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
                               ___________

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.