Senate Bill S3180C

2009-2010 Legislative Session

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

download bill text pdf

Archive: Last Bill Status Via A6741 - 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

Please enter your contact information

First Name

Last Name

Email Address

A valid email address is required.

Home address is used to determine the senate district in which you reside. Your support or opposition to this bill is then shared immediately with the senator who represents you.

Optional services from the NY State Senate:

Create an account. An account allows you to officially support or oppose key legislation, sign petitions with a single click, and follow issues, committees, and bills that matter to you. When you create an account, you agree to this platform's terms of participation.

Include a custom message for your Senator? (Optional)

Enter a message to your senator. Many New Yorkers use this to share the reasoning behind their support or opposition to the bill. Others might share a personal anecdote about how the bill would affect them or people they care about.

Actions

View Actions

Date of Action	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jul 16, 2009	lost 3rd reading cal.908 substituted for s3180b
Jun 29, 2010	ordered to third reading cal.1323
Jun 15, 2010	committee discharged and committed to rules
Feb 02, 2010	reported and committed to finance
Jan 27, 2010	print number 3180c
Jan 27, 2010	amend and recommit to health
Jan 06, 2010	referred to health
Jul 16, 2009	substituted by a6741b ordered to third reading cal.908 committee discharged and committed to rules
Jun 08, 2009	print number 3180b
Jun 08, 2009	amend and recommit to finance
May 19, 2009	reported and committed to finance
May 05, 2009	print number 3180a
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
  Jun 29, 2010 - Rules Committee Vote
  S3180C
  
  Aye
  
  13
  
  Nay
  
  9
  
  Aye with Reservations
  
  1
  
  Absent
  
  0
  
  Excused
  
  0
  
  Abstained
  
  0
  - - Rules Committee Vote: Jun 29, 2010
      
      aye (13)
      
      Dilan
      
      Duane
      
      Espada
      
      Hassell-Thompson
      
      Klein
      
      Krueger
      
      Montgomery
      
      Parker
      
      Serrano
      
      Smith
      
      Stachowski
      
      Stewart-Cousins
      
      Valesky
      
      nay (9)
      
      Farley
      
      Hannon
      
      Johnson
      
      LaValle
      
      Larkin
      
      Saland
      
      Seward
      
      Skelos
      
      Volker
      
      aye wr (1)
      
      Padavan
  Jul 16, 2009 - Rules Committee Vote
  S3180C
  
  Aye
  
  16
  
  Nay
  
  3
  
  Aye with Reservations
  
  4
  
  Absent
  
  0
  
  Excused
  
  1
  
  Abstained
  
  0
  - - Rules Committee Vote: Jul 16, 2009
      
      aye (16)
      
      Dilan
      
      Duane
      
      Espada
      
      Hassell-Thompson
      
      Klein
      
      Krueger
      
      Monserrate
      
      Montgomery
      
      Padavan
      
      Parker
      
      Serrano
      
      Smith
      
      Stachowski
      
      Stewart-Cousins
      
      Valesky
      
      Volker
      
      nay (3)
      
      Hannon
      
      Seward
      
      Skelos
      
      aye wr (4)
      
      Farley
      
      LaValle
      
      Larkin
      
      Saland
      
      excused (1)
      
      Johnson
  Feb 2, 2010 - Health Committee Vote
  S3180C
  
  Aye
  
  10
  
  Nay
  
  7
  
  Aye with Reservations
  
  0
  
  Absent
  
  0
  
  Excused
  
  0
  
  Abstained
  
  0
  - - Health Committee Vote: Feb 2, 2010
      
      aye (10)
      
      Duane
      
      Johnson
      
      Klein
      
      Kruger
      
      Montgomery
      
      Onorato
      
      Sampson
      
      Stewart-Cousins
      
      Thompson
      
      Valesky
      
      nay (7)
      
      Farley
      
      Fuschillo
      
      Hannon
      
      Larkin
      
      Little
      
      Winner
      
      Young

Bill Amendments

2009-S3180 - Details

See Assembly Version of this Bill:: A9896
Law Section:: Public Health Law
Laws Affected:: Amd §4406, Pub Health L; amd §4804, Ins L
Versions Introduced in 2011-2012 Legislative Session:: A4101

2009-S3180 - Summary

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

2009-S3180 - Sponsor Memo

                                 BILL NUMBER:  S3180

 TITLE OF BILL :
An act to amend the public health 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, reimburse out-of-network providers of
clinical laboratory services to which in-network organizations or
providers refer plan participants for the provision of such ,services.

 SUMMARY OF SPECIFIC PROVISIONS :
This bill amends Section 4406 of the public health law by adding a new
subdivision 5 to provide that organizations providing or offering
comprehensive health services plans shall reimburse out-of-network
providers of clinical laboratory services to plan participants for the
provision of such services. The bill limits the amounts reimbursed to
out-of-network providers to amounts reimbursed to in-network providers
for such services. 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 without billing the plan

participant. 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.

 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 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-S3180 - 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-S3180A - Details

See Assembly Version of this Bill:: A9896
Law Section:: Public Health Law
Laws Affected:: Amd §4406, Pub Health L; amd §4804, Ins L
Versions Introduced in 2011-2012 Legislative Session:: A4101

2009-S3180A - Summary

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

2009-S3180A - Sponsor Memo

                                 BILL NUMBER:  S3180A

 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, reimburse out-of-network providers of
clinical laboratory services to which in-network organizations or
providers refer plan participants for the provision of such services.

 SUMMARY OF SPECIFIC PROVISIONS :
Section 1 of the bill amends section 4406 of the public health law by
adding a new subdivision 5 to provide that organizations providing or
offering comprehensive health services plans shall reimburse
out-of-network providers of clinical laboratory services to plan
participants for the provision of such services. The bill limits the
amounts reimbursed to out-of-network providers to amounts reimbursed
to in-network providers for such services. 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 without

billing the plan participant. 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.

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
foregoing.

 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 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-S3180A - 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-S3180B - Details

See Assembly Version of this Bill:: A9896
Law Section:: Public Health Law
Laws Affected:: Amd §4406, Pub Health L; amd §4804, Ins L
Versions Introduced in 2011-2012 Legislative Session:: A4101

2009-S3180B - Summary

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

2009-S3180B - Sponsor Memo

                                 BILL NUMBER:  S3180B

 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, directly 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 comprehensive 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
foregoing.

 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-S3180B - 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.

2009-S3180C (ACTIVE) - Details

See Assembly Version of this Bill:: A9896
Law Section:: Public Health Law
Laws Affected:: Amd §4406, Pub Health L; amd §4804, Ins L
Versions Introduced in 2011-2012 Legislative Session:: A4101

2009-S3180C (ACTIVE) - Summary

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

2009-S3180C (ACTIVE) - Sponsor Memo

                                 BILL NUMBER:  S3180C

 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 :

To provide that organizations providing or offering comprehensive
health services plans, such as managed care organizations and health
maintenance organizations, directly 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 PROVISIONS :

Section 1 of the bill amends section 4406 of the public health law by
adding a new subdivision 6.  The new subdivision 6 provides that
organizations providing or offering comprehensive 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
foregoing.

 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-S3180C (ACTIVE) - Bill Text download pdf

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

                                 3180--C

                       2009-2010 Regular Sessions

                            I N  S E N A T E

                             March 12, 2009
                               ___________

Introduced  by  Sen.  DUANE  -- read twice and ordered printed, and when
  printed to be committed  to  the  Committee  on  Health  --  committee
  discharged, bill amended, ordered reprinted as amended and recommitted
  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 -- 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 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

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD09070-05-0

S. 3180--C                          2

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.

Comments

Open Legislation is a forum for New York State legislation. All comments are subject to review and community moderation is encouraged.

Comments deemed off-topic, commercial, campaign-related, self-promotional; or that contain profanity, hate or toxic speech; or that link to sites outside of the nysenate.gov domain are not permitted, and will not be published. Attempts to intimidate and silence contributors or deliberately deceive the public, including excessive or extraneous posting/posts, or coordinated activity, are prohibited and may result in the temporary or permanent banning of the user. Comment moderation is generally performed Monday through Friday. By contributing or voting you agree to the Terms of Participation and verify you are over 13.

Create an account. An account allows you to sign petitions with a single click, officially support or oppose key legislation, and follow issues, committees, and bills that matter to you. When you create an account, you agree to this platform's terms of participation.

Find your Senator and share your views on important issues.

Do you support this bill?

Senate Bill S3180C

Sponsored By

Archive: Last Bill Status Via A6741 - Lost

Actions

Votes

Jul 16, 2009 - Floor Vote

Floor Vote: Jul 16, 2009

Jun 29, 2010 - Rules Committee Vote

Rules Committee Vote: Jun 29, 2010

Jul 16, 2009 - Rules Committee Vote

Rules Committee Vote: Jul 16, 2009

Feb 2, 2010 - Health Committee Vote

Health Committee Vote: Feb 2, 2010

Bill Amendments

2009-S3180 - Details

2009-S3180 - Summary

2009-S3180 - Sponsor Memo

2009-S3180 - Bill Text download pdf

2009-S3180A - Details

2009-S3180A - Summary

2009-S3180A - Sponsor Memo

2009-S3180A - Bill Text download pdf

2009-S3180B - Details

2009-S3180B - Summary

2009-S3180B - Sponsor Memo

2009-S3180B - Bill Text download pdf

2009-S3180C (ACTIVE) - Details

2009-S3180C (ACTIVE) - Summary

2009-S3180C (ACTIVE) - Sponsor Memo

2009-S3180C (ACTIVE) - Bill Text download pdf

Comments

Do you support this bill?

Get Status Alerts for 2009-S3180C

Senate Bill S3180C

Share this bill

Sponsored By

Thomas K. Duane

Archive: Last Bill Status Via A6741 - Lost

Actions

Votes

Bill Amendments

2009-S3180 - Details

2009-S3180 - Summary

2009-S3180 - Sponsor Memo

2009-S3180 - Bill Text download pdf

2009-S3180A - Details

2009-S3180A - Summary

2009-S3180A - Sponsor Memo

2009-S3180A - Bill Text download pdf

2009-S3180B - Details

2009-S3180B - Summary

2009-S3180B - Sponsor Memo

2009-S3180B - Bill Text download pdf

2009-S3180C (ACTIVE) - Details

2009-S3180C (ACTIVE) - Summary

2009-S3180C (ACTIVE) - Sponsor Memo

2009-S3180C (ACTIVE) - Bill Text download pdf

Comments