New York Governor David A. Paterson recently signed into law three Governor’s Program bills. “We must take the necessary steps to improve our broken health care system. By making insurance coverage more accessible, we bring people into the system before they need emergency treatment, reducing the overall cost of health care to the State,” states Governor Paterson.

WHAT DOES THIS MEAN TO YOU AS AN EMPLOYER?

There are three new laws. Subject to coordination of multi-state law (a gray area), certain fully-insured plans written in states outside of New York may or may not be impacted by these laws. With respect to self-insured plans, the federal Employee Retirement Income Security Act of 1974, as amended (“ERISA”) preempts all state law mandates. As such, self-insured plans would be exempt from this legislation.

The details of this legislation are listed below:

Expand COBRA for Employees to 36 Months:
This bill will increase the period for employees who lose their jobs to continue their health insurance under COBRA from 18 to 36 months. This law is effective as of July 1, 2009, and would apply to all contracts issued, renewed, modified, amended or altered on or after that date. Therefore, this law will most likely become effective upon the first renewal of your plan on or after July 1, 2009. This will delay the effective date for most plans until January 1, 2010. Participants who would have normally been granted admission to the new plan, but had been terminated due to their COBRA period ending, will be given the possibility to resume their coverage for a total of 36 months. These qualified beneficiaries will be given 18 months of additional coverage.

Insure Dependents through Age 29:
This bill, outlined by the Governor in his State of the State address, requires insurers to allow unmarried children through age 29 – regardless of financial dependence – to be covered under a parent’s group health insurance policy. Under the new law, premiums will be paid for by families, not employers, and would cost less because coverage is under group policies rather than individual policies. The law also requires insurers to offer employers an option to purchase coverage that includes young adults as dependents in family policies through age 29. However, if the dependent is eligible for any coverage through his or her employer, or is covered by Medicare, the dependent is not covered by the legislation. Additionally, the young adults must be legal residents of New York state. This law is effective as of September 1, 2009, and would apply to all contracts issued, renewed, modified, amended or altered on or after that date. Insured group health plans will need to amend their state “mini-COBRA” notices, as well as their federal COBRA notices for this new rule. For large nationwide employers with operations in New York, consideration should be given to separate New York COBRA notices for any insured plan offerings.

Managed Care Reform:
This legislation, which is effective immediately, will make sure consumers receive the care they need and protect them against inappropriately delayed or denied claims. Some of the protections that will benefit consumers under the proposal include:

• Prohibiting insurers from treating an in-network provider as out-of-network simply because the referring provider was out-of-network
• Extending current protections for consumers in HMOs to consumers in “HMO look-alike” plans – health plans that operate the same as HMOs but are not licensed as HMOs, such as “exclusive provider organizations” or EPOs
• Reducing the prompt-pay timeframe from 45 days to 30 days for electronically submitted claims so doctors and hospitals are paid more quickly
• Reducing the time insurers have to review requests for post-hospital home health care
• Extending providers a right to request an external appeal of a concurrent denial
  
• Extending protections to doctors and hospitals when health insurers seek to recover alleged overpayments. The protections include basic notice and an opportunity to challenge the insurers’ overpayment recovery efforts.
  
• Limiting health insurers’ and HMOs’ ability to deny or delay payment of claims by sending a coordination of benefits questionnaire
  
• Permitting participating health care providers to request reconsideration of a claim that is denied as untimely and limiting penalties for untimely claims
  
• Requiring insurers and HMOs to give participating providers notice of adverse reimbursement changes to provider contracts and giving providers an opportunity to cancel the contract
  
• Requiring insurers and HMOs who fail to meet a loss-ratio requirement to make efforts to locate and pay dividends or credits to former policy holders
  
• Permitting newly licensed providers and providers moving to New York to be provisionally credentialed until the final determination is made
  
• Establishing a new external appeal standard for rare disease treatments.
  

WHAT SHOULD I DO NEXT?
For answers to commonly asked questions regarding this new legislation, please CLICK HERE. Corporate Synergies will continue to release information and guidance as to how the carriers will be administering this new legislation as it is released.

If you have any additional questions regarding the information within this eCommunication, please call Corporate Synergies at 1.866.CSG.1719 or click here to contact us today.

Source:  http://www.state.ny.us/governor/press/press_0729095.html

This alert is a legislative update designed to help you administer your employee benefits program and is not legal counsel. Please consult with an attorney for legal advice.