Bill Text: NY A09781 | 2019-2020 | General Assembly | Introduced

New York Assembly Bill 9781 (Prior Session Legislation)

Introduced

Bill Title: Prohibits an insurer or health maintenance organization from including certain requirements in insurance contracts.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2020-02-11 - referred to insurance [A09781 Detail]

Download: New_York-2019-A09781-Introduced.html


                STATE OF NEW YORK
        ________________________________________________________________________

                                          9781

                   IN ASSEMBLY

                                    February 11, 2020
                                       ___________

        Introduced by M. of A. HUNTER -- read once and referred to the Committee
          on Insurance

        AN ACT to amend the insurance law and the public health law, in relation
          to prohibiting certain requirements in insurance contracts

          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:

     1    Section 1. Section 3217-b of the insurance law is amended by adding  a
     2  new subsection (m) to read as follows:
     3    (m)(1)  No  insurer that offers a managed care product or a comprehen-
     4  sive policy that utilizes a network of  providers  shall  enter  into  a
     5  contract, written policy, written procedure or agreement with any health
     6  care provider that:
     7    (A)  Requires  an  insurer to include all members of a provider group,
     8  including medical practice groups and  facilities,  in  its  network  of
     9  participating providers;
    10    (B)  Requires  an  insurer  to  place all members of a provider group,
    11  including medical practice groups and facilities, in  the  same  network
    12  tier;
    13    (C)  Requires  an  insurer to include all members of a provider group,
    14  including medical  practice  groups  and  facilities,  in  all  products
    15  offered by the insurer;
    16    (D) Prohibits insurers from using benefit designs to encourage members
    17  to seek services from higher-value health care providers;
    18    (E) Contains a most-favored-nation provision; provided, however, noth-
    19  ing  in this section shall be construed to prohibit a health insurer and
    20  a provider from negotiating payment rates and performance-based contract
    21  terms that would result in the insurer  receiving  a  rate  that  is  as
    22  favorable, or more favorable, than the rates negotiated between a health
    23  care provider and another entity; and
    24    (F)  Limits  the  ability  of the insurer or health care provider from
    25  disclosing fees for services or the allowed amounts  to  an  insured  or
    26  insured's health care provider.
    27    (2)  After January first, two thousand twenty-one, any contract, writ-
    28  ten policy, written  procedure  or  agreement  that  contains  a  clause

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD15287-01-0

        A. 9781                             2

     1  contrary  to  the provisions set forth in this section shall be null and
     2  void; provided, however, the remaining clauses  of  the  contract  shall
     3  remain in effect for the duration of the contract term.
     4    §  2. Section 4406 of the public health law is amended by adding a new
     5  subdivision 6 to read as follows:
     6    6. (a) No health maintenance organization that offers a  managed  care
     7  product  or  a comprehensive policy that utilizes a network of providers
     8  shall enter into a contract, written policy, written procedure or agree-
     9  ment with any health care provider that:
    10    (i) Requires an insurer to include all members of  a  provider  group,
    11  including  medical  practice  groups  and  facilities, in its network of
    12  participating providers;
    13    (ii) Requires an insurer to place all members  of  a  provider  group,
    14  including  medical  practice  groups and facilities, in the same network
    15  tier;
    16    (iii) Requires an insurer to include all members of a provider  group,
    17  including  medical  practice  groups  and  facilities,  in  all products
    18  offered by the insurer;
    19    (iv) Prohibits  insurers  from  using  benefit  designs  to  encourage
    20  members to seek services from higher-value health care providers;
    21    (v) Contains a most-favored-nation provision; provided, however, noth-
    22  ing  in this section shall be construed to prohibit a health insurer and
    23  a provider from negotiating payment rates and performance-based contract
    24  terms that would result in the insurer  receiving  a  rate  that  is  as
    25  favorable, or more favorable, than the rates negotiated between a health
    26  care provider and another entity; and
    27    (vi)  Limits  the  ability of the insurer or health care provider from
    28  disclosing fees for services or the allowed amounts  to  an  insured  or
    29  insured's health care provider.
    30    (b)  After January first, two thousand twenty-one, any contract, writ-
    31  ten policy, written  procedure  or  agreement  that  contains  a  clause
    32  contrary  to  the provisions set forth in this section shall be null and
    33  void; provided, however, the remaining clauses  of  the  contract  shall
    34  remain in effect for the duration of the contract term.
    35    § 3. This act shall take effect on January 1, 2021.