S T A T E O F N E W Y O R K
________________________________________________________________________
2210
2015-2016 Regular Sessions
I N A S S E M B L Y
January 15, 2015
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Introduced by M. of A. GOTTFRIED, DINOWITZ, ENGLEBRIGHT, GALEF, PAULIN,
CUSICK, KAVANAGH, ROSENTHAL, TITONE -- Multi-Sponsored by -- M. of A.
AUBRY, BRENNAN, COLTON, COOK, CYMBROWITZ, GLICK, GUNTHER, HEASTIE,
HOOPER, LIFTON, PERRY, RIVERA, ROBINSON, SCARBOROUGH -- 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 13 and four new
subdivisions 9, 10, 11 and 12 are added to read as follows:
9. 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.
10. NO HEALTH CARE PLAN SHALL BY CONTRACT, WRITTEN POLICY OR WRITTEN
PROCEDURE PROHIBIT 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 PRODUCT SUBSCRIBED
TO BY THE PATIENT OR ENROLLEE.
11. 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.
12. NO HEALTH CARE PLAN 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
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD02982-01-5
A. 2210 2
PRESCRIBING HEALTH CARE PROFESSIONAL OR BY A PHARMACIST UNDER SECTION
SIXTY-EIGHT HUNDRED ONE-A OF THE EDUCATION LAW.
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 (m) and (n) and four new subsections (h), (i), (k) and (l)
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 ANY HEALTH CARE PROVIDER FROM REFERRING AN INSURED TO A PHYSI-
CIAN 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 OR BY A PHAR-
MACIST UNDER SECTION SIXTY-EIGHT HUNDRED ONE-A OF THE EDUCATION LAW.
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 (n) and (o) and four new subsections (i), (j), (l) and (m)
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 ANY HEALTH CARE PROVIDER FROM REFERRING AN INSURED TO A PHYSI-
CIAN BASED SOLELY UPON SUCH PHYSICIAN'S PARTICIPATION STATUS WITH THE
INSURANCE PRODUCT SUBSCRIBED TO BY THE INSURED.
(L) 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.
(M) 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 OR BY A PHAR-
MACIST UNDER SECTION SIXTY-EIGHT HUNDRED ONE-A OF THE EDUCATION LAW.
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
(n) of section 3217-b and the relettering of subsection (o) 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.