S T A T E O F N E W Y O R K
________________________________________________________________________
4456--A
2011-2012 Regular Sessions
I N A S S E M B L Y
February 3, 2011
___________
Introduced by M. of A. CASTRO, HOOPER, BARRON, STEVENSON, P. RIVERA,
RAMOS, LINARES, WEPRIN, ROBERTS, ORTIZ -- Multi-Sponsored by -- M. of
A. BOYLAND, COOK -- read once and referred to the Committee on Insur-
ance -- recommitted to the Committee on Insurance in accordance with
Assembly Rule 3, sec. 2 -- committee discharged, bill amended, ordered
reprinted as amended and recommitted to said committee
AN ACT to amend the insurance law and the public health law, in relation
to prohibiting the disruption of health services by any third party
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Section 3217-e of the insurance law, as added by chapter
219 of the laws of 2011, is amended to read as follows:
S 3217-e. Choice of health care provider. An insurer that is subject
to this article and requires or provides for designation by an insured
of a participating primary care provider shall permit the insured to
designate any participating primary care provider who is available to
accept such individual, and in the case of a child, shall permit the
insured to designate a physician (allopathic or osteopathic) who
specializes in pediatrics as the child's primary care provider if such
provider participates in the network of the insurer. NO INSURER SUBJECT
TO THIS ARTICLE SHALL CAUSE A DISRUPTION IN HEALTH CARE SERVICES BY
REQUIRING THAT AN INSURED RECEIVE SERVICES FROM A SPECIFIC PRIMARY CARE
PROVIDER; PROVIDED HOWEVER, NOTHING HEREIN SHALL RESTRICT AN INSURER
FROM REQUIRING AN INSURED TO SELECT A PRIMARY CARE PROVIDER FROM WITHIN
THE INSURER'S NETWORK OF PARTICIPATING PROVIDERS. IT SHALL NOT BE
CONSIDERED TO BE A DISRUPTION OF HEALTH CARE SERVICES WHEN AN INSURER
SUBJECT TO THIS ARTICLE IS AUTHORIZED BY LAW, RULE, OR REGULATION TO
SELECT A PRIMARY CARE PROVIDER ON BEHALF OF THE INSURED WHEN SUCH
INSURED HAS NOT MADE SUCH SELECTION IN A TIMELY MANNER.
S 2. Section 4306-d of the insurance law, as added by chapter 219 of
the laws of 2011, is amended to read as follows:
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD03001-03-2
A. 4456--A 2
S 4306-d. Choice of health care provider. A corporation that is
subject to the provisions of this article and requires or provides for
designation by a subscriber of a participating primary care provider
shall permit the subscriber to designate any participating primary care
provider who is available to accept such individual, and in the case of
a child, shall permit the subscriber to designate a physician (allopath-
ic or osteopathic) who specializes in pediatrics as the child's primary
care provider if such provider participates in the network of the corpo-
ration. NO INSURER SUBJECT TO THIS ARTICLE SHALL CAUSE A DISRUPTION IN
HEALTH CARE SERVICES BY REQUIRING THAT AN INSURED RECEIVE SERVICES FROM
A SPECIFIC PRIMARY CARE PROVIDER; PROVIDED HOWEVER, NOTHING HEREIN SHALL
RESTRICT AN INSURER FROM REQUIRING AN INSURED TO SELECT A PRIMARY CARE
PROVIDER FROM WITHIN THE INSURER'S NETWORK OF PARTICIPATING PROVIDERS.
IT SHALL NOT BE CONSIDERED TO BE A DISRUPTION OF HEALTH CARE SERVICES
WHEN AN INSURER SUBJECT TO THIS ARTICLE IS AUTHORIZED BY LAW, RULE, OR
REGULATION TO SELECT A PRIMARY CARE PROVIDER ON BEHALF OF THE INSURED
WHEN SUCH INSURED HAS NOT MADE SUCH SELECTION IN A TIMELY MANNER.
S 3. Subdivision 7 of section 4403 of the public health law, as added
by chapter 219 of the laws of 2011, is amended to read as follows:
7. A health maintenance organization that requires or provides for
designation by an enrollee of a participating primary care provider
shall permit the enrollee to designate any participating primary care
provider who is available to accept such individual, and in the case of
a child, shall permit the enrollee to designate a physician (allopathic
or osteopathic) who specializes in pediatrics as the child's primary
care provider if such provider participates in the network of the health
maintenance organization. NO HEALTH MAINTENANCE ORGANIZATION SUBJECT TO
THIS ARTICLE SHALL CAUSE A DISRUPTION IN HEALTH CARE SERVICES BY REQUIR-
ING THAT AN INSURED RECEIVE SERVICES FROM A SPECIFIC PRIMARY CARE
PROVIDER; PROVIDED HOWEVER, NOTHING HEREIN SHALL RESTRICT A HEALTH MAIN-
TENANCE ORGANIZATION FROM REQUIRING AN INSURED TO SELECT A PRIMARY CARE
PROVIDER FROM WITHIN THE HEALTH MAINTENANCE ORGANIZATION'S NETWORK OF
PARTICIPATING PROVIDERS. IT SHALL NOT BE CONSIDERED TO BE A DISRUPTION
OF HEALTH CARE SERVICES WHEN A HEALTH MAINTENANCE ORGANIZATION SUBJECT
TO THIS ARTICLE IS AUTHORIZED BY LAW, RULE, OR REGULATION TO SELECT A
PRIMARY CARE PROVIDER ON BEHALF OF THE INSURED WHEN SUCH INSURED HAS NOT
MADE SUCH SELECTION IN A TIMELY MANNER.
S 4. This act shall take effect on the first of January next succeed-
ing the date upon which it shall have become a law.