Bill Text: NY A09865 | 2021-2022 | General Assembly | Introduced
Bill Title: Enacts the Health Care Nondiscrimination Act.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2022-04-19 - referred to insurance [A09865 Detail]
Download: New_York-2021-A09865-Introduced.html
STATE OF NEW YORK ________________________________________________________________________ 9865 IN ASSEMBLY April 19, 2022 ___________ Introduced by M. of A. WEPRIN -- read once and referred to the Committee on Insurance AN ACT to enact the Health Care Nondiscrimination Act of 2021 The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Short title. This act shall be known and may be cited as 2 the "Health Care Nondiscrimination Act of 2021". 3 § 2. Legislative findings. All residents should have freedom to seek 4 the care, treatment and provider of their choosing with respect to their 5 healthcare if treatment of a health condition is within a licensed 6 healthcare provider's scope of practice. Given the historic bias against 7 nonpharmacological-based healthcare in New York, it shall be the policy 8 of the state to redress this imbalance by removing barriers and enhanc- 9 ing access to such services. First, a health insurance plan or health 10 benefit should not discriminate against licensed, nonpharmacological- 11 based healthcare providers regarding fee reimbursement or payment for 12 the provision of similar or like-kind healthcare services. Second, to 13 further reverse this bias and promote the public health, the state 14 should promote licensed, nonpharmacological-based healthcare services to 15 ensure that the public has full and unfettered access to the evidence- 16 based benefits of such services, including the treatment of substance 17 abuse disorders to combat the opioid crisis. Third, all residents should 18 have equal access to nonpharmacological-based healthcare alternatives, 19 whether through self-funded healthcare plans or plans which are fully 20 funded through insurance, or other contracts, when making personal 21 healthcare decisions. Finally, to better ensure compliance and enforce- 22 ment, the departments of health, financial services and labor should 23 have the ability to impose substantial fines and penalties against 24 insurers, healthcare plans and healthcare organizations that continue to 25 deny patients' freedom of choice regarding their healthcare. 26 § 3. Definitions. For the purposes of this act, the following terms 27 shall have the following meanings: EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD11882-01-1A. 9865 2 1 1. "Licensed health care provider or providers" shall mean any person 2 duly licensed under articles 132, 136, 153, 155, 156 or 160 of the 3 education law. 4 2. "Managed care product" shall mean: (i) a policy which requires that 5 medical or other health care services covered under the policy, other 6 than emergency care services, be provided by, or pursuant to, a referral 7 from a primary care provider and that services provided pursuant to such 8 a referral be rendered by a licensed health care provider participating 9 in the insurer's managed care provider network; (ii) the in-network 10 portion of a contract which requires that medical or other health care 11 services covered under the contract, other than emergency care services, 12 be provided by, or pursuant to, a referral from a primary care provider 13 and that services provided pursuant to such a referral be rendered by a 14 licensed health care provider participating in the insurer's managed 15 care provider network, in order for the insured to be entitled to the 16 maximum reimbursement under the contract; and (iii) other healthcare 17 plans through which each member of an enrolled population is entitled to 18 receive comprehensive in-network and out-of-network health services, in 19 consideration for a basic advance or periodic charge, which may or may 20 not require a referral for such services. 21 3. "Health services plan provider" shall mean an insurer or any organ- 22 ization or agency that provides health services or benefits under a 23 policy, plan or other contract. 24 § 4. Insurance and health plan equality and non-discrimination. 1. 25 Every policy or plan which is a managed care product, as such term is 26 defined in section three of this act, that provides coverage for physi- 27 cian services in a physician's office, every policy or plan which is a 28 managed care product that provides major medical or similar comprehen- 29 sive-type coverage and every contract issued by a health service corpo- 30 ration or a medical expense indemnity corporation which is a managed 31 care product that includes coverage for physician services in a physi- 32 cian's office, shall include coverage for licensed health care provider 33 services. Licensed health care provider services may be subject to 34 reasonable deductible, co-payment and co-insurance amounts, reasonable 35 fee or benefit limits and reasonable utilization review, provided that 36 any such amounts, limits and review shall not: 37 (a) function to direct treatment in a manner discriminative against 38 any licensed health care provider; 39 (b) create underwriting standards that are more restrictive for any 40 licensed health care provider than care provided by other health profes- 41 sionals licensed under title 8 of the education law; 42 (c) apply cost containment, quality or performance measures to 43 licensed health care providers unequally, as compared with those applied 44 to primary care providers; 45 (d) impose a co-payment or co-insurance amount on an insured for 46 services provided by any licensed health care provider that is greater 47 than the co-payment or co-insurance amount imposed on an insured for the 48 same or similar services provided by a primary care provider; and 49 (e) individually and collectively be more restrictive than those 50 applicable under the same policy for care or services provided by other 51 health professionals in the diagnosis, treatment and management of the 52 same or similar conditions, injuries, complaints, disorders or ailments, 53 even if differing nomenclature is used to describe the condition, inju- 54 ry, complaint, disorder or ailment. 55 2. Every policy or plan which includes coverage for physician services 56 in a physician's office, every policy or plan which provides majorA. 9865 3 1 medical or similar comprehensive-type coverage, other than a managed 2 care product as such term is defined in section three of this act, and 3 every contract issued by a health service corporation or medical expense 4 indemnity corporation which includes coverage for physician services in 5 a physician's office other than a managed care product and benefits 6 provided under articles 2 and 3 of the workers' compensation law and 7 article 51 of the insurance law, shall include coverage for licensed 8 health care provider services. Licensed health care provider services 9 may be subject to reasonable deductible, co-payment and co-insurance 10 amounts, reasonable fee or benefit limits, and reasonable utilization 11 review, provided that any such amounts, limits and review shall not: 12 (a) function to direct treatment in a manner discriminative against 13 any licensed health care provider; 14 (b) create underwriting standards that are more restrictive for any 15 licensed health care provider than care provided by other health profes- 16 sionals licensed under title 8 of the education law; 17 (c) apply cost containment, quality or performance measures to 18 licensed health care provider care unequally as compared with those 19 applied to primary care providers; 20 (d) impose a co-payment or co-insurance amount on an insured for 21 services provided by any licensed health care provider that is greater 22 than the co-payment or co-insurance amount imposed on an insured for the 23 same or similar services provided by a primary care provider; and 24 (e) individually and collectively be more restrictive than those 25 applicable under the same policy for care or services provided by other 26 health professionals in the diagnosis, treatment and management of the 27 same or similar conditions, injuries, complaints, disorders or ailments, 28 even if differing nomenclature is used to describe the condition, inju- 29 ry, complaint, disorder or ailment. 30 3. The contract between a health maintenance organization, as such 31 term is defined in article 44 of the public health law and an enrollee, 32 shall be subject to regulation by the superintendent of the department 33 of financial services as if it were a health insurance subscriber 34 contract and shall include, but shall not be limited to, all mandated 35 benefits required by this act. 36 4. Any person, partnership, corporation, limited liability company or 37 other organization licensed under the laws of the state of New York, 38 which provides or contracts to provide health and accident benefit 39 coverage as a self-insurer for its employees, shareholders, or other 40 persons shall be subject to the provisions of this act. 41 5. The coverage required by this section shall not be abridged by any 42 regulation promulgated by the superintendent of financial services, the 43 commissioner of health or the chair of the workers' compensation board. 44 § 5. Fee parity. 1. A health services plan provider shall not pay a 45 licensed health care provider less for care and services identified 46 under current procedural terminology, as listed in a nationally recog- 47 nized services and procedures code book, such as the most recent Ameri- 48 can Medical Association procedural terminology code book, than it pays 49 any other individual licensed under title 8 of the education law, except 50 as provided in subdivisions two and three of this section. A health 51 services plan provider shall not circumvent the requirements of this 52 section by creating a provider-specific code not listed in a nationally 53 recognized code book otherwise used by such health services plan provid- 54 er for payment, or by creating or using any other provider-specific 55 billing code or policy not listed in a nationally recognized coding 56 system otherwise used by the health services plan provider.A. 9865 4 1 2. This section shall not affect a health service plan's ability to: 2 (a) implement a health care quality improvement program to promote cost 3 effective and clinically efficacious health care services, including but 4 not limited to, pay-for-performance payment methodologies and other 5 programs fairly applied to all individuals licensed under title 8 of the 6 education law, that are designed to promote evidence-based and 7 research-based practices; (b) establish health care network adequacy 8 standards; and (c) pay a licensed health care provider less than another 9 provider licensed under title 8 of the education law for procedures or 10 services under the same code based upon geographic differences in the 11 cost of maintaining a practice. 12 3. This section shall not expand the scope of practice of any licensed 13 health care provider. 14 § 6. Treatment of pain. 1. When a patient seeks treatment for any 15 neuromusculoskeletal condition that causes pain where a health care 16 practitioner considers an opioid treatment, the practitioner shall 17 discuss with the patient and, as appropriate, refer or prescribe non- 18 pharmacological treatment alternatives, before starting a patient on an 19 opioid. For purposes of this section, "non-pharmacological treatment 20 alternatives" shall include chiropractic, acupuncture, massage therapy, 21 physical therapy, psychology, occupational therapy, cognitive behavioral 22 therapy, and non-clinical activities such as exercise. The health care 23 practitioner shall further advise that some treatment options may not be 24 covered by the patient's health insurance plan or coverage. 25 2. Nothing in this section shall be deemed to require that all non-o- 26 pioid treatment alternatives set forth in subdivision one of this 27 section must be exhausted prior to the patient receiving an opioid 28 prescription. 29 3. The requirements of this section shall not apply to patients being 30 treated under any of the following circumstances: cancer; hospice or 31 other end-of-life care; post-surgery treatment immediately following a 32 surgical procedure; or a medical emergency. For purposes of this 33 section, "medical emergency" shall mean an acute injury or illness that 34 poses an immediate risk to a person's life or health. 35 § 7. Performing certain services including certifying disability and 36 employment by school districts. 1. To qualify as physically disabled for 37 the purposes of compliance with section 459 of the real property tax 38 law, an individual may also submit to the assessor, as such term is 39 defined in subdivision 3 of section 102 of the real property tax law, a 40 certified statement from any licensed health care provider on a form 41 prescribed and made available by the commissioner of taxation and 42 finance which states that the individual has a physical impairment which 43 substantially limits one or more of such individual's major life activ- 44 ities. 45 2. The commissioner of motor vehicles may issue license plates to 46 severely disabled persons in accordance with section 404-a of the vehi- 47 cle and traffic law upon the receipt of proof of an individual's disa- 48 bility or the disability of a family member, as certified by any 49 licensed health care provider. 50 3. "Health professionals," as such term is defined in section 902 of 51 the education law, with respect to the employment of such individuals by 52 school districts, shall also include any licensed health care provider. 53 § 8. Enforcement and penalties. 1. Every health services plan provider 54 shall annually and no later than February first of each year, file a 55 report with the department of health, the department of financial 56 services and the department of labor that demonstrates compliance withA. 9865 5 1 the provisions of this act. The department of health, the department of 2 financial services and the department of labor shall prescribe the 3 manner of filing and the content and format of the report required under 4 this section and shall make such filed reports available to the public 5 on each department's respective website. If a health services plan 6 provider that is required to file a report under this section does not 7 file such report by the time required, the department of health, the 8 department of financial services or the department of labor shall impose 9 a fine against the health services plan provider of not less than one 10 thousand dollars per day for each day such report is overdue. 11 2. Any person seeking treatment by a licensed health care provider who 12 has suffered loss or injury by reason of any violation of this act by a 13 health services plan provider shall have a private right of action to 14 enjoin such unlawful act or practice and to recover his or her actual 15 damages sustained because of any violation of this act. Actions may be 16 brought by one or more patients or licensed health care providers for 17 and on behalf of themselves, and other persons or licensed health care 18 providers similarly situated. A court of competent jurisdiction may, in 19 its discretion, award punitive damages, if the court finds that the 20 defendant health services plan provider willfully or knowingly violated 21 this act. The court may also award reasonable attorneys' fees to a 22 prevailing plaintiff. 23 § 9. This act shall take effect immediately.
