Assembly Actions -
Senate Actions - UPPERCASE
|Jan 03, 2018||
referred to health
|Jan 05, 2017||
referred to health
Senate Bill S948
2017-2018 Legislative Session
Archive: Last Bill Status - In Senate Committee Health Committee
- In Committee Assembly
- On Floor Calendar Assembly
- Passed Assembly
- Delivered to Governor
- Signed By Governor
2017-S948 (ACTIVE) - Details
2017-S948 (ACTIVE) - Sponsor Memo
BILL NUMBER: S948 TITLE OF BILL : An act to amend the public health law and the insurance law, in relation to the reimbursement of out-of-network providers of clinical laboratory services by organizations providing or offering comprehensive health services plans PURPOSE OF BILL : To provide that organizations providing or offering comprehensive health service plans, such as managed care organizations and health maintenance organizations, directly reimburse out-of-network providers of clinical laboratory services when plan participants are referred to out-of-network providers by in-network organizations or providers. SUMMARY OF SPECIFIC PROVISIONS : Section 1. Section 4406 of the public health law by adding a new subdivision 6. The new subdivision provides when the participant or enrollee is referred to non-participating medical providers by in-network medical providers, the services must be reimbursable under the plan; requiring the out-of-network to bill the in-network organization directly for services performed. Any payment made by the medical provider directly to the participant rather than to the
2017-S948 (ACTIVE) - Bill Text download pdf
S T A T E O F N E W Y O R K ________________________________________________________________________ 948 2017-2018 Regular Sessions I N S E N A T E January 5, 2017 ___________ Introduced by Sen. FUNKE -- read twice and ordered printed, and when printed to be committed to the Committee on Health 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.
Open Legislation is a forum for New York State legislation. All comments are subject to review and community moderation is encouraged.
Comments deemed off-topic, commercial, campaign-related, self-promotional; or that contain profanity, hate or toxic speech; or that link to sites outside of the nysenate.gov domain are not permitted, and will not be published. Attempts to intimidate and silence contributors or deliberately deceive the public, including excessive or extraneous posting/posts, or coordinated activity, are prohibited and may result in the temporary or permanent banning of the user. Comment moderation is generally performed Monday through Friday. By contributing or voting you agree to the Terms of Participation and verify you are over 13.
Create an account. An account allows you to sign petitions with a single click, officially support or oppose key legislation, and follow issues, committees, and bills that matter to you. When you create an account, you agree to this platform's terms of participation.