum of ten visits—the managed care provider must approve a single patient agreement with that professional, even if they are not part of the provider's network. The healthcare professional will be compensated at the managed care provider's in-network rates, subject to certain conditions.
The bill aims to enhance patient autonomy in choosing healthcare providers by ensuring that long-term relationships with healthcare professionals are honored, even when those professionals are outside the managed care network. This is particularly significant for patients who may have developed trust and continuity of care with their providers, which is crucial for effective treatment. The provisions also include stipulations for annual deductibles and co-insurance, as determined by the commissioner of health, ensuring that while patients can access their preferred providers, there are still cost considerations in place.
The impact of this legislation on state laws is notable, as it modifies existing provisions in the social services law regarding managed care coverage. By mandating coverage for certain out-of-network services, the bill could lead to increased costs for managed care providers, potentially affecting their operational models. Furthermore, it may set a precedent for similar legislative efforts aimed at enhancing patient choice and access to care in other areas of healthcare legislation.
The sentiment surrounding the bill appears to be supportive, particularly among advocates for patient rights and healthcare access. However, there may be concerns from managed care providers regarding the financial implications and operational challenges posed by the requirement to cover out-of-network services. The discussions around the bill have highlighted the importance of balancing patient choice with the sustainability of managed care systems, indicating a complex landscape of opinions on the matter.
Impact
The bill modifies the social services law to require managed care providers to cover out-of-network services for patients with long-term relationships with their healthcare providers. This change could lead to increased access to care for patients but may also impose additional financial burdens on managed care systems, potentially impacting their ability to manage costs effectively. The requirement for coverage under specific conditions could prompt further legislative discussions on patient rights and managed care regulations in New York.
Sentiment
Overall, the sentiment around Bill A07239 is positive, particularly among patient advocacy groups who support increased access to healthcare providers. However, there are concerns from managed care organizations about the potential financial impact and the feasibility of implementing such requirements. The discussions indicate a recognition of the importance of patient-provider relationships while also acknowledging the challenges faced by managed care systems.
Contention
Notable points of contention include the financial implications for managed care providers who may be required to cover out-of-network services, which could lead to increased costs and operational challenges. Advocates for the bill argue that patient choice and continuity of care should take precedence, while some managed care representatives express concerns about the sustainability of their networks and the potential for increased premiums or reduced services as a result.
Same As
Requires Medicare and Medicaid managed care providers to provide coverage for certain out-of-network health care when the patient has a long term relationship with a medical professional who is not a recurring provider under the managed care provider's network.
Requires Medicare and Medicaid managed care providers to provide coverage for certain out-of-network health care when the patient has a long term relationship with a medical professional who is not a recurring provider under the managed care provider's network.
Requires Medicare and Medicaid managed care providers to provide coverage for certain out-of-network health care when the patient has a long term relationship with a medical professional who is not a recurring provider under the managed care provider's network.
Ensures Medicaid spending results in real access to medical care by increasing transparency in Medicaid managed care network adequacy reviews and safeguarding continuity of care in light of recent major provider network withdrawals.
An Act Requiring The Development Of A Program For Providing Medicaid, Medicare And Health Care Coverage For A Network Of Paid Or Volunteer Attendants To Assist With The Transporting Of Patients With A Physical Disability.
Requires Medicaid and NJ FamilyCare managed care organizations to offer patient-centered medical home model or other alternative payment model to primary care providers.