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

                                   594

                       2011-2012 Regular Sessions

                          I N  A S S E M B L Y

                               (PREFILED)

                             January 5, 2011
                               ___________

Introduced  by M. of A. GOTTFRIED, DINOWITZ, ENGLEBRIGHT, GALEF, PAULIN,
  CUSICK, PHEFFER, KAVANAGH -- Multi-Sponsored by --  M.  of  A.  AUBRY,
  BRENNAN,  COLTON,  COOK,  CYMBROWITZ, GLICK, GUNTHER, HEASTIE, HOOPER,
  JACOBS,  KELLNER,  LIFTON,  MAYERSOHN,  McENENY,   PERRY,   J. RIVERA,
  P. RIVERA,  ROBINSON,  SCARBOROUGH, SWEENEY, TOWNS, WEISENBERG -- read
  once and referred to the Committee on Health

AN ACT to amend the public health law and the insurance law, in relation
  to certain contracts or agreements by health maintenance organizations

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

  Section 1. Subdivision 7 of section 4406-c of the public health law as
added  by  chapter  705 of the laws of 1996 and as renumbered by chapter
487 of the laws of 2010, is  renumbered  subdivision  12  and  four  new
subdivisions 8, 9, 10 and 11 are added to read as follows:
  8.  NO  CONTRACT  OR AGREEMENT BETWEEN A HEALTH CARE PLAN AND A HEALTH
CARE PROVIDER SHALL CONTAIN ANY CLAUSE WHICH ENTITLES SUCH  HEALTH  CARE
PLAN  TO  REIMBURSE THE HEALTH CARE PROVIDER AT THE LOWEST PRICE OR RATE
THAT SUCH HEALTH CARE PROVIDER HAS CHARGED ANOTHER PERSON OR ENTITY  FOR
RENDERING THE SAME TREATMENT OR PERFORMING THE SAME PROCEDURE.
  9.  NO  HEALTH  CARE PLAN SHALL BY CONTRACT, WRITTEN POLICY OR WRITTEN
PROCEDURE PROHIBIT OR RESTRICT ANY HEALTH CARE PROVIDER FROM REFERRING A
PATIENT OR ENROLLEE TO A HEALTH CARE PROVIDER  BASED  SOLELY  UPON  SUCH
HEALTH  CARE PROVIDER'S PARTICIPATION STATUS WITH THE MANAGED CARE PROD-
UCT SUBSCRIBED TO BY THE PATIENT OR ENROLLEE.
  10. NO HEALTH CARE PLAN SHALL BY CONTRACT, WRITTEN POLICY  OR  WRITTEN
PROCEDURE  REQUIRE  THE  DISCLOSURE  OF  AN  ENROLLEE'S  DIAGNOSIS  ON A
PRESCRIPTION AS A CONDITION FOR DISPENSING OF A PHARMACEUTICAL  DRUG  OR
AGENT, UNLESS OTHERWISE REQUIRED BY LAW.
  11. NO HEALTH CARE PLAN SHALL BY CONTRACT, WRITTEN POLICY OR PROCEDURE
PROVIDE  FOR OR ALLOW THE SUBSTITUTION OF A PHARMACEUTICAL DRUG OR AGENT

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

                                                           LBD02331-01-1

A. 594                              2

(OTHER THAN A  GENERIC  SUBSTITUTION)  BY  ANY  PERSON  OTHER  THAN  THE
PRESCRIBING HEALTH CARE PROFESSIONAL.
  S  2.  Subsections (h) and (i) of section 3217-b of the insurance law,
as relettered by chapter  237  of  the  laws  of  2009,  are  relettered
subsections  (l)  and (m) and four new subsections (h), (i), (j) and (k)
are added to read as follows:
  (H) NO CONTRACT OR AGREEMENT BETWEEN AN  INSURER  AND  A  HEALTH  CARE
PROVIDER  SHALL  CONTAIN ANY CLAUSE WHICH ENTITLES SUCH INSURER TO REIM-
BURSE THE HEALTH CARE PROVIDER AT THE LOWEST PRICE  OR  RATE  THAT  SUCH
HEALTH  CARE PROVIDER HAS CHARGED ANOTHER PERSON OR ENTITY FOR RENDERING
THE SAME TREATMENT OR PERFORMING THE SAME PROCEDURE.
  (I) NO INSURER SHALL BY CONTRACT, WRITTEN POLICY OR WRITTEN  PROCEDURE
PROHIBIT  OR RESTRICT ANY HEALTH CARE PROVIDER FROM REFERRING AN INSURED
TO A PHYSICIAN BASED SOLELY UPON SUCH PHYSICIAN'S  PARTICIPATION  STATUS
WITH THE INSURANCE PRODUCT SUBSCRIBED TO BY THE INSURED.
  (J)  NO INSURER SHALL BY CONTRACT, WRITTEN POLICY OR WRITTEN PROCEDURE
REQUIRE THE DISCLOSURE OF AN INSURED'S DIAGNOSIS ON A PRESCRIPTION AS  A
CONDITION FOR AUTHORIZING THE COVERAGE FOR OR PAYMENT OR DISPENSING OF A
PHARMACEUTICAL DRUG OR AGENT, UNLESS OTHERWISE REQUIRED BY LAW.
  (K)  NO  INSURER  WHICH MAINTAINS A DRUG FORMULARY, OR WHICH CONTRACTS
WITH ANOTHER ENTITY TO MAINTAIN A DRUG  FORMULARY,  SHALL  BY  CONTRACT,
WRITTEN  POLICY  OR PROCEDURE PROVIDE FOR OR ALLOW THE SUBSTITUTION OF A
PHARMACEUTICAL DRUG OR AGENT (OTHER THAN A GENERIC SUBSTITUTION) BY  ANY
PERSON OTHER THAN THE PRESCRIBING HEALTH CARE PROFESSIONAL.
  S  3. Subsections (i) and (j) of section 4325 of the insurance law, as
relettered  by  chapter  487  of  the  laws  of  2010,  are   relettered
subsections  (m)  and (n) and four new subsections (i), (j), (k) and (l)
are added to read as follows:
  (I) NO CONTRACT OR AGREEMENT BETWEEN AN  INSURER  AND  A  HEALTH  CARE
PROVIDER  SHALL  CONTAIN ANY CLAUSE WHICH ENTITLES SUCH INSURER TO REIM-
BURSE THE HEALTH CARE PROVIDER AT THE LOWEST PRICE  OR  RATE  THAT  SUCH
HEALTH  CARE PROVIDER HAS CHARGED ANOTHER PERSON OR ENTITY FOR RENDERING
THE SAME TREATMENT OR PERFORMING THE SAME PROCEDURE.
  (J) NO INSURER SHALL BY CONTRACT, WRITTEN POLICY OR WRITTEN  PROCEDURE
PROHIBIT  OR RESTRICT ANY HEALTH CARE PROVIDER FROM REFERRING AN INSURED
TO A PHYSICIAN BASED SOLELY UPON SUCH PHYSICIAN'S  PARTICIPATION  STATUS
WITH THE INSURANCE PRODUCT SUBSCRIBED TO BY THE INSURED.
  (K)  NO INSURER SHALL BY CONTRACT, WRITTEN POLICY OR WRITTEN PROCEDURE
REQUIRE THE DISCLOSURE OF AN INSURED'S DIAGNOSIS ON A PRESCRIPTION AS  A
CONDITION FOR AUTHORIZING THE COVERAGE FOR OR PAYMENT OR DISPENSING OF A
PHARMACEUTICAL DRUG OR AGENT, UNLESS OTHERWISE REQUIRED BY LAW.
  (L)  NO  INSURER  WHICH MAINTAINS A DRUG FORMULARY, OR WHICH CONTRACTS
WITH ANOTHER ENTITY TO MAINTAIN A DRUG  FORMULARY,  SHALL  BY  CONTRACT,
WRITTEN  POLICY  OR PROCEDURE PROVIDE FOR OR ALLOW THE SUBSTITUTION OF A
PHARMACEUTICAL DRUG OR AGENT (OTHER THAN A GENERIC SUBSTITUTION) BY  ANY
PERSON OTHER THAN THE PRESCRIBING HEALTH CARE PROFESSIONAL.
  S 4. This act shall take effect on the one hundred eightieth day after
it  shall have become a law, provided that the relettering of subsection
(m) of section 3217-b and the relettering of subsection (n)  of  section
4325  of  the  insurance law made by sections two and three of this act,
respectively, shall not affect the repeal of such subsections and  shall
be deemed repealed therewith.