Bill Text: NY S06858 | 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 1-0)
Status: (Introduced - Dead) 2020-01-08 - REFERRED TO HEALTH [S06858 Detail]
Download: New_York-2019-S06858-Introduced.html
STATE OF NEW YORK ________________________________________________________________________ 6858 2019-2020 Regular Sessions IN SENATE November 18, 2019 ___________ Introduced by Sen. SANDERS -- read twice and ordered printed, and when printed to be committed to the Committee on Rules 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 15 and four new 4 subdivisions 11, 12, 13 and 14 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 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 14. 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. 24 § 2. Subsection (h) of section 3217-b of the insurance law, as relet- 25 tered by chapter 237 of the laws of 2009, is relettered subsection (p) EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD03359-03-9S. 6858 2 1 and four new subsections (h), (m), (n) and (o) are added to read as 2 follows: 3 (h) No contract or agreement between an insurer and a health care 4 provider shall contain any clause which entitles such insurer to reim- 5 burse the health care provider at the lowest price or rate that such 6 health care provider has charged another person or entity for rendering 7 the same treatment or performing the same procedure. 8 (m) No insurer shall by contract, written policy or written procedure 9 prohibit any health care provider from referring an insured to a physi- 10 cian based solely upon such physician's participation status with the 11 insurance product subscribed to by the insured. 12 (n) No insurer shall by contract, written policy or written procedure 13 require the disclosure of an insured's diagnosis on a prescription as a 14 condition for authorizing the coverage for or payment or dispensing of a 15 pharmaceutical drug or agent, unless otherwise required by law. 16 (o) No insurer which maintains a drug formulary, or which contracts 17 with another entity to maintain a drug formulary, shall by contract, 18 written policy or procedure provide for or allow the substitution of a 19 pharmaceutical drug or agent (other than a generic substitution) by any 20 person other than the prescribing health care professional or by a phar- 21 macist under section sixty-eight hundred one-a of the education law. 22 § 3. Subsection (i) of section 4325 of the insurance law, as relet- 23 tered by chapter 487 of the laws of 2010, is relettered subsection (q) 24 and four new subsections (i), (n), (o) and (p) are added to read as 25 follows: 26 (i) No contract or agreement between an insurer and a health care 27 provider shall contain any clause which entitles such insurer to reim- 28 burse the health care provider at the lowest price or rate that such 29 health care provider has charged another person or entity for rendering 30 the same treatment or performing the same procedure. 31 (n) No insurer shall by contract, written policy or written procedure 32 prohibit any health care provider from referring an insured to a physi- 33 cian based solely upon such physician's participation status with the 34 insurance product subscribed to by the insured. 35 (o) No insurer shall by contract, written policy or written procedure 36 require the disclosure of an insured's diagnosis on a prescription as a 37 condition for authorizing the coverage for or payment or dispensing of a 38 pharmaceutical drug or agent, unless otherwise required by law. 39 (p) No insurer which maintains a drug formulary, or which contracts 40 with another entity to maintain a drug formulary, shall by contract, 41 written policy or procedure provide for or allow the substitution of a 42 pharmaceutical drug or agent (other than a generic substitution) by any 43 person other than the prescribing health care professional or by a phar- 44 macist under section sixty-eight hundred one-a of the education law. 45 § 4. This act shall take effect on the one hundred eightieth day after 46 it shall have become a law.
