Bill Text: NY S07199 | 2021-2022 | General Assembly | Amended

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Bill Title: Prohibits certain provisions in health plan contracts including most-favored-nation provisions and restrictions on disclosure of actual claim costs, prices or quality in certain situations.

Spectrum: Partisan Bill (Democrat 22-0)

Status: (Passed) 2022-12-09 - APPROVAL MEMO.36 [S07199 Detail]

Download: New_York-2021-S07199-Amended.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                         7199--A

                               2021-2022 Regular Sessions

                    IN SENATE

                                      June 7, 2021
                                       ___________

        Introduced  by  Sens.  GOUNARDES, BAILEY, BIAGGI, BROUK, CLEARE, COMRIE,
          HINCHEY, HOYLMAN,  JACKSON,  KAVANAGH,  KRUEGER,  LIU,  MAYER,  MYRIE,
          RAMOS,  REICHLIN-MELNICK, RIVERA, SALAZAR, SAVINO, SEPULVEDA, SKOUFIS,
          STAVISKY -- read twice and ordered printed, and  when  printed  to  be
          committed to the Committee on Rules -- recommitted to the Committee on
          Insurance  in  accordance  with  Senate  Rule  6,  sec. 8 -- committee
          discharged, bill amended, ordered reprinted as amended and recommitted
          to said committee

        AN ACT to amend the insurance law, in  relation  to  certain  prohibited
          contract provisions

          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 (o) to read as follows:
     3    (o) (1) No contract or agreement between a health plan subject to this
     4  article  and  a  health care provider,   other than a residential health
     5  care facility as defined by section two thousand eight  hundred  one  of
     6  the public health law, shall include a provision that:
     7    (A) contains a most-favored-nation provision; or
     8    (B)  restricts  the ability of a health plan, an entity that contracts
     9  with a health plan for a provider network, or a health care provider  to
    10  disclose  (i)  actual  claims costs or (ii) price or quality information
    11  required to be  disclosed  under  federal  law,  including  the  allowed
    12  amount, negotiated rates or discounts, or any other claim-related finan-
    13  cial  obligations,  including,  but not limited to, patient cost-sharing
    14  covered by the provider contract to any insured, group or  other  entity
    15  receiving  health  care  services  pursuant  to  the contract, or to any
    16  public compilation of reimbursement data such as the New York all  payer
    17  database  required  by  law  or  regulation, provided that no disclosure
    18  shall include protected health information or other information  covered
    19  by statutory or other privilege.

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD11774-08-2
        S. 7199--A                          2

     1    (2)  For  purposes  of  this  subsection, the term "health plan" shall
     2  include (A) an insurer licensed pursuant  to  the  insurance  law  or  a
     3  health maintenance organization certified pursuant to article forty-four
     4  of the public health law and (B) a third-party administrator, affiliated
     5  with  an  insurer  or health maintenance organization, who administers a
     6  health benefit plan.
     7    § 2. This act shall take effect January 1, 2023.