STATE OF NEW YORK
________________________________________________________________________
9781
IN ASSEMBLY
February 11, 2020
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Introduced by M. of A. HUNTER -- read once and referred to the Committee
on Insurance
AN ACT to amend the insurance law and the public health law, in relation
to prohibiting certain requirements in insurance contracts
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 (m) to read as follows:
3 (m)(1) No insurer that offers a managed care product or a comprehen-
4 sive policy that utilizes a network of providers shall enter into a
5 contract, written policy, written procedure or agreement with any health
6 care provider that:
7 (A) Requires an insurer to include all members of a provider group,
8 including medical practice groups and facilities, in its network of
9 participating providers;
10 (B) Requires an insurer to place all members of a provider group,
11 including medical practice groups and facilities, in the same network
12 tier;
13 (C) Requires an insurer to include all members of a provider group,
14 including medical practice groups and facilities, in all products
15 offered by the insurer;
16 (D) Prohibits insurers from using benefit designs to encourage members
17 to seek services from higher-value health care providers;
18 (E) Contains a most-favored-nation provision; provided, however, noth-
19 ing in this section shall be construed to prohibit a health insurer and
20 a provider from negotiating payment rates and performance-based contract
21 terms that would result in the insurer receiving a rate that is as
22 favorable, or more favorable, than the rates negotiated between a health
23 care provider and another entity; and
24 (F) Limits the ability of the insurer or health care provider from
25 disclosing fees for services or the allowed amounts to an insured or
26 insured's health care provider.
27 (2) After January first, two thousand twenty-one, any contract, writ-
28 ten policy, written procedure or agreement that contains a clause
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD15287-01-0
A. 9781 2
1 contrary to the provisions set forth in this section shall be null and
2 void; provided, however, the remaining clauses of the contract shall
3 remain in effect for the duration of the contract term.
4 § 2. Section 4406 of the public health law is amended by adding a new
5 subdivision 6 to read as follows:
6 6. (a) No health maintenance organization that offers a managed care
7 product or a comprehensive policy that utilizes a network of providers
8 shall enter into a contract, written policy, written procedure or agree-
9 ment with any health care provider that:
10 (i) Requires an insurer to include all members of a provider group,
11 including medical practice groups and facilities, in its network of
12 participating providers;
13 (ii) Requires an insurer to place all members of a provider group,
14 including medical practice groups and facilities, in the same network
15 tier;
16 (iii) Requires an insurer to include all members of a provider group,
17 including medical practice groups and facilities, in all products
18 offered by the insurer;
19 (iv) Prohibits insurers from using benefit designs to encourage
20 members to seek services from higher-value health care providers;
21 (v) Contains a most-favored-nation provision; provided, however, noth-
22 ing in this section shall be construed to prohibit a health insurer and
23 a provider from negotiating payment rates and performance-based contract
24 terms that would result in the insurer receiving a rate that is as
25 favorable, or more favorable, than the rates negotiated between a health
26 care provider and another entity; and
27 (vi) Limits the ability of the insurer or health care provider from
28 disclosing fees for services or the allowed amounts to an insured or
29 insured's health care provider.
30 (b) After January first, two thousand twenty-one, any contract, writ-
31 ten policy, written procedure or agreement that contains a clause
32 contrary to the provisions set forth in this section shall be null and
33 void; provided, however, the remaining clauses of the contract shall
34 remain in effect for the duration of the contract term.
35 § 3. This act shall take effect on January 1, 2021.