S T A T E   O F   N E W   Y O R K
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                                  3688

                       2009-2010 Regular Sessions

                          I N  A S S E M B L Y

                            January 28, 2009
                               ___________

Introduced by M. of A. BRADLEY, JACOBS, FIELDS, GUNTHER, GALEF, BENEDET-
  TO,  CLARK,  MAGNARELLI,  TITONE,  ALESSI,  KOON,  PHEFFER, LANCMAN --
  Multi-Sponsored by -- M. of A.  BING,  BOYLAND,  CHRISTENSEN,  COLTON,
  DelMONTE,  GLICK,  GOTTFRIED,  HYER-SPENCER,  JOHN,  LATIMER,  MAISEL,
  MAYERSOHN, McENENY, PERRY, SCHIMEL, SWEENEY, WEISENBERG --  read  once
  and referred to the Committee on Insurance

AN ACT to amend the public health law and the insurance law, in relation
  to altering the terms of a health care plan

  THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. Section 4406-c of the  public  health  law  is  amended  by
adding a new subdivision 5-d to read as follows:
  5-D.  A  PROVIDER  OF  A HEALTH CARE PLAN MAY NOT DURING THE TERM OF A
CONTRACT WITH A HEALTH CARE PROVIDER IMPLEMENT POLICIES  AND  PROCEDURES
THAT  RESULT  IN A MATERIAL ADVERSE CHANGE TO SUCH HEALTH CARE PROVIDER.
FOR THE PURPOSES OF THIS SECTION, A "MATERIAL ADVERSE CHANGE" SHALL MEAN
ANY CHANGE IN A HEALTH CARE PLAN'S POLICIES  THAT  COULD  REASONABLY  BE
EXPECTED TO HAVE A MATERIAL ADVERSE IMPACT ON:
  (A)  THE LEVEL OF REIMBURSEMENT BY A HEALTH CARE PLAN TO A CONTRACTING
HEALTH CARE PROVIDER; OR
  (B) THE ADMINISTRATION OF A CONTRACTING HEALTH CARE  PROVIDER'S  PRAC-
TICE.
  S  2.  Section  3217-b of the insurance law is amended by adding a new
subsection (f-1) to read as follows:
  (F-1) AN INSURER MAY NOT DURING THE TERM OF A CONTRACT WITH  A  HEALTH
CARE PROVIDER IMPLEMENT POLICIES AND PROCEDURES THAT RESULT IN A MATERI-
AL ADVERSE CHANGE TO SUCH HEALTH CARE PROVIDER. FOR THE PURPOSES OF THIS
SECTION,  A "MATERIAL ADVERSE CHANGE" SHALL MEAN ANY CHANGE IN AN INSUR-
ER'S POLICIES THAT COULD REASONABLY  BE  EXPECTED  TO  HAVE  A  MATERIAL
ADVERSE IMPACT ON:

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD03360-01-9

              

A. 3688                             2

  (1)  THE  LEVEL OF REIMBURSEMENT BY AN INSURER TO A CONTRACTING HEALTH
CARE PROVIDER; OR
  (2)  THE  ADMINISTRATION OF A CONTRACTING HEALTH CARE PROVIDER'S PRAC-
TICE.
  S 3. Section 4325 of the insurance law is  amended  by  adding  a  new
subsection (f-1) to read as follows:
  (F-1)  AN  INSURER MAY NOT DURING THE TERM OF A CONTRACT WITH A HEALTH
CARE PROVIDER IMPLEMENT POLICIES AND PROCEDURES THAT RESULT IN A MATERI-
AL ADVERSE CHANGE TO SUCH HEALTH CARE PROFESSIONAL. FOR THE PURPOSES  OF
THIS  SECTION,  A  "MATERIAL ADVERSE CHANGE" SHALL MEAN ANY CHANGE IN AN
INSURER'S POLICIES THAT COULD REASONABLY BE EXPECTED TO HAVE A  MATERIAL
ADVERSE IMPACT ON:
  (1)  THE  LEVEL OF REIMBURSEMENT BY AN INSURER TO A CONTRACTING HEALTH
CARE PROVIDER; OR
  (2) THE ADMINISTRATION OF A CONTRACTING HEALTH CARE  PROVIDER'S  PRAC-
TICE.
  S  4.  This  act shall take effect on the ninetieth day after it shall
have become a law.