Relates to the New York state of health transparency act; requires certain information be listed on the New York state of health marketplace for each plan.
STATE OF NEW YORK
________________________________________________________________________
10033
IN ASSEMBLY
March 4, 2020
___________
Introduced by M. of A. BYRNE -- read once and referred to the Committee
on Health
AN ACT to amend the public health law, in relation to the New York state
of health transparency act
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. This act shall be known and may be cited as the "New York
2 State of Health Transparency Act".
3 § 2. Section 268-h of the public health law is renumbered section
4 268-i and a new section 268-h is added to read as follows:
5 § 268-h. Marketplace transparency. The following information about
6 each health plan offered for sale to consumers shall be available to
7 consumers on the marketplace in a clear and understandable form for use
8 in comparing plans, plan coverage, and plan premiums:
9 1. the ability to determine whether specific types of health care
10 practitioners are in-network and to determine whether a named health
11 care practitioner, hospital, or other provider is in network;
12 2. any exclusions from coverage and any restrictions on use or quanti-
13 ty of covered items and services in each category of benefits;
14 3. a description of how medications will specifically be included in
15 or excluded from the deductible, including a description of out-of-pock-
16 et costs that may not apply to the deductible for a medication;
17 4. the specific dollar amount of any copay or percentage of coinsu-
18 rance for each item or service;
19 5. the ability to determine whether a specific drug is available on
20 formulary, the applicable cost-sharing requirement, whether a specific
21 drug is covered when furnished by a physician or clinic and any clinical
22 prerequisites or authorization requirements for coverage of a drug;
23 6. the process for a patient to obtain reversal of a health plan deci-
24 sion where an item or service prescribed or ordered by the treating
25 physician has been denied; and
26 7. an explanation of the amount of coverage for out-of-network provid-
27 ers or non-covered services, and any rights of appeal that exist when
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD15256-01-0
A. 10033 2
1 out-of-network providers or non-covered services are medically neces-
2 sary.
3 § 3. Severability clause. If any clause, sentence, paragraph, subdivi-
4 sion, or section of this act shall be adjudged by any court of competent
5 jurisdiction to be invalid, such judgment shall not affect, impair, or
6 invalidate the remainder thereof, but shall be confined in its operation
7 to the clause, sentence, paragraph, subdivision, or section thereof
8 directly involved in the controversy in which such judgment shall have
9 been rendered. It is hereby declared to be the intent of the legislature
10 that this act would have been enacted even if such invalid provisions
11 had not been included herein.
12 § 4. This act shall take effect one year after it shall have become a
13 law.
