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A09019 Summary:

BILL NOA09019
 
SAME ASSAME AS S08414
 
SPONSORWoerner
 
COSPNSRThiele, Glick, McDonald, Bichotte Hermelyn
 
MLTSPNSR
 
Amd §3217-b, Ins L
 
Includes permissible payment methods, advance consent for direct payments, and annually providing the updated rate schedule as required terms for certain insurance contracts.
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A09019 Actions:

BILL NOA09019
 
02/05/2024referred to insurance
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A09019 Memo:

NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
submitted in accordance with Assembly Rule III, Sec 1(f)
 
BILL NUMBER: A9019
 
SPONSOR: Woerner
  TITLE OF BILL: An act to amend the insurance law, in relation to required terms for certain insurance contracts   PURPOSE OR GENERAL IDEA OF BILL: This bill requires insurers to include basic provisions in their contracts with health care providers that will offer providers more clarity and reliability concerning reimbursement issues.   SUMMARY OF PROVISIONS: Section one amends paragraph 3 of subsection (e) of section 3217-b of the insurance law to clarify an insurer's obligation to describe records or information relied upon to calculate payments and adjustments made to health care providers, including to provide dates of service, patient identification numbers, identification of the services for which payments are being made, and the reimbursement paid for each such service. Section one also adds new paragraphs (3-a), (3-b) and (3-c) to identify the methods of payment insurers may use to reimburse health care providers, require insurers to make payments in full without encum- brances, costs, charges or fees being assessed to the provider, require insurers to receive advance written consent from health care providers concerning the method of payment to be used, and direct insurers to notify providers annually of the updated payment rate schedule applica- ble to such provider, as well as the median rate paid by the insurer for comparable services within the provider's service area. § 2 establishes the effective date.   JUSTIFICATION: Medical and dental practices are small businesses. Like other small businesses, they must track revenues and expenses to make crucial deci- sions concerning personnel management and overhead costs. Under current law, there is a frequent lack of clarity and reliability in insurer/provider relations. Standard contracts are not required to include provisions that obligate insurers to notify providers annually of the applicable reimbursement rate schedule, do not require insurers to provide information that connects a particular payment to particular services rendered, and do not mandate insurers to bear the cost of tran- saction fees and other charges associated with the payment method used to reimburse a provider. Such contractual ambiguities, paired with the position of strength from which insurers typically negotiate provider contracts, hobble health care providers when seeking to effectively manage their businesses. By requiring insurers to include certain basic contract provisions that give network providers valuable information, this bill will support these small businesses in caring for their patients while also helping them to survive and thrive in the communi- ties they serve.   PRIOR LEGISLATIVE HISTORY: New bill.   FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS: None.   EFFECTIVE DATE: This act shall take effect on the thirtieth day after it shall have become a law and shall apply to all contracts entered into, renewed, modified or amended on or after such effective date.
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A09019 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          9019
 
                   IN ASSEMBLY
 
                                    February 5, 2024
                                       ___________
 
        Introduced  by M. of A. WOERNER, THIELE, GLICK -- read once and referred
          to the Committee on Insurance
 
        AN ACT to amend the insurance law, in relation  to  required  terms  for
          certain insurance contracts
 
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
 
     1    Section 1. Paragraph 3 of subsection (e)  of  section  3217-b  of  the
     2  insurance  law, as added by chapter 586 of the laws of 1998,  is amended
     3  and three new subparagraphs 3-a, 3-b  and  3-c  are  added  to  read  as
     4  follows:
     5    (3)  a description of the records or information relied upon to calcu-
     6  late any such payments and adjustments, including the date  of  service,
     7  patient  identification  number,  an  identification  of the service for
     8  which the payment is made, the reimbursement paid by the insurer for the
     9  service, and a description of how the provider can access a  summary  of
    10  such calculations and adjustments;
    11    (3-a)  the permissible payment methods as cash, check, direct deposit,
    12  debit or credit card or online payment system, provided the health  care
    13  provider  can  access  his or her payment in full, without encumbrances,
    14  costs, charges, or fees, including a fee for replacement of  a  lost  or
    15  stolen check;
    16    (3-b) the advance written consent of a provider to the insurer for the
    17  method  of  payment and to directly pay or deposit payments in a bank or
    18  other financial institution of the provider's choosing;
    19    (3-c) the insurer's annual obligation, beginning on the effective date
    20  of this paragraph and continuing every first of January  thereafter,  to
    21  provide  the health care provider with an updated payment rate schedule,
    22  including a description of any services bundled within  a  single  rate,
    23  and  the  median rate paid by the insurer for comparable services within
    24  the provider's service area;
    25    § 2. This act shall take effect on the thirtieth day  after  it  shall
    26  have  become  a  law  and  shall  apply  to  all contracts entered into,
    27  renewed, modified or amended on or after such effective date.
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD14217-01-4
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