BILL NUMBER: S4785A
SPONSOR: RIVERA
 
TITLE OF BILL:
An act to amend the public health law, in relation to requirements for
collective negotiations by health care providers with certain health
benefit plans
 
PURPOSE:
Enacts the Health Care Consumer and Provider Protection Act relating to
collective negotiations by health care providers with certain health
care plans.
 
SUMMARY OF SPECIFIC PROVISIONS:
Section 1 provides the statement of legislative intent.
Section 2 cites the act to be known as the "Health Care Consumer and
Provider Protection Act."
Section 3 adds a new title III to article 49 of the public health law
known as "Collective Negotiations By Health Care Providers With Health
Care Plans." For the purpose of this title, this section defines the
terms "health care plan," "person," "strike," "substantial market share
in a business line," and "health care provider." Guidelines pertaining
to negotiations, utilization review plans, and other terms and condi-
tions are included in this section.
Section 4 provides the effective date.
 
JUSTIFICATION:
This legislation authorizes collective bargaining for independent
contractor healthcare providers or entities that employ or utilize
healthcare providers to provide healthcare services, including physi-
cians. This bill would create a system under which the State would
closely monitor those negotiations and any negotiations involving fee-
related matters would only be permitted when an individual managed care
plan controls a substantial share of the managed care market. The
Commissioner of Health would be authorized to approve the healthcare
providers' representatives' request to negotiate based upon the benefits
to be achieved for providers and consumers of health services and is
required to review any offer submitted to the health care providers'
representatives prior to sharing with affected health care providers.
The legislation would also create a mechanism for resolving disputes
when there is an impasse or when the health plan refuses to negotiate.
The bill would also direct the Commissioner of Health, with input from
the Superintendent of Department of Financial Services (DFS) and the
Attorney General, to approve any final agreement as well as monitor the
implemented agreements to ensure continued compliance with the law.
Importantly, this legislation would not authorize strikes or concerted
action by healthcare providers in response to negotiations with health-
care plans.
Currently, federal antitrust laws prohibit individual healthcare provid-
ers from collectively negotiating any provisions of contracts they sign
with managed care entities. This bill would allow health care providers
in New York State to conduct some collective negotiations by creating a
system under which the state would closely monitor those negotiations,
facilitate resolution of negotiation impasses, and actively monitor
implementation of agreements. Negotiations involving fee-related
matters would be prohibited unless an individual managed care plan
controls a substantial share of the managed care market.
Giving health care providers greater ability to advocate for patients in
contract negotiations is critical since large health maintenance organ-
izations (HMO) control huge shares of the health insurance market, both
in New York and across the country. In the last few years, we have seen
the mergers of United Healthcare with Oxford, MVP with Preferred Care,
and Wellpoint with Welichoice (Empire). As of March 2008, almost 75% of
the enrollees in managed care plans in New York State were enrolled in
just five health plans (GM/HIP, United/Oxford/Americhoice, Excel!us,
Empire, and MVP/Preferred Care). We have also seen an emerging trend of
longtime not for profit health insurance companies such as Empire and
HIP seeking to convert to for-profit status.
Due to the current imbalance of negotiating power in favor of the
managed care plans, physicians and other health care providers are
offered take-it-or-leave-it contracts by health plans that significantly
hamper their ability to provide quality patient care. These contracts
permit burdensome processes and unjustifiably long wait times for
obtaining pre-authorization to provide needed patient care; impose limi-
tations on whom a physician or other health care provider may refer a
patient for necessary care; permit demands for refunds of payments long
after the time that such payments were originally made; permit health
plans to make major changes to key elements of a contract without physi-
cian or other health care provider consent; and cede to physicians and
other health care providers the legal consequences for patients harmed
by health plan utilization review decisions.
This bill, by allowing independent contractor physicians and health care
providers to conduct some collective negotiations while being closely
monitored by the State, would give physicians and health care providers
greater ability to advocate for patients in contract negotiations. This
bill would create a system under which the state would closely monitor
those negotiations, and any negotiations involving fee-related matters
would only be permitted when an individual managed care plan controls a
substantial share of the managed care market. This legislation would not
authorize strikes or boycotts of health benefit plans by physicians.
 
LEGISLATIVE HISTORY:
2023: S4785 (Rivera) Referred to Health
2022: S1575 (Rivera) Referred to Health
2021: S1575 (Rivera) Referred to Health
2020: S3462 (Rivera) Referred to Health
2019: S3462 (Rivera) - Referred to Health
 
FISCAL IMPLICATIONS:
Undetermined.
 
EFFECTIVE DATE:
This act shall be effective 120 days after it shall have become a law,
provided that the department of health may promulgate and establish any
regulations pursuant hereto prior to the effective date.