NY State Assembly Bill 2009-A6741

Archive: Last Bill Status - Lost

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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Actions

View Actions

Date of Action	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jul 16, 2009	lost 3rd reading cal.908 substituted for s3180b
Jun 22, 2009	referred to rules delivered to senate passed assembly
Jun 08, 2009	amended on third reading 6741b
May 14, 2009	advanced to third reading cal.577
May 12, 2009	reported
May 05, 2009	print number 6741a
May 05, 2009	amend (t) and recommit to health
Mar 12, 2009	referred to health

Votes

- Jul 16, 2009 - Floor Vote
  A6741
  
  Aye
  
  28
  
  Nay
  
  29
  
  Absent
  
  0
  
  Excused
  
  5
  
  Abstained
  
  0
  - - Floor Vote: Jul 16, 2009
      
      aye (28)
      
      Adams
      
      Addabbo Jr.
      
      Aubertine
      
      Breslin
      
      Dilan
      
      Duane
      
      Espada
      
      Hassell-Thompson
      
      Huntley
      
      Johnson
      
      Klein
      
      Krueger
      
      Monserrate
      
      Montgomery
      
      Onorato
      
      Oppenheimer
      
      Parker
      
      Perkins
      
      Sampson
      
      Savino
      
      Schneiderman
      
      Serrano
      
      Smith
      
      Stachowski
      
      Stavisky
      
      Stewart-Cousins
      
      Thompson
      
      Valesky
      
      nay (29)
      
      Alesi
      
      Bonacic
      
      DeFrancisco
      
      Farley
      
      Flanagan
      
      Fuschillo
      
      Golden
      
      Griffo
      
      Hannon
      
      LaValle
      
      Lanza
      
      Larkin
      
      Leibell
      
      Libous
      
      Little
      
      Marcellino
      
      Maziarz
      
      McDonald
      
      Morahan
      
      Nozzolio
      
      Padavan
      
      Ranzenhofer
      
      Robach
      
      Saland
      
      Seward
      
      Skelos
      
      Volker
      
      Winner
      
      Young
      
      excused (5)
      
      Diaz
      
      Foley
      
      Johnson
      
      Kruger
      
      Squadron

Bill Amendments

Original

B (Active)

2009-A6741 - Details

Laws Affected:: Amd §4406, Pub Health L; amd §4804, Ins L

2009-A6741 - Summary

Relates to the reimbursement of out-of-network providers of clinical laboratory services.

2009-A6741 - Bill Text download pdf

                            
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

    S. 3180                                                  A. 6741

                       2009-2010 Regular Sessions

                      S E N A T E - A S S E M B L Y

                             March 12, 2009
                               ___________

IN SENATE -- Introduced by Sen. DUANE -- read twice and ordered printed,
  and when printed to be committed to the Committee on Health

IN  ASSEMBLY -- Introduced by M. of A. BRADLEY -- read once and referred
  to the Committee on Health

AN ACT to amend the public health law, in relation to the  reimbursement
  of  out-of-network providers of clinical laboratory services by organ-
  izations 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:

  Section  1. Section 4406 of the public health law is amended by adding
a new subdivision 5 to read as follows:
  5. NOTWITHSTANDING ANY OTHER PROVISION  OF  LAW,  IF  AN  ENROLLEE  IS
REFERRED  BY  AN  IN-PLAN  PROVIDER TO A PROVIDER OF CLINICAL LABORATORY
SERVICES NOT PARTICIPATING IN THE PLAN (A "NON-PARTICIPATING PROVIDER"),
ANY SERVICE THAT WOULD OTHERWISE BE COVERED AS AN IN-PLAN SERVICE  UNDER
THE  PLAN  THAT  IS  PROVIDED BY THE NON-PARTICIPATING PROVIDER SHALL BE
COVERED AS AN IN-PLAN SERVICE, AND THE ORGANIZATION SHALL BE RESPONSIBLE
FOR PAYMENT  TO  THE  NON-PARTICIPATING  PROVIDER  FOR  THOSE  SERVICES,
PROVIDED HOWEVER, THAT THE AMOUNT OF ANY SUCH PAYMENT IS NOT REQUIRED TO
EXCEED  THAT  FOR WHICH THE ORGANIZATION WOULD HAVE BEEN RESPONSIBLE HAD
THE  REFERRAL  BEEN  TO  AN  IN-PLAN  PROVIDER  OF  CLINICAL  LABORATORY
SERVICES,  AND  THE  ENROLLEE  SHALL  BE  RESPONSIBLE FOR ANY APPLICABLE
IN-PLAN COPAY, COINSURANCE OR DEDUCTIBLE  FOR  SUCH  SERVICES.  CLINICAL
LABORATORIES SEEKING REIMBURSEMENT PURSUANT TO THIS ARTICLE FOR SERVICES
RENDERED  SHALL SEEK PAYMENT DIRECTLY FROM THE ORGANIZATION WHOSE ENROL-
LEE RECEIVED THE SERVICES WITHOUT SEEKING PAYMENT FROM THE ENROLLEE. ANY
PAYMENT MADE BY AN ORGANIZATION DIRECTLY TO THE ENROLLEE RATHER THAN  TO
THE  CLINICAL  LABORATORY  SEEKING  REIMBURSEMENT  SHALL NOT SATISFY THE
ORGANIZATION'S PAYMENT OBLIGATION TO THE CLINICAL LABORATORY.
  S 2. This act shall take effect immediately.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD09070-01-9

2009-A6741A - Details

Laws Affected:: Amd §4406, Pub Health L; amd §4804, Ins L

2009-A6741A - Summary

Relates to the reimbursement of out-of-network providers of clinical laboratory services.

2009-A6741A - Bill Text download pdf

                            
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

    S. 3180--A                                            A. 6741--A

                       2009-2010 Regular Sessions

                      S E N A T E - A S S E M B L Y

                             March 12, 2009
                               ___________

IN SENATE -- Introduced by Sen. DUANE -- read twice and ordered printed,
  and when printed to be committed to the Committee on Health -- commit-
  tee  discharged, bill amended, ordered reprinted as amended and recom-
  mitted to said committee

IN ASSEMBLY -- Introduced by M. of A. BRADLEY, GUNTHER, GALEF,  LANCMAN,
  BING,  GOTTFRIED,  DenDEKKER,  ZEBROWSKI,  COLTON,  ESPAILLAT, JAFFEE,
  SPANO, SCHIMEL, FIELDS -- Multi-Sponsored by  --  M.  of  A.  BOYLAND,
  BRENNAN,  EDDINGTON, GREENE, HIKIND, HYER-SPENCER, LUPARDO, MAYERSOHN,
  McENENY, PHEFFER, REILLY, SWEENEY, TITONE, WEISENBERG -- read once and
  referred to the Committee on  Health  --  committee  discharged,  bill
  amended,  ordered reprinted as amended and recommitted to said commit-
  tee

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:

  Section 1. Section 4406 of the public health law is amended by  adding
a new subdivision 5 to read as follows:
  5.  NOTWITHSTANDING  ANY  OTHER  PROVISION  OF  LAW, IF AN ENROLLEE IS
REFERRED BY AN IN-PLAN PROVIDER TO A  PROVIDER  OF  CLINICAL  LABORATORY
SERVICES NOT PARTICIPATING IN THE PLAN (A "NON-PARTICIPATING PROVIDER"),
ANY  SERVICE THAT WOULD OTHERWISE BE COVERED AS AN IN-PLAN SERVICE UNDER
THE PLAN THAT IS PROVIDED BY THE  NON-PARTICIPATING  PROVIDER  SHALL  BE
COVERED AS AN IN-PLAN SERVICE, AND THE ORGANIZATION SHALL BE RESPONSIBLE
FOR  PAYMENT  TO  THE  NON-PARTICIPATING  PROVIDER  FOR  THOSE SERVICES,
PROVIDED HOWEVER, THAT THE AMOUNT OF ANY SUCH PAYMENT IS NOT REQUIRED TO
EXCEED THAT FOR WHICH THE ORGANIZATION WOULD HAVE BEEN  RESPONSIBLE  HAD
THE  REFERRAL  BEEN  TO  AN  IN-PLAN  PROVIDER  OF  CLINICAL  LABORATORY

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD09070-02-9

S. 3180--A                          2                         A. 6741--A

SERVICES, AND THE ENROLLEE  SHALL  BE  RESPONSIBLE  FOR  ANY  APPLICABLE
IN-PLAN  COPAY,  COINSURANCE  OR  DEDUCTIBLE FOR SUCH SERVICES. CLINICAL
LABORATORIES SEEKING REIMBURSEMENT PURSUANT TO THIS ARTICLE FOR SERVICES
RENDERED  SHALL SEEK PAYMENT DIRECTLY FROM THE ORGANIZATION WHOSE ENROL-
LEE RECEIVED THE SERVICES WITHOUT SEEKING PAYMENT FROM THE ENROLLEE. ANY
PAYMENT MADE BY AN ORGANIZATION DIRECTLY TO THE ENROLLEE RATHER THAN  TO
THE  CLINICAL  LABORATORY  SEEKING  REIMBURSEMENT  SHALL NOT SATISFY THE
ORGANIZATION'S PAYMENT OBLIGATION TO THE CLINICAL LABORATORY.
  S 2. Section 4804 of the insurance law is  amended  by  adding  a  new
subsection (g) to read as follows:
  (G)  NOTWITHSTANDING  ANY  OTHER  PROVISION  OF LAW, IF AN ENROLLEE IS
REFERRED BY AN IN-PLAN PROVIDER TO A  PROVIDER  OF  CLINICAL  LABORATORY
SERVICES NOT PARTICIPATING IN THE PLAN (A "NON-PARTICIPATING PROVIDER"),
ANY  SERVICE THAT WOULD OTHERWISE BE COVERED AS AN IN-PLAN SERVICE UNDER
THE PLAN THAT IS PROVIDED BY THE  NON-PARTICIPATING  PROVIDER  SHALL  BE
COVERED AS AN IN-PLAN SERVICE, AND THE ORGANIZATION SHALL BE RESPONSIBLE
FOR  PAYMENT  TO  THE  NON-PARTICIPATING  PROVIDER  FOR  THOSE SERVICES,
PROVIDED HOWEVER, THAT THE AMOUNT OF ANY SUCH PAYMENT IS NOT REQUIRED TO
EXCEED THAT FOR WHICH THE ORGANIZATION WOULD HAVE BEEN  RESPONSIBLE  HAD
THE  REFERRAL  BEEN  TO  AN  IN-PLAN  PROVIDER  OF  CLINICAL  LABORATORY
SERVICES, AND THE ENROLLEE  SHALL  BE  RESPONSIBLE  FOR  ANY  APPLICABLE
IN-PLAN  COPAY,  COINSURANCE  OR  DEDUCTIBLE FOR SUCH SERVICES. CLINICAL
LABORATORIES SEEKING REIMBURSEMENT PURSUANT TO THIS ARTICLE FOR SERVICES
RENDERED SHALL SEEK PAYMENT DIRECTLY FROM THE ORGANIZATION WHOSE  ENROL-
LEE RECEIVED THE SERVICES WITHOUT SEEKING PAYMENT FROM THE ENROLLEE. ANY
PAYMENT  MADE BY AN ORGANIZATION DIRECTLY TO THE ENROLLEE RATHER THAN TO
THE CLINICAL LABORATORY SEEKING  REIMBURSEMENT  SHALL  NOT  SATISFY  THE
ORGANIZATION'S PAYMENT OBLIGATION TO THE CLINICAL LABORATORY.
  S 3. This act shall take effect immediately.

2009-A6741B (ACTIVE) - Details

Laws Affected:: Amd §4406, Pub Health L; amd §4804, Ins L

2009-A6741B (ACTIVE) - Summary

Relates to the reimbursement of out-of-network providers of clinical laboratory services.

2009-A6741B (ACTIVE) - Sponsor Memo

                                BILL NUMBER:A6741B

TITLE OF BILL:  An act to amend the public health law and the insurance
law, in relation to the reimbursement of out-of-network providers of
clinical laboratory services by organizations providing or offering
comprehensive health services plans

PURPOSE OR GENERAL IDEA OF THE BILL: To provide that organizations
providing or offering comprehensive health services plans, such as
managed care organizations and health maintenance organizations, direct-
ly reimburse out-of-network providers of clinical laboratory services
when plan participants are referred to out-of-network providers by
in-network organizations or providers.

SUMMARY OF SPECIFIC PROVISIONS: Section 1 of the bill amends section
4406 of the public health law by adding a new subdivision 5. The new
subdivision 5 provides that organizations providing or offering compre-
hensive health services plans must reimburse out-of-network providers of
clinical laboratory services for the provision of such services to plan
participants, when the participants are referred to out-of-network
providers by in-network organizations or providers.  The services must
be of the type reimbursable under the plan, The bill would require the
clinical laboratory to bill the organization directly for the services.
Any payment made by an organization directly to the enrollee rather than
to the clinical laboratory seeking reimbursement shall not satisfy the
organization's direct payment obligation to the clinical laboratory.

Section 2 of the bill amends section 4804 of the insurance law by adding
a new subsection (g) with provisions that are identical to the forego-
ing.

JUSTIFICATION: In an effort to provide the best health care available,
health care organizations and providers regularly refer patients to
providers outside of such patients' organization's networks. Under
current law, however, such organizations are not required to directly
reimburse out-of-network providers for clinical laboratory services
rendered. Instead, out-of-network providers of clinical laboratory
services must look directly to the patients for payment of their fees,
even though patients are less likely to pay for the services once
rendered and may assume that the organization is required to pay for the
services. This provides a disincentive to out-of-network providers to
render services to such patients even in cases where the out of network
provider may offer better services. This practice also thwarts the
medical advice and direction of the patient's medical care giver and
limits patient health care options.

This legislation would expand the health care service options available
to the residents of the state and promote the referral of patients to
providers deemed to be the best for the medical care of such patients,
whether in or out-of-network.

LEGISLATIVE HISTORY: New bill.

FISCAL IMPLICATIONS:  None to the State.

EFFECTIVE DATE: Immediately.

2009-A6741B (ACTIVE) - Bill Text download pdf

                            
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

    S. 3180--B                                            A. 6741--B
                                                        Cal. No. 577

                       2009-2010 Regular Sessions

                      S E N A T E - A S S E M B L Y

                             March 12, 2009
                               ___________

IN SENATE -- Introduced by Sen. DUANE -- read twice and ordered printed,
  and when printed to be committed to the Committee on Health -- commit-
  tee  discharged, bill amended, ordered reprinted as amended and recom-
  mitted to said committee -- reported favorably from said committee and
  committed to the Committee on Finance --  committee  discharged,  bill
  amended,  ordered reprinted as amended and recommitted to said commit-
  tee

IN ASSEMBLY -- Introduced by M. of A. BRADLEY, GUNTHER, GALEF,  LANCMAN,
  BING,  GOTTFRIED,  DenDEKKER,  ZEBROWSKI,  COLTON,  ESPAILLAT, JAFFEE,
  SPANO, SCHIMEL, FIELDS -- Multi-Sponsored by  --  M.  of  A.  BOYLAND,
  BRENNAN, EDDINGTON, HIKIND, HYER-SPENCER, LUPARDO, MAYERSOHN, McENENY,
  PHEFFER, REILLY, SWEENEY, TITONE, WEISENBERG -- read once and referred
  to  the  Committee  on  Health  -- committee discharged, bill amended,
  ordered reprinted as amended and  recommitted  to  said  committee  --
  again amended on third reading, ordered reprinted, retaining its place
  on the order of third reading

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:

  Section  1. Section 4406 of the public health law is amended by adding
a new subdivision 5 to read as follows:
  5. NOTWITHSTANDING ANY OTHER PROVISION  OF  LAW,  IF  AN  ENROLLEE  IS
REFERRED  BY  AN  IN-PLAN  PROVIDER TO A PROVIDER OF CLINICAL LABORATORY
SERVICES NOT PARTICIPATING IN THE PLAN (A "NON-PARTICIPATING PROVIDER"),
ANY SERVICE THAT WOULD OTHERWISE BE COVERED AS AN IN-PLAN SERVICE  UNDER
THE  PLAN  THAT  IS  PROVIDED BY THE NON-PARTICIPATING PROVIDER SHALL BE
COVERED, AND THE ORGANIZATION SHALL BE RESPONSIBLE FOR PAYMENT  DIRECTLY

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

                                                           LBD09070-04-9

S. 3180--B                          2                         A. 6741--B

TO  THE NON-PARTICIPATING PROVIDER FOR THOSE SERVICES IN ACCORDANCE WITH
THE TIME FRAME FOR SUCH PAYMENTS SET FORTH IN SECTION THREE THOUSAND TWO
HUNDRED TWENTY-FOUR-A OF THE INSURANCE LAW; PROVIDED, HOWEVER, THAT  THE
ENROLLEE  SHALL  BE RESPONSIBLE FOR ANY APPLICABLE COPAY, COINSURANCE OR
DEDUCTIBLE FOR SUCH SERVICES. CLINICAL LABORATORIES  SEEKING  REIMBURSE-
MENT  PURSUANT TO THIS ARTICLE FOR SERVICES RENDERED SHALL DIRECTLY BILL
THE ORGANIZATION WHOSE ENROLLEE RECEIVED THE SERVICES.  ANY PAYMENT MADE
BY AN ORGANIZATION DIRECTLY TO THE ENROLLEE RATHER THAN TO THE  CLINICAL
LABORATORY  SEEKING  REIMBURSEMENT  SHALL NOT SATISFY THE ORGANIZATION'S
PAYMENT OBLIGATION TO THE CLINICAL LABORATORY.
  S 2. Section 4804 of the insurance law is  amended  by  adding  a  new
subsection (g) to read as follows:
  (G)  NOTWITHSTANDING  ANY  OTHER  PROVISION  OF LAW, IF AN ENROLLEE IS
REFERRED BY AN IN-PLAN PROVIDER TO A  PROVIDER  OF  CLINICAL  LABORATORY
SERVICES NOT PARTICIPATING IN THE PLAN (A "NON-PARTICIPATING PROVIDER"),
ANY  SERVICE THAT WOULD OTHERWISE BE COVERED AS AN IN-PLAN SERVICE UNDER
THE PLAN THAT IS PROVIDED BY THE  NON-PARTICIPATING  PROVIDER  SHALL  BE
COVERED,  AND THE ORGANIZATION SHALL BE RESPONSIBLE FOR PAYMENT DIRECTLY
TO THE NON-PARTICIPATING PROVIDER FOR THOSE SERVICES IN ACCORDANCE  WITH
THE TIME FRAME FOR SUCH PAYMENTS SET FORTH IN SECTION THREE THOUSAND TWO
HUNDRED  TWENTY-FOUR-A  OF  THIS  CHAPTER;  PROVIDED,  HOWEVER, THAT THE
ENROLLEE SHALL BE RESPONSIBLE FOR ANY APPLICABLE COPAY,  COINSURANCE  OR
DEDUCTIBLE  FOR  SUCH SERVICES. CLINICAL LABORATORIES SEEKING REIMBURSE-
MENT PURSUANT TO THIS ARTICLE FOR SERVICES RENDERED SHALL DIRECTLY  BILL
THE ORGANIZATION WHOSE ENROLLEE RECEIVED THE SERVICES.  ANY PAYMENT MADE
BY  AN ORGANIZATION DIRECTLY TO THE ENROLLEE RATHER THAN TO THE CLINICAL
LABORATORY SEEKING REIMBURSEMENT SHALL NOT  SATISFY  THE  ORGANIZATION'S
PAYMENT OBLIGATION TO THE CLINICAL LABORATORY.
  S 3. This act shall take effect immediately.

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Assembly Bill A6741

Sponsored By

Archive: Last Bill Status - Lost

Actions

Votes

Jul 16, 2009 - Floor Vote

Floor Vote: Jul 16, 2009

Bill Amendments

2009-A6741 - Details

2009-A6741 - Summary

2009-A6741 - Bill Text download pdf

2009-A6741A - Details

2009-A6741A - Summary

2009-A6741A - Bill Text download pdf

2009-A6741B (ACTIVE) - Details

2009-A6741B (ACTIVE) - Summary

2009-A6741B (ACTIVE) - Sponsor Memo

2009-A6741B (ACTIVE) - Bill Text download pdf

Comments

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Assembly Bill A6741

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Sponsored By

BRADLEY

Archive: Last Bill Status - Lost

Actions

Votes

Bill Amendments

2009-A6741 - Details

2009-A6741 - Summary

2009-A6741 - Bill Text download pdf

2009-A6741A - Details

2009-A6741A - Summary

2009-A6741A - Bill Text download pdf

2009-A6741B (ACTIVE) - Details

2009-A6741B (ACTIVE) - Summary

2009-A6741B (ACTIVE) - Sponsor Memo

2009-A6741B (ACTIVE) - Bill Text download pdf

Comments