S.4007 / A.3007 (HMH Part J)


Executive Vice President


S.4007 / A.3007 (HMH Part J)


Pay & Pursue



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The Business Council strongly opposes Part J of S.4007 / A.3007.  This Executive Budget proposal would fundamentally change New York’s health care financing system and significantly increase the cost of healthcare coverage paid by employers and employees throughout the state. 

The proposal requires health plans to pay a hospital claim for any emergency services and resulting inpatient admission upfront without prior authorization or clinical review process to determine whether the treatment or service was medically necessary. Hospitals would then have 30 days to submit the necessary paperwork to a joint committee. If the hospital and health plan cannot agree on the medical necessity of the procedure, then the claim is sent to an independent third-party review agent for a final determination.  

While the intent may be to create efficiencies within the healthcare financial system, Pay and Pursue does the exact opposite.  Pay and Pursue will lead to drawn out payment disputes for things such as administrative billing errors.  This complete overhaul of the health care financing system neglects the state’s independent external review statute and will contribute to escalating health care costs across the state.  

This proposal will make health care dramatically more expensive for businesses, small and large, and their employees, who are trying to recover from the current economic crisis.

Pay and Pursue is nothing but a hidden tax on hardworking New Yorkers. 

For these reasons, The Business Council strongly opposes Part J of S.4007 / A.3007 and recommends against its inclusion in the final state budget.