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

                                 6320--A

                       2009-2010 Regular Sessions

                            I N  S E N A T E

                            November 30, 2009
                               ___________

Introduced  by  Sen.  ESPADA -- read twice and ordered printed, and when
  printed to be committed to the Committee on Rules  --  recommitted  to
  the  Committee  on  Health 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 public health law and the insurance law, in relation
  to  providing  access to diagnostic laboratories by patients in health
  maintenance organizations

  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 6 to read as follows:
  6. 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 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 4406-c of the public health law is amended by adding two
new subdivisions 4-a and 4-b to read as follows:

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD14273-04-0

              

S. 6320--A                          2

  4-A. NO HEALTH CARE PLAN, NOT-FOR-PROFIT OR FOR-PROFIT HEALTH  MAINTE-
NANCE  ORGANIZATION,  PREFERRED  PROVIDER ORGANIZATION, POINT OF SERVICE
PLAN, GOVERNMENT SUBSIDIZED  HEALTH  CARE  PLAN  OR  SELF  INSURED  PLAN
(COLLECTIVELY,  "PLAN")  SHALL  EXCLUDE  FROM  PARTICIPATING  WITHIN ITS
NETWORK  ANY  PROVIDER  OF  CLINICAL  LABORATORY SERVICES THAT MEETS THE
FOLLOWING REQUIREMENTS: (A) SUCH PROVIDER  IS  LICENSED  AS  A  MEDICAID
PROVIDER  BY  THE  STATE DEPARTMENT OF HEALTH AND A MEDICARE PROVIDER BY
THE UNITED STATES DEPARTMENT  OF  HEALTH  &  HUMAN  SERVICES;  (B)  SUCH
PROVIDER  IS ACCREDITED BY THE COLLEGE OF AMERICAN PATHOLOGISTS; AND (C)
SUCH PROVIDER SUBMITS ELECTRONIC CLAIMS TO THE HEALTH CARE PLAN FOR  THE
PAYMENT OF CLINICAL LABORATORY SERVICES RENDERED TO ENROLLEES. EACH PLAN
SHALL  DIRECTLY  PAY FOR CLINICAL LABORATORY SERVICES RENDERED TO ENROL-
LEES BY ANY PROVIDER OF CLINICAL LABORATORY SERVICES  PRACTICING  WITHIN
ITS  NETWORK  IN  ACCORDANCE  WITH  THE TIME FRAME FOR SUCH PAYMENTS SET
FORTH IN SECTION THREE THOUSAND TWO HUNDRED TWENTY-FOUR-A OF THE  INSUR-
ANCE  LAW; PROVIDED, HOWEVER, THAT THE ENROLLEE SHALL BE RESPONSIBLE FOR
ANY APPLICABLE COPAY, COINSURANCE OR DEDUCTIBLE FOR SUCH SERVICES.
  4-B. NOTWITHSTANDING ANY OTHER PROVISION OF LAW, IN NO EVENT SHALL ANY
PLAN: (A) PROHIBIT ANY PROVIDER OF CLINICAL LABORATORY SERVICES PRACTIC-
ING WITHIN ITS NETWORK FROM PROVIDING TO ENROLLEES ANY  LABORATORY  TEST
WHICH  THE  PROVIDER  IS  LICENSED TO PROVIDE BY THE STATE DEPARTMENT OF
HEALTH; (B) TREAT ANY PROVIDER OF CLINICAL LABORATORY SERVICES  PRACTIC-
ING  WITHIN  ITS NETWORK IN A MANNER WHICH IS NOT THE SAME AS OR SIMILAR
IN ALL MATERIAL RESPECTS TO THE MANNER IN WHICH ALL OTHER  PROVIDERS  OF
CLINICAL  LABORATORY SERVICES PRACTICING WITHIN ITS NETWORK ARE TREATED;
OR (C) TREAT ANY ENROLLEE UTILIZING THE  SERVICES  OF  ANY  PROVIDER  OF
CLINICAL  LABORATORY SERVICES PRACTICING WITHIN ITS NETWORK, IN A MANNER
WHICH IS NOT THE SAME AS OR SIMILAR IN  ALL  MATERIAL  RESPECTS  TO  THE
MANNER  IN  WHICH  ALL  OTHER  ENROLLEES  UTILIZING  THE SERVICES OF ANY
PROVIDER OF CLINICAL LABORATORY SERVICES PRACTICING WITHIN  ITS  NETWORK
ARE TREATED.
  S  3.  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  INSURED  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
INSURED  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 INSURED RECEIVED THE SERVICES. ANY  PAYMENT  MADE
BY  AN  ORGANIZATION DIRECTLY TO THE INSURED RATHER THAN TO THE CLINICAL
LABORATORY SEEKING REIMBURSEMENT SHALL NOT  SATISFY  THE  ORGANIZATION'S
PAYMENT OBLIGATION TO THE CLINICAL LABORATORY.
  S 4. This act shall take effect immediately.

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

                                 6320--B

                       2009-2010 Regular Sessions

                            I N  S E N A T E

                            November 30, 2009
                               ___________

Introduced  by  Sen.  ESPADA -- read twice and ordered printed, and when
  printed to be committed to the Committee on Rules  --  recommitted  to
  the  Committee  on  Health in accordance with Senate Rule 6, sec. 8 --
  committee discharged, bill amended, ordered reprinted as  amended  and
  recommitted  to  said committee -- committee discharged, bill amended,
  ordered reprinted as amended and recommitted to said committee

AN ACT to amend the public health law and the insurance law, in relation
  to providing access to diagnostic laboratories by patients  in  health
  maintenance organizations

  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 6 to read as follows:
  6.  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 OUT-OF-PLAN SERVICE
UNDER THE PLAN THAT IS PROVIDED BY THE NON-PARTICIPATING PROVIDER  SHALL
BE  PAID  AT  THE  SAME RATE, IF ANY, AS THAT WOULD HAVE BEEN PAID TO AN
IN-PLAN PROVIDER, AND THE PLAN 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 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  PLAN  WHOSE  ENROLLEE  RECEIVED THE SERVICES. ANY PAYMENT MADE BY A
PLAN DIRECTLY TO THE ENROLLEE RATHER THAN  TO  THE  CLINICAL  LABORATORY
SEEKING REIMBURSEMENT SHALL NOT SATISFY THE PLAN'S PAYMENT OBLIGATION TO
THE CLINICAL LABORATORY.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD14273-10-0

              

S. 6320--B                          2

  S  2. Section 4406-c of the public health law is amended by adding two
new subdivisions 4-a and 4-b to read as follows:
  4-A.  NO HEALTH CARE PLAN, NOT-FOR-PROFIT OR FOR-PROFIT HEALTH MAINTE-
NANCE ORGANIZATION, PREFERRED PROVIDER ORGANIZATION,  POINT  OF  SERVICE
PLAN,  GOVERNMENT  SUBSIDIZED  HEALTH  CARE  PLAN  OR  SELF INSURED PLAN
(COLLECTIVELY, "PLAN")  SHALL  EXCLUDE  FROM  PARTICIPATING  WITHIN  ITS
NETWORK  ANY  PROVIDER  OF  CLINICAL  LABORATORY SERVICES THAT MEETS THE
FOLLOWING REQUIREMENTS: (A) SUCH PROVIDER  IS  LICENSED  AS  A  MEDICAID
PROVIDER  BY  THE  STATE DEPARTMENT OF HEALTH AND A MEDICARE PROVIDER BY
THE UNITED STATES DEPARTMENT OF HEALTH  AND  HUMAN  SERVICES;  (B)  SUCH
PROVIDER  IS ACCREDITED BY THE COLLEGE OF AMERICAN PATHOLOGISTS; AND (C)
SUCH PROVIDER SUBMITS ELECTRONIC CLAIMS TO THE PLAN FOR THE  PAYMENT  OF
CLINICAL  LABORATORY  SERVICES  RENDERED  TO  ENROLLEES. EACH PLAN SHALL
DIRECTLY PAY FOR CLINICAL LABORATORY SERVICES RENDERED TO  ENROLLEES  BY
ANY  PROVIDER  OF  CLINICAL  LABORATORY  SERVICES  PRACTICING WITHIN ITS
NETWORK 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 APPLI-
CABLE COPAY, COINSURANCE OR DEDUCTIBLE FOR SUCH SERVICES.
  4-B. NOTWITHSTANDING ANY OTHER PROVISION OF LAW, IN NO EVENT SHALL ANY
PLAN: (A) REIMBURSE ANY IN-PLAN PROVIDER OF CLINICAL LABORATORY SERVICES
FOR  A  PARTICULAR  LABORATORY  TEST  BUT  NOT REIMBURSE ANOTHER IN-PLAN
PROVIDER OF CLINICAL LABORATORY SERVICES FOR THAT LABORATORY  TEST;  (B)
ASSIGN  PREFERENTIAL  STATUS  NOR  PROVIDE  PREFERENTIAL  TREATMENT TO A
PROVIDER OF CLINICAL LABORATORY SERVICES PRACTICING WITHIN ITS  NETWORK.
SUCH PROHIBITED PREFERENTIAL TREATMENT SHALL INCLUDE, BUT IS NOT LIMITED
TO,  MAINTAINING  A  SUBSTANTIALLY DIFFERENT RATE OF PAYMENT OR FEES FOR
SIMILAR PRODUCTS AND SERVICES PROVIDED  BY  ONE  IN-PLAN  PROVIDER  OVER
THOSE  OF  OTHER  IN-PLAN PROVIDERS, OR ESTABLISHING A DIFFERENT PAYMENT
PROCEDURE WITH ONE IN-PLAN PROVIDER AS OPPOSED TO OTHER IN-PLAN  PROVID-
ERS  KNOWN  TO  LIKELY  RESULT  IN  THE LOSS OF PAYMENT FOR SUCH IN-PLAN
PROVIDERS; (C) ESTABLISH DIFFERENT PERFORMANCE MEASURES OR  REQUIREMENTS
FOR  ONE IN-PLAN PROVIDER OVER THOSE OF OTHER IN-PLAN PROVIDERS OF CLIN-
ICAL LABORATORY SERVICES, INCLUDING BUT NOT LIMITED TO,  THE  NUMBER  OF
PATIENT  SERVICE  CENTERS  REQUIRED  TO BE OPERATED IN A COVERED AREA OR
FLUCTUATING REPORTING GUIDELINES AND REQUIREMENTS; (D)  SUBCONTRACT  THE
MANAGEMENT  OF  THE  NETWORK  TO  AN  IN-PLAN LABORATORY THAT COLLECTS A
MANAGEMENT FEE FOR SUCH MANAGEMENT SERVICES; OR (E) TREAT  ANY  ENROLLEE
UTILIZING  THE  SERVICES OF ANY PROVIDER OF CLINICAL LABORATORY SERVICES
PRACTICING WITHIN ITS NETWORK IN A MANNER WHICH IS NOT THE  SAME  AS  OR
SIMILAR IN ALL MATERIAL RESPECTS TO THE MANNER IN WHICH ALL OTHER ENROL-
LEES  UTILIZING  THE  SERVICES  OF  ANY  PROVIDER OF CLINICAL LABORATORY
SERVICES PRACTICING WITHIN ITS NETWORK ARE TREATED.
  S 3. 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 INSURED 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
INSURED SHALL BE RESPONSIBLE FOR ANY APPLICABLE  COPAY,  COINSURANCE  OR
DEDUCTIBLE  FOR  SUCH SERVICES. CLINICAL LABORATORIES SEEKING REIMBURSE-

S. 6320--B                          3

MENT PURSUANT TO THIS ARTICLE FOR SERVICES RENDERED SHALL DIRECTLY  BILL
THE  ORGANIZATION  WHOSE INSURED RECEIVED THE SERVICES. ANY PAYMENT MADE
BY AN ORGANIZATION DIRECTLY TO THE INSURED RATHER THAN TO  THE  CLINICAL
LABORATORY  SEEKING  REIMBURSEMENT  SHALL NOT SATISFY THE ORGANIZATION'S
PAYMENT OBLIGATION TO THE CLINICAL LABORATORY.
  S 4. This act shall take effect immediately.

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

                                 6320--C

                       2009-2010 Regular Sessions

                            I N  S E N A T E

                            November 30, 2009
                               ___________

Introduced  by  Sen.  ESPADA -- read twice and ordered printed, and when
  printed to be committed to the Committee on Rules  --  recommitted  to
  the  Committee  on  Health in accordance with Senate Rule 6, sec. 8 --
  committee discharged, bill amended, ordered reprinted as  amended  and
  recommitted  to  said committee -- committee discharged, bill amended,
  ordered reprinted as amended and  recommitted  to  said  committee  --
  committee  discharged,  bill amended, ordered reprinted as amended and
  recommitted to said committee

AN ACT to amend the public health law and the insurance law, in relation
  to providing access to diagnostic laboratories by patients  in  health
  maintenance organizations

  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 6 to read as follows:
  6.  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  PROVIDED BY A NON-PARTICIPATING PROVIDER THAT WOULD OTHER-
WISE BE PAID FOR BY THE PLAN TO OTHER NON-PARTICIPATING PROVIDERS  SHALL
BE  PAID  FOR BY THE PLAN, AND THE PLAN SHALL BE RESPONSIBLE FOR PAYMENT
DIRECTLY TO THE NON-PARTICIPATING PROVIDER FOR THAT SERVICE  IN  ACCORD-
ANCE  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  LABORATO-
RIES  SEEKING  REIMBURSEMENT  PURSUANT  TO  THIS  ARTICLE  FOR  SERVICES
RENDERED SHALL DIRECTLY  BILL  THE  PLAN  WHOSE  ENROLLEE  RECEIVED  THE
SERVICES.  ANY  PAYMENT  MADE  BY A PLAN DIRECTLY TO THE ENROLLEE RATHER
THAN TO THE CLINICAL LABORATORY SEEKING REIMBURSEMENT SHALL NOT  SATISFY
THE PLAN'S PAYMENT OBLIGATION TO THE CLINICAL LABORATORY.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD14273-11-0
              

S. 6320--C                          2

  S  2. Section 4406-c of the public health law is amended by adding two
new subdivisions 4-a and 4-b to read as follows:
  4-A.  NO HEALTH CARE PLAN, NOT-FOR-PROFIT OR FOR-PROFIT HEALTH MAINTE-
NANCE ORGANIZATION, PREFERRED PROVIDER ORGANIZATION,  POINT  OF  SERVICE
PLAN,  GOVERNMENT  SUBSIDIZED  HEALTH  CARE  PLAN  OR  SELF INSURED PLAN
(COLLECTIVELY, "PLAN")  SHALL  EXCLUDE  FROM  PARTICIPATING  WITHIN  ITS
NETWORK  ANY  PROVIDER  OF  CLINICAL  LABORATORY SERVICES THAT MEETS THE
FOLLOWING REQUIREMENTS: (A) SUCH PROVIDER  IS  LICENSED  AS  A  MEDICAID
PROVIDER  BY  THE  STATE DEPARTMENT OF HEALTH AND A MEDICARE PROVIDER BY
THE UNITED STATES DEPARTMENT OF HEALTH  AND  HUMAN  SERVICES;  (B)  SUCH
PROVIDER  IS ACCREDITED BY THE COLLEGE OF AMERICAN PATHOLOGISTS; AND (C)
SUCH PROVIDER SUBMITS ELECTRONIC CLAIMS TO THE PLAN FOR THE  PAYMENT  OF
CLINICAL  LABORATORY  SERVICES  RENDERED  TO  ENROLLEES. EACH PLAN SHALL
DIRECTLY PAY FOR CLINICAL LABORATORY SERVICES RENDERED TO  ENROLLEES  BY
ANY  PROVIDER  OF  CLINICAL  LABORATORY  SERVICES  PRACTICING WITHIN ITS
NETWORK 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 APPLI-
CABLE COPAY, COINSURANCE OR DEDUCTIBLE FOR SUCH SERVICES.
  4-B. NOTWITHSTANDING ANY OTHER PROVISION OF LAW, IN NO EVENT SHALL ANY
PLAN: (A) REIMBURSE ANY IN-PLAN PROVIDER OF CLINICAL LABORATORY SERVICES
FOR  A  PARTICULAR  LABORATORY  TEST  BUT  NOT REIMBURSE ANOTHER IN-PLAN
PROVIDER OF CLINICAL LABORATORY SERVICES FOR THAT LABORATORY  TEST;  (B)
ASSIGN  PREFERENTIAL  STATUS  NOR  PROVIDE  PREFERENTIAL  TREATMENT TO A
PROVIDER OF CLINICAL LABORATORY SERVICES PRACTICING WITHIN ITS  NETWORK.
SUCH PROHIBITED PREFERENTIAL TREATMENT SHALL INCLUDE, BUT IS NOT LIMITED
TO,  MAINTAINING  A  SUBSTANTIALLY DIFFERENT RATE OF PAYMENT OR FEES FOR
SIMILAR PRODUCTS AND SERVICES PROVIDED  BY  ONE  IN-PLAN  PROVIDER  OVER
THOSE  OF  OTHER  IN-PLAN PROVIDERS, OR ESTABLISHING A PAYMENT PROCEDURE
WITH ONE IN-PLAN PROVIDER AS OPPOSED TO OTHER IN-PLAN PROVIDERS KNOWN TO
LIKELY RESULT IN THE LOSS OF PAYMENT FOR  SUCH  IN-PLAN  PROVIDERS;  (C)
ESTABLISH DIFFERENT PERFORMANCE MEASURES OR REQUIREMENTS FOR ONE IN-PLAN
PROVIDER  OVER  THOSE  OF OTHER IN-PLAN PROVIDERS OF CLINICAL LABORATORY
SERVICES, INCLUDING BUT NOT LIMITED TO, THE NUMBER  OF  PATIENT  SERVICE
CENTERS REQUIRED TO BE OPERATED IN A COVERED AREA OR FLUCTUATING REPORT-
ING  GUIDELINES  AND REQUIREMENTS; (D) SUBCONTRACT THE MANAGEMENT OF THE
NETWORK TO AN IN-PLAN LABORATORY THAT COLLECTS A MANAGEMENT FEE FOR SUCH
MANAGEMENT SERVICES; OR (E) TREAT ANY ENROLLEE UTILIZING THE SERVICES OF
ANY PROVIDER OF  CLINICAL  LABORATORY  SERVICES  PRACTICING  WITHIN  ITS
NETWORK  IN A MANNER WHICH IS NOT THE SAME AS OR SIMILAR IN ALL MATERIAL
RESPECTS TO THE MANNER  IN  WHICH  ALL  OTHER  ENROLLEES  UTILIZING  THE
SERVICES  OF  ANY  PROVIDER  OF  CLINICAL LABORATORY SERVICES PRACTICING
WITHIN ITS NETWORK ARE TREATED.
  S 3. 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 INSURED 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
INSURED SHALL BE RESPONSIBLE FOR ANY APPLICABLE  COPAY,  COINSURANCE  OR
DEDUCTIBLE  FOR  SUCH SERVICES. CLINICAL LABORATORIES SEEKING REIMBURSE-

S. 6320--C                          3

MENT PURSUANT TO THIS ARTICLE FOR SERVICES RENDERED SHALL DIRECTLY  BILL
THE  ORGANIZATION  WHOSE INSURED RECEIVED THE SERVICES. ANY PAYMENT MADE
BY AN ORGANIZATION DIRECTLY TO THE INSURED RATHER THAN TO  THE  CLINICAL
LABORATORY  SEEKING  REIMBURSEMENT  SHALL NOT SATISFY THE ORGANIZATION'S
PAYMENT OBLIGATION TO THE CLINICAL LABORATORY.
  S 4. This act shall take effect immediately.

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

                                 6320--D

                       2009-2010 Regular Sessions

                            I N  S E N A T E

                            November 30, 2009
                               ___________

Introduced  by  Sen.  ESPADA -- read twice and ordered printed, and when
  printed to be committed to the Committee on Rules  --  recommitted  to
  the  Committee  on  Health in accordance with Senate Rule 6, sec. 8 --
  committee discharged, bill amended, ordered reprinted as  amended  and
  recommitted  to  said committee -- committee discharged, bill amended,
  ordered reprinted as amended and  recommitted  to  said  committee  --
  committee  discharged,  bill amended, ordered reprinted as amended and
  recommitted to said committee -- committee discharged,  bill  amended,
  ordered reprinted as amended and recommitted to said committee

AN ACT to amend the public health law and the insurance law, in relation
  to  providing  access to diagnostic laboratories by patients in health
  maintenance organizations

  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 6 to read as follows:
  6. 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 PROVIDED BY A NON-PARTICIPATING PROVIDER THAT  WOULD  OTHER-
WISE  BE PAID FOR BY THE PLAN TO OTHER NON-PARTICIPATING PROVIDERS SHALL
BE PAID FOR BY THE PLAN, AND THE PLAN SHALL BE RESPONSIBLE  FOR  PAYMENT
DIRECTLY  TO  THE NON-PARTICIPATING PROVIDER FOR THAT SERVICE IN ACCORD-
ANCE 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 LABORATO-
RIES  SEEKING  REIMBURSEMENT  PURSUANT  TO  THIS  ARTICLE  FOR  SERVICES
RENDERED  SHALL  DIRECTLY  BILL  THE  PLAN  WHOSE  ENROLLEE RECEIVED THE
SERVICES. ANY PAYMENT MADE BY A PLAN DIRECTLY  TO  THE  ENROLLEE  RATHER

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD14273-13-0

              

S. 6320--D                          2

THAN  TO THE CLINICAL LABORATORY SEEKING REIMBURSEMENT SHALL NOT SATISFY
THE PLAN'S PAYMENT OBLIGATION TO THE CLINICAL LABORATORY.
  S  2. Section 4406-c of the public health law is amended by adding two
new subdivisions 4-a and 4-b to read as follows:
  4-A. NO HEALTH CARE PLAN, NOT-FOR-PROFIT OR FOR-PROFIT HEALTH  MAINTE-
NANCE  ORGANIZATION,  PREFERRED  PROVIDER ORGANIZATION, POINT OF SERVICE
PLAN, GOVERNMENT SUBSIDIZED  HEALTH  CARE  PLAN  OR  SELF  INSURED  PLAN
(COLLECTIVELY,  "PLAN")  SHALL  EXCLUDE  FROM  PARTICIPATING  WITHIN ITS
NETWORK ANY PROVIDER OF CLINICAL  LABORATORY  SERVICES  THAT  MEETS  THE
FOLLOWING  REQUIREMENTS:  (A)  SUCH  PROVIDER  IS LICENSED AS A MEDICARE
PROVIDER BY THE UNITED STATES DEPARTMENT OF HEALTH AND  HUMAN  SERVICES;
(B)  SUCH  PROVIDER  IS  EITHER  ACCREDITED  BY  THE COLLEGE OF AMERICAN
PATHOLOGISTS, OR LICENSED BY THE NEW YORK STATE  DEPARTMENT  OF  HEALTH;
AND  (C)  SUCH  PROVIDER  SUBMITS  ELECTRONIC CLAIMS TO THE PLAN FOR THE
PAYMENT OF CLINICAL LABORATORY SERVICES RENDERED TO ENROLLEES. EACH PLAN
SHALL DIRECTLY PAY FOR CLINICAL LABORATORY SERVICES RENDERED  TO  ENROL-
LEES  BY  ANY PROVIDER OF CLINICAL LABORATORY SERVICES PRACTICING WITHIN
ITS NETWORK IN ACCORDANCE WITH THE TIME  FRAME  FOR  SUCH  PAYMENTS  SET
FORTH  IN SECTION THREE THOUSAND TWO HUNDRED TWENTY-FOUR-A OF THE INSUR-
ANCE LAW; PROVIDED, HOWEVER, THAT THE ENROLLEE SHALL BE RESPONSIBLE  FOR
ANY APPLICABLE COPAY, COINSURANCE OR DEDUCTIBLE FOR SUCH SERVICES.
  4-B. NOTWITHSTANDING ANY OTHER PROVISION OF LAW, IN NO EVENT SHALL ANY
PLAN: (A) REIMBURSE ANY IN-PLAN PROVIDER OF CLINICAL LABORATORY SERVICES
FOR  A  PARTICULAR  LABORATORY  TEST  BUT  NOT REIMBURSE ANOTHER IN-PLAN
PROVIDER OF CLINICAL LABORATORY SERVICES FOR THAT LABORATORY  TEST;  (B)
ASSIGN  PREFERENTIAL  STATUS  NOR  PROVIDE  PREFERENTIAL  TREATMENT TO A
PROVIDER OF CLINICAL LABORATORY SERVICES PRACTICING WITHIN ITS  NETWORK.
SUCH PROHIBITED PREFERENTIAL TREATMENT SHALL INCLUDE, BUT IS NOT LIMITED
TO,  MAINTAINING  A  SUBSTANTIALLY DIFFERENT RATE OF PAYMENT OR FEES FOR
SIMILAR PRODUCTS AND SERVICES PROVIDED  BY  ONE  IN-PLAN  PROVIDER  OVER
THOSE  OF  OTHER  IN-PLAN PROVIDERS, OR ESTABLISHING A PAYMENT PROCEDURE
WITH ONE IN-PLAN PROVIDER AS OPPOSED TO OTHER IN-PLAN PROVIDERS KNOWN TO
LIKELY RESULT IN THE LOSS OF PAYMENT FOR  SUCH  IN-PLAN  PROVIDERS;  (C)
ESTABLISH DIFFERENT PERFORMANCE MEASURES OR REQUIREMENTS FOR ONE IN-PLAN
PROVIDER  OVER  THOSE  OF OTHER IN-PLAN PROVIDERS OF CLINICAL LABORATORY
SERVICES, INCLUDING BUT NOT LIMITED TO, THE NUMBER  OF  PATIENT  SERVICE
CENTERS REQUIRED TO BE OPERATED IN A COVERED AREA OR FLUCTUATING REPORT-
ING  GUIDELINES  AND REQUIREMENTS; (D) SUBCONTRACT THE MANAGEMENT OF THE
NETWORK TO AN IN-PLAN LABORATORY THAT COLLECTS A MANAGEMENT FEE FOR SUCH
MANAGEMENT SERVICES; OR (E) TREAT ANY ENROLLEE UTILIZING THE SERVICES OF
ANY PROVIDER OF  CLINICAL  LABORATORY  SERVICES  PRACTICING  WITHIN  ITS
NETWORK  IN A MANNER WHICH IS NOT THE SAME AS OR SIMILAR IN ALL MATERIAL
RESPECTS TO THE MANNER  IN  WHICH  ALL  OTHER  ENROLLEES  UTILIZING  THE
SERVICES  OF  ANY  PROVIDER  OF  CLINICAL LABORATORY SERVICES PRACTICING
WITHIN ITS NETWORK ARE TREATED.
  S 3. 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 INSURED 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

S. 6320--D                          3

INSURED 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 INSURED RECEIVED THE SERVICES. ANY PAYMENT MADE
BY AN ORGANIZATION DIRECTLY TO THE INSURED RATHER THAN TO  THE  CLINICAL
LABORATORY  SEEKING  REIMBURSEMENT  SHALL NOT SATISFY THE ORGANIZATION'S
PAYMENT OBLIGATION TO THE CLINICAL LABORATORY.
  S 4. This act shall take effect immediately.