Amd §§3216, 3221 & 4303, Ins L; add §§4406-j & 2404-e, Pub Health L
Ensures continuity of care for cancer patients during insurance contract negotiations by requiring insurance coverage and treatment continue until the conclusion of care.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A7944A
SPONSOR: Sayegh TITLE OF BILL:
An act to amend the insurance law and the public health law, in relation
to ensuring continuity of care for cancer patients during insurance
contract negotiations
PURPOSE:
This legislation will ensure that for oncology patients currently being
treated for cancer, that both their insurers and oncology treatment
providers will provide continuous care to these patients, even in the
event that the insurer and oncology treatment provider fail to agree
during contract renewal negotiations. In such an event, all such
patients will be "grandfathered" under the insurer and oncology treat-
ment provider, and will remain covered by insurance and treated by such
provider, for the balance of the course of their treatment.
SUMMARY OF SPECIFIC PROVISIONS:
Section 1 sets forth that this act shall be know and may be cited as the
"Continuity of Cancer Care Act" or the "COCCA".
Section 2 amends Section 3216 of the insurance law by adding a new
subsection (n) stating insurers must continue to cover such treatments,
regardless of contractual disputes, at the rate payable under the previ-
ous contract, for such insured until the conclusion of such insured's
entire course of treatment and the insured is found to be clinically
stable, provided that the rate payable under the prior contract shall be
adjusted by the applicable Medicare Economic Index minus one percentage
point applied to payment rates at the start of the next calendar year,
and for each succeeding calendar year, for individuals that are continu-
ing to receive treatment pursuant to this provision.
Section 3 amends Section 3221 of the insurance law by adding a new
subsection (v)stating insurers must continue to cover such treatments,
regardless of contractual disputes, at the rate payable under the previ-
ous contract, for such insured until the conclusion of such insured's
entire course of treatment and the insured is found to be clinically
stable, provided that the rate payable under the prior contract shall be
adjusted by the applicable Medicare Economic Index minus one percentage
point applied to payment rates at the start of the next calendar year,
and for each succeeding calendar year, for individuals that are continu-
ing to receive treatment pursuant to this provision.
Section 4 amends Section 4303 of the insurance law by adding a new
subsection (i) stating insurers must continue to cover such treatments,
regardless of contractual disputes, at the rate payable under the previ-
ous contract, for such insured until the conclusion of such insured's
entire course of treatment and the insured is found to be clinically
stable, provided that the rate payable under the prior contract shall be
adjusted by the applicable Medicare Economic Index minus one percentage
point applied to payment rates at the start of the next calendar year,
and for each succeeding calendar year, for individuals that are continu-
ing to receive treatment pursuant to this provision.
Section 5 amends Section 4400 of the insurance law by adding a new
section 4406-j stating insurers must continue to cover such treatments,
regardless of contractual disputes, at the rate payable under the previ-
ous contract, for such insured until the conclusion of such insured's
entire course of treatment and the insured is found to be clinically
stable, provided that the rate payable under the prior contract shall be
adjusted by the applicable Medicare Economic Index minus one percentage
point applied to payment rates at the start of the next calendar year,
and for each succeeding calendar year, for individuals that are continu-
ing to receive treatment pursuant to this provision.
Section 6 amends the Public Health Law by adding a new section 2404-e
entitled Cancer; duty to continue treatment - which states insurers must
continue covering care for such treatments, regardless of contractual
disputes, until the conclusion of the insured's care
Section 7 sets the effective date.
JUSTIFICATION:
Dealing with a diagnosis of cancer is difficult enough for both the
patient and their loved ones. For a patient to thereafter receive a
letter from their insurance provider, that their oncologists may no
longer be considered "in network" with such insurance provider, is
simply too much to bear. Nonetheless, in October 2024 and again in June
2025, two major insurance providers sent such a letter to tens of thou-
sands of its insured patients, regarding each of their contract negoti-
ations with Memorial Sloan Kettering Cancer Center ("MSKCC"), stating
coverage for any and all treatments would end December 31, 2024, and
July 1, 2025, respectively. Thankfully, the parties came to an agree-
ment. Had they not, thousands of cancer patients would have been forced
to leave MSKCC. This bill ensures that any patients currently under
treatment, will be automatically grandfathered for continued care until
the end of their treatment.
PRIOR LEGISLATIVE HISTORY:
NEW BILL
FISCAL IMPLICATIONS:
None.
EFFECTIVE DATE:
This act shall take effect on the ninetieth day after it shall have
become a law.
