Bill Text: NY A01932 | 2015-2016 | General Assembly | Amended

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Bill Title: Extends period during which health maintenance organization enrollees may continue to receive services from a health care provider who disaffiliates from 60 or 90 days to 1 year, or in case of terminal illness, until the time of such insured's death; bars incentives which induce a provider to provide health care to an enrollee in a manner inconsistent with law.

Spectrum: Partisan Bill (Democrat 7-0)

Status: (Introduced - Dead) 0000-00-00 - [A01932 Detail]

Download: New_York-2015-A01932-Amended.html

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                STATE OF NEW YORK
        ________________________________________________________________________
                                          1932
                               2015-2016 Regular Sessions
                   IN ASSEMBLY
                                    January 13, 2015
                                       ___________
        Introduced  by  M.  of  A.  DINOWITZ, GOTTFRIED, GALEF, HOOPER, CLARK --
          Multi-Sponsored by -- M.  of A. BRENNAN, COLTON, LIFTON --  read  once
          and referred to the Committee on Health
        AN ACT to amend the insurance law and the public health law, in relation
          to access to health care providers in managed care plans
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
     1    Section 1. Subsection (e) of section 4803 of  the  insurance  law,  as
     2  added by chapter 705 of the laws of 1996, is amended to read as follows:
     3    (e)  No  insurer  shall  terminate  or  refuse to renew a contract for
     4  participation in the in-network benefits portion of an insurer's network
     5  for a managed care product solely because the health  care  professional
     6  has:  (1) advocated on behalf of an insured; (2) [has] filed a complaint
     7  against the insurer; (3) [has] appealed a decision of the  insurer;  (4)
     8  provided  information  or  filed a report pursuant to section forty-four
     9  hundred six-c of the public health law; [or] (5) requested a hearing  or
    10  review  pursuant  to  this section; or (6) rendered an opinion regarding
    11  whether an insured's illness is terminal pursuant to section four  thou-
    12  sand eight hundred four of this article.
    13    §  2. Subsections (e) and (f) of section 4804 of the insurance law, as
    14  added by chapter 705 of the  laws  of  1996,  are  amended  to  read  as
    15  follows:
    16    (e)  (1)  If  an  insured's  health care provider leaves the insurer's
    17  in-network benefits portion of its network of providers  for  a  managed
    18  care  product  for reasons other than those for which the provider would
    19  not be eligible to receive  a  hearing  pursuant  to  paragraph  one  of
    20  subsection  (b)  of  section  [forty-eight]  four thousand eight hundred
    21  three of this [chapter] article, the insurer shall permit the insured to
    22  continue [an ongoing course of treatment with] to  receive  health  care
    23  procedures,  treatments,  and services from the insured's current health
    24  care provider during a transitional period of (i) up  to  [ninety  days]
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD00904-01-5