Bill Text: NY A00832 | 2021-2022 | General Assembly | Amended
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 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 17-0)
Status: (Engrossed - Dead) 2022-03-30 - REFERRED TO HEALTH [A00832 Detail]
Download: New_York-2021-A00832-Amended.html
STATE OF NEW YORK ________________________________________________________________________ 832--A Cal. No. 80 2021-2022 Regular Sessions IN ASSEMBLY (Prefiled) January 6, 2021 ___________ Introduced by M. of A. GOTTFRIED, DINOWITZ, ENGLEBRIGHT, GALEF, PAULIN, CUSICK, L. ROSENTHAL, SAYEGH, BARRON -- Multi-Sponsored by -- M. of A. CARROLL, COLTON, COOK, CYMBROWITZ, GLICK, GUNTHER, PERRY, J. RIVERA -- read once and referred to the Committee on Health -- reported from committee, advanced to a third reading, amended and ordered reprinted, retaining its place on the order of third reading 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, 2 as added by chapter 705 of the laws of 1996 and as renumbered by chapter 3 487 of the laws of 2010, is renumbered subdivision 14 and three new 4 subdivisions 11, 12 and 13 are added to read as follows: 5 11. 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 12. No health care plan shall by contract, written policy or written 11 procedure prohibit any health care provider from referring a patient or 12 enrollee to a health care provider based solely upon such health care 13 provider's participation status with the managed care product subscribed 14 to by the patient or enrollee. 15 13. No health care plan shall by contract, written policy or procedure 16 provide for or allow the substitution of a pharmaceutical drug or agent 17 (other than a generic substitution) by any person other than the 18 prescribing health care professional or by a pharmacist under section 19 sixty-eight hundred one-a of the education law. EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD00253-02-1A. 832--A 2 1 § 2. Subsection (h) of section 3217-b of the insurance law, as relet- 2 tered by chapter 237 of the laws of 2009, is relettered subsection (o) 3 and three new subsections (h), (m) and (n) are added to read as follows: 4 (h) No contract or agreement between an insurer and a health care 5 provider shall contain any clause which entitles such insurer to reim- 6 burse the health care provider at the lowest price or rate that such 7 health care provider has charged another person or entity for rendering 8 the same treatment or performing the same procedure. 9 (m) No insurer shall by contract, written policy or written procedure 10 prohibit any health care provider from referring an insured to a physi- 11 cian based solely upon such physician's participation status with the 12 insurance product subscribed to by the insured. 13 (n) No insurer which maintains a drug formulary, or which contracts 14 with another entity to maintain a drug formulary, shall by contract, 15 written policy or procedure provide for or allow the substitution of a 16 pharmaceutical drug or agent (other than a generic substitution) by any 17 person other than the prescribing health care professional or by a phar- 18 macist under section sixty-eight hundred one-a of the education law. 19 § 3. Subsection (i) of section 4325 of the insurance law, as relet- 20 tered by chapter 487 of the laws of 2010, is relettered subsection (p) 21 and three new subsections (i), (n) and (o) are added to read as follows: 22 (i) No contract or agreement between an insurer and a health care 23 provider shall contain any clause which entitles such insurer to reim- 24 burse the health care provider at the lowest price or rate that such 25 health care provider has charged another person or entity for rendering 26 the same treatment or performing the same procedure. 27 (n) No insurer shall by contract, written policy or written procedure 28 prohibit any health care provider from referring an insured to a physi- 29 cian based solely upon such physician's participation status with the 30 insurance product subscribed to by the insured. 31 (o) No insurer which maintains a drug formulary, or which contracts 32 with another entity to maintain a drug formulary, shall by contract, 33 written policy or procedure provide for or allow the substitution of a 34 pharmaceutical drug or agent (other than a generic substitution) by any 35 person other than the prescribing health care professional or by a phar- 36 macist under section sixty-eight hundred one-a of the education law. 37 § 4. This act shall take effect on the one hundred eightieth day after 38 it shall have become a law.
