Provides that no insurer, health maintenance organization, or any other entity shall, by contract, written policy, or procedure, reduce the payment of a negotiated rate for evaluation and management or procedural services furnished by a participating provider that are otherwise covered services, solely because the provider also billed other health care services.
STATE OF NEW YORK
________________________________________________________________________
11688
IN ASSEMBLY
September 2, 2026
___________
Introduced by COMMITTEE ON RULES -- (at request of M. of A. Weprin) --
read once and referred to the Committee on Insurance
AN ACT to amend the insurance law, in relation to reducing inequities in
access to medical procedures
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 (q) to read as follows:
3 (q) (1) No insurer, health maintenance organization, or any other
4 entity subject to this article shall, by contract, written policy, or
5 procedure, reduce the payment of a negotiated rate for evaluation and
6 management or procedural services furnished by a participating provider
7 that are otherwise covered services, solely because the provider also
8 billed other health care services, including but not limited to minor
9 procedures, on the same day as the evaluation and management or proce-
10 dural services.
11 (2) Any provision of a participating provider agreement that allows
12 for a reduction in reimbursement as prohibited by this subsection shall
13 be void and unenforceable.
14 (3) With respect to an insured enrolled in a health benefit plan under
15 which the insurer or utilization review organization only provides
16 administrative services, the obligations created by this subsection
17 shall be limited to recommending to the third-party payor that coverage
18 and payment should be authorized in accordance with the prohibitions set
19 forth herein.
20 § 2. This act shall take effect immediately and shall apply to all
21 contracts and policies issued, renewed, modified, or amended on or after
22 such effective date.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD16240-01-6
