S T A T E O F N E W Y O R K
________________________________________________________________________
3165
2009-2010 Regular Sessions
I N A S S E M B L Y
January 23, 2009
___________
Introduced by M. of A. BRADLEY, SCARBOROUGH, SCHIMMINGER, FIELDS, LATIM-
ER, CLARK, GALEF, MAYERSOHN, ENGLEBRIGHT, GREENE, PHEFFER -- Multi-
Sponsored by -- M. of A. ALFANO, AUBRY, BACALLES, BARRA, BRENNAN,
CAMARA, COLTON, COOK, DelMONTE, GLICK, GOTTFRIED, GUNTHER, HIKIND,
JACOBS, LAVINE, McENENY, MILLMAN, REILLY, J. RIVERA, N. RIVERA, SEMIN-
ERIO, SWEENEY, WEISENBERG -- read once and referred to the Committee
on Insurance
AN ACT to amend the insurance law and the public health law, in relation
to the display of participating physicians on an insurance provider's
website
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Paragraph 17 of subsection (a) of section 3217-a of the
insurance law, as added by chapter 705 of the laws of 1996, is amended
to read as follows:
(17) where applicable, a listing by specialty, which may be in a sepa-
rate document that is updated annually, of the name, address, and tele-
phone number of all participating providers, including facilities, and
in addition, in the case of physicians, board certification, PROVIDED,
HOWEVER, THAT AN INSURER WHICH ELECTS TO POST SUCH INFORMATION ELECTRON-
ICALLY ON ITS WEBSITE SHALL:
(A) REMOVE ANY NON-PARTICIPATING PROVIDER FROM ITS LIST WITHIN THIRTY
CALENDAR DAYS FROM THE DATE WHEN: (I) THE PROVIDER HAS NOTIFIED THE
INSURER, IN WRITING, IT WILL NO LONGER PARTICIPATE WITH THE INSURER; OR
(II) THE CONTRACTUAL AGREEMENT BETWEEN THE INSURER AND PROVIDER CEASES
TO BE IN EFFECT; AND
(B) INCLUDE A PROVISION IN CONTRACTS WITH PARTICIPATING PROVIDERS
UNDER WHICH THE INSURER, WHEN IT FAILS TO REMOVE A NON-PARTICIPATING
PROVIDER FROM ITS WEBSITE WITHIN SUCH THIRTY DAY PERIOD, SHALL BE LIABLE
FOR OUT-OF-NETWORK RATES FOR SERVICES RENDERED BY A NON-PARTICIPATING
PROVIDER TO AN INSURED FROM THE DATE SUCH NON-PARTICIPATING PROVIDER
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD03277-01-9
A. 3165 2
SHOULD HAVE BEEN REMOVED TO THE DATE THAT SUCH NON-PARTICIPATING PROVID-
ER IS REMOVED. SUCH CONTRACT PROVISION SHALL ALSO PROVIDE THAT SUCH
PAYMENT AMOUNT SHALL NOT BE REDUCED BY ANY APPLICABLE CO-PAYMENT OR
DEDUCTIBLE AND SHALL INCLUDE EXPRESS PROVISIONS INDICATING THAT THE
PROVIDER SHALL HOLD INSUREDS HARMLESS FROM LIABILITY AND SHALL NOT BILL
INSUREDS UNDER ANY CIRCUMSTANCES FOR THE COSTS OF COVERED SERVICES
RENDERED BY THE CONTRACTING PROVIDER.
S 2. Paragraph 17 of subsection (a) of section 4324 of the insurance
law, as added by chapter 705 of the laws of 1996, is amended to read as
follows:
(17) where applicable, a listing by specialty, which may be in a sepa-
rate document that is updated annually, of the name, address, and tele-
phone number of all participating providers, including facilities, and
in addition, in the case of physicians, board certification, PROVIDED,
HOWEVER, THAT A HEALTH SERVICE, HOSPITAL SERVICE OR MEDICAL INDEMNITY
EXPENSE CORPORATION WHICH ELECTS TO POST SUCH INFORMATION ELECTRONICALLY
ON ITS WEBSITE SHALL:
(A) REMOVE ANY NON-PARTICIPATING PROVIDER FROM ITS LIST WITHIN THIRTY
CALENDAR DAYS FROM THE DATE WHEN: (I) THE PROVIDER HAS NOTIFIED THE
CORPORATION, IN WRITING, IT WILL NO LONGER PARTICIPATE WITH THE CORPO-
RATION; OR (II) THE CONTRACTUAL AGREEMENT BETWEEN THE CORPORATION AND
THE PROVIDER CEASES TO BE IN EFFECT; AND
(B) INCLUDE A PROVISION IN ITS CONTRACTS WITH PARTICIPATING PROVIDERS
UNDER WHICH THE CORPORATION, WHEN IT FAILS TO REMOVE A NONPARTICIPATING
PROVIDER FROM ITS WEBSITE WITHIN SUCH THIRTY DAY PERIOD, SHALL BE LIABLE
FOR PAYMENT OF OUT-OF-NETWORK RATES FOR ANY SERVICES RENDERED BY A
NONPARTICIPATING PROVIDER TO A SUBSCRIBER OF THE CORPORATION FROM THE
DATE SUCH NONPARTICIPATING PROVIDER SHOULD HAVE BEEN REMOVED TO THE DATE
THAT SUCH NONPARTICIPATING PROVIDER IS REMOVED. SUCH CONTRACT PROVISIONS
SHALL ALSO PROVIDE THAT SUCH PAYMENT AMOUNT SHALL NOT BE REDUCED BY ANY
APPLICABLE CO-PAYMENT OR DEDUCTIBLE PROVISION AND SHALL INCLUDE EXPRESS
PROVISIONS INDICATING THAT THE PROVIDER SHALL HOLD SUBSCRIBERS HARMLESS
FROM LIABILITY AND SHALL NOT BILL SUBSCRIBERS UNDER ANY CIRCUMSTANCES
FOR THE COSTS OF COVERED SERVICES RENDERED BY THE CONTRACTING PROVIDER;
and
S 3. Paragraph (r) of subdivision 1 of section 4408 of the public
health law, as added by chapter 705 of the laws of 1996, is amended to
read as follows:
(r) a listing by specialty, which may be in a separate document that
is updated annually, of the name, address and telephone number of all
participating providers, including facilities, and, in addition, in the
case of physicians, board certification, PROVIDED, HOWEVER, THAT A
HEALTH MAINTENANCE ORGANIZATION WHICH ELECTS TO POST SUCH INFORMATION
ELECTRONICALLY ON ITS WEBSITE SHALL:
(A) REMOVE ANY NON-PARTICIPATING PROVIDER FROM ITS LIST WITHIN THIRTY
CALENDAR DAYS FROM THE DATE WHEN: (I) THE PROVIDER HAS NOTIFIED THE
HEALTH MAINTENANCE ORGANIZATION, IN WRITING, IT WILL NO LONGER PARTIC-
IPATE WITH THE HEALTH MAINTENANCE ORGANIZATION; OR (II) THE CONTRACTUAL
AGREEMENT BETWEEN THE HEALTH MAINTENANCE ORGANIZATION AND THE PROVIDER
CEASES TO BE IN EFFECT; AND
(B) INCLUDE A PROVISION IN ITS CONTRACTS WITH PARTICIPATING PROVIDERS
UNDER WHICH THE HEALTH MAINTENANCE ORGANIZATION, WHEN IT FAILS TO REMOVE
A NONPARTICIPATING PROVIDER FROM ITS WEBSITE WITHIN SUCH THIRTY DAY
PERIOD, SHALL BE LIABLE FOR PAYMENT OF OUT-OF-NETWORK RATES FOR ANY
SERVICES RENDERED BY A NONPARTICIPATING PROVIDER TO AN ENROLLEE OF THE
HEALTH MAINTENANCE ORGANIZATION FROM THE DATE SUCH NONPARTICIPATING
A. 3165 3
PROVIDER SHOULD HAVE BEEN REMOVED TO THE DATE THAT SUCH NONPARTICIPATING
PROVIDER IS REMOVED. SUCH CONTRACT PROVISIONS SHALL ALSO PROVIDE THAT
SUCH PAYMENT AMOUNT SHALL NOT BE REDUCED BY ANY APPLICABLE CO-PAYMENT OR
DEDUCTIBLE PROVISION AND SHALL INCLUDE EXPRESS PROVISIONS INDICATING
THAT THE PROVIDER SHALL HOLD ENROLLEES HARMLESS FROM LIABILITY AND SHALL
NOT BILL ENROLLEES UNDER ANY CIRCUMSTANCES FOR THE COSTS OF COVERED
SERVICES RENDERED BY THE CONTRACTING PROVIDER.
S 4. This act shall take effect on the first of January next succeed-
ing the date on which it shall have become a law and shall apply to all
contracts issued, renewed, modified or altered on and after such effec-
tive date.