Senate Bill S6224

2009-2010 Legislative Session

Relates to the reimbursement of out-of-network providers of clinical laboratory services by organizations providing or offering comprehensive health services plans

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Archive: Last Bill Status - In Senate Committee Health Committee

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

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Date of Action	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jan 06, 2010	referred to health
Oct 14, 2009	referred to rules

2009-S6224 (ACTIVE) - Details

Current Committee:: Senate Health
Law Section:: Public Health Law
Laws Affected:: Amd §4406, Pub Health L; amd §4804, Ins L

2009-S6224 (ACTIVE) - Summary

Relates to the reimbursement of out-of-network providers of clinical laboratory services by organizations providing or offering comprehensive health services plans.

2009-S6224 (ACTIVE) - Sponsor Memo

                                 BILL NUMBER:  S6224

 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 S. 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-S6224 (ACTIVE) - Bill Text download pdf

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

                                  6224

                       2009-2010 Regular Sessions

                            I N  S E N A T E

                            October 14, 2009
                               ___________

Introduced  by  Sen.  DUANE  -- read twice and ordered printed, and when
  printed to be committed to the Committee on Rules

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"),

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD14746-01-9

S. 6224                             2

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.

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Senate Bill S6224

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Archive: Last Bill Status - In Senate Committee Health Committee

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2009-S6224 (ACTIVE) - Details

2009-S6224 (ACTIVE) - Summary

2009-S6224 (ACTIVE) - Sponsor Memo

2009-S6224 (ACTIVE) - Bill Text download pdf

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Sponsored By

Thomas K. Duane

Archive: Last Bill Status - In Senate Committee Health Committee

Actions

2009-S6224 (ACTIVE) - Details

2009-S6224 (ACTIVE) - Summary

2009-S6224 (ACTIVE) - Sponsor Memo

2009-S6224 (ACTIVE) - Bill Text download pdf

Comments