Bill Text: NY A02983 | 2019-2020 | General Assembly | Amended


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 - Dead) 2020-01-13 - amended on third reading 2983a [A02983 Detail]

Download: New_York-2019-A02983-Amended.html



                STATE OF NEW YORK
        ________________________________________________________________________

                                         2983--A
                                                                Cal. No. 124

                               2019-2020 Regular Sessions

                   IN ASSEMBLY

                                    January 28, 2019
                                       ___________

        Introduced  by M. of A. GOTTFRIED, DINOWITZ, ENGLEBRIGHT, GALEF, PAULIN,
          CUSICK, L. ROSENTHAL, D'URSO, SAYEGH -- Multi-Sponsored by -- M. of A.
          CARROLL, COLTON, COOK,  CYMBROWITZ,  GLICK,  GUNTHER,  LIFTON,  PERRY,
          RIVERA -- read once and referred to the Committee on Health -- ordered
          to a third reading, amended and ordered reprinted, retaining its place
          on the order of third reading

        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

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD03359-02-9

        A. 2983--A                          2

     1  prescribing health care professional or by a  pharmacist  under  section
     2  sixty-eight hundred one-a of the education law.
     3    §  2. Subsection (h) of section 3217-b of the insurance law, as relet-
     4  tered by chapter 237 of the laws of 2009, is relettered  subsection  (p)
     5  and  four  new  subsections  (h),  (m), (n) and (o) are added to read as
     6  follows:
     7    (h) No contract or agreement between an  insurer  and  a  health  care
     8  provider  shall  contain any clause which entitles such insurer to reim-
     9  burse the health care provider at the lowest price  or  rate  that  such
    10  health  care provider has charged another person or entity for rendering
    11  the same treatment or performing the same procedure.
    12    (m) No insurer shall by contract, written policy or written  procedure
    13  prohibit  any health care provider from referring an insured to a physi-
    14  cian based solely upon such physician's participation  status  with  the
    15  insurance product subscribed to by the insured.
    16    (n)  No insurer shall by contract, written policy or written procedure
    17  require the disclosure of an insured's diagnosis on a prescription as  a
    18  condition for authorizing the coverage for or payment or dispensing of a
    19  pharmaceutical drug or agent, unless otherwise required by law.
    20    (o)  No  insurer  which maintains a drug formulary, or which contracts
    21  with another entity to maintain a drug  formulary,  shall  by  contract,
    22  written  policy  or procedure provide for or allow the substitution of a
    23  pharmaceutical drug or agent (other than a generic substitution) by  any
    24  person other than the prescribing health care professional or by a phar-
    25  macist under section sixty-eight hundred one-a of the education law.
    26    §  3.  Subsection  (i) of section 4325 of the insurance law, as relet-
    27  tered by chapter 487 of the laws of 2010, is relettered  subsection  (q)
    28  and  four  new  subsections  (i),  (n), (o) and (p) are added to read as
    29  follows:
    30    (i) No contract or agreement between an  insurer  and  a  health  care
    31  provider  shall  contain any clause which entitles such insurer to reim-
    32  burse the health care provider at the lowest price  or  rate  that  such
    33  health  care provider has charged another person or entity for rendering
    34  the same treatment or performing the same procedure.
    35    (n) No insurer shall by contract, written policy or written  procedure
    36  prohibit  any health care provider from referring an insured to a physi-
    37  cian based solely upon such physician's participation  status  with  the
    38  insurance product subscribed to by the insured.
    39    (o)  No insurer shall by contract, written policy or written procedure
    40  require the disclosure of an insured's diagnosis on a prescription as  a
    41  condition for authorizing the coverage for or payment or dispensing of a
    42  pharmaceutical drug or agent, unless otherwise required by law.
    43    (p)  No  insurer  which maintains a drug formulary, or which contracts
    44  with another entity to maintain a drug  formulary,  shall  by  contract,
    45  written  policy  or procedure provide for or allow the substitution of a
    46  pharmaceutical drug or agent (other than a generic substitution) by  any
    47  person other than the prescribing health care professional or by a phar-
    48  macist under section sixty-eight hundred one-a of the education law.
    49    § 4. This act shall take effect on the one hundred eightieth day after
    50  it shall have become a law.
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