Bill Text: NY A00594 | 2011-2012 | General Assembly | Introduced
Bill Title: Relates to certain prohibitions in contracts or agreements by health maintenance organizations; prohibits clauses which entitle reimbursement at the lowest price or rate; prohibits contracts which restrict referral of patients based solely upon a health care provider's status with a managed care product; prohibits disclosure of an enrollee's diagnosis on a prescription as a condition for authorizing coverage for payment or dispensing of a prescription; and prohibits contracts which allow for the substitution of a pharmaceutical drug or agent by any person other than the prescribing health care professional.
Spectrum: Partisan Bill (Democrat 30-0)
Status: (Engrossed - Dead) 2012-02-07 - REFERRED TO HEALTH [A00594 Detail]
Download: New_York-2011-A00594-Introduced.html
S T A T E O F N E W Y O R K ________________________________________________________________________ 594 2011-2012 Regular Sessions I N A S S E M B L Y (PREFILED) January 5, 2011 ___________ Introduced by M. of A. GOTTFRIED, DINOWITZ, ENGLEBRIGHT, GALEF, PAULIN, CUSICK, PHEFFER, KAVANAGH -- Multi-Sponsored by -- M. of A. AUBRY, BRENNAN, COLTON, COOK, CYMBROWITZ, GLICK, GUNTHER, HEASTIE, HOOPER, JACOBS, KELLNER, LIFTON, MAYERSOHN, McENENY, PERRY, J. RIVERA, P. RIVERA, ROBINSON, SCARBOROUGH, SWEENEY, TOWNS, WEISENBERG -- read once and referred to the Committee on Health AN ACT to amend the public health law and the insurance law, in relation to certain contracts or agreements by health maintenance organizations THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: 1 Section 1. Subdivision 7 of section 4406-c of the public health law as 2 added by chapter 705 of the laws of 1996 and as renumbered by chapter 3 487 of the laws of 2010, is renumbered subdivision 12 and four new 4 subdivisions 8, 9, 10 and 11 are added to read as follows: 5 8. NO CONTRACT OR AGREEMENT BETWEEN A HEALTH CARE PLAN AND A HEALTH 6 CARE PROVIDER SHALL CONTAIN ANY CLAUSE WHICH ENTITLES SUCH HEALTH CARE 7 PLAN TO REIMBURSE THE HEALTH CARE PROVIDER AT THE LOWEST PRICE OR RATE 8 THAT SUCH HEALTH CARE PROVIDER HAS CHARGED ANOTHER PERSON OR ENTITY FOR 9 RENDERING THE SAME TREATMENT OR PERFORMING THE SAME PROCEDURE. 10 9. NO HEALTH CARE PLAN SHALL BY CONTRACT, WRITTEN POLICY OR WRITTEN 11 PROCEDURE PROHIBIT OR RESTRICT ANY HEALTH CARE PROVIDER FROM REFERRING A 12 PATIENT OR ENROLLEE TO A HEALTH CARE PROVIDER BASED SOLELY UPON SUCH 13 HEALTH CARE PROVIDER'S PARTICIPATION STATUS WITH THE MANAGED CARE PROD- 14 UCT SUBSCRIBED TO BY THE PATIENT OR ENROLLEE. 15 10. NO HEALTH CARE PLAN SHALL BY CONTRACT, WRITTEN POLICY OR WRITTEN 16 PROCEDURE REQUIRE THE DISCLOSURE OF AN ENROLLEE'S DIAGNOSIS ON A 17 PRESCRIPTION AS A CONDITION FOR DISPENSING OF A PHARMACEUTICAL DRUG OR 18 AGENT, UNLESS OTHERWISE REQUIRED BY LAW. 19 11. NO HEALTH CARE PLAN SHALL BY CONTRACT, WRITTEN POLICY OR PROCEDURE 20 PROVIDE FOR OR ALLOW THE SUBSTITUTION OF A PHARMACEUTICAL DRUG OR AGENT EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD02331-01-1 A. 594 2 1 (OTHER THAN A GENERIC SUBSTITUTION) BY ANY PERSON OTHER THAN THE 2 PRESCRIBING HEALTH CARE PROFESSIONAL. 3 S 2. Subsections (h) and (i) of section 3217-b of the insurance law, 4 as relettered by chapter 237 of the laws of 2009, are relettered 5 subsections (l) and (m) and four new subsections (h), (i), (j) and (k) 6 are added to read as follows: 7 (H) NO CONTRACT OR AGREEMENT BETWEEN AN INSURER AND A HEALTH CARE 8 PROVIDER SHALL CONTAIN ANY CLAUSE WHICH ENTITLES SUCH INSURER TO REIM- 9 BURSE THE HEALTH CARE PROVIDER AT THE LOWEST PRICE OR RATE THAT SUCH 10 HEALTH CARE PROVIDER HAS CHARGED ANOTHER PERSON OR ENTITY FOR RENDERING 11 THE SAME TREATMENT OR PERFORMING THE SAME PROCEDURE. 12 (I) NO INSURER SHALL BY CONTRACT, WRITTEN POLICY OR WRITTEN PROCEDURE 13 PROHIBIT OR RESTRICT ANY HEALTH CARE PROVIDER FROM REFERRING AN INSURED 14 TO A PHYSICIAN BASED SOLELY UPON SUCH PHYSICIAN'S PARTICIPATION STATUS 15 WITH THE INSURANCE PRODUCT SUBSCRIBED TO BY THE INSURED. 16 (J) NO INSURER SHALL BY CONTRACT, WRITTEN POLICY OR WRITTEN PROCEDURE 17 REQUIRE THE DISCLOSURE OF AN INSURED'S DIAGNOSIS ON A PRESCRIPTION AS A 18 CONDITION FOR AUTHORIZING THE COVERAGE FOR OR PAYMENT OR DISPENSING OF A 19 PHARMACEUTICAL DRUG OR AGENT, UNLESS OTHERWISE REQUIRED BY LAW. 20 (K) NO INSURER WHICH MAINTAINS A DRUG FORMULARY, OR WHICH CONTRACTS 21 WITH ANOTHER ENTITY TO MAINTAIN A DRUG FORMULARY, SHALL BY CONTRACT, 22 WRITTEN POLICY OR PROCEDURE PROVIDE FOR OR ALLOW THE SUBSTITUTION OF A 23 PHARMACEUTICAL DRUG OR AGENT (OTHER THAN A GENERIC SUBSTITUTION) BY ANY 24 PERSON OTHER THAN THE PRESCRIBING HEALTH CARE PROFESSIONAL. 25 S 3. Subsections (i) and (j) of section 4325 of the insurance law, as 26 relettered by chapter 487 of the laws of 2010, are relettered 27 subsections (m) and (n) and four new subsections (i), (j), (k) and (l) 28 are added to read as follows: 29 (I) NO CONTRACT OR AGREEMENT BETWEEN AN INSURER AND A HEALTH CARE 30 PROVIDER SHALL CONTAIN ANY CLAUSE WHICH ENTITLES SUCH INSURER TO REIM- 31 BURSE THE HEALTH CARE PROVIDER AT THE LOWEST PRICE OR RATE THAT SUCH 32 HEALTH CARE PROVIDER HAS CHARGED ANOTHER PERSON OR ENTITY FOR RENDERING 33 THE SAME TREATMENT OR PERFORMING THE SAME PROCEDURE. 34 (J) NO INSURER SHALL BY CONTRACT, WRITTEN POLICY OR WRITTEN PROCEDURE 35 PROHIBIT OR RESTRICT ANY HEALTH CARE PROVIDER FROM REFERRING AN INSURED 36 TO A PHYSICIAN BASED SOLELY UPON SUCH PHYSICIAN'S PARTICIPATION STATUS 37 WITH THE INSURANCE PRODUCT SUBSCRIBED TO BY THE INSURED. 38 (K) NO INSURER SHALL BY CONTRACT, WRITTEN POLICY OR WRITTEN PROCEDURE 39 REQUIRE THE DISCLOSURE OF AN INSURED'S DIAGNOSIS ON A PRESCRIPTION AS A 40 CONDITION FOR AUTHORIZING THE COVERAGE FOR OR PAYMENT OR DISPENSING OF A 41 PHARMACEUTICAL DRUG OR AGENT, UNLESS OTHERWISE REQUIRED BY LAW. 42 (L) NO INSURER WHICH MAINTAINS A DRUG FORMULARY, OR WHICH CONTRACTS 43 WITH ANOTHER ENTITY TO MAINTAIN A DRUG FORMULARY, SHALL BY CONTRACT, 44 WRITTEN POLICY OR PROCEDURE PROVIDE FOR OR ALLOW THE SUBSTITUTION OF A 45 PHARMACEUTICAL DRUG OR AGENT (OTHER THAN A GENERIC SUBSTITUTION) BY ANY 46 PERSON OTHER THAN THE PRESCRIBING HEALTH CARE PROFESSIONAL. 47 S 4. This act shall take effect on the one hundred eightieth day after 48 it shall have become a law, provided that the relettering of subsection 49 (m) of section 3217-b and the relettering of subsection (n) of section 50 4325 of the insurance law made by sections two and three of this act, 51 respectively, shall not affect the repeal of such subsections and shall 52 be deemed repealed therewith.