Prohibits certain provisions in health plan contracts including most-favored-nation provisions and restrictions on disclosure of actual claim costs, prices or quality in certain situations.
STATE OF NEW YORK
________________________________________________________________________
8169--A
2021-2022 Regular Sessions
IN ASSEMBLY
July 7, 2021
___________
Introduced by M. of A. CRUZ, ANDERSON, SOLAGES, JACKSON, SIMON, MAMDANI,
FERNANDEZ, HEVESI, DINOWITZ, SEAWRIGHT, SAYEGH, J. D. RIVERA,
WILLIAMS, JOYNER, TAPIA, BURGOS, BARNWELL, COLTON, GLICK, GONZALEZ-RO-
JAS, FORREST, RAMOS, AUBRY, J. RIVERA, CARROLL, BURDICK,
BICHOTTE HERMELYN, EPSTEIN, GALLAGHER, JACOBSON, SEPTIMO,
DE LOS SANTOS, KIM, JEAN-PIERRE, DICKENS, NIOU -- read once and
referred to the Committee on Insurance -- recommitted to the Committee
on Insurance in accordance with Assembly Rule 3, sec. 2 -- committee
discharged, bill amended, ordered reprinted as amended and recommitted
to said committee
AN ACT to amend the insurance law, in relation to certain prohibited
contract provisions
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 (o) to read as follows:
3 (o) (1) No contract or agreement between a health plan subject to this
4 article and a health care provider, other than a residential health
5 care facility as defined by section two thousand eight hundred one of
6 the public health law, shall include a provision that:
7 (A) contains a most-favored-nation provision; or
8 (B) restricts the ability of a health plan, an entity that contracts
9 with a health plan for a provider network, or a health care provider to
10 disclose (i) actual claims costs or (ii) price or quality information
11 required to be disclosed under federal law, including the allowed
12 amount, negotiated rates or discounts, or any other claim-related finan-
13 cial obligations, including, but not limited to, patient cost-sharing
14 covered by the provider contract to any insured, group or other entity
15 receiving health care services pursuant to the contract, or to any
16 public compilation of reimbursement data such as the New York all payer
17 database required by law or regulation, provided that no disclosure
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD11774-09-2
A. 8169--A 2
1 shall include protected health information or other information covered
2 by statutory or other privilege.
3 (2) For purposes of this subsection, the term "health plan" shall
4 include (A) an insurer licensed pursuant to the insurance law or a
5 health maintenance organization certified pursuant to article forty-four
6 of the public health law and (B) a third-party administrator, affiliated
7 with an insurer or health maintenance organization, who administers a
8 health benefit plan.
9 § 2. This act shall take effect January 1, 2023.
