Bill Text: NY A03779 | 2021-2022 | General Assembly | Introduced

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Bill Title: 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.

Spectrum: Partisan Bill (Republican 1-0)

Status: (Introduced - Dead) 2022-01-05 - referred to health [A03779 Detail]

Download: New_York-2021-A03779-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                          3779

                               2021-2022 Regular Sessions

                   IN ASSEMBLY

                                    January 28, 2021
                                       ___________

        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

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD06307-01-1
        A. 3779                             2

     1    7. an explanation of the amount of coverage for out-of-network provid-
     2  ers  or  non-covered  services, and any rights of appeal that exist when
     3  out-of-network providers or non-covered services  are  medically  neces-
     4  sary.
     5    § 3. Severability clause. If any clause, sentence, paragraph, subdivi-
     6  sion, or section of this act shall be adjudged by any court of competent
     7  jurisdiction  to  be invalid, such judgment shall not affect, impair, or
     8  invalidate the remainder thereof, but shall be confined in its operation
     9  to the clause, sentence,  paragraph,  subdivision,  or  section  thereof
    10  directly  involved  in the controversy in which such judgment shall have
    11  been rendered. It is hereby declared to be the intent of the legislature
    12  that this act would have been enacted even if  such  invalid  provisions
    13  had not been included herein.
    14    §  4. This act shall take effect one year after it shall have become a
    15  law.