NYSCOP Supports Managed Care Bill Signed Into Law

ALBANY, NY (07/29/2009)(readMedia)-- Today Governor David A. Paterson signed a managed care measure (S.5472-A/8402-A) into law, which enhances provider and consumer rights without exorbitantly increasing the cost of coverage.

The bill is a product of cooperation and negotiation between health care stakeholders and New York's legislative staff and leaders. It builds upon the Managed Care Reform Act enacted in 1996, the External Appeal Law enacted in 1998 and managed care legislation enacted in 2006 and 2007 to provide further protections to consumers and providers.

"This measure was a long time in the making and we are proud of the accomplishment," said Mark Wagar, president and CEO, Empire BlueCross BlueShield. "With all stakeholders at the table, we were able to come together and enhance the way care and services are delivered in New York. This bill improves consumer and provider protections by instituting a series of managed care reforms, which will ensure better access to health care services for consumers and improve protections for providers."

Specifically, the measure includes among its many provisions:

  • Creates the potential for greater collaboration between plans and providers by reducing administrative denials, improving coordination of benefits, establishing a process for provisional credentialing of providers, incentivizing the timely submission of claims, accelerating the payment of claims submitted electronically, and creates a process for plans to recoup the overpayment of certain claims by providers;
  • Expands consumer protections currently applicable to HMO products, such as grievance procedures, transitional care and specialist care, to HMO look-alike products (PPO and EPO products);
  • Affords greater access to treatment for consumers diagnosed with a "rare disease"; and
  • Provides an extended time period for consumers to submit claims.

"We are all striving for the same outcome - to provide better access to quality, affordable health care," said David Klein, president and CEO, Excellus BlueCross BlueShield. "Regrettably, without stakeholder involvement, measures that might look good at first glance may only do more harm than good. Thankfully in this circumstance, all parties were able to come together and improve upon the original managed care measure - creating a bill that will ultimately strengthen New York's health care system. We must continue to have this type of collaboration - the health of all New Yorker's truly depends on it."

This is the fourth consecutive year that various stakeholders have negotiated legislation. The Senate has passed each version the past four years. The 2008 bill, which passed the Senate, failed to pass the Assembly at the end of the 2008 legislative session. This year's bill incorporates, in its entirety, the 2008 bill, plus adds some additional provider and consumer protections.

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