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S01330 Summary:

S01330 Actions:

S01330 Committee Votes:

S01330 Floor Votes:

S01330 Text:

 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          1330
 
                               2023-2024 Regular Sessions
 
                    IN SENATE
 
                                    January 11, 2023
                                       ___________
 
        Introduced by Sen. GOUNARDES -- read twice and ordered printed, and when
          printed to be committed to the Committee on Rules
 
        AN ACT to amend the insurance law and the public health law, in relation
          to certain health care contracts or agreements; and to amend a chapter
          of  the  laws  of  2022 amending the insurance law relating to certain
          prohibited contract  provisions,  as  proposed  in  legislative  bills
          numbers  S.  7199-A  and  A.  8169-A, in relation to the effectiveness
          thereof
 
          The People of the State of New York, represented in Senate and  Assem-
        bly, do enact as follows:
 
     1    Section  1.  Section  4235 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 care
     5  facility as defined by section twenty-eight hundred one  of  the  public
     6  health law, shall include a provision that:
     7    (A) contains a most-favored-nation provision; or
     8    (B)  restricts  the ability of a corporation, an entity that contracts
     9  with a corporation 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 subscriber, enrollee, group,  or
    15  other entity receiving health care services pursuant to the contract, or
    16  to any public compilation of reimbursement data such as the New York all
    17  payer  database  required by law or regulation, provided that no disclo-
    18  sure shall include protected health  information  or  other  information
    19  covered by statutory or other privilege.
    20    (2)  For  purposes  of  this  subsection, the term "health plan" shall
    21  include: (A) an insurer licensed pursuant to this chapter  or  a  health
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD04298-01-3
        S. 1330                             2
 
     1  maintenance organization certified pursuant to article forty-four of the
     2  public health law; and
     3    (B)  a third-party administrator, affiliated with an insurer or health
     4  maintenance organization, who administers a health benefit plan.
     5    § 2. Section 4406-c of the public health law is amended  by  adding  a
     6  new subdivision 13 to read as follows:
     7    13. (a) No contract or agreement between a health plan subject to this
     8  article and a health care provider, other than a residential health care
     9  facility as defined by section twenty-eight hundred one of this chapter,
    10  shall include a provision that:
    11    (i) contains a most-favored-nation provision; or
    12    (ii)  restricts the ability of a health plan, an entity that contracts
    13  with a health care plan for a provider network, or a health care provid-
    14  er to disclose: (A) actual claims costs; or (B) price or quality  infor-
    15  mation required to be disclosed under federal law, including the allowed
    16  amount, negotiated rates or discounts, or any other claim-related finan-
    17  cial  obligations,  including,  but not limited to, patient cost-sharing
    18  covered by the provider contract to any subscriber, enrollee, group,  or
    19  other entity receiving health care services pursuant to the contract, or
    20  to any public compilation of reimbursement data such as the New York all
    21  payer  database  required by law or regulation, provided that no disclo-
    22  sure shall include protected health  information  or  other  information
    23  covered by statutory or other privilege.
    24    (b)  For  purposes  of  this subdivision, the term "health plan" shall
    25  include:
    26    (i) an insurer licensed pursuant to the  insurance  law  or  a  health
    27  maintenance organization certified pursuant to this article; and
    28    (ii) a third-party administrator, affiliated with an insurer or health
    29  maintenance organization, who administers a health benefit plan.
    30    § 3. Section 2 of a chapter of the laws of 2022 amending the insurance
    31  law  relating  to certain prohibited contract provisions, as proposed in
    32  legislative bills numbers S. 7199-A and A. 8169-A, is amended to read as
    33  follows:
    34    § 2. This act shall take effect [January] July 1, 2023.
    35    § 4. This act shall take effect immediately, provided,  however,  that
    36  sections  one and two of this act shall take effect on the same date and
    37  in the same manner as a chapter of the laws of 2022 amending the  insur-
    38  ance law relating to certain prohibited contract provisions, as proposed
    39  in legislative bills numbers S. 7199-A and A. 8169-A, takes effect.