The Healthcare Accountability and Consumer Protection Act (HACPA) enacted on June 23, 2023 amends the New York City Charter to establish an Office of Healthcare Accountability (OHA), headed by a Director of Healthcare Accountability (DHA). According to HACPA primary sponsor and NYC Council member Julie Menin, the legislation will “save NYC billions and empower consumers with vital information.” The OHA will either be established under the Office of the Mayor, in which case the Mayor will appoint the DHA, or within any NYC agency/department, in which case the head of that agency will appoint the DHA. The legislation provides that the OHA may also be established as a standalone office. 

The DHA will only have access to publicly available information, including disclosures pursuant to state and federal law, and the HACPA does not create any additional disclosure requirements from hospitals or insurance companies. 

DIRECT PRICE COMPARISON 

The OHA website will create a way to publicly compare the price of common hospital services between hospitals. OHA staff will do so by compiling and analyzing the public information hospitals are required to disclose under the federal “Hospital Price Transparency” law as well as state law, and they are to format such information in a “simplified and publicly accessible” manner. 

COMPILATION OF HOSPITAL DOCUMENTATION 

The DHA will also collect and compile publicly available hospital financial documents and make them available upon request. According to the legislation, this includes the following: 

• Each hospital’s United States Internal Revenue Service form 990, Schedule H; 
• Audited financial statements as required by section 6033(b)(15)(b) of the Internal Revenue Service Code; and 
• Annual cost reports as required by the Centers for Medicare & Medicaid Services (CMS). 

DHA ANNUAL PUBLIC REPORT 

Starting no later than one year after HACPA takes effect, and every January 1st after that, the DHA must submit a report to the Mayor, the Speaker of the Council, and the New York State Attorney General that details, “the pricing practices of the hospital systems in the city.” These reports must be made publicly available on the OHA website, and must include the following: 

• A summary of any analysis performed of the city’s publicly available expenditures on healthcare costs for city employees, retirees and their dependents including the price of common hospital procedures paid for by the city disaggregated by hospital; 
• A summary of the common prices charged by hospitals for common hospital procedures, including but not limited to disaggregation by such things as hospital, type of procedure, the average rate of reimbursement received by hospitals from each major insurance provider or other classification of payer for each common procedure, and the average rate of denial by major insurance providers or payers of medically necessary care; 
• A summary of each hospital and major insurance provider’s pricing transparency requirements under state and federal law; 
• A breakdown of each major insurance provider’s profit margins, employee headcounts, overhead costs, and executive salaries and bonuses; 
• A summary of each hospital’s community benefit programs as required by and reported on IRS form 990, schedule H, and their implementation report on caring for uninsured and underserved members of their community; and 
• A summary of the impact of pharmaceutical pricing, insurance premiums, and the cost of medical devices on the city’s healthcare costs and individuals’ out-of-pocket spending. 

RECOMMENDATIONS AND THE ABILITY TO CONVENE STAKEHOLDERS 

Another duty conferred upon the DHA is to provide recommendations to the Mayor and certain other city and state officials concerning healthcare and hospital costs with the needs of NYC’s safety net hospitals to be included in any such recommendation. 

The DHA will also be able to call meetings of key healthcare stakeholders, both governmental and private, to assist in examining the costs of healthcare services in the city. 

Categories: DATA TRANSPARENCY