Bill Text: NY A05296 | 2009-2010 | General Assembly | Introduced
Bill Title: An act to amend the insurance law and the public health law, in relation to prohibiting certain adverse reimbursement change to a contract with a physician; and in relation to grievance procedures and providing access to specialty care
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2010-01-06 - referred to insurance [A05296 Detail]
Download: New_York-2009-A05296-Introduced.html
S T A T E O F N E W Y O R K
________________________________________________________________________
5296
2009-2010 Regular Sessions
I N A S S E M B L Y
February 11, 2009
___________
Introduced by M. of A. MORELLE -- read once and referred to the Commit-
tee on Insurance
AN ACT to amend the insurance law and the public health law, in relation
to prohibiting certain adverse reimbursement change to a contract with
a physician; and in relation to grievance procedures and providing
access to specialty care
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
1 Section 1. Subsections (g) and (h) of section 3217-b of the insurance
2 law, subsection (g) as relettered by chapter 586 of the laws of 1998,
3 are relettered subsections (h) and (i) and a new subsection (g) is added
4 to read as follows:
5 (G)(1) NO INSURER SHALL IMPLEMENT AN ADVERSE REIMBURSEMENT CHANGE TO A
6 CONTRACT WITH A PHYSICIAN THAT IS OTHERWISE PERMITTED BY THE CONTRACT,
7 UNLESS, PRIOR TO THE EFFECTIVE DATE OF THE CHANGE, THE INSURER GIVES THE
8 PHYSICIAN WITH WHOM THE INSURER HAS DIRECTLY CONTRACTED AND WHO IS
9 IMPACTED BY THE ADVERSE REIMBURSEMENT CHANGE, AT LEAST NINETY DAYS WRIT-
10 TEN NOTICE OF THE CHANGE. IF THE CONTRACTING PHYSICIAN OBJECTS TO THE
11 CHANGE THAT IS THE SUBJECT OF THE NOTICE BY THE INSURER, THE PHYSICIAN
12 MAY, WITHIN THIRTY DAYS OF THE DATE OF THE NOTICE, GIVE WRITTEN NOTICE
13 TO THE INSURER TO TERMINATE HIS OR HER CONTRACT WITH THE INSURER EFFEC-
14 TIVE UPON THE IMPLEMENTATION DATE OF THE ADVERSE REIMBURSEMENT CHANGE.
15 FOR THE PURPOSES OF THIS SUBSECTION, THE TERM "ADVERSE REIMBURSEMENT
16 CHANGE" SHALL MEAN A PROPOSED CHANGE THAT COULD REASONABLY BE EXPECTED
17 TO HAVE THE EFFECT OF MATERIALLY REDUCING THE LEVEL OF PAYMENT TO A
18 PHYSICIAN. THE NOTICE PROVISIONS REQUIRED BY THIS SUBSECTION SHALL NOT
19 APPLY WHERE: (A) SUCH CHANGE IS OTHERWISE REQUIRED BY LAW, REGULATION OR
20 APPLICABLE REGULATORY AUTHORITY, OR IS REQUIRED AS A RESULT OF CHANGES
21 IN FEE SCHEDULES, REIMBURSEMENT METHODOLOGY OR PAYMENT POLICIES ESTAB-
22 LISHED BY A GOVERNMENT AGENCY; OR (B) SUCH CHANGE IS EXPRESSLY PROVIDED
23 FOR UNDER THE TERMS OF THE CONTRACT BY THE INCLUSION OF OR REFERENCE TO
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD08737-01-9
A. 5296 2
1 A SPECIFIC FEE OR FEE SCHEDULE, REIMBURSEMENT METHODOLOGY OR PAYMENT
2 POLICY INDEXING MECHANISM.
3 (2) NOTHING IN THIS SUBSECTION SHALL CREATE A PRIVATE RIGHT OF ACTION
4 ON BEHALF OF A PHYSICIAN AGAINST AN INSURER FOR VIOLATIONS OF THIS
5 SUBSECTION.
6 S 2. The insurance law is amended by adding a new section 3217-d to
7 read as follows:
8 S 3217-D. GRIEVANCE PROCEDURE AND ACCESS TO SPECIALTY CARE. (A) AN
9 INSURER THAT ISSUES A COMPREHENSIVE POLICY THAT UTILIZES A NETWORK OF
10 PROVIDERS AND IS NOT A MANAGED CARE HEALTH INSURANCE CONTRACT AS DEFINED
11 IN SUBSECTION (C) OF SECTION FOUR THOUSAND EIGHT HUNDRED ONE OF THIS
12 CHAPTER SHALL ESTABLISH AND MAINTAIN A GRIEVANCE PROCEDURE CONSISTENT
13 WITH THE REQUIREMENTS OF SECTION FOUR THOUSAND EIGHT HUNDRED TWO OF THIS
14 CHAPTER.
15 (B) AN INSURER THAT ISSUES A COMPREHENSIVE POLICY THAT UTILIZES A
16 NETWORK OF PROVIDERS AND IS NOT A MANAGED CARE HEALTH INSURANCE CONTRACT
17 AS DEFINED IN SUBSECTION (C) OF SECTION FOUR THOUSAND EIGHT HUNDRED ONE
18 OF THIS CHAPTER AND REQUIRES THAT SPECIALTY CARE BE PROVIDED PURSUANT TO
19 A REFERRAL FROM A PRIMARY CARE PROVIDER SHALL PROVIDE ACCESS TO SUCH
20 SPECIALTY CARE CONSISTENT WITH THE REQUIREMENTS OF SUBSECTIONS (B), (C)
21 AND (D) OF SECTION FOUR THOUSAND EIGHT HUNDRED FOUR OF THIS CHAPTER;
22 PROVIDED HOWEVER, THAT NOTHING HEREIN SHALL BE CONSTRUED TO REQUIRE THAT
23 AN INSURER, OR A PRIMARY CARE PROVIDER ON BEHALF OF THE INSURER, MAKE A
24 REFERRAL TO A PROVIDER THAT IS NOT IN THE INSURER'S NETWORK.
25 (C) AN INSURER THAT ISSUES A COMPREHENSIVE POLICY THAT UTILIZES A
26 NETWORK OF PROVIDERS AND IS NOT A MANAGED CARE HEALTH INSURANCE CONTRACT
27 AS DEFINED IN SUBSECTION (C) OF SECTION FOUR THOUSAND EIGHT HUNDRED ONE
28 OF THIS CHAPTER SHALL PROVIDE ACCESS TO TRANSITIONAL CARE CONSISTENT
29 WITH THE REQUIREMENTS OF SUBSECTIONS (E) AND (F) OF SECTION FOUR THOU-
30 SAND EIGHT HUNDRED FOUR OF THIS CHAPTER.
31 S 3. Paragraph (B) of paragraph 2 of subsection (e) of section 3231 of
32 the insurance law, as added by chapter 501 of the laws of 1992, is
33 amended to read as follows:
34 (B) Each calendar year, an insurer shall return, in the form of aggre-
35 gate benefits for each policy form filed pursuant to the alternate
36 procedure set forth in this paragraph at least seventy-five percent of
37 the aggregate premiums collected for the policy form during that calen-
38 dar year. Insurers shall annually report, no later than May first of
39 each year, the loss ratio calculated pursuant to this paragraph for each
40 such policy form for the previous calendar year. In each case where the
41 loss ratio for a policy form fails to comply with the seventy-five
42 percent loss ratio requirement, the insurer shall issue a dividend or
43 credit against future premiums for all policy holders with that policy
44 form in an amount sufficient to assure that the aggregate benefits paid
45 in the previous calendar year plus the amount of the dividends and cred-
46 its shall equal seventy-five percent of the aggregate premiums collected
47 for the policy form in the previous calendar year. The dividend or cred-
48 it shall be issued to each policy which was in effect as of December
49 thirty-first of the applicable year [and remains in effect as of the
50 date the dividend or credit is issued]. AN INSURER SHALL MAKE A REASON-
51 ABLE EFFORT TO IDENTIFY THE CURRENT ADDRESS OF THOSE POLICY HOLDERS WHO
52 ARE NO LONGER POLICY HOLDERS WHEN THE DIVIDEND OR CREDIT IS ISSUED. All
53 dividends and credits must be distributed by September thirtieth of the
54 year following the calendar year in which the loss ratio requirements
55 were not satisfied. The annual report required by this paragraph shall
56 include an insurer's calculation of the dividends and credits, as well
A. 5296 3
1 as an explanation of the insurer's plan to issue dividends or credits.
2 The instructions and format for calculating and reporting loss ratios
3 and issuing dividends or credits shall be specified by the superinten-
4 dent by regulation. Such regulations shall include provisions for the
5 distribution of a dividend or credit in the event of cancellation or
6 termination by a policy holder.
7 S 4. The insurance law is amended by adding a new section 4306-c to
8 read as follows:
9 S 4306-C. GRIEVANCE PROCEDURE AND ACCESS TO SPECIALTY CARE. (A) A
10 CORPORATION, INCLUDING A MUNICIPAL COOPERATIVE HEALTH BENEFITS PLAN
11 CERTIFIED PURSUANT TO ARTICLE FORTY-SEVEN OF THIS CHAPTER, THAT ISSUES A
12 COMPREHENSIVE CONTRACT THAT UTILIZES A NETWORK OF PROVIDERS AND IS NOT A
13 MANAGED CARE HEALTH INSURANCE CONTRACT AS DEFINED IN SUBSECTION (C) OF
14 SECTION FOUR THOUSAND EIGHT HUNDRED ONE OF THIS CHAPTER SHALL ESTABLISH
15 AND MAINTAIN A GRIEVANCE PROCEDURE CONSISTENT WITH THE REQUIREMENTS OF
16 SECTION FOUR THOUSAND EIGHT HUNDRED TWO OF THIS CHAPTER.
17 (B) A CORPORATION, INCLUDING A MUNICIPAL COOPERATIVE HEALTH BENEFITS
18 PLAN CERTIFIED PURSUANT TO ARTICLE FORTY-SEVEN OF THIS CHAPTER, THAT
19 ISSUES A COMPREHENSIVE CONTRACT THAT UTILIZES A NETWORK OF PROVIDERS AND
20 IS NOT A MANAGED CARE HEALTH INSURANCE CONTRACT AS DEFINED IN SUBSECTION
21 (C) OF SECTION FOUR THOUSAND EIGHT HUNDRED ONE OF THIS CHAPTER AND
22 REQUIRES THAT SPECIALTY CARE BE PROVIDED PURSUANT TO A REFERRAL FROM A
23 PRIMARY CARE PROVIDER SHALL PROVIDE ACCESS TO SUCH SPECIALTY CARE
24 CONSISTENT WITH THE REQUIREMENTS OF SUBSECTIONS (B), (C) AND (D) OF
25 SECTION FOUR THOUSAND EIGHT HUNDRED FOUR OF THIS CHAPTER; PROVIDED
26 HOWEVER, THAT NOTHING HEREIN SHALL BE CONSTRUED TO REQUIRE THAT A CORPO-
27 RATION, OR A PRIMARY CARE PROVIDER ON BEHALF OF THE CORPORATION, MAKE A
28 REFERRAL TO A PROVIDER THAT IS NOT IN THE CORPORATION'S NETWORK.
29 (C) A CORPORATION, INCLUDING A MUNICIPAL COOPERATIVE HEALTH BENEFITS
30 PLAN CERTIFIED PURSUANT TO ARTICLE FORTY-SEVEN OF THIS CHAPTER, THAT
31 ISSUES A COMPREHENSIVE CONTRACT THAT UTILIZES A NETWORK OF PROVIDERS AND
32 IS NOT A MANAGED CARE HEALTH INSURANCE CONTRACT AS DEFINED IN SUBSECTION
33 (C) OF SECTION FOUR THOUSAND EIGHT HUNDRED ONE OF THIS CHAPTER SHALL
34 PROVIDE ACCESS TO TRANSITIONAL CARE CONSISTENT WITH THE REQUIREMENTS OF
35 SUBSECTIONS (E) AND (F) OF SECTION FOUR THOUSAND EIGHT HUNDRED FOUR OF
36 THIS CHAPTER.
37 S 5. Paragraph 2 of subsection (h) of section 4308 of the insurance
38 law, as added by chapter 504 of the laws of 1995, is amended to read as
39 follows:
40 (2) In each case where the loss ratio for a contract form fails to
41 comply with the eighty-five percent minimum loss ratio requirement for
42 individual direct payment contracts, or the seventy-five percent minimum
43 loss ratio requirement for small group and small group remittance
44 contracts, as set forth in paragraph one of this subsection, the corpo-
45 ration shall issue a dividend or credit against future premiums for all
46 contract holders with that contract form in an amount sufficient to
47 assure that the aggregate benefits incurred in the previous calendar
48 year plus the amount of the dividends and credits shall equal no less
49 than eighty-five percent for individual direct payment contracts, or
50 seventy-five percent for small group and small group remittance
51 contracts, of the aggregate premiums earned for the contract form in the
52 previous calendar year. The dividend or credit shall be issued to each
53 contract that was in effect as of December thirty-first of the applica-
54 ble year [and remains in effect as of the date the dividend or credit is
55 issued]. A CORPORATION SHALL MAKE A REASONABLE EFFORT TO IDENTIFY THE
56 CURRENT ADDRESS OF THOSE CONTRACT HOLDERS OR SUBSCRIBERS WHO ARE NO
A. 5296 4
1 LONGER CONTRACT HOLDERS OR SUBSCRIBERS WHEN THE DIVIDEND OR CREDIT IS
2 ISSUED. All dividends and credits must be distributed by September thir-
3 tieth of the year following the calendar year in which the loss ratio
4 requirements were not satisfied. The annual report required by paragraph
5 one of this subsection shall include a corporation's calculation of the
6 dividends and credits, as well as an explanation of the corporation's
7 plan to issue dividends or credits. The instructions and format for
8 calculating and reporting loss ratios and issuing dividends or credits
9 shall be specified by the superintendent by regulation. Such regulations
10 shall include provisions for the distribution of a dividend or credit in
11 the event of cancellation or termination by a contract holder or
12 subscriber.
13 S 6. Subsections (g) and (h) of section 4325 of the insurance law,
14 subsection (g) as relettered by chapter 586 of the laws of 1998, are
15 relettered subsections (h) and (i) and a new subsection (g) is added to
16 read as follows:
17 (G)(1) NO INSURER SHALL IMPLEMENT AN ADVERSE REIMBURSEMENT CHANGE TO A
18 CONTRACT WITH A PHYSICIAN THAT IS OTHERWISE PERMITTED BY THE CONTRACT,
19 UNLESS, PRIOR TO THE EFFECTIVE DATE OF THE CHANGE, THE INSURER GIVES THE
20 PHYSICIAN WITH WHOM THE INSURER HAS DIRECTLY CONTRACTED AND WHO IS
21 IMPACTED BY THE ADVERSE REIMBURSEMENT CHANGE, AT LEAST NINETY DAYS WRIT-
22 TEN NOTICE OF THE CHANGE. IF THE CONTRACTING PHYSICIAN OBJECTS TO THE
23 CHANGE THAT IS THE SUBJECT OF THE NOTICE BY THE INSURER, THE PHYSICIAN
24 MAY, WITHIN THIRTY DAYS OF THE DATE OF THE NOTICE, GIVE WRITTEN NOTICE
25 TO THE INSURER TO TERMINATE HIS OR HER CONTRACT WITH THE INSURER EFFEC-
26 TIVE UPON THE IMPLEMENTATION DATE OF THE ADVERSE REIMBURSEMENT CHANGE.
27 FOR THE PURPOSES OF THIS SUBSECTION, THE TERM "ADVERSE REIMBURSEMENT
28 CHANGE" SHALL MEAN A PROPOSED CHANGE THAT COULD REASONABLY BE EXPECTED
29 TO HAVE THE EFFECT OF MATERIALLY REDUCING THE LEVEL OF PAYMENT TO A
30 PHYSICIAN. THE NOTICE PROVISIONS REQUIRED BY THIS SUBSECTION SHALL NOT
31 APPLY WHERE: (A) SUCH CHANGE IS OTHERWISE REQUIRED BY LAW, REGULATION OR
32 APPLICABLE REGULATORY AUTHORITY, OR IS REQUIRED AS A RESULT OF CHANGES
33 IN FEE SCHEDULES, REIMBURSEMENT METHODOLOGY OR PAYMENT POLICIES ESTAB-
34 LISHED BY A GOVERNMENT AGENCY; OR (B) SUCH CHANGE IS EXPRESSLY PROVIDED
35 FOR UNDER THE TERMS OF THE CONTRACT BY THE INCLUSION OF OR REFERENCE TO
36 A SPECIFIC FEE OR FEE SCHEDULE, REIMBURSEMENT METHODOLOGY OR PAYMENT
37 POLICY INDEXING MECHANISM.
38 (2) NOTHING IN THIS SUBSECTION SHALL CREATE A PRIVATE RIGHT OF ACTION
39 ON BEHALF OF A PHYSICIAN AGAINST AN INSURER FOR VIOLATIONS OF THIS
40 SUBSECTION.
41 S 7. Subsection (a) of section 4803 of the insurance law, as amended
42 by chapter 551 of the laws of 2006, is amended to read as follows:
43 (a) (1) An insurer which offers a managed care product shall, upon
44 request, make available and disclose to health care professionals writ-
45 ten application procedures and minimum qualification requirements which
46 a health care professional must meet in order to be considered by the
47 insurer for participation in the in-network benefits portion of the
48 insurer's network for the managed care product. The insurer shall
49 consult with appropriately qualified health care professionals in devel-
50 oping its qualification requirements for participation in the in-network
51 benefits portion of the insurer's network for the managed care product.
52 An insurer shall complete review of the health care professional's
53 application to participate in the in-network portion of the insurer's
54 network and, within ninety days of receiving a health care profes-
55 sional's completed application to participate in the insurer's network,
56 will notify the health care professional as to [(i)]: (A) whether he or
A. 5296 5
1 she is credentialed; or [(ii)] (B) whether additional time is necessary
2 to make a determination in spite of THE insurer's best efforts or
3 because of a failure of a third party to provide necessary documenta-
4 tion, or non-routine or unusual circumstances require additional time
5 for review. In such instances where additional time is necessary
6 because of a lack of necessary documentation, an insurer shall make
7 every effort to obtain such information as soon as possible.
8 (2) IF THE COMPLETE APPLICATION OF A NEWLY-LICENSED PHYSICIAN OR A
9 PHYSICIAN THAT HAS RECENTLY RELOCATED TO THIS STATE FROM ANOTHER STATE
10 AND HAS NOT PREVIOUSLY PRACTICED IN THIS STATE, WHO JOINS A GROUP PRAC-
11 TICE OF PHYSICIANS EACH OF WHOM PARTICIPATES IN THE IN-NETWORK PORTION
12 OF AN INSURER'S NETWORK, IS NOT APPROVED OR DECLINED WITHIN NINETY DAYS
13 PURSUANT TO PARAGRAPH ONE OF THIS SUBSECTION, SUCH PHYSICIAN SHALL BE
14 DEEMED "PROVISIONALLY CREDENTIALED" AND MAY PARTICIPATE IN THE IN-NET-
15 WORK PORTION OF AN INSURER'S NETWORK; PROVIDED, HOWEVER, THAT SUCH
16 PHYSICIAN MAY NOT BE DESIGNATED AS AN INSURED'S PRIMARY CARE PHYSICIAN
17 UNTIL SUCH TIME AS THE PHYSICIAN HAS BEEN FULLY CREDENTIALED. THE
18 NETWORK PARTICIPATION FOR THE PROVISIONALLY CREDENTIALED PHYSICIAN SHALL
19 BEGIN ON THE DAY FOLLOWING THE NINETIETH DAY OF RECEIPT OF THE COMPLETED
20 APPLICATION AND SHALL LAST UNTIL THE FINAL CREDENTIALING DETERMINATION
21 IS MADE BY THE INSURER. A PHYSICIAN SHALL ONLY BE ELIGIBLE FOR PROVI-
22 SIONAL CREDENTIALING IF THE GROUP PRACTICE OF PHYSICIANS AGREES THAT,
23 SHOULD THE APPLICATION ULTIMATELY BE DENIED, THE PHYSICIAN OR THE GROUP
24 PRACTICE: (A) SHALL REFUND ANY PAYMENTS MADE BY THE INSURER FOR IN-NET-
25 WORK SERVICES PROVIDED BY THE PROVISIONALLY CREDENTIALED PHYSICIAN THAT
26 EXCEED ANY OUT-OF-NETWORK BENEFITS PAYABLE UNDER THE INSURED'S CONTRACT
27 WITH THE INSURER; AND (B) SHALL NOT PURSUE REIMBURSEMENT FROM THE
28 INSURED, EXCEPT TO COLLECT THE COPAYMENT OR COINSURANCE THAT OTHERWISE
29 WOULD HAVE BEEN PAYABLE HAD THE INSURED RECEIVED SERVICES FROM A PHYSI-
30 CIAN PARTICIPATING IN THE IN-NETWORK PORTION OF AN INSURER'S NETWORK.
31 INTEREST AND PENALTIES PURSUANT TO SECTION THREE THOUSAND TWO HUNDRED
32 TWENTY-FOUR-A OF THIS CHAPTER SHALL NOT BE ASSESSED BASED ON THE DENIAL
33 OF A CLAIM SUBMITTED DURING THE PERIOD WHEN THE PHYSICIAN WAS PROVI-
34 SIONALLY CREDENTIALED; PROVIDED, HOWEVER, THAT NOTHING HEREIN SHALL
35 PREVENT AN INSURER FROM PAYING A CLAIM FROM A PHYSICIAN WHO IS PROVI-
36 SIONALLY CREDENTIALED UPON SUBMISSION OF SUCH CLAIM. AN INSURER SHALL
37 NOT DENY, AFTER APPEAL, A CLAIM FOR SERVICES PROVIDED BY A PROVISIONALLY
38 CREDENTIALED PHYSICIAN SOLELY ON THE GROUND THAT THE CLAIM WAS NOT TIME-
39 LY FILED.
40 S 8. Section 4906 of the insurance law, as amended by chapter 586 of
41 the laws of 1998, is amended to read as follows:
42 S 4906. Waiver. (A) Any agreement which purports to waive, limit,
43 disclaim, or in any way diminish the rights set forth in this article,
44 except as provided pursuant to section four thousand nine hundred ten of
45 this article shall be void as contrary to public policy.
46 (B) NOTWITHSTANDING SUBSECTION (A) OF THIS SECTION, IN LIEU OF THE
47 EXTERNAL APPEAL PROCESS AS SET FORTH IN THIS ARTICLE, A HEALTH CARE PLAN
48 AND A FACILITY LICENSED PURSUANT TO ARTICLE TWENTY-EIGHT OF THE PUBLIC
49 HEALTH LAW MAY MUTUALLY AGREE TO AN ALTERNATIVE DISPUTE RESOLUTION MECH-
50 ANISM TO RESOLVE DISPUTES OTHERWISE SUBJECT TO THIS ARTICLE.
51 S 9. The opening paragraph of subsection (b) of section 4910 of the
52 insurance law, as added by chapter 586 of the laws of 1998, is amended
53 to read as follows:
54 An insured, the insured's designee and, in connection with CONCURRENT
55 AND retrospective adverse determinations, an insured's health care
56 provider, shall have the right to request an external appeal when:
A. 5296 6
1 S 10. Paragraphs 2 and 3 of subsection (b) of section 4914 of the
2 insurance law, as added by chapter 586 of the laws of 1998, are amended
3 to read as follows:
4 (2) The external appeal agent shall make a determination with regard
5 to the appeal within thirty days of the receipt of the [insured's]
6 request therefor, submitted in accordance with the superintendent's
7 instructions. The external appeal agent shall have the opportunity to
8 request additional information from the insured, the insured's health
9 care provider and the insured's health care plan within such thirty-day
10 period, in which case the agent shall have up to five additional busi-
11 ness days if necessary to make such determination. The external appeal
12 agent shall notify the insured, WHERE APPROPRIATE THE INSURED'S HEALTH
13 CARE PROVIDER, and the health care plan, in writing, of the appeal
14 determination within two business days of the rendering of such determi-
15 nation.
16 (3) Notwithstanding the provisions of paragraphs one and two of this
17 subsection, if the insured's attending physician states that a delay in
18 providing the health care service would pose an imminent or serious
19 threat to the health of the insured, the external appeal shall be
20 completed within three days of the request therefor and the external
21 appeal agent shall make every reasonable attempt to immediately notify
22 the insured, WHERE APPROPRIATE, THE INSURED'S HEALTH CARE PROVIDER, and
23 the health plan of its determination by telephone or facsimile, followed
24 immediately by written notification of such determination.
25 S 11. Subsection (d) of section 4914 of the insurance law, as added by
26 chapter 586 of the laws of 1998, is amended to read as follows:
27 (d) [Payment] (1) EXCEPT AS PROVIDED IN PARAGRAPHS TWO AND THREE OF
28 THIS SUBSECTION, PAYMENT for an external appeal shall be the responsi-
29 bility of the health care plan. The health care plan shall make payment
30 to the external appeal agent within forty-five days, from the date the
31 appeal determination is received by the health care plan, and the health
32 care plan shall be obligated to pay such amount together with interest
33 thereon calculated at a rate which is the greater of the rate set by the
34 commissioner of taxation and finance for corporate taxes pursuant to
35 paragraph one of subsection (e) of section one thousand ninety-six of
36 the tax law or twelve percent per annum, to be computed from the date
37 the bill was required to be paid, in the event that payment is not made
38 within such forty-five days.
39 (2) IF AN INSURED'S HEALTH CARE PROVIDER REQUESTS AN EXTERNAL APPEAL
40 OF A CONCURRENT ADVERSE DETERMINATION AND THE EXTERNAL APPEAL AGENT
41 UPHOLDS THE HEALTH CARE PLAN'S DETERMINATION IN WHOLE, PAYMENT FOR THE
42 EXTERNAL APPEAL SHALL BE MADE BY THE HEALTH CARE PROVIDER IN THE MANNER
43 AND SUBJECT TO THE TIMEFRAMES AND REQUIREMENTS SET FORTH IN PARAGRAPH
44 ONE OF THIS SUBSECTION.
45 (3) IF AN INSURED'S HEALTH CARE PROVIDER REQUESTS AN EXTERNAL APPEAL
46 OF A CONCURRENT ADVERSE DETERMINATION AND THE EXTERNAL APPEAL AGENT
47 UPHOLDS THE HEALTH CARE PLAN'S DETERMINATION IN PART, PAYMENT FOR THE
48 EXTERNAL APPEAL SHALL BE EVENLY SPLIT BETWEEN THE HEALTH CARE PLAN AND
49 THE INSURED'S HEALTH CARE PROVIDER WHO REQUESTED THE EXTERNAL APPEAL AND
50 SHALL BE MADE BY THE HEALTH CARE PLAN AND THE INSURED'S HEALTH CARE
51 PROVIDER IN THE MANNER AND SUBJECT TO THE TIMEFRAMES AND REQUIREMENTS
52 SET FORTH IN PARAGRAPH ONE OF THIS SUBSECTION FOR ONE YEAR FROM THE
53 EFFECTIVE DATE OF THIS SUBSECTION. AFTER ONE YEAR FROM THE EFFECTIVE
54 DATE OF THIS SUBSECTION, THE SUPERINTENDENT SHALL EVALUATE WHETHER
55 HEALTH CARE PLANS OR HEALTH CARE PROVIDERS ARE EXPERIENCING A SUBSTAN-
56 TIAL HARDSHIP AS A RESULT OF PAYMENT FOR THE EXTERNAL APPEAL WHEN THE
A. 5296 7
1 EXTERNAL APPEAL AGENT UPHOLDS THE HEALTH CARE PLAN'S DETERMINATION IN
2 PART. THE SUPERINTENDENT, IN CONSULTATION WITH THE COMMISSIONER OF
3 HEALTH, MAY PROMULGATE A REGULATION TO SPECIFY PAYMENT RESPONSIBILITIES
4 OF PROVIDERS AND HEALTH CARE PLANS WHEN THE EXTERNAL APPEAL AGENT
5 UPHOLDS THE HEALTH CARE PLAN'S DETERMINATION IN PART WHICH SHALL SUPER-
6 SEDE THE REQUIREMENTS OF THIS PARAGRAPH.
7 (4) IF AN INSURED'S HEALTH CARE PROVIDER WAS ACTING AS THE INSURED'S
8 DESIGNEE, PAYMENT FOR THE EXTERNAL APPEAL SHALL BE MADE BY THE HEALTH
9 CARE PLAN. THE EXTERNAL APPEAL AND ANY DESIGNATION SHALL BE SUBMITTED
10 ON A STANDARD FORM DEVELOPED BY THE SUPERINTENDENT IN CONSULTATION WITH
11 THE COMMISSIONER OF HEALTH PURSUANT TO SUBSECTION (E) OF THIS SECTION.
12 THE SUPERINTENDENT SHALL HAVE THE AUTHORITY UPON RECEIPT OF AN EXTERNAL
13 APPEAL TO CONFIRM THE DESIGNATION OR REQUEST OTHER INFORMATION AS NECES-
14 SARY. THE SUPERINTENDENT SHALL MAKE AT LEAST TWO WRITTEN REQUESTS TO THE
15 INSURED TO CONFIRM THE DESIGNATION. THE INSURED SHALL HAVE TWO WEEKS TO
16 RESPOND TO EACH SUCH REQUEST. IF THE INSURED FAILS TO RESPOND TO THE
17 SUPERINTENDENT WITHIN THE SPECIFIED TIMEFRAME, THE SUPERINTENDENT SHALL
18 PEND THE EXTERNAL APPEAL AND MAKE TWO WRITTEN REQUESTS TO THE HEALTH
19 CARE PROVIDER TO FILE AN EXTERNAL APPEAL ON HIS OR HER OWN BEHALF. THE
20 HEALTH CARE PROVIDER SHALL HAVE TWO WEEKS TO RESPOND TO EACH SUCH
21 REQUEST. IF THE HEALTH CARE PROVIDER DOES NOT RESPOND TO THE SUPERINTEN-
22 DENT'S REQUESTS WITHIN THE SPECIFIED TIMEFRAME, THE SUPERINTENDENT SHALL
23 REJECT THE APPEAL.
24 S 12. The insurance law is amended by adding a new section 4917 to
25 read as follows:
26 S 4917. HOLD HARMLESS. A HEALTH CARE PROVIDER REQUESTING AN EXTERNAL
27 APPEAL OF A CONCURRENT ADVERSE DETERMINATION, INCLUDING WHEN THE HEALTH
28 CARE PROVIDER REQUESTS AN EXTERNAL APPEAL AS THE INSURED'S DESIGNEE,
29 SHALL NOT PURSUE REIMBURSEMENT FROM THE INSURED EXCEPT TO COLLECT A
30 COPAYMENT, COINSURANCE OR DEDUCTIBLE FOR SERVICES DETERMINED NOT
31 MEDICALLY NECESSARY BY THE EXTERNAL APPEAL AGENT.
32 S 13. Subdivision 5-c of section 4406-c of the public health law is
33 relettered subdivision 5-d and a new subdivision 5-c is added to read as
34 follows:
35 5-C. (A) NO HEALTH CARE PLAN SHALL IMPLEMENT AN ADVERSE REIMBURSEMENT
36 CHANGE TO A CONTRACT WITH A PHYSICIAN THAT IS OTHERWISE PERMITTED BY THE
37 CONTRACT, UNLESS, PRIOR TO THE EFFECTIVE DATE OF THE CHANGE, THE HEALTH
38 CARE PLAN GIVES THE PHYSICIAN WITH WHOM THE HEALTH CARE PLAN HAS DIRECT-
39 LY CONTRACTED AND WHO IS IMPACTED BY THE ADVERSE REIMBURSEMENT CHANGE,
40 AT LEAST NINETY DAYS WRITTEN NOTICE OF THE CHANGE. IF THE CONTRACTING
41 PHYSICIAN OBJECTS TO THE CHANGE THAT IS THE SUBJECT OF THE NOTICE BY THE
42 HEALTH CARE PLAN, THE PHYSICIAN MAY, WITHIN THIRTY DAYS OF THE DATE OF
43 THE NOTICE, GIVE WRITTEN NOTICE TO THE HEALTH CARE PLAN TO TERMINATE HIS
44 OR HER CONTRACT WITH THE HEALTH CARE PLAN EFFECTIVE UPON THE IMPLEMENTA-
45 TION DATE OF THE ADVERSE REIMBURSEMENT CHANGE. FOR THE PURPOSES OF THIS
46 SUBDIVISION, THE TERM "ADVERSE REIMBURSEMENT CHANGE" SHALL MEAN A
47 PROPOSED CHANGE THAT COULD REASONABLY BE EXPECTED TO HAVE THE EFFECT OF
48 MATERIALLY REDUCING THE LEVEL OF PAYMENT TO A PHYSICIAN. THE NOTICE
49 PROVISIONS REQUIRED BY THIS SUBDIVISION SHALL NOT APPLY WHERE: (I) SUCH
50 CHANGE IS OTHERWISE REQUIRED BY LAW, REGULATION OR APPLICABLE REGULATORY
51 AUTHORITY, OR IS REQUIRED AS A RESULT OF CHANGES IN FEE SCHEDULES,
52 REIMBURSEMENT METHODOLOGY OR PAYMENT POLICIES ESTABLISHED BY A GOVERN-
53 MENT AGENCY; OR (II) SUCH CHANGE IS EXPRESSLY PROVIDED FOR UNDER THE
54 TERMS OF THE CONTRACT BY THE INCLUSION OF OR REFERENCE TO A SPECIFIC FEE
55 OR FEE SCHEDULE, REIMBURSEMENT METHODOLOGY OR PAYMENT POLICY INDEXING
56 MECHANISM.
A. 5296 8
1 (B) NOTHING IN THIS SUBDIVISION SHALL CREATE A PRIVATE RIGHT OF ACTION
2 ON BEHALF OF A PHYSICIAN AGAINST AN INSURER FOR VIOLATIONS OF THIS
3 SUBDIVISION.
4 S 14. Subdivision 1 of section 4406-d of the public health law, as
5 amended by chapter 551 of the laws of 2006, is amended to read as
6 follows:
7 1. (A) A health care plan shall, upon request, make available and
8 disclose to health care professionals written application procedures and
9 minimum qualification requirements which a health care professional must
10 meet in order to be considered by the health care plan. The plan shall
11 consult with appropriately qualified health care professionals in devel-
12 oping its qualification requirements. A health care plan shall complete
13 review of the health care professional's application to participate in
14 the in-network portion of the health care plan's network and shall,
15 within ninety days of receiving a health care professional's completed
16 application to participate in the health care plan's network, notify the
17 health care professional as to [(a)]: (I) whether he or she is creden-
18 tialed; or [(b)] (II) whether additional time is necessary to make a
19 determination in spite of the health care plan's best efforts or because
20 of a failure of a third party to provide necessary documentation, or
21 non-routine or unusual circumstances require additional time for review.
22 In such instances where additional time is necessary because of a lack
23 of necessary documentation, a health plan shall make every effort to
24 obtain such information as soon as possible.
25 (B) IF THE COMPLETE APPLICATION OF A NEWLY-LICENSED PHYSICIAN OR A
26 PHYSICIAN THAT HAS RECENTLY RELOCATED TO THIS STATE FROM ANOTHER STATE
27 AND HAS NOT PREVIOUSLY PRACTICED IN THIS STATE, WHO JOINS A GROUP PRAC-
28 TICE OF PHYSICIANS EACH OF WHOM PARTICIPATES IN THE IN-NETWORK PORTION
29 OF A HEALTH CARE PLAN'S NETWORK, IS NOT APPROVED OR DECLINED WITHIN
30 NINETY DAYS PURSUANT TO PARAGRAPH (A) OF THIS SUBDIVISION, THE PHYSICIAN
31 SHALL BE DEEMED "PROVISIONALLY CREDENTIALED" AND MAY PARTICIPATE IN THE
32 IN-NETWORK PORTION OF THE HEALTH CARE PLAN'S NETWORK; PROVIDED, HOWEVER,
33 THAT SUCH PHYSICIAN MAY NOT BE DESIGNATED AS AN ENROLLEE'S PRIMARY CARE
34 PHYSICIAN UNTIL SUCH TIME AS THE PHYSICIAN HAS BEEN FULLY CREDENTIALED.
35 THE NETWORK PARTICIPATION FOR THE PROVISIONALLY CREDENTIALED PHYSICIAN
36 SHALL BEGIN ON THE DAY FOLLOWING THE NINETIETH DAY OF RECEIPT OF THE
37 COMPLETED APPLICATION AND SHALL LAST UNTIL THE FINAL CREDENTIALING
38 DETERMINATION IS MADE BY THE HEALTH CARE PLAN. A PHYSICIAN SHALL ONLY BE
39 ELIGIBLE FOR PROVISIONAL CREDENTIALING IF THE GROUP PRACTICE OF PHYSI-
40 CIANS AGREES THAT, SHOULD THE APPLICATION ULTIMATELY BE DENIED, THE
41 PHYSICIAN OR THE GROUP PRACTICE: (I) SHALL REFUND ANY PAYMENTS MADE BY
42 THE HEALTH CARE PLAN FOR IN-NETWORK SERVICES PROVIDED BY THE PROVI-
43 SIONALLY CREDENTIALED PHYSICIAN THAT EXCEED ANY OUT-OF-NETWORK BENEFITS
44 PAYABLE UNDER THE ENROLLEE'S CONTRACT WITH THE HEALTH CARE PLAN; AND
45 (II) SHALL NOT PURSUE REIMBURSEMENT FROM THE ENROLLEE, EXCEPT TO COLLECT
46 THE COPAYMENT THAT OTHERWISE WOULD HAVE BEEN PAYABLE HAD THE ENROLLEE
47 RECEIVED SERVICES FROM A PHYSICIAN PARTICIPATING IN THE IN-NETWORK
48 PORTION OF A HEALTH CARE PLAN'S NETWORK. INTEREST AND PENALTIES PURSUANT
49 TO SECTION THREE THOUSAND TWO HUNDRED TWENTY-FOUR-A OF THE INSURANCE LAW
50 SHALL NOT BE ASSESSED BASED ON THE DENIAL OF A CLAIM SUBMITTED DURING
51 THE PERIOD WHEN THE PHYSICIAN WAS PROVISIONALLY CREDENTIALED; PROVIDED,
52 HOWEVER, THAT NOTHING HEREIN SHALL PREVENT A HEALTH CARE PLAN FROM
53 PAYING A CLAIM FROM A PHYSICIAN WHO IS PROVISIONALLY CREDENTIALED UPON
54 SUBMISSION OF SUCH CLAIM. A HEALTH CARE PLAN SHALL NOT DENY, AFTER
55 APPEAL, A CLAIM FOR SERVICES PROVIDED BY A PROVISIONALLY CREDENTIALED
56 PHYSICIAN SOLELY ON THE GROUND THAT THE CLAIM WAS NOT TIMELY FILED.
A. 5296 9
1 S 15. Section 4906 of the public health law, as amended by chapter 586
2 of the laws of 1998, is amended to read as follows:
3 S 4906. Waiver. 1. Any agreement which purports to waive, limit,
4 disclaim, or in any way diminish the rights set forth in this article,
5 except as provided pursuant to section four thousand nine hundred ten of
6 this article shall be void as contrary to public policy.
7 2. NOTWITHSTANDING SUBDIVISION ONE OF THIS SECTION, IN LIEU OF THE
8 EXTERNAL APPEAL PROCESS AS SET FORTH IN THIS ARTICLE, A HEALTH CARE PLAN
9 AND A FACILITY LICENSED PURSUANT TO ARTICLE TWENTY-EIGHT OF THIS CHAPTER
10 MAY MUTUALLY AGREE TO AN ALTERNATIVE DISPUTE RESOLUTION MECHANISM TO
11 RESOLVE DISPUTES OTHERWISE SUBJECT TO THIS ARTICLE.
12 S 16. The opening paragraph of subdivision 2 of section 4910 of the
13 public health law, as added by chapter 586 of the laws of 1998, is
14 amended to read as follows:
15 An enrollee, the enrollee's designee and, in connection with CONCUR-
16 RENT AND retrospective adverse determinations, an enrollee's health care
17 provider, shall have the right to request an external appeal when:
18 S 17. Paragraphs (b) and (c) of subdivision 2 of section 4914 of the
19 public health law, as added by chapter 586 of the laws of 1998, are
20 amended to read as follows:
21 (b) The external appeal agent shall make a determination with respect
22 to the appeal within thirty days of the receipt of the [enrollee's]
23 request therefor, submitted in accordance with the commissioner's
24 instructions. The external appeal agent shall have the opportunity to
25 request additional information from the enrollee, the enrollee's health
26 care provider and the enrollee's health care plan within such thirty-day
27 period, in which case the agent shall have up to five additional busi-
28 ness days if necessary to make such determination. The external appeal
29 agent shall notify the enrollee, WHERE APPROPRIATE, THE ENROLLEE'S
30 HEALTH CARE PROVIDER, and the health care plan, in writing, of the
31 appeal determination within two business days of the rendering of such
32 determination.
33 (c) Notwithstanding the provisions of paragraphs (a) and (b) of this
34 subdivision, if the enrollee's attending physician states that a delay
35 in providing the health care service would pose an imminent or serious
36 threat to the health of the enrollee, the external appeal shall be
37 completed within three days of the request therefor and the external
38 appeal agent shall make every reasonable attempt to immediately notify
39 the enrollee, WHERE APPROPRIATE, THE ENROLLEE'S HEALTH CARE PROVIDER,
40 and the health plan of its determination by telephone or facsimile,
41 followed immediately by written notification of such determination.
42 S 18. Subdivision 4 of section 4914 of the public health law, as added
43 by chapter 586 of the laws of 1998, is amended to read as follows:
44 4. [Payment] (A) EXCEPT AS PROVIDED IN PARAGRAPHS (B) AND (C) OF THIS
45 SUBDIVISION, PAYMENT for an external appeal shall be the responsibility
46 of the health care plan. The health care plan shall make payment to the
47 external appeal agent within forty-five days from the date the appeal
48 determination is received by the health care plan, and the health care
49 plan shall be obligated to pay such amount together with interest there-
50 on calculated at a rate which is the greater of the rate set by the
51 commissioner of taxation and finance for corporate taxes pursuant to
52 paragraph one of subsection (e) of section one thousand ninety-six of
53 the tax law or twelve percent per annum, to be computed from the date
54 the bill was required to be paid, in the event that payment is not made
55 within such forty-five days.
A. 5296 10
1 (B) IF AN ENROLLEE'S HEALTH CARE PROVIDER REQUESTS AN EXTERNAL APPEAL
2 OF A CONCURRENT ADVERSE DETERMINATION AND THE EXTERNAL APPEAL AGENT
3 UPHOLDS THE HEALTH CARE PLAN'S DETERMINATION IN WHOLE, PAYMENT FOR THE
4 EXTERNAL APPEAL SHALL BE MADE BY THE HEALTH CARE PROVIDER IN THE MANNER
5 AND SUBJECT TO THE TIMEFRAMES AND REQUIREMENTS SET FORTH IN PARAGRAPH
6 (A) OF THIS SUBDIVISION.
7 (C) IF AN ENROLLEE'S HEALTH CARE PROVIDER REQUESTS AN EXTERNAL APPEAL
8 OF A CONCURRENT ADVERSE DETERMINATION AND THE EXTERNAL APPEAL AGENT
9 UPHOLDS THE HEALTH CARE PLAN'S DETERMINATION IN PART, PAYMENT FOR THE
10 EXTERNAL APPEAL SHALL BE EVENLY SPLIT BETWEEN THE HEALTH CARE PLAN AND
11 THE ENROLLEE'S HEALTH CARE PROVIDER WHO REQUESTED THE EXTERNAL APPEAL
12 AND SHALL BE MADE BY THE HEALTH CARE PLAN AND THE ENROLLEE'S HEALTH CARE
13 PROVIDER IN THE MANNER AND SUBJECT TO THE TIMEFRAMES AND REQUIREMENTS
14 SET FORTH IN PARAGRAPH (A) OF THIS SUBDIVISION. AFTER ONE YEAR FROM THE
15 EFFECTIVE DATE OF THIS SUBDIVISION, THE SUPERINTENDENT OF INSURANCE
16 SHALL EVALUATE WHETHER HEALTH CARE PLANS OR HEALTH CARE PROVIDERS ARE
17 EXPERIENCING A SUBSTANTIAL HARDSHIP AS A RESULT OF PAYMENT FOR THE
18 EXTERNAL APPEAL WHEN THE EXTERNAL APPEAL AGENT UPHOLDS THE HEALTH CARE
19 PLAN'S DETERMINATION IN PART. THE COMMISSIONER, IN CONSULTATION WITH THE
20 SUPERINTENDENT OF INSURANCE, MAY PROMULGATE A REGULATION TO SPECIFY
21 PAYMENT RESPONSIBILITIES OF PROVIDERS AND HEALTH CARE PLANS WHEN THE
22 EXTERNAL APPEAL AGENT UPHOLDS THE HEALTH CARE PLAN'S DETERMINATION IN
23 PART WHICH SHALL SUPERSEDE THE REQUIREMENTS OF THIS PARAGRAPH.
24 (D) IF AN ENROLLEE'S HEALTH CARE PROVIDER WAS ACTING AS THE ENROLLEE'S
25 DESIGNEE, PAYMENT FOR THE EXTERNAL APPEAL SHALL BE MADE BY THE HEALTH
26 CARE PLAN. THE EXTERNAL APPEAL AND ANY DESIGNATION SHALL BE SUBMITTED
27 ON A STANDARD FORM DEVELOPED BY THE COMMISSIONER IN CONSULTATION WITH
28 THE SUPERINTENDENT OF INSURANCE PURSUANT TO SUBDIVISION FIVE OF THIS
29 SECTION. THE SUPERINTENDENT OF INSURANCE SHALL HAVE THE AUTHORITY UPON
30 RECEIPT OF AN EXTERNAL APPEAL TO CONFIRM THE DESIGNATION OR REQUEST
31 OTHER INFORMATION AS NECESSARY. THE SUPERINTENDENT OF INSURANCE SHALL
32 MAKE AT LEAST TWO WRITTEN REQUESTS TO THE ENROLLEE TO CONFIRM THE DESIG-
33 NATION. THE ENROLLEE SHALL HAVE TWO WEEKS TO RESPOND TO EACH SUCH
34 REQUEST. IF THE ENROLLEE FAILS TO RESPOND TO THE SUPERINTENDENT OF
35 INSURANCE WITHIN THE SPECIFIED TIME FRAME, THE SUPERINTENDENT OF INSUR-
36 ANCE SHALL PEND THE EXTERNAL APPEAL AND MAKE TWO WRITTEN REQUESTS TO THE
37 HEALTH CARE PROVIDER TO FILE AN EXTERNAL APPEAL ON HIS OR HER OWN
38 BEHALF. THE HEALTH CARE PROVIDER SHALL HAVE TWO WEEKS TO RESPOND TO EACH
39 SUCH REQUEST. IF THE HEALTH CARE PROVIDER DOES NOT RESPOND TO THE SUPER-
40 INTENDENT OF INSURANCE REQUESTS WITHIN THE SPECIFIED TIMEFRAME, THE
41 SUPERINTENDENT OF INSURANCE SHALL REJECT THE APPEAL.
42 S 19. The public health law is amended by adding a new section 4917 to
43 read as follows:
44 S 4917. HOLD HARMLESS. A HEALTH CARE PROVIDER REQUESTING AN EXTERNAL
45 APPEAL OF A CONCURRENT ADVERSE DETERMINATION, INCLUDING WHEN THE HEALTH
46 CARE PROVIDER REQUESTS AN EXTERNAL APPEAL AS THE ENROLLEE'S DESIGNEE,
47 SHALL NOT PURSUE REIMBURSEMENT FROM THE ENROLLEE EXCEPT TO COLLECT A
48 COPAYMENT FOR SERVICES DETERMINED NOT MEDICALLY NECESSARY BY THE
49 EXTERNAL APPEAL AGENT.
50 S 20. This act shall take effect January 1, 2010; provided, however,
51 that:
52 1. sections seven and fourteen of this act shall take effect October
53 1, 2009, and shall apply to applications submitted after that date, and
54 shall not apply to applications submitted prior to such date if such
55 application is resubmitted in substantially similar form on or after
56 October 1, 2009;
A. 5296 11
1 2. the amendments to subsection (a) of section 3217-d of the insurance
2 law made by section two of this act and subsection (a) of section 4306-c
3 of the insurance law made by section four of this act shall take effect
4 January 1, 2010 or the date uniform standards for a grievance procedure
5 are adopted to be consistent with federal requirements, whichever is
6 later;
7 3. provided, further, that the amendments to subsection (i) of section
8 3217-b of the insurance law made by section one of this act shall not
9 affect the repeal of such subsection and shall be deemed repealed there-
10 with;
11 4. provided, further, that the amendments to subsection (i) of section
12 4325 of the insurance law made by section six of this act shall not
13 affect the repeal of such subsection and shall be deemed repealed there-
14 with; and
15 5. provided, further, that the amendments made to subdivision 5-d of
16 section 4406-c of the public health law made by section thirteen of this
17 act shall not affect the repeal of such subdivision and shall be deemed
18 repealed therewith.
