A.7976-A S. 7614 National Cancer Institute Mandate

This legislation, A.7976-A/S. 7614, seeks to ensure that individuals who are enrolled in Medicaid managed care, the Essential Plan and individual and small group qualified health plans offered on the New York State of Health Exchange have greater access to National Cancer Institute (NCI)-designated cancer centers. While this seems well intentioned, it is unnecessary and the New York Health Plan Association (HPA) opposes this legislation.

Health plans strive to make a robust network of qualified providers available to meet the needs of their members, and access to the provider of their choice remains a strong consumer demand for health plan members who expect that their health plans will make all reasonable efforts to reach agreements with providers. Integrated health care networks are the foundation of health care plans. Building a quality network requires considerable skill and a menu of incentives that encourage providers to join a network. Providing coverage through a network increases quality, enhances medical competency and encourages greater coordination and collaboration by providers. Networks also promote cost efficiencies, which help make health care more affordable and accessible.

Mandating specific types of providers be included in plans’ networks without any requirement on the provider to control their costs or meet performance standards will increase the costs for options available on the Marketplace and do nothing to improve the quality of care for individuals enrolled in these plans.  Further, it would have the potential to create an incentive for contracted providers to drop out of health plans’ networks and establish a problematic precedent that other providers would seek to follow.

Moreover, while health plans recognize the expertise of NCI-designated cancer centers, many of these centers remain outside health plan networks because they choose not to accept the plans’ contract reimbursement. The legislation proposes to require the bill would require NCI-designated cancer centers to accept the prevailing rate for hospital services — specifically tying reimbursement levels to “not lower than the Medicaid 1-TS rate for Medicaid managed care and qualified health plans and not less than the FFS rate applicable to the Essential Plan.” However, there is no guarantee these centers will agree to these terms.

Protections already exist to ensure that patients can access the care they need.  State law requires the Department of Health to review and approve the adequacy of plans’ provider networks. Additional protections in state law to allow health care consumers to obtain care from providers outside the plan’s network when there is not an in-network provider with the appropriate training and experience to meet the particular health care needs of a patient.

For all these reasons, HPA opposes A.7976-A/S. 7614.