Bill Text: NY A03148 | 2023-2024 | General Assembly | Introduced

New York Assembly Bill 3148

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) 2024-01-03 - referred to insurance [A03148 Detail]

Download: New_York-2023-A03148-Introduced.html


                STATE OF NEW YORK
        ________________________________________________________________________

                                          3148

                               2023-2024 Regular Sessions

                   IN ASSEMBLY

                                    February 2, 2023
                                       ___________

        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 (p) to read as follows:
     3    (p)(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

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD07800-01-3

        A. 3148                             2

     1    (F)  Limits  the  ability  of the insurer or health care provider from
     2  disclosing fees for services or the allowed amounts  to  an  insured  or
     3  insured's health care provider.
     4    (2) After January first, two thousand twenty-four, any contract, writ-
     5  ten  policy,  written  procedure  or  agreement  that  contains a clause
     6  contrary to the provisions set forth in this section shall be  null  and
     7  void;  provided,  however,  the  remaining clauses of the contract shall
     8  remain in effect for the duration of the contract term.
     9    § 2. Section 4406 of the public health law is amended by adding a  new
    10  subdivision 6 to read as follows:
    11    6.  (a)  No health maintenance organization that offers a managed care
    12  product or a comprehensive policy that utilizes a network  of  providers
    13  shall enter into a contract, written policy, written procedure or agree-
    14  ment with any health care provider that:
    15    (i)  Requires  an  insurer to include all members of a provider group,
    16  including medical practice groups and  facilities,  in  its  network  of
    17  participating providers;
    18    (ii)  Requires  an  insurer  to place all members of a provider group,
    19  including medical practice groups and facilities, in  the  same  network
    20  tier;
    21    (iii)  Requires an insurer to include all members of a provider group,
    22  including medical  practice  groups  and  facilities,  in  all  products
    23  offered by the insurer;
    24    (iv)  Prohibits  insurers  from  using  benefit  designs  to encourage
    25  members to seek services from higher-value health care providers;
    26    (v) Contains a most-favored-nation provision; provided, however, noth-
    27  ing in this section shall be construed to prohibit a health insurer  and
    28  a provider from negotiating payment rates and performance-based contract
    29  terms  that  would  result  in  the  insurer receiving a rate that is as
    30  favorable, or more favorable, than the rates negotiated between a health
    31  care provider and another entity; and
    32    (vi) Limits the ability of the insurer or health  care  provider  from
    33  disclosing  fees  for  services  or the allowed amounts to an insured or
    34  insured's health care provider.
    35    (b) After January first, two thousand twenty-four, any contract, writ-
    36  ten policy, written  procedure  or  agreement  that  contains  a  clause
    37  contrary  to  the provisions set forth in this section shall be null and
    38  void; provided, however, the remaining clauses  of  the  contract  shall
    39  remain in effect for the duration of the contract term.
    40    § 3. This act shall take effect January 1, 2024.