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A03683 Summary:

BILL NOA03683
 
SAME ASSAME AS S05319
 
SPONSORWoerner
 
COSPNSRGlick, Bichotte Hermelyn, Weprin
 
MLTSPNSR
 
Amd §§3217-b & 4325, Ins L; amd §4406-c, Pub Health L
 
Includes permissible payment methods, advance consent for direct payments, and annually providing the updated rate schedule as required terms for certain insurance contracts.
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A03683 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          3683
 
                               2025-2026 Regular Sessions
 
                   IN ASSEMBLY
 
                                    January 29, 2025
                                       ___________
 
        Introduced by M. of A. WOERNER, GLICK, BICHOTTE HERMELYN, WEPRIN -- read
          once and referred to the Committee on Insurance
 
        AN ACT to amend the insurance law and the public health law, in relation
          to required terms for certain insurance contracts
 
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
 
     1    Section 1. Paragraph 3 of subsection (e)  of  section  3217-b  of  the
     2  insurance  law, as added by chapter 586 of the laws of 1998,  is amended
     3  and three new paragraphs 3-a, 3-b and 3-c are added to read as follows:
     4    (3) a description of the records or information relied upon to  calcu-
     5  late  any  such payments and adjustments, including the date of service,
     6  patient identification number, an  identification  of  the  service  for
     7  which the payment is made, the reimbursement paid by the insurer for the
     8  service,  and  a description of how the provider can access a summary of
     9  such calculations and adjustments;
    10    (3-a) the permissible payment methods as check, direct deposit,  debit
    11  or  credit  card  or  online  payment  system,  provided the health care
    12  provider can access the payment in full,  without  encumbrances,  costs,
    13  charges,  or  fees,  including a fee for replacement of a lost or stolen
    14  check, under at least one payment method offered by the insurer;
    15    (3-b) the advance written consent of a provider to the insurer for the
    16  method of payment and to directly pay or deposit payments in a  bank  or
    17  other financial institution of the provider's choosing;
    18    (3-c) the insurer's annual obligation, beginning on the effective date
    19  of  this  paragraph and continuing every first of January thereafter, to
    20  provide the health care provider with an updated payment rate schedule;
    21    § 2. Paragraph 3 of subsection (e) of section 4325  of  the  insurance
    22  law,  as  added by chapter 586 of the laws of 1998, is amended and three
    23  new paragraphs 3-a, 3-b and 3-c are added to read as follows:
    24    (3) a description of the records or information relied upon to  calcu-
    25  late  any  such payments and adjustments, including the date of service,
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD07324-01-5

        A. 3683                             2
 
     1  patient identification number, an  identification  of  the  service  for
     2  which the payment is made, the reimbursement paid by the corporation for
     3  the  service, and a description of how the provider can access a summary
     4  of such calculations and adjustments;
     5    (3-a)  the permissible payment methods as check, direct deposit, debit
     6  or credit card or  online  payment  system,  provided  the  health  care
     7  provider  can  access  the payment in full, without encumbrances, costs,
     8  charges, or fees, including a fee for replacement of a  lost  or  stolen
     9  check, under at least one payment method offered by the corporation;
    10    (3-b) the advance written consent of a provider to the corporation for
    11  the  method of payment and to directly pay or deposit payments in a bank
    12  or other financial institution of the provider's choosing;
    13    (3-c) the corporation's annual obligation, beginning on the  effective
    14  date of this paragraph and continuing every first of January thereafter,
    15  to  provide the health care provider with an updated payment rate sched-
    16  ule, including a description of any services  bundled  within  a  single
    17  rate;
    18    §  3. Paragraph (c) of subdivision 5-a of section 4406-c of the public
    19  health law, as added by chapter 586 of the laws of 1998, is amended  and
    20  three  new  paragraphs  (c-1),  (c-2)  and  (c-3)  are  added to read as
    21  follows:
    22    (c) a description of the records or information relied upon to  calcu-
    23  late  any  such payments and adjustments, including the date of service,
    24  patient identification number, an  identification  of  the  service  for
    25  which  the  payment  is  made, the reimbursement paid by the health care
    26  plan for the service, and a description of how the provider can access a
    27  summary of such calculations and adjustments;
    28    (c-1) the permissible payment methods as check, direct deposit,  debit
    29  or  credit  card  or  online  payment  system,  provided the health care
    30  provider can access the payment in  full,  without  encumbrances,  costs
    31  charges,  or  fees,  including a fee for replacement of a lost or stolen
    32  check, under at least one payment method  offered  by  the  health  care
    33  plan;
    34    (c-2)  the  advance  written  consent of a provider to the health care
    35  plan for the method of payment and to directly pay or  deposit  payments
    36  in a bank or other financial institution of the provider's choosing;
    37    (c-3)  the  health  care  plan's  annual  obligation, beginning on the
    38  effective date of this paragraph and continuing every first  of  January
    39  thereafter,  to provide the health care provider with an updated payment
    40  rate schedule, including a description of any services bundled within  a
    41  single rate;
    42    §  4.  This  act shall take effect on the thirtieth day after it shall
    43  have become a law  and  shall  apply  to  all  contracts  entered  into,
    44  renewed, modified or amended on or after such effective date.
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