S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   3231
 
                        2021-2022 Regular Sessions
 
                             I N  S E N A T E
 
                             January 28, 2021
                                ___________
 
 Introduced  by  Sen. SANDERS -- 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 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  15  and  four  new
 subdivisions 11, 12, 13 and 14 are added to read as follows:
   11.  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.
   12.  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.
   13. 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.
   14. 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
 PRESCRIBING  HEALTH  CARE  PROFESSIONAL OR BY A PHARMACIST UNDER SECTION
 SIXTY-EIGHT HUNDRED ONE-A OF THE EDUCATION LAW.
   § 2. Subsection (h) of section 3217-b of the insurance law, as  relet-
 tered  by  chapter 237 of the laws of 2009, is relettered subsection (p)
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD00253-01-1

 S. 3231                             2
 
 and four new subsections (h), (m), (n) and (o)  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.
   (M)  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.
   (N) 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.
   (O) 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.
   § 3. Subsection (i) of section 4325 of the insurance  law,  as  relet-
 tered  by  chapter 487 of the laws of 2010, is relettered subsection (q)
 and four new subsections (i), (n), (o) and (p)  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.
   (N)  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.
   (O) 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.
   (P) 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.
   § 4. This act shall take effect on the one hundred eightieth day after
 it shall have become a law.