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.