Assembly Bill A10303

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   10303
 
                           I N  A S S E M B L Y
 
                               May 13, 2022
                                ___________
 
 Introduced  by COMMITTEE ON RULES -- (at request of M. of A. Gunther) --
   read once and referred to the Committee on Insurance
 
 AN ACT to amend the insurance law and the public health law, in relation
   to the processing of health claims
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:

   Section  1.  Paragraph  2  of  subsection (a) of section 3224-b of the
 insurance law, as added by chapter 551 of the laws of 2006,  is  amended
 to read as follows:
   (2) Subject to the provisions of paragraph three of this subsection, a
 health  plan shall accept and initiate the processing of all health care
 claims submitted by a physician, INCLUDING BUT NOT LIMITED TO EVALUATION
 AND MANAGEMENT CODES,  pursuant  to  and  consistent  with  the  current
 version  of the American medical association's current procedural termi-
 nology (CPT) codes, reporting guidelines and conventions and the centers
 for medicare and medicaid services healthcare  common  procedure  coding
 system (HCPCS).
   §  2.  Paragraphs  4  and 5 of subsection (b) of section 3224-b of the
 insurance law, as amended by chapter 237 of the laws of 2009, are renum-
 bered paragraphs 5 and 6 and a new paragraph  4  is  added  to  read  as
 follows:
   (4)  NOTWITHSTANDING  PARAGRAPH THREE OF THIS SUBSECTION, WITH RESPECT
 TO CLAIMS FOR EVALUATION AND MANAGEMENT CODES AS SUCH  ARE  DEFINED  AND
 SET  FORTH  IN  THE  CURRENT  EDITION  OF AMERICAN MEDICAL ASSOCIATION'S
 CURRENT PROCEDURAL TERMINOLOGY (CPT), A HEALTH PLAN SHALL FOLLOW, COMPLY
 WITH AND IMPLEMENT FOR PURPOSES OF CLAIMS PROCESSING, CLAIMS PAYMENT AND
 CLAIMS REVIEW, SUCH CURRENT PROCEDURAL  TERMINOLOGY  PROVISIONS,  GUIDE-
 LINES  AND  CONVENTIONS  FOR BOTH THE SELECTION AND THE DOCUMENTATION OF
 EVALUATION AND MANAGEMENT SERVICES.
   § 3. Section 4406-c of the public health law is amended by adding  two
 new subdivisions 13 and 14 to read as follows:
   13.  A  HEALTH  MAINTENANCE  ORGANIZATION LICENSED PURSUANT TO ARTICLE
 FORTY-THREE OF THE INSURANCE LAW OR CERTIFIED PURSUANT TO  THIS  ARTICLE
 OR  AN INDEPENDENT PRACTICE ASSOCIATION CERTIFIED OR RECOGNIZED PURSUANT
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD15680-01-2
 A. 10303                            2
 
 TO THIS ARTICLE OR A MEDICAL GROUP SHALL NOT  PROHIBIT  THE  ACCEPTANCE,
 INITIATION  AND  PROCESSING  OF  ALL  HEALTH  CARE CLAIMS SUBMITTED BY A
 PHYSICIAN, INCLUDING BUT NOT LIMITED TO EVALUATION AND MANAGEMENT CODES,
 PURSUANT  TO  AND  CONSISTENT  WITH  THE CURRENT VERSION OF THE AMERICAN
 MEDICAL ASSOCIATION'S CURRENT PROCEDURAL  TERMINOLOGY  (CPT),  REPORTING
 GUIDELINES  AND  CONVENTIONS  AND  THE CENTERS FOR MEDICARE AND MEDICAID
 SERVICES HEALTHCARE COMMON PROCEDURE CODING SYSTEM (HCPCS).
   14. NOTWITHSTANDING PROVISIONS OF THIS SECTION OR PARAGRAPH  THREE  OF
 SUBSECTION  (B) OF SECTION THREE THOUSAND TWO HUNDRED TWENTY-FOUR OF THE
 INSURANCE LAW, WITH RESPECT TO  CLAIMS  FOR  EVALUATION  AND  MANAGEMENT
 CODES AS SUCH ARE DEFINED AND SET FORTH IN THE CURRENT EDITION OF AMERI-
 CAN MEDICAL ASSOCIATION'S CURRENT PROCEDURAL TERMINOLOGY (CPT), A HEALTH
 PLAN  SHALL  FOLLOW,  COMPLY  WITH  AND IMPLEMENT FOR PURPOSES OF CLAIMS
 PROCESSING, CLAIMS PAYMENT AND CLAIMS REVIEW,  SUCH  CURRENT  PROCEDURAL
 TERMINOLOGY   PROVISIONS,  GUIDELINES,  AND  CONVENTIONS  FOR  BOTH  THE
 SELECTION  OF  AND  THE  DOCUMENTATION  OF  EVALUATION  AND   MANAGEMENT
 SERVICES.
   §  4. The commissioner of health and the superintendent of the depart-
 ment of financial services shall promulgate rules  and  regulations  and
 take  any other actions reasonably necessary to implement the provisions
 of this act.
   § 5. This act shall take effect immediately.