BILL NUMBER: S3364
SPONSOR: RIVERA
 
TITLE OF BILL:
An act to amend the public health law, in relation to establishing an
office of the state medical indemnity fund ombudsperson and a medical
indemnity fund advisory panel
 
PURPOSE:
To establish an office of the state medical fund ombudsman and a medical
indemnity fund advisory panel.
 
SUMMARY OF SPECIFIC PROVISIONS:
Section 1 amends the Public Health Law by adding new sections 2999-k and
2999-1 to establish the Medical Indemnity Fund Ombudsman and the Medical
Indemnity Fund Advisory Panel. This section provides language that
establishes the duties and responsibilities of each program. The medical
indemnity fund ombudsman will help identify, investigate, and resolve
complaints that are made by or on behalf of qualified plaintiffs. The
medical indemnity fund advisory panel serves to bring stakeholders
together to draft and amend regulations, guidelines, or policies in a
way that helps improve the fund.
Section 2 provides the effective date.
 
JUSTIFICATION:
The Medical Indemnity Fund (MIF) was created in 2011 to provide a fund-
ing source for future healthcare costs associated with birth-related
neurological injuries and to reduce medical malpractice insurance premi-
ums. MIF enrollees have either settled or won a judgment in a malprac-
tice action. Rather than receiving damages for future health care costs,
the law requires these children to be enrolled in the MIF to cover said
costs. A few years after implementation, issues began to arise regarding
reimbursement rates, access to care, coverage, and appeals within the
fund. Accordingly, the Legislature enacted Ch. 517 of 2016 to address
these concerns. Amendments to this Chapter were negotiated (Ch. 4 of
2017) at the behest of the Executive. The final result was legislation
that: clarified qualifying health care costs could not be denied on the
grounds they may incidentally benefit others in the household; increased
reimbursement rates until December 21, 2019; and required a report to be
issued by the Executive to the Legislature on or before April 1, 2017
detailing the financial condition of the MIF. The purpose of this report
was to educate the Legislature on how to proceed with any future amend-
ments to the MIF. On June 12, 2017, two da ys prior to the Senate
roundtable on the MIF, said the report was released.
At the June 14, 2017 Senate roundtable parents, attorneys, and providers
recounted their experiences and challenges with the MIF. One parent,
who is a lawyer by trade, testified to the need for a patient advocate
to educate and assist parents trying to navigate the MIF. Additionally,
many concerns were raised regarding the potential disruption that may be
caused by the transition to a new administrator scheduled to occur a few
months later. While all were assured by the Departments of Health and
Financial Services that there was a plan in the works to ensure a smooth
transition, months later complaints began coming in. The new administra-
tor was not reimbursing claims, families were unable to obtain supplies,
claims were being paid cents on the dollar, families were forced to
obtain new providers, and the new administrator was seemingly applying
new policy guidelines that were unknown to providers, enrollees, and
their families. The families with children enrolled in the MIF struggle
with enough challenges to obtain quality care for their child and they
should not have to deal with administrative hurdles and changing poli-
cies in order to obtain services and supplies needed to keep their child
alive. This legislation establishes an ombudsman to serve as a much
needed advocate for the MIF families to ensure they are educated and
able to access the services, supplies, and modifications to which they
are entitled.
Another issue raised at the roundtable by many was the need to continue
conversations, to take a deeper look into the data, and have an ongoing
process to address concerns regarding the functioning of the MIF. Much
like the workgroup proposed in the original Chapter from 2016, this
legislation establishes a MIF stakeholder advisory panel that will meet
at a minimum of twice annually to discuss ongoing issues and make recom-
mendations.
Together these protections will help ensure the MIF is functioning as
originally intended and that families are getting the care they are
entitled to and need for their children.
 
LEGISLATIVE HISTORY:
2017-18: S6948-A Hannon/A9018-A Abinanti
2019-2020: S4811/A2347 Abinanti
2021-2022: S2527-A/A4958-A Abinanti
2023-2024: S5958/A9994 Buttenschon
 
FISCAL IMPLICATIONS:
To be determined
 
EFFECTIVE DATE:
This act shall take effect on the ninetieth day after it becomes law.