S T A T E O F N E W Y O R K
________________________________________________________________________
7616
2015-2016 Regular Sessions
I N A S S E M B L Y
May 20, 2015
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Introduced by M. of A. LAVINE -- read once and referred to the Committee
on Health
AN ACT to amend the public health law and the insurance law, in relation
to prohibiting health care plans and health insurers from requiring
any health care provider to provide services through the state health
benefit exchange, unless the health care provider has agreed to
participate in the in-network portion of such plan or insurance
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Section 4406-c of the public health law is amended by
adding a new subdivision 5-e to read as follows:
5-E. NO HEALTH CARE PLAN SHALL, BY CONTRACT OR WRITTEN POLICY OR WRIT-
TEN PROCEDURE, REQUIRE A HEALTH CARE PROVIDER TO PARTICIPATE IN A PROD-
UCT OFFERED AS A QUALIFIED HEALTH PLAN IN A STATE HEALTH BENEFIT
EXCHANGE ESTABLISHED PURSUANT TO THE FEDERAL PATIENT PROTECTION AND
AFFORDABLE CARE ACT (P.L. 111-148), AS AMENDED BY THE FEDERAL HEALTH
CARE AND EDUCATION RECONCILIATION ACT OF 2010 (P.L. 111-152), UNLESS
THE HEALTH CARE PROVIDER AND HEALTH CARE PLAN HAVE EXECUTED A SEPARATE
AGREEMENT WHEREBY THE HEALTH CARE PROVIDER AGREES TO BE A PARTICIPANT IN
THE IN-NETWORK PORTION OF SUCH QUALIFIED HEALTH PLAN.
S 2. Section 3217-b of the insurance law is amended by adding a new
subsection (d-1) to read as follows:
(D-1) NO INSURER SUBJECT TO THIS ARTICLE SHALL, BY CONTRACT OR WRITTEN
POLICY OR WRITTEN PROCEDURE, REQUIRE A HEALTH CARE PROVIDER TO PARTIC-
IPATE IN A PRODUCT OFFERED AS A QUALIFIED HEALTH PLAN IN A STATE HEALTH
BENEFIT EXCHANGE ESTABLISHED PURSUANT TO THE FEDERAL PATIENT PROTECTION
AND AFFORDABLE CARE ACT (P.L. 111-148), AS AMENDED BY THE FEDERAL HEALTH
CARE AND EDUCATION RECONCILIATION ACT OF 2010 (P.L. 111-152), UNLESS THE
HEALTH CARE PROVIDER AND INSURER HAVE EXECUTED A SEPARATE AGREEMENT
WHEREBY THE HEALTH CARE PROVIDER AGREES TO BE A PARTICIPANT IN THE
IN-NETWORK PORTION OF SUCH QUALIFIED HEALTH PLAN.
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD10490-01-5
A. 7616 2
S 3. Section 4325 of the insurance law is amended by adding a new
subsection (d-1) to read as follows:
(D-1) NO CORPORATION ORGANIZED UNDER THIS ARTICLE SHALL, BY CONTRACT
OR WRITTEN POLICY OR WRITTEN PROCEDURE, REQUIRE A HEALTH CARE PROVIDER
TO PARTICIPATE IN A PRODUCT OFFERED AS A QUALIFIED HEALTH PLAN IN A
STATE HEALTH BENEFIT EXCHANGE ESTABLISHED PURSUANT TO THE FEDERAL
PATIENT PROTECTION AND AFFORDABLE CARE ACT (P.L. 111-148), AS AMENDED BY
THE FEDERAL HEALTH CARE AND EDUCATION RECONCILIATION ACT OF 2010 (P.L.
111-152), UNLESS THE HEALTH CARE PROVIDER AND CORPORATION HAVE EXECUTED
A SEPARATE AGREEMENT WHEREBY THE HEALTH CARE PROVIDER AGREES TO BE A
PARTICIPANT IN THE IN-NETWORK PORTION OF SUCH QUALIFIED HEALTH PLAN.
S 4. This act shall take effect immediately.