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

New York Senate Bill 7199 (Prior Session Legislation)

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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-Introduced.html


                STATE OF NEW YORK
        ________________________________________________________________________

                                          7199

                               2021-2022 Regular Sessions

                    IN SENATE

                                      June 7, 2021
                                       ___________

        Introduced by Sen. GOUNARDES -- read twice and ordered printed, and when
          printed to be committed to the Committee on Rules

        AN ACT to amend the insurance law and the public health 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 (m) to read as follows:
     3    (m)  (1) No insurer that offers a managed care product or a comprehen-
     4  sive policy that utilizes a network of  providers  shall  enter  into  a
     5  contract,  written  policy,  written procedure or agreement (hereinafter
     6  and solely for purposes of this subsection collectively referred to as a
     7  "contract") with any health care provider that:
     8    (A) requires the insurer to include within the scope of  the  contract
     9  all  covered  groups  of  the insurer, including groups or benefit funds
    10  that contract with the insurer, or an  affiliate  of  the  insurer,  for
    11  access to the insurer's network of participating providers;
    12    (B)  requires  an insurer to include all members of a provider system,
    13  including medical practice groups  and  affiliated  facilities,  in  its
    14  network of participating providers;
    15    (C) requires an insurer, or an affiliate of an insurer, to include all
    16  members  of  a  provider  system,  including medical practice groups and
    17  affiliated facilities, in all products offered  by  the  insurer  or  an
    18  affiliate of the insurer;
    19    (D)  restricts  the ability of an insurer to create or modify a tiered
    20  network benefit plan or requires an insurer to place all  members  of  a
    21  provider system, including medical practice groups and affiliated facil-
    22  ities,  in  the  same  network  tier or otherwise limits the right of an
    23  insurer to place a provider in a particular tier;

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD11774-01-1

        S. 7199                             2

     1    (E) prohibits insurers from using benefit designs, including  wellness
     2  programs  and other benefits, to encourage members to seek services from
     3  value-based health care providers;
     4    (F) contains a most-favored-nation provision; provided, however, noth-
     5  ing  in this section shall be construed to prohibit a health insurer and
     6  a provider from negotiating payment rates and performance-based contract
     7  terms that would result in the insurer  receiving  a  rate  that  is  as
     8  favorable, or more favorable, than the rates negotiated between a health
     9  care provider and another entity; or
    10    (G)  restricts the ability of the insurer to disclose price or quality
    11  information,  including  the  allowed  amount,   negotiated   rates   or
    12  discounts,  or  any other claim-related financial obligations covered by
    13  the provider contract to any enrollee, group or other  entity  receiving
    14  health care services pursuant to the contract.
    15    (2)  Beginning  January  first, two thousand twenty-two, any contract,
    16  written policy, written procedure or agreement that  contains  a  clause
    17  contrary  to  the provisions set forth in this section shall be null and
    18  void; provided, however, the remaining clauses  of  the  contract  shall
    19  remain in effect for the duration of the contract term.
    20    §  2. Section 4406 of the public health law is amended by adding a new
    21  subdivision 6 to read as follows:
    22    6. (a) No health maintenance organization that offers a  managed  care
    23  product  or  a comprehensive policy that utilizes a network of providers
    24  shall enter into a contract, written policy, written procedure or agree-
    25  ment with any health care provider that:
    26    (i) requires the insurer to include within the scope of  the  contract
    27  all  covered  groups  of  the insurer, including groups or benefit funds
    28  that contract with the insurer, or an  affiliate  of  the  insurer,  for
    29  access to the insurer's network of participating providers;
    30    (ii)  requires an insurer to include all members of a provider system,
    31  including medical practice groups  and  affiliated  facilities,  in  its
    32  network of participating providers;
    33    (iii)  requires  an insurer, or an affiliate of an insurer, to include
    34  all members of a provider system, including medical practice groups  and
    35  affiliated  facilities,  in  all  products  offered by the insurer or an
    36  affiliate of the insurer;
    37    (iv) restricts the ability of an insurer to create or modify a  tiered
    38  network  benefit  plan  or requires an insurer to place all members of a
    39  provider system, including medical practice groups and affiliated facil-
    40  ities, in the same network tier or otherwise  limits  the  right  of  an
    41  insurer to place a provider in a particular tier;
    42    (v)  prohibits insurers from using benefit designs, including wellness
    43  programs and other benefits, to encourage members to seek services  from
    44  value-based health care providers;
    45    (vi)  contains  a  most-favored-nation  provision;  provided, however,
    46  nothing in this section shall be construed to prohibit a health  insurer
    47  and  a  provider  from  negotiating  payment rates and performance-based
    48  contract terms that would result in the insurer receiving a rate that is
    49  as favorable, or more favorable, than the  rates  negotiated  between  a
    50  health care provider and another entity; or
    51    (vii) restricts the ability of the insurer to disclose price or quali-
    52  ty  information,  including  the  allowed  amount,  negotiated  rates or
    53  discounts, or any other claim-related financial obligations  covered  by
    54  the  provider  contract to any enrollee, group or other entity receiving
    55  health care services pursuant to the contract.

        S. 7199                             3

     1    (b) After January first, two thousand twenty-two, any contract,  writ-
     2  ten  policy,  written  procedure  or  agreement  that  contains a clause
     3  contrary to the provisions set forth in this section shall be  null  and
     4  void;  provided,  however,  the  remaining clauses of the contract shall
     5  remain in effect for the duration of the contract term.
     6    § 3. This act shall take effect January 1, 2022.