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

                                  9896

                          I N  A S S E M B L Y

                            February 9, 2010
                               ___________

Introduced  by M. of A. MORELLE -- read once and referred to the Commit-
  tee on Health

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 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  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

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

                                                           LBD09070-06-0

A. 9896                             2

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.