assembly Bill A5409

2017-2018 Legislative Session

Relates to the reimbursement of out-of-network providers of clinical laboratory services

download bill text pdf

Sponsored By

Archive: Last Bill Status - In Assembly Committee


  • Introduced
  • In Committee
  • On Floor Calendar
    • Passed Senate
    • Passed Assembly
  • Delivered to Governor
  • Signed/Vetoed by Governor

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Actions

view actions (2)
Assembly Actions - Lowercase
Senate Actions - UPPERCASE
Jan 03, 2018 referred to insurance
Feb 08, 2017 referred to insurance

Multi-Sponsors

A5409 (ACTIVE) - Details

See Senate Version of this Bill:
S948
Current Committee:
Assembly Insurance
Law Section:
Public Health Law
Laws Affected:
Amd §4406, Pub Health L; amd §4804, Ins L
Versions Introduced in Other Legislative Sessions:
2009-2010: A11385
2011-2012: A3802, S2817
2013-2014: A636, S1083
2015-2016: A3527, S5374
2019-2020: A3928, S1323
2021-2022: A8909

A5409 (ACTIVE) - Summary

Relates to the reimbursement of out-of-network providers of clinical laboratory services by organizations providing or offering comprehensive health services plans.

A5409 (ACTIVE) - Bill Text download pdf


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

                                  5409

                       2017-2018 Regular Sessions

                          I N  A S S E M B L Y

                            February 8, 2017
                               ___________

Introduced  by  M. of A. WEPRIN -- Multi-Sponsored by -- M. of A. JAFFEE
  -- read once and referred to the Committee on Insurance

AN ACT to amend the public health law and the insurance law, in relation
  to the reimbursement of out-of-network providers of clinical laborato-
  ry services  by  organizations  providing  or  offering  comprehensive
  health services plans

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

  Section 1. Section 4406 of the public health law is amended by  adding
a new subdivision 6 to read as follows:
  6.  NOTWITHSTANDING  ANY  OTHER  PROVISION  OF  LAW, IF AN ENROLLEE IS
REFERRED BY AN IN-PLAN PROVIDER TO A  PROVIDER  OF  CLINICAL  LABORATORY
SERVICES  NOT PARTICIPATING IN THE PLAN (A "NON-PARTICIPATING PROVIDER")
FOR ANY SERVICE COVERED UNDER THE TERMS OF THE  PLAN,  THE  ORGANIZATION
SHALL  BE  RESPONSIBLE  FOR  PAYMENT  DIRECTLY  TO THE NON-PARTICIPATING
PROVIDER FOR THOSE SERVICES IN ACCORDANCE WITH THE TIME FRAME  FOR  SUCH
PAYMENTS  SET  FORTH IN SECTION THREE THOUSAND TWO HUNDRED TWENTY-FOUR-A
OF THE INSURANCE LAW; PROVIDED, HOWEVER,  THAT  THE  ENROLLEE  SHALL  BE
RESPONSIBLE FOR ANY APPLICABLE COPAY, COINSURANCE OR DEDUCTIBLE FOR SUCH
SERVICES.  CLINICAL  LABORATORIES SEEKING REIMBURSEMENT PURSUANT TO THIS
SECTION FOR SERVICES RENDERED SHALL DIRECTLY BILL THE ORGANIZATION WHOSE
ENROLLEE RECEIVED THE SERVICES. ANY  PAYMENT  MADE  BY  AN  ORGANIZATION
DIRECTLY  TO THE ENROLLEE RATHER THAN TO THE CLINICAL LABORATORY SEEKING
REIMBURSEMENT SHALL NOT SATISFY THE ORGANIZATION'S PAYMENT OBLIGATION TO
THE CLINICAL LABORATORY.
  § 2. Section 4804 of the insurance law is  amended  by  adding  a  new
subsection (g) to read as follows:
  (G)  NOTWITHSTANDING  ANY  OTHER  PROVISION  OF LAW, IF AN ENROLLEE IS
REFERRED BY AN IN-PLAN PROVIDER TO A  PROVIDER  OF  CLINICAL  LABORATORY
SERVICES  NOT PARTICIPATING IN THE PLAN (A "NON-PARTICIPATING PROVIDER")
FOR ANY SERVICE COVERED UNDER THE TERMS OF THE  PLAN,  THE  ORGANIZATION

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