Bill Text: NY A08909 | 2021-2022 | General Assembly | Introduced

---

Bill Title: Relates to the reimbursement of out-of-network providers of clinical laboratory services by organizations providing or offering comprehensive health services plans.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2022-01-19 - referred to insurance [A08909 Detail]

Download: New_York-2021-A08909-Introduced.html

---

                STATE OF NEW YORK
        ________________________________________________________________________

                                          8909

                   IN ASSEMBLY

                                    January 19, 2022
                                       ___________

        Introduced by M. of A. WEPRIN -- read once and referred to the Committee
          on Insurance

        AN ACT to amend the public health law and the insurance law, in relation
          to the reimbursement of out-of-network providers of clinical laborato-
          ry  services  by  organizations  providing  or  offering comprehensive
          health services plans

          The People of the State of New York, represented in Senate and  Assem-
        bly, do enact as follows:

     1    Section  1. Section 4406 of the public health law is amended by adding
     2  a new subdivision 6 to read as follows:
     3    6. Notwithstanding any other provision  of  law,  if  an  enrollee  is
     4  referred  by  an  in-plan  provider to a provider of clinical laboratory
     5  services not participating in the plan (a "non-participating  provider")
     6  for  any  service  covered under the terms of the plan, the organization
     7  shall be responsible  for  payment  directly  to  the  non-participating
     8  provider  for  those services in accordance with the time frame for such
     9  payments set forth in section three thousand two  hundred  twenty-four-a
    10  of  the  insurance  law;  provided,  however, that the enrollee shall be
    11  responsible for any applicable copay, coinsurance or deductible for such
    12  services. Clinical laboratories seeking reimbursement pursuant  to  this
    13  section for services rendered shall directly bill the organization whose
    14  enrollee  received  the  services.  Any  payment made by an organization
    15  directly to the enrollee rather than to the clinical laboratory  seeking
    16  reimbursement shall not satisfy the organization's payment obligation to
    17  the clinical laboratory.
    18    §  2.  Section  4804  of  the insurance law is amended by adding a new
    19  subsection (g) to read as follows:
    20    (g) Notwithstanding any other provision of  law,  if  an  enrollee  is
    21  referred  by  an  in-plan  provider to a provider of clinical laboratory
    22  services not participating in the plan (a "non-participating  provider")
    23  for  any  service  covered under the terms of the plan, the organization
    24  shall be responsible  for  payment  directly  to  the  non-participating
    25  provider  for  those services in accordance with the time frame for such
    26  payments set forth in section three thousand two  hundred  twenty-four-a

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD14234-01-2
        A. 8909                             2

     1  of this chapter; provided, however, that the enrollee shall be responsi-
     2  ble  for  any  applicable  copay,  coinsurance  or  deductible  for such
     3  services. Clinical laboratories seeking reimbursement pursuant  to  this
     4  section for services rendered shall directly bill the organization whose
     5  enrollee  received  the  services.  Any  payment made by an organization
     6  directly to the enrollee rather than to the clinical laboratory  seeking
     7  reimbursement shall not satisfy the organization's payment obligation to
     8  the clinical laboratory.
     9    § 3. This act shall take effect immediately.