Bill Text: NY A02983 | 2019-2020 | 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 18-0)

Status: (Introduced) 2019-05-09 - advanced to third reading cal.286 [A02983 Detail]

Download: New_York-2019-A02983-Introduced.html


                STATE OF NEW YORK
        ________________________________________________________________________
                                          2983
                               2019-2020 Regular Sessions
                   IN ASSEMBLY
                                    January 28, 2019
                                       ___________
        Introduced  by M. of A. GOTTFRIED, DINOWITZ, ENGLEBRIGHT, GALEF, PAULIN,
          CUSICK, L. ROSENTHAL,  D'URSO  --  Multi-Sponsored  by  --  M.  of  A.
          CARROLL,  COLTON,  COOK,  CYMBROWITZ,  GLICK,  GUNTHER, LIFTON, PERRY,
          RIVERA -- 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,
     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  four  new
     4  subdivisions 10, 11, 12 and 13 are added to read as follows:
     5    10.  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    11.  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    12. 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    13. No health care plan shall by contract, written policy or procedure
    20  provide  for or allow the substitution of a pharmaceutical drug or agent
    21  (other than a  generic  substitution)  by  any  person  other  than  the
    22  prescribing  health  care  professional or by a pharmacist under section
    23  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.
                                                                   LBD03359-01-9

        A. 2983                             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 four new subsections (h), (l), (m) and (n)  are  added  to  read  as
     4  follows:
     5    (h)  No  contract  or  agreement  between an insurer and a health care
     6  provider shall contain any clause which entitles such insurer  to  reim-
     7  burse  the  health  care  provider at the lowest price or rate that such
     8  health care provider has charged another person or entity for  rendering
     9  the same treatment or performing the same procedure.
    10    (l)  No insurer shall by contract, written policy or written procedure
    11  prohibit any health care provider from referring an insured to a  physi-
    12  cian  based  solely  upon such physician's participation status with the
    13  insurance product subscribed to by the insured.
    14    (m) No insurer shall by contract, written policy or written  procedure
    15  require  the disclosure of an insured's diagnosis on a prescription as a
    16  condition for authorizing the coverage for or payment or dispensing of a
    17  pharmaceutical drug or agent, unless otherwise required by law.
    18    (n) No insurer which maintains a drug formulary,  or  which  contracts
    19  with  another  entity  to  maintain a drug formulary, shall by contract,
    20  written policy or procedure provide for or allow the substitution  of  a
    21  pharmaceutical  drug or agent (other than a generic substitution) by any
    22  person other than the prescribing health care professional or by a phar-
    23  macist under section sixty-eight hundred one-a of the education law.
    24    § 3. Subsection (i) of section 4325 of the insurance  law,  as  relet-
    25  tered  by  chapter 487 of the laws of 2010, is relettered subsection (p)
    26  and four new subsections (i), (m), (n) and (o)  are  added  to  read  as
    27  follows:
    28    (i)  No  contract  or  agreement  between an insurer and a health care
    29  provider shall contain any clause which entitles such insurer  to  reim-
    30  burse  the  health  care  provider at the lowest price or rate that such
    31  health care provider has charged another person or entity for  rendering
    32  the same treatment or performing the same procedure.
    33    (m)  No insurer shall by contract, written policy or written procedure
    34  prohibit any health care provider from referring an insured to a  physi-
    35  cian  based  solely  upon such physician's participation status with the
    36  insurance product subscribed to by the insured.
    37    (n) No insurer shall by contract, written policy or written  procedure
    38  require  the disclosure of an insured's diagnosis on a prescription as a
    39  condition for authorizing the coverage for or payment or dispensing of a
    40  pharmaceutical drug or agent, unless otherwise required by law.
    41    (o) No insurer which maintains a drug formulary,  or  which  contracts
    42  with  another  entity  to  maintain a drug formulary, shall by contract,
    43  written policy or procedure provide for or allow the substitution  of  a
    44  pharmaceutical  drug or agent (other than a generic substitution) by any
    45  person other than the prescribing health care professional or by a phar-
    46  macist under section sixty-eight hundred one-a of the education law.
    47    § 4. This act shall take effect on the one hundred eightieth day after
    48  it shall have become a law.
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