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A00594 Summary:

A00594 Actions:

A00594 Floor Votes:

A00594 Text:

 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                           594
 
                               2011-2012 Regular Sessions
 
                   IN ASSEMBLY
 
                                       (Prefiled)
 
                                     January 5, 2011
                                       ___________
 
        Introduced  by M. of A. GOTTFRIED, DINOWITZ, ENGLEBRIGHT, GALEF, PAULIN,
          CUSICK, PHEFFER, KAVANAGH -- Multi-Sponsored by --  M.  of  A.  AUBRY,
          BRENNAN,  COLTON,  COOK,  CYMBROWITZ, GLICK, GUNTHER, HEASTIE, HOOPER,
          JACOBS,  KELLNER,  LIFTON,  MAYERSOHN,  McENENY,   PERRY,   J. RIVERA,

          P. RIVERA,  ROBINSON,  SCARBOROUGH, SWEENEY, TOWNS, WEISENBERG -- read
          once and referred to the Committee on Health
 
        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 as
     2  added  by  chapter  705 of the laws of 1996 and as renumbered by chapter
     3  487 of the laws of 2010, is  renumbered  subdivision  12  and  four  new
     4  subdivisions 8, 9, 10 and 11 are added to read as follows:
     5    8.  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    9.  No  health  care plan shall by contract, written policy or written
    11  procedure prohibit or restrict any health care provider from referring a
    12  patient or enrollee to a health care provider  based  solely  upon  such
    13  health  care provider's participation status with the managed care prod-
    14  uct subscribed to by the patient or enrollee.
    15    10. 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    11. No health care plan shall by contract, written policy or procedure
    20  provide  for or allow the substitution of a pharmaceutical drug or agent
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD02331-01-1
        A. 594                              2
 
     1  (other than a  generic  substitution)  by  any  person  other  than  the
     2  prescribing health care professional.
     3    §  2.  Subsections (h) and (i) of section 3217-b of the insurance law,

     4  as relettered by chapter  237  of  the  laws  of  2009,  are  relettered
     5  subsections  (l)  and (m) and four new subsections (h), (i), (j) and (k)
     6  are added to read as 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    (i) No insurer shall by contract, written policy or written  procedure
    13  prohibit  or restrict any health care provider from referring an insured
    14  to a physician based solely upon such physician's  participation  status

    15  with the insurance product subscribed to by the insured.
    16    (j)  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    (k)  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.
    25    §  3. Subsections (i) and (j) of section 4325 of the insurance law, as

    26  relettered  by  chapter  487  of  the  laws  of  2010,  are   relettered
    27  subsections  (m)  and (n) and four new subsections (i), (j), (k) and (l)
    28  are added to read as follows:
    29    (i) No contract or agreement between an  insurer  and  a  health  care
    30  provider  shall  contain any clause which entitles such insurer to reim-
    31  burse the health care provider at the lowest price  or  rate  that  such
    32  health  care provider has charged another person or entity for rendering
    33  the same treatment or performing the same procedure.
    34    (j) No insurer shall by contract, written policy or written  procedure
    35  prohibit  or restrict any health care provider from referring an insured
    36  to a physician based solely upon such physician's  participation  status

    37  with the insurance product subscribed to by the insured.
    38    (k)  No insurer shall by contract, written policy or written procedure
    39  require the disclosure of an insured's diagnosis on a prescription as  a
    40  condition for authorizing the coverage for or payment or dispensing of a
    41  pharmaceutical drug or agent, unless otherwise required by law.
    42    (l)  No  insurer  which maintains a drug formulary, or which contracts
    43  with another entity to maintain a drug  formulary,  shall  by  contract,
    44  written  policy  or procedure provide for or allow the substitution of a
    45  pharmaceutical drug or agent (other than a generic substitution) by  any
    46  person other than the prescribing health care professional.
    47    § 4. This act shall take effect on the one hundred eightieth day after

    48  it  shall have become a law, provided that the relettering of subsection
    49  (m) of section 3217-b and the relettering of subsection (n)  of  section
    50  4325  of  the  insurance law made by sections two and three of this act,
    51  respectively, shall not affect the repeal of such subsections and  shall
    52  be deemed repealed therewith.