In the summer of 2023, New York City Mayor Eric Adams signed the intro. He enacted Local Law 844-A, which amended the New York City Charter. Local Law 844-A directs Mayor Adams to establish an Office of Medical Accountability to increase transparency in health care prices in New York City. Health Price Transparency Acts have been enacted at the state level across the United States, but New York City became the first municipality in the nation to enact such laws. In fact, New York City Council member Julie Menin, who sponsored Local Law 844-A, said during the bill's consideration that New York City, like other states, would benefit from the positive impact of price transparency measures in other states. “The time has come to curb excessive medical prices,” he said. Signing ceremony. This law entered into force on February 18, 2024.
Duties of the Director of the Office of Medical Responsibility
Pursuant to Local Law 844-A, Mayor Adams is required to appoint the Director of the Office of Medical Accountability, who will be responsible for:
- Provide recommendations regarding medical and “hospitalization” costs, including, but not limited to, the proportion of health care costs spent on inpatient care.
- Analyze city spending on health care costs for city employees, retirees, and their dependents.
- Post detailed information on the prices of surgeries at general hospitals on the website so that the public can compare prices between hospitals.
- Convene key stakeholders, including representatives from hospitals, health care providers, health plans, and self-insured organizations, to study the cost of health care services in New York City.and
- We collect each hospital's IRS Form 900, Schedule H, audited financial statements, and annual cost reports and make them available to the public upon request.
Specifically, Local Law 844-A defines “hospital” to mean a “general hospital” as defined in New York State Public Health Law § 2801(10). A “general hospital” is a hospital that provides medical and surgical services 24 hours a day, primarily to hospitalized patients or under the guidance of a physician. General hospitals have regulations that allow them to admit and treat people who require emergency treatment. This defined term does not include residential health care facilities, health centers, diagnostic centers, treatment centers, outpatient lodging facilities, clinics, laboratories, or central service facilities serving multiple institutions. .
reporting requirements
The Director shall submit a report detailing the hospital system to the Mayor, the President of the New York City Council, and the New York State Attorney General by January 1 of each year by February 18, 2025 . New York City Pricing Practices. This report must also be published on her website for the Office of Medical Accountability. Reports must include a summary of the following data (to the extent the data is publicly available):
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Prices charged for common hospital procedures, categorized by hospital, using standard prices such as Medicare.
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Fees charged for common hospital procedures are categorized as follows:
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hospital;
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type of procedure;
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Reimbursement from Medicaid and Medicare average rate of reimbursement received from (accounted for). whether such reimbursement meets the cost of caring for patients in such programs and, where practicable, meets negotiated prices, cash prices, and Medicare prices for each payer and health plan; .and
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Average rate of denial of “medically necessary care” by major insurance companies or payers.
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pricing transparency requirements for each hospital and each major insurance company or other payer under state and federal law;
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Breakdown of profit margins, number of employees, overhead costs, executive salaries and bonuses for each major insurance company and other payers.
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Community benefit information for each hospital as publicly reported on IRS Form 990, Schedule H, and each hospital's performance in meeting community health care needs, providing charity care services, and improving access to health care services. Implementation reports of each hospital that are available to the public.and
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The impact of drug pricing, insurance premiums, and medical device costs on city health care costs and individual out-of-pocket payments.
conclusion
Over the past year, New York state health care legislation has been moving forward with the goal of increasing price transparency. This is evidenced by the recent enactment of New York State's Significant Healthcare Transaction Review Act and its Facility Fees Act, which, like Local Law 884-A, aims to increase public awareness of healthcare costs and their impact. Includes public notice requirements.
Local Law 884-A just took effect, so there is still much to learn about how the Office of Medical Accountability will operate. As of the date of this blog post, the mayor has not yet appointed a director, and the department's website is not live. Additionally, certain key terms used throughout the law include what exactly makes a hospital procedure “common” and what exactly makes an insurance company “common” a “material part” of a hospital's payment. The amount of work that constitutes this is not defined by the Secretariat. A hospital affiliated with a major insurance company. In the coming months, we expect the Office of Medical Accountability to provide further clarity on these definitions, potentially leading more municipalities across the country to follow New York City's lead.
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